Inspection on 10/05/07 for Haven Residential Rehabilitation Alcohol Dependency Unit The

This inspection was carried out on 10th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven Residential Rehabilitation... 01/06/09

Haven Residential Rehabilitation... 30/04/09

Haven Residential Rehabilitation... 02/05/08

Haven Residential Rehabilitation... 15/06/06

Haven Residential Rehabilitation... 08/12/05

Haven Residential Rehabilitation... 22/06/05

Haven Residential Rehabilitation... 02/12/04

Haven Residential Rehabilitation... 19/05/04

Similar services:

Oakmount Hostel

Ark House

St Anne`s Alcohol Services - Leeds

Lynwode Park

Parkfield Rest Home

Priory Road

Elmhurst

Linwood Court

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Haven Residential Rehabilitation Alcohol Dependency Unit The The Haven 5-7 Marshall Avenue Bridlington East Yorkshire YO15 2DT Lead Inspector Mr M. A. Tomlinson Key Unannounced 10th May 2007 09:30 Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haven Residential Rehabilitation Alcohol Dependency Unit The The Haven 5-7 Marshall Avenue Bridlington East Yorkshire YO15 2DT 01262 400329 Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) havenalcoholinfo@yahoo.co.uk Mr Cyril Herbert Dennis Marsburg Vacant post Care Home 10 Category(ies) of Past or present alcohol dependence (10) registration, with number of places Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2006 Brief Description of the Service: The Haven is a residential facility for up to ten service users who have alcohol dependency problems. It is situated in the centre of Bridlington close to all main community facilities and the public transport network. It was previously awarded the ‘Investors in People Award’. The staff team currently consists of the registered person, the manager (not registered with the Commission for Social Care Inspection)) and a qualified counsellor. When possible the manager also employs experienced volunteers. The double fronted property has two floors. There are ten single bedrooms. None have en suite facilities. The property does not have a passenger lift and is consequently not suitable for service users who have mobility problems. Nursing care or medical detoxification is not provided. The home provides a programme of recovery for service users who have made a positive decision to stop drinking alcohol. The service users are required to be alcohol free prior to their admission into the home and must remain so whilst resident in the home. They are encouraged to maintain contact with family and friends within agreed limitations. Specific ‘house rules’ deemed to be necessary and of benefit to the service users are explained during the admission/assessment process and incorporated in the Service Users’ Guide. The rehabilitation and recovery programme is based on the recognised ‘twelve step’ approach as advocated by Alcoholics Anonymous. This process involves manageable stages so that the service users can obtain sobriety and are prepared for living within the community. The programme of recovery takes a minimum of three months to complete but the time scale is flexible to take into account each service user’s needs, abilities and circumstances. It is primarily based on group and individual therapy/counselling and places considerable emphasis on peer group support. Through the use of a planned daily routine the service users are provided with an opportunity to learn, or re-learn, life skills in order to develop their confidence so that eventually they are able to live independently within the community. The fee for accommodation and rehabilitation at The Haven is £450 a week. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was the first undertaken by the Commission for Social Care Inspection (CSCI) during this inspectoral year. The inspection visit formed an integral part of The Haven’s Key Inspection. The pre-inspection questionnaire was not available prior to the inspection visit and consequently information on the home was obtained on the day of, and subsequent to, the inspection visit. Discussions were held with all of the service users without staff being present. The service users were invited to speak with the inspector alone but none wished to. Discussions were also held with the Manager, who is yet to be registered with the CSCI, and the Support Worker/Counsellor, who had recently been employed in the home. Information obtained on the home prior to the inspection visit was also taken into account. This information included two sets of concerns from placing authorities on behalf of ex-service users. The Registered Provider had provided a response to these concerns to the CSCI. Subsequent to the inspection visit telephone conversations were held with six health and social care professionals who had a direct involvement with The Haven. A number of statutory records were inspected. On the completion of the inspection visit the findings of the visit was provided for the manager. What the service does well: The Haven continues to provide a friendly and informal environment in which the service users (clients) are able to undergo the programme of recovery and rehabilitation at a pace best suited to the individual. A social worker had commented in a letter to the home, “I have been very pleased with the individualised care planning that has been put in place to meet my client’s particular needs. His difficulties with mental health and literacy skills have been taken into account and these needs addressed in an appropriate and sensitive way.”. Comments from telephone conversations with health and social care professionals included, “My client had access to learning opportunities. He followed his faith and went to church. He also received support in getting local accommodation (on the completion of the recovery programme); “The client reviews are of a good quality”; “I’ve got a couple of clients there (The Haven) and I’ve been very impressed. They (staff) are focussed and the manager is very responsive. They provide continued contact with the client after they have completed the programme. I’ve received no negative feedback and they are always welcoming” and “The Counsellor is very aware of the clients’ needs and is able to get to the core of a problem. My communication is good with the home. They will keep me informed and then I can work things out with them”. A general comment summarised by a Social Worker was, “I’m selective regarding placements as The Haven, for example, wouldn’t suit everyone or meet their needs”. