Inspection on 03/07/09 for First Step

This inspection was carried out on 3rd July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

First Step 20/08/07

First Step 01/08/06

First Step 25/10/05

First Step 17/05/05

First Step 17/11/04

First Step 12/05/04

Similar services:

Park House

Huntercombe Centre

Wellburn House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: First Step 114 Marton Road Middlesbrough TS1 2DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tanya Newton     Date: 1 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: First Step 114 Marton Road Middlesbrough TS1 2DY 01642231476 01642232239 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: First Step Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: Date of last inspection Brief description of the care home First Step is housed in a large detached, converted vicarage, with some purpose built flats adjoining it, which have been taken over by the home. There is a small garden to the front of the property, and a private paved area to the rear where people can sit outside. It is situated on a busy main road close to Middlesbrough town centre, so is convenient for services required by the user group. Accommodation is provided for up to fifteen people in thirteen single bedrooms (seven with en-suite facilities) and one double room. Of these rooms, three were under size requirements. However, the flats were spacious, with each person having their own kitchen, bed sitting room and bathroom. These were used by people who had completed the first two stages of their rehabilitation programme, and were progressing towards eventual discharge. There are two lounges and a large dining/activity room as well as a counselling room in the main building. People are supported and encouraged to use both the kitchen and the laundry. Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 0 15 15 Brief description of the care home The home offers a programme of rehabilitation that may include a period of detoxification for both drug and alcohol dependencies. Fees charged by the service range from £428.25 to £491.36 per week. Care Homes for Adults (18-65 years) Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and carried out over two days on the 3rd and 10th July 2009. The inspection lasted eight hours in total. Prior to the inspection the manager was asked to complete an annual quality assurance assessment (AQAA). This provides CQC with information about the service. During the visit, records were looked at, a tour was taken of the building and 6 people using the service were asked for their views, along with the manager and members of the staff team. Questionnaires were also received from 6 people using the service, 8 staff members and 5 health care professionals. Comments from these conversations and surveys have been included within the body of the report. Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the service have their needs thoroughly assessed and are provided with a contract which sets out the key terms and conditions of their stay as well as any restrictions on their liberty and freedom of movement. Evidence: Prior to any person being admitted to First Step, all clients must visit the service to undergo a comprehensive assessment and risk assessment (a consent form is signed to obtain further information).This is completed by a competent member of staff and the client is given the opportunity to choose themselves that the service will meet their own needs and that they feel comfortable to live at First Step. Within the assessment the clients past and present drug and alcohol history will be obtained as well as the physical, psychiatric and offending history. In addition the clients social history, housing needs and financial support required is obtained. On admission all clients sign a license agreement/contract and the copy is kept in the clients file throughout their stay. The license agreement covers many areas i.e. landlord responsibilities, service users responsibilities, personal support, charges and Care Homes for Adults (18-65 years) Page 9 of 24 Evidence: breach of contract. They also include information regarding any restrictions on their liberty and freedom which are a necessary part of the treatment programme. All six client surveys returned confirmed that people were given sufficient information and choice about moving into the home. One person said, I was given sufficient information and was able to visit the service before I was admitted. I was told what restrictions were in place and was given a client information book. Care Homes for Adults (18-65 years) Page 10 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the nature of the programme places restrictions on people, individuals are involved in decisions about their lives and play an active roll in planning the care and support they receive. Evidence: During the inspection four care plans were examined. Care plans contained detailed information for each stage of the programme of rehabilitation. Information included the emotional and psychological support offered to people, as well as any relevant health care including any interventions from other health professionals. People are encouraged to be involved in decisions about their care. All clients attend morning meetings and weekly house meetings with their key worker. Any changes to the rehabilitation programme are discussed and documented. Comments from people accommodated included, Its a good programme, Staff support you with appointments, its a decent place to be and I enjoy the key working sessions. Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: Risk management commences prior to admission and continues throughout the rehabilitation programme. For people entering the last stage of the programme this also includes a relapse prevention plan. All people spoken to either during the visit or via surveys, said that they were made clear of any restrictions from their admission and that any changes in care were discussed fully. The home has connections with a number of support agencies including alcoholics anonymous, narcotics anonymous and a counseling service. Care Homes for Adults (18-65 years) Page 12 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a strong commitment to enabling residents to reach their goals and develop independent living skills. People are involved in all aspects of daily living at the home. Evidence: First Step provide life skills and social skills which include personal development groups, life skills groups, relapse prevention, health promotion, cooking, budgeting, complementary therapies, counseling, voluntary work, education and computer classes. First Step have an activities programme which includes sky TV in 2 lounges, darts, pool, exercise bike,several board games, 2 computers and have weekly visits to the gym and swimming as well as organised trips for the day and visits to the cinema. First Step support people to integrate back into society once it is safe to do so and Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: with support. First Step have many community links from drug and alcohol services to GPs and the crisis team. As clients are integrated back into society, more community links are established, such as housing support, counseling services, day centres, outreach services, support groups, on going hospital care and a 24 hour support telephone service. Comments from people include, attend all group meetings, staff take us out and I like watching TV, been to college and have a voluntary job, we have a daily programme so that we know what we are doing, counseling sessions are available and staff take us out, its more difficult at weekends as there are less staff available. Some staff said that they would like additional staff so that more people could go out and others felt that house rules in relation to cleaning duties during set hours should be relaxed so that people could attend outside support groups or take up voluntary work. This was an opinion shared by some of the people resident at the home. Visiting is restricted in the initial stage of the programme and some people accommodated raised concern about this. Children are able to visit in the latter stages of the programme although the home says that they are going to look at the needs of toddlers and new babies via the Sure Start programme. Each situation is assessed individually to look at the risks and benefits to those involved. Comments included, I can make calls to family and friends, visiting hours are 1 - 5 PM on a Saturday and Sunday and I am looking forward to see my family this weekend. People are encouraged to make choices and decisions, particularly with regard to their care. However, restrictions are in place, especially during the early stages of the programme and these are agreed as part of the placement. There is a rolling four week menu, people are encouraged to make their own breakfast and lunch. The home employs a cook to prepare the main evening meal with support from people staying at the home. If people do not want what is on the menu they can request an alternative. Comments included, food is good, although depends who is cooking, we all take turns. If you dont know how to cook you get support, its lovely food and we help the cook, there is a set menu but you can have something else if you dont like it. Care Homes for Adults (18-65 years) Page 14 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and helped with both physical and emotional health care promoting their Independence and well being. Evidence: Peoples care needs are discussed, agreed and recorded within their individual care plan. The home provides a key worker system to offer one to one support from a named individual. The home has access to a good range of support systems which include, GPs, dentists, CPN,s, crisis intervention teams, Nurses via the lifeline scheme, connexions and the probation service. A number of people using the service also had access to an outreach worker based within the home whose role is to enable people to obtain appropriate benefits and housing support after leaving the programme. All staff have completed the safe handling of medicines prior to them being able to administer medication to anyone living at the home. There are clear protocols in place for the management, storage and administration and disposal of medicines. Weekly medication audits are carried out. Controlled medication is always administered and signed for by two staff. People staying at First Step are unable to administer their own Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: medication due to the risks involved to either themselves or other people living at the home. Five health professional surveys were received, comments included, caring attention to patients, very lucky to have such dedicated staff, the home engages well with the client group, carries out all main functions of detoxification and rehabilitation. There is good support for people who become ill, willing to offer support to a complex client group, would like to see increased staff awareness of DTs, unsure if they use any rating scales and the service would benefit from clinical input regarding medication. Clinicians need to observe the clients and be able to respond to the needs of clients appropriately and to amend medication as necessary. Care Homes for Adults (18-65 years) Page 16 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust complaints procedure. Evidence: First Step have a clear complaints and whistle blowing procedure and this