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 6 It was evident from discussions with the service users and the counsellor that the service users are provided with good standards of personal support and are able to discuss their concerns and problems on a one-to-one basis. The counsellor stated, “I like to think that I work with people’s feelings and behaviour, a holistic approach, not just their addiction”. What has improved since the last inspection? What they could do better: There are two main areas in which the service needs to improve: Firstly, the Registered Provider needs to apply to the Commission for Social Care Inspection for the registration of the manager. The manager not being registered means that the ultimate responsibility for the day to day running of the home remains with the Registered Provider which given the arrangements in the home is impracticable. The lack of a registered manager also Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 7 undermines the professional credibility of the home and could have an effect on future placements. Secondly, the lines of communication, particularly with the representatives of the service users’ placing authorities, needs to be made clear at the start of a placement. It is recommended that consideration be given to providing placing authorities with regular updates on the progress of the respective service user in writing. The manager should also be more pro-active with regard to complaints and concerns and encourage placing authorities to openly discuss any concerns with the home in order to quash any misinformation or rumours. In such cases the outcomes of such discussions should be followed up in writing to the placing authority concerned. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 The information provided by the assessments of prospective service users enables the manager to make a considered decision as to whether the home is able to meet the needs of the individual. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the Service Users’ Guide (S.U.G.) was available in the entrance hall. It required updating particularly with regard to the management and staffing arrangements. The manager was aware of this. The service users and the representatives of the their placing authorities spoken to confirmed that they had been provided with adequate information by the home prior to their admission so that a considered decision could be made regarding the proposed placement. The care records of three current service users were examined. They contained records of the pre-admission assessments undertaken on the service users. These contained sufficient information on the prospective service user Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 10 to confirm that the home was able to meet that person’s needs. They were in addition to any assessment provided by a service user’s placing authority. Considerable emphasis was placed on establishing a prospective service user’s motivation for undertaking the programme of rehabilitation. The assessments were carried out with the prospective service users when they visited the home prior to admission. The manager was adamant that telephone assessments would not be considered acceptable. In one recent case a service user was accepted for an initial one month’s trial period as their motivation and attitude were considered suspect. The service user concerned confirmed this. This service user was subsequently assessed as being suitable for the programme of rehabilitation. There were no letters on file to a prospective service user or their representative confirming that the home could meet the prospective service user’s needs and agreeing to the proposed placement. From an examination of the service users’ care records and discussions with the staff, it was evident that the home was capable of meeting the service users’ assessed needs. In the case of the service users at The Haven, however, these needs were constantly changing as they progressed through the programme of rehabilitation and recovery and consequently the service users were constantly being re-assessed. A common criticism made by representatives of the service users’ placing authorities was that they were not regularly or routinely kept up to date with the progress made by a service user and of any problems the home had encountered with the programme of care. This was particularly relevant to those service users whose placing authority was a considerable distance from the home and the allocated care manager unable to routinely visit their client. The representatives of the placing authorities spoken to all said that they placed clients at The Haven with considerable care, as the home’s flexible and informal approach would not suit the needs of all prospective service users. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 The service users are provided with good support to obtain and maintain sobriety. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users had been provided with care plans by the home. This was in addition to, but compatible with, the care plans provided by a placing authority. Whilst the core plan was based on the twelve-step recovery programme the service users’ individual needs had also been taken into account and identified in the care plan. The service users were aware of their care plan and confirmed that it was regularly discussed with them. As previously mentioned in the report, the service users’ needs were constantly changing as they progressed through the programme and consequently the care plans needed to be regularly reviewed and updated. There was evidence Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 12 in the care plans that this had taken place. The service users’ placing authorities also held regular reviews although in some cases, due to the distance involved, these would occasionally take place over the