is displayed on the clients notice board as well as being included in the license agreement/contract and the Statement of Purpose. The Manager and/or Care Co-ordinator meet with the client group on a weekly basis without the staff being present and this is to explore any concerns raised or to activate or follow up any complaints. First Step also have a suggestion box which allows clients to raise points in an anonymous way if they require. Although some staff have completed training in the protection of vulnerable adults, it is recommended that this training be provided for all staff. Comments from people living at the home include, I could raise any concerns, I could tell staff if I had any problems, we have weekly manager meetings and separate key worker meetings. If you have any problems the staff help you sort them out and I could raise concerns, no problem, in fact I do frequently. Care Homes for Adults (18-65 years) Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The layout of the home enables people who use the service to live in a safe, wellmaintained and comfortable environment. Evidence: First Step provide a comfortable and safe environment for the client group. The building is some what restrictive as it is a listed building and old vicarage but all efforts to make a homely atmosphere are taken at every opportunity. The clients are involved when upgrading or replacing items and their choice and view are incorporated. The dimensions of the rooms are documented within the statement of purpose. The home is within easy access to the town center and local amenities. There is limited wheelchair access, two bedrooms are situated on the ground floor as well as 3 self contained flats. The premises are kept clean and tidy with the aid of a house keeper as well as being an integral element to the clients compulsory programme. Comments from people included, I do my own cleaning and laundry, you have your own room then share the rest of the facilities, you can bring in small electrical items like a stereo and when you move in you start in the detox room, if successful you can then move upstairs and if you continue to be successful you progress to having your own flat. The flats have their own kitchen, bathroom and lounge. Care Homes for Adults (18-65 years) Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service and to support the smooth running of the home. Evidence: During the inspection the files of three staff members were examined. All contained an application form, two references and an enhanced CRB (police check). All staff receive an induction when they begin employment. Out of the eight staff surveys received, when asked if there were sufficient staff on duty, one ticked always, four ticked usually and three ticked sometimes. Staff receive regular training to support them in their role. This includes mandatory training such as first aid, food hygiene and fire safety and additional training such as drug and alcohol awareness, acupuncture, crack awareness and counseling. All staff are currently completing a customer service training course NVQ level 3 to ensure the needs of clients are considered and met. NVQs at level 2, 3 or 4 in care are also held by the majority of the staff. Comments about the staff include, staff are brilliant, support from staff is good, most of the time,staff are sound and very good staff, couldnt ask for better. All staff receive regular supervision and ongoing support. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the interests of the people accommodated. Evidence: The manager has relevant training and experience in the field of drugs and alcohol and holds qualifications as a Registered Mental Nurse, Certificate and Diploma in Counseling, Diversity and Quality, Practice Teacher and Post Graduate Certificate in Education, Registered Managers Award and Management and accounting qualifications as well as the Royal College of General Practitioners Substance Misuse parts 1 & 2 and a Master of Science in Contemporary Drug Issues. All people spoken to during the inspection said that the manager was approachable and that the service was well led. Comments about the manager included, the manager is approachable, she gives me time and is brilliant with me and we attend weekly meetings with the manager, you always get feedback if you raise any issues. Six of the seven staff surveys returned confirmed that staff felt they always had enough support, knowledge and experience to meet the needs of the people accommodated. A survey from a visiting professional said, the manager is very willing to consider the needs of Middlesbrough people and has been very flexible about developing First Step to meet their needs. Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: There are a number of quality assurance systems in place which include regular meetings, audits, surveys and Regulation 26 visits. It may be beneficial for the home to develop questionnaires which could be given to health professionals to seek their views of the service being offered. Health and safety systems were in place to protect the health, safety and well being of people residing and working at the home. The only certificate not seen, was the electrical wiring certificate. It was asked that a copy of this be sent to CQC following the inspection. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 The house rules in relation to cleaning duties during set hours should be reviewed so that people are given further opportunities to attend outside support groups or take up voluntary work. All staff should receive training in the protection of vulnerable adults. The home should consider additional ways of gaining formal feedback from health professionals. 2 3 23 39 Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!