telephone. There were ‘house rules’ in place that restricted the service users independence and choice. The manager deemed these necessary particularly during the early stages of a service user’s programme of recovery. These restrictions were documented and explained to the service users prior to their admission into the home. The service users confirmed this and stated that in their opinion the restrictions were necessary, fair and sensible. As a service user progressed through the programme so the restrictions were gradually lifted eventually leading on discharge to a service user having total independence. The home regularly breathalysed the service users to check for the use of alcohol. This was generally undertaken each morning for, according to the service users, they were more likely to have a relapse during the night and in the privacy of their rooms. The service users all accepted this as necessary practice and did not feel that it undermined their human rights. The recovery programme consisted of two stages: primary and secondary care. Primary care consisted of implementing the twelve-step recovery programme. There was no time limit set for this and the service users could achieve each step at their own pace. The service users stated that some of the ‘steps’ were difficult to accept but the staff gave excellent support to enable them to do so. The service users also commended the Counsellor who spent considerable time in explaining the steps to make them more acceptable and meaningful. Secondary care mainly consisted of providing the service users with opportunities to learn or re-learn life skills including re-establishing relationships with friends and family although they continued to use the twelve steps in order to maintain their sobriety. During the second phase of the recovery programme the service users were encouraged to make decisions for themselves. Several of the service users provided examples of this. Life skills training also included an expectation that the service users would take some responsibility for the cleanliness of the home. They had consequently been allocated daily domestic tasks and were responsible for maintaining their bedrooms in a clean and hygienic condition. The service users accepted this and presented as having considerable pride in their environment. Time was allocated for this so that it did not interfere with the recovery programme. The Haven provided a flexible and relatively informal approach to recovery that took into account the service users’ needs and abilities. It was underpinned, however, by staff good support for the service users. Whilst, for example, they were able to take assessed risks by going out into the town or visiting their families, it was closely monitored to ensure that they were able to cope with the risks involved. They were also able to discuss their concerns relating to taking risks and their vulnerability on a one-to-one basis during Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 13 their counselling sessions. Written risk assessments were in place and the care records reflected the possible risks involved. The service users felt confident that they could call on the support of the home’s staff both during and on completion of the recovery programme. The home also provided a degree of ‘after care’ for those service users who had completed the programme and were living within the community. They were at liberty to contact the home at any time for support and could visit and participate in the programme if they wished. The representatives of the service users’ placing authorities confirmed this. The service users said that they developed a network of external support through attendance at the local Alcoholics Anonymous meetings. The service users were expected to attend these meetings as an integral part of the programme. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The service users are provided with good support to enable them to be reintegrated into society. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The ultimate aim of The Haven was to enable the service users to gain and maintain sobriety and be able to live reasonably independently within the community. As stated in this report, this was a phased approach. During the initial stages of recovery emphasis was placed on the first three steps of the programme, which basically entailed a service user acknowledging that a problem of addiction exists. Only after the successful completion of this stage are the service users able to start developing their life skills in preparation for independent living. An important and integral part of this was contact with the local community and use of the community facilities. Initially the service users Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 15 went out accompanied by another and more experienced service user. Later in the programme they could, when the time was judged to be right, go out unaccompanied. In all cases, however, they were expected to keep the staff informed of the their intentions and where they were going. Examples of this were observed during the inspection visit. One service user provided an example where he went back to his family on his own but felt very vulnerable and quickly returned to the security of The Haven. Without exception the service users said that success of the programme relied on mutual trust between them and the staff. They acknowledged that if they betrayed that trust then they would have to accept the consequences, which in some instances may mean the termination of the recovery programme. During the latter stages of the recovery programme the service users were provided with opportunities to participate in local educational and work preparation programmes. These had included courses that developed computer skills and, more recently, the use of digital cameras. The service users had access to a computer within the home in order that they could further develop their computer skills. Where possible the service users were provided with work experience opportunities and several had worked in local charity shops. Those service users who were approaching completion of the recovery programme confirmed that they were given good support with regard to the transition into the community and were encouraged to think about possible career paths. Without exception the service users expressed satisfaction with the rehabilitation programme and stated that boredom was not an issue. The service users occasionally went out for meal with the staff. From discussions with the staff and service users the registered provider generally paid for this. From discussions with the service users and the staff, it was apparent that a reasonable balance had been achieved between promoting the service users’ independence and the need to ensure their safety and continued sobriety. For example, whilst the service users had unrestricted access to their rooms care was taken by the staff to ensure that the service users did not become isolated with the risk of returning to an ‘addictive mentality’. From the menus provided by the home it was evident that the meals were reasonably balanced and nutritious. The service users confirmed that got their own breakfast and tea but that the Registered Provider prepared the lunchtime meal. The rationale behind this was to ensure that the service users were reintroduced to normal and healthy eating which many had ignored due to their addiction. Without exception all of the service users expressed satisfaction with the meals. The only criticism was that there was no fresh fruit or biscuits available during the day. One service user stated that their relatives had brought fruit in to the home to be used by the service users. This issue was discussed with the manager and the registered provider. The service users ate their meals in the dining room which was appropriately furnished. It was observed that as part of their domestic duties the service users laid and Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 16 cleared the dining room tables. Due to the necessity to adhere to the timing of the recovery programme the meals were taken at set times. For reasons of safety, the kitchen was locked at night. The service users stated, however, that they did not have ready access to drinks and snacks during the night. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The service users’ health and personal care needs are met with good input from health and social care professionals. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager emphasised that the need to establish ‘routine’ for the service users was important as many had previously lead rather chaotic lives due to their addiction. They were expected, therefore, to meet their commitments with regard to the programme of recovery and undertake tasks allocated to them at the appropriate time. The service users acknowledged this need for routine. The service users also stated that they were treated with respect by the staff and were spoken to in an adult manner. It was noted that the conversations between the service users and staff were open and spontaneous. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 18 Most of the personal support provided for the service users was in the form of guidance and encouragement. The service users required little physical care and consequently considerable emphasis was placed on meeting their emotional and social care needs. This was reflected in the care plans examined. Importance was also attached to encouraging the service users’ to maintain good standards of personal care. In many cases this, according to the service users spoken to, had been neglected in their former lives. On the day of the inspection visit the service users were dressed in clean and appropriate clothing. They had been allocated a day on which they did their own laundry as part of their life skills training. All of the service users had been registered with a local medical practice. The staff stated that they received good support from the medical practitioners and one general practitioner in particular had developed a particular interest in problems of alcohol addiction. The records confirmed that service users had access to other health care services such as opticians and dentists. During discussions with the service users a recently admitted service user had a major seizure. The staff promptly responded to this and provided the service user concerned with re-assurance and took appropriate action in terms of first aid. The staff also telephoned the emergency services and an ambulance attended with five minutes of the seizure. The service user concerned was taken to hospital for observation. The manager advised the remaining service users of the situation. The service users stated that seizures were not uncommon for people in recovery from alcohol addiction but for the majority it was the first occasion that they had witnessed one. The staff handled the whole incident in a competent, effective and professional manner. The medication administration arrangements remained unchanged. The service users’ medication was secured in a locked container. The need for a dedicated drugs cabinet was discussed with the manager. The medication administration sheets were complete and up to date. No controlled drugs were in use at the time of the inspection visit. The manager stated that the service users were encouraged to take some responsibility for partially selfadministering their own medication. This was done in preparation for the service users gaining independence and leaving The Haven. Following an assessment of competence the service users were given their medication to self-medicate on a daily basis. Checks were made to ensure that they had taken it. Whilst detoxification was not undertaken by the home, there had been occasions where a service user was still on detoxification medication on their admission into the home. This had been administered with the knowledge of the medical practitioner. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The internal and external network of support provided for the service users should ensure that any issue or concern is quickly identified and acted upon. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had an appropriate complaints procedure in place. The service users stated that they were aware of it and that they were confident that they could use it. In reality the majority of complaints were made to the representative of the service users’ placing authority. Several concerns, of a similar nature, had been made over the last year. The majority of the complaints were relatively minor and were easily addressed. Some appeared to have come from a breakdown in communication between the placing authority and The Haven. One of the more serious complaints alleged that a service user had drunk alcohol whilst at The Haven. According to the records and the manager there had been an instance where a member of staff, who was an ex-service user, had taken alcohol. This member of staff was subsequently removed from their post. Most of the representatives of the placing authorities were aware of this. The service users stated that they were at liberty to raise any concerns directly with the staff; particularly during their counselling sessions, and in their opinion the manager would appropriately address the concerns. As on previous occasions, the manager operated an ‘open door’ policy and encouraged the service users to come directly to her Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 20 with any concerns. The service users also stated that they would not hesitate to report any breach of the ‘house rules’ such as the use of alcohol or drugs. From discussions with the staff it was apparent that they were aware of the guidelines for Safeguarding Adults and they expressed confidence that any issue would be quickly identified and acted upon. The service users also had access to external complaints/abuse procedures via their placing authorities. It was concluded that the network of external and internal support provided for the service users should act as a safeguard. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30 The service users are provided with suitable accommodation that meets their needs. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No major changes had been made to the premises since the previous inspection except that double-glazing had been installed in the windows to the front of the property. The property continued to be maintained, decorated and furnished to an appropriate standard. In-line with the ‘non-smoking’ legislation, the home had a dedicated room and area used for smoking. The registered provider was advised to refer to this legislation to ensure that the premises fully comply with it. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 22 All of the bedrooms were for single occupancy. The service users said that they preferred this arrangement as it gave them privacy. The locks on the bedroom doors were not used in order to lessen the chance of isolation of the service users. The cleanliness of the bedrooms remained the responsibility of the service users as part of their rehabilitation and life skills training. None of the service users objected to this. Without exception the service users expressed satisfaction with their accommodation and one said that, ‘it really did feel like home’. The premises did not have a passenger lift and consequently it was only considered suitable for service users who were fully ambulant. The registered provider had their private accommodation on the top floor of the property. They were available during the night and could be alerted through the use of a call-system. The home had suitable laundry facilities which had domestic standard equipment. The service users were responsible for undertaking their own laundry albeit with the assistance of the staff. As far as could be ascertained from the home’s records the premises satisfied the specific requirements of the Environmental Health and Fire Safety departments. A CCTV camera continued to be used to monitor the main entrance door for purposes of security. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 The service users are provided with good support by an experienced and qualified staff team. Inappropriate staff vetting procedures could undermine the safety of the service users. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection the staff team at The Haven had been through a rather traumatic period. The employment contract of the previous staff counsellor had been terminated as they had breached the terms and conditions of their employment. Coincidentally with this the manager had sustained a serious illness which limited her involvement in the home. Over this period the operating capacity of the home had been seriously affected and consequently the number of people using the service had been reduced. The manager had informed the Commission of Social Care Inspection of this problem along with the actions being taken to resolve it. The representatives of the placing authorities were also aware of the problem although they had Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 24 not been formally advised by the home. One of the outcomes to the staffing problem was that there had been a spate of complaints primarily alleging poor staff coverage. It was evident from discussions with the staff and service users along with an examination of the staff roster, that the home now provided twenty-four hour coverage. In general there were two staff on during the day and the registered provider available during the night. The service users confirmed that they had support during the night and that the registered provider was contactable. The manager and the counsellor were also on-call. The staff team primarily consisted of the registered provider, the manager and a counsellor who had been recently recruited. The counsellor was very experienced and was qualified in a number of counselling fields including alcohol addiction. She demonstrated an excellent understanding of the service users’ needs particularly with regard to the programme of recovery. It was evident from discussions with the service users that she had considerable empathy with them and was able to discuss issues and problems with them in an open and frank manner. The service users commended the attitude and professionalism of the counsellor. A social service’s care manager was also impressed with her and thought that she would be ‘the answer to The Haven’s current problems’. From an examination of the staff records it was evident that although the counsellor had been in post for a number of weeks a response to a CRB clearance check had not been received. She had also not undergone a ‘POVA First’ check. The manager had primarily relied on her prior knowledge of the counsellor and other information received such as references. The manager justified the employment of the counsellor in advance of the completion of her vetting on the grounds that the home could not continue to operate successfully without the counsellor in post. The manager had undertaken training on statutory subjects such as first aid and health and safety. She intended to provide the counsellor with such training when she had established herself in post. The counsellor confirmed that she had received regular supervision from the manager. It was evident that there were good lines of communication between the manager and the counsellor, they worked well together and had common aims. The counsellor had made several changes since taking up her post at The Haven. These included the introduction of a ‘Joys of Sobriety’ meeting each Friday when ex-service users were able to share their experiences with the current service users. The recovery programme now consisted of two group meetings each day and greater emphasis was placed on self-study by the service users. The counsellor had also introduced a meeting styled on that held by Alcoholics Anonymous (AA) on the grounds that “It can be traumatic for service users going to a (AA) meeting for the first time and meeting Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 25 strangers and so I’ve introduced this meeting for them to experience it”. She also stated, “I promote the physical and well-being of the clients. I believe in a supportive approach not confrontational” and “I like to think that I work with people’s feelings and behaviour – a holistic approach – not just their addiction”. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Whilst the staff and service users received good support from the manager, the credibility of the home is undermined by the fact that the manager is not registered with the Commission for Social Care Inspection. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not had a registered manager for over two years and although the current manager had indicated her intention to apply for registration with the Commission for Social Care Inspection (CSCI), this had not taken place. In mitigation, and as indicated in a previous part of the report, the manager had sustained a serious long-term illness that had consequently delayed the Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 27 application. The manager was very experienced and well qualified having obtained the Registered Managers Award and a National Vocational Qualification at level 4 in management. She was also a qualified counsellor. It was apparent from discussions with, and observation of, the manager and the service users that an open and professional relationship existed between them. The service users said that they felt able to discuss any concerns and problems directly with the manager. A formal quality assurance process had not been implemented. The manager felt that it would not be viable given the size of the service. She stated that she is intending to link the home’s quality assurance process into the annual return made to the CSCI. A number of statutory records were examined including selected care records, staff records, fire safety records and medication records. These records were all complete and up to date. From an examination of the health and safety records and servicing certificates, it was apparent that all reasonable steps had been taken to ensure that the environment was safe for the use by the service users and staff. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019743.V339705.R01.S.doc 3 3 3 4 X LIFESTYLES Standard No Score 11 4 12 3 13 4 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Haven Residential Rehabilitation Alcohol Dependency Unit The Score 3 3 3 X 1 3 2 X X 3 X Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The Service Users’ Guide and Statement of Purpose must accurately reflect the service provided, the staffing and management arrangements and details of the recovery programme. Previous requirement – timescale of 01/11/06 not met. The registered provider must advise a prospective service users and/or their placing authority in writing that the home is able to meet the service user’s needs. In exceptional circumstances where a member of staff is employed prior to obtaining a CRB check then a POVA First must be obtained and appropriate supervision arrangements put in place in order to safeguard the service users. The registered provider must apply for registration of the manager to the Commission for Social Care Inspection DS0000019743.V339705.R01.S.doc Timescale for action 01/09/07 2. YA3 14(d) 01/06/07 3. YA34 19 01/06/07 3. YA37 8 01/06/07 Haven Residential Rehabilitation Alcohol Dependency Unit The Version 5.2 Page 30 Previous requirement – timescale of 01/11/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The progress made by service users should be regularly and automatically communicated to their placing authority in writing. The placing authority should also be kept informed of any issues or concerns that may affect the welfare of their service users. 2. YA17 3. 4. 5. YA20 YA33 YA39 The service users should be provided with fresh fruit on a regular basis to supplement their intake of vitamin C. They should also have access to drink making facilities and light snacks during the nighttime period. Consideration should be given to purchasing a dedicated drugs cabinet that provides a greater degree of security than the current arrangements. The current level of staffing should be kept under review to ensure that it is adequate to meet the service users’ needs at all times. Action should be taken to obtain the views of the service users and the representatives of their placing authorities in writing on the standard of the service provided. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V339705.R01.S.doc Version 5.2 Page 32 - 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!