Inspection on 02/05/08 for Haven Residential Rehabilitation Alcohol Dependency Unit The

This inspection was carried out on 2nd May 2008.

CSCI found this care home to be providing an Adequate service.

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 13 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... 10/05/07

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 28/09/2008.

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 Janet Lamb & David Finney Unannounced Key Inspection 2nd May 2008 10:00 Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.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.V363886.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.V363886.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 Manager post vacant – Margaret Mansfield is the unregistered manager 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.V363886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2007 Brief Description of the Service: The Haven is a residential facility for up to ten people 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 provider, the manager (not registered with the Commission for Social Care Inspection), a qualified counsellor and one care worker. 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 people who have mobility problems. There are no gardens to the property and car parking is only on the main street with use of visitor’s permits. The home provides a programme of recovery and rehabilitation for people who have made a positive decision to stop drinking alcohol. Nursing care or medical detoxification is not provided. People are required to be alcohol free prior to their admission into the home and must remain so whilst resident there. They are encouraged to maintain contact with family and friends within agreed limitations. Specific ‘house rules’ deemed to be necessary and of benefit to people’s recovery 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 people 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 person’s needs, abilities and circumstances. It is primarily based on group and individual therapy/counselling and places considerable emphasis on Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 5 peer group support. Through the use of a planned daily routine people 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, the same as reported at the last key inspection. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1-star. This means the people who use this service experience adequate quality outcomes. The Key Inspection of The Haven has taken place over a period of time. It involved sending an ‘annual quality assurance assessment’ (AQAA) document to the home on 6th March 2008 requesting information about people and their family members, and the health care professionals that attend them. It also asked for numerical data held in the home. We received the requested information on 14th April 2008 and survey questionnaires were then issued to all seven of the people staying there and their care managers. Then on the 2nd May 2008 Janet Lamb, visiting Inspector, and David Finney, Provider Relationship Manager with the national lead on drug and alcohol rehabilitation services, visited The Haven, without prior warning to check out the information the Commission had received. All of the people staying there at the time of the visit were spoken to in a group interview. The provider, unregistered manager and counsellor were interviewed to provide further information. The communal parts of the home were inspected, and a couple of people’s bedrooms were also briefly viewed. Care plans or rehabilitation programmes, risk assessment documents and some records were read and staff files and training records were seen. All personal and private documents were only seen with the permission of the people they belong to. Safety maintenance certificates and records were also viewed. What the service does well: The home produces individual and effective care plans and programmes that fit in with the AA 12-step programme of rehabilitation. It offers very good support through a structured system of routine, expectation that meetings and one-to-one sessions will be attended and that ‘house rules’ will be adhered to. It encourages people to work hard at keeping to their programmes and expects them to place trust in the rehabilitation process and in one another. It offers people high levels of choice and independence at the right times during the programme and enables them to make informed decisions. The home encourages people to take risks in life, but to have risk management strategies in place before any action is taken. It offers good opportunities to Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 7 engage in pastimes, activities or occupation, either in-house or in the local community. Links with the local community are good and well organised. The home encourages a planned daily routine, which includes personal care and safety, household chores and living skills and how to manage money and how to make and keep appointments, etc. The home provides satisfactory food provision and people say they eat well and healthily. The home provides good support in the form of counselling, guidance, information on rehabilitative techniques, and general help in the local community. The home also encourages people to take responsibility for oneself and others in respect of supporting one another. There are good healthcare support systems in place and the home has good links with the local GP surgeries and Community Psychiatric Nurses, as well as local alcohol support groups. The home provides satisfactory laundry facilities. What has improved since the last inspection? What they could do better: The home could make sure the Service User Guide and Statement of Purpose accurately reflect the service provided, the staffing and management arrangements, as well as the contact details of the Commission and placing local authorities, so people know they have accurate information and can make representations to the right organisation. It could make sure people are fully assessed according to the list at standard 2.3, so they are confident their individual needs are met. It could make sure people’s care plans contain information on areas assessed as listed in standard 2.3, even if only to state what is and what is not applicable to them, so they know their assessed needs are being met. The home could encourage people to complete a basic food hygiene certificate if they are to prepare food in the home for other people staying there. It should also make sure staff update their food hygiene certificate on a three yearly basis. Both of these are recommended so people are confident their food is being prepared safely and hygienically and they are protected from risk of exposure to bacteria and food poisoning. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 8 The home could make sure medicines received into the home are stored safely in a wall mounted cabinet and in line with the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971, so people know their medicines are being safely handled. It could make sure all staff administering medication have accredited medication administration training so people know their medicines are being safely administered. The home could make sure there is an understandable and recorded stock control system on all medicines received into the home and that any returned to the pharmacy is properly recorded in a log, so people know their medicines are being safely handled. And it could also make sure there is appropriate cold storage for those medicines requiring cooler temperatures, so people know their medicines are being safely stored. It could make sure all complaints are recorded in a dedicated complaint register/log, which shows what, when and how complaints are dealt with and whether or not people are satisfied with the outcomes. The manager and staff could exercise an open and transparent approach to dealing with issues raised, so that people know their concerns are taken seriously and are dealt with effectively and efficiently. The home could make sure the complaint procedure is amended to include details of how to contact the East Riding of Yorkshire Council and placing local authorities, so people know how to make concerns known to the right organisations/bodies. It could make sure all staff receive regular and updated safeguarding adults training, with an external organisation where possible, so people know they are protected from risk of abuse or harm. It could also maintain a safeguarding register/log, but keep any issues raised or discussed in a more confidential format. The home could make sure all parts of the home are maintained and kept reasonably decorated. The first floor gentleman’s single toilet requires the lock repairing. The first floor bathrooms require new bathroom suites, new floor covering and redecorating. An audit of all bathrooms should be carried out and any identified work completed. A written record of identified and completed maintenance should be kept. It could make sure counselling staff are qualified to do the job and are competence checked according to the Drug and Alcohol National Occupational Standards recommendations. 50 of staff could also have the required qualifications to do the job. This is so people are confident that qualified and trained staff are supporting them. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 9 The home could make sure that only in exceptional circumstances where a member of staff is employed prior to obtaining a full security check, a preliminary quicker check is obtained and appropriate supervision arrangements put in place so that people know they are being protected. It could make sure staff are recruited according to the requirements of the standard and regulations, in respect of their identification and references etc., so people know that safe staff are supporting them in the home. The home could make sure the current level of staffing is kept under review to ensure that it is adequate to meet peoples’ needs at all times. It may be a matter of deploying staff more effectively throughout the week. A written roster would assist in determining the levels of staff needed and show accountability in covering shifts. It could consider employing a second counsellor to share the responsibility to support people through their rehabilitation programme and to conduct some of the one-to-one sessions and group meetings. The home could make sure all staff working in the home, including the manager, receive training that equips them with the skills to do the job they are employed for, so people know competent staff are supporting them in the home. All mandatory courses should be completed on an annual basis. It could make sure all staff are appropriately supervised, that records of supervision are maintained and that where counsellors access external clinical supervision this is paid for them, so people know the staff that support them in the home are themselves well supported. The home could make an application to register the manager with the Commission, so people know someone ‘fit’ and competent to do so is managing the home. It could make sure the names of staff and people involved in fire safety drills are recorded on the fire drill record. The home could also make sure that any checks made on the temperature of hot water at outlets is recorded on a log. It could make sure a legionella water test is carried out on the hot water storage every three years. The home could make sure there is a risk assessment document completed for anyone (people staying in the home) using cleaning products when learning or re-learning living skills as part of their rehabilitation programme. It could supply the Commission with documentary evidence that effective financial accountability of the viability of the home is carried out. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 10 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.V363886.R01.S.doc Version 5.2 Page 11 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.V363886.R01.S.doc Version 5.2 Page 12 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 and 2. People who use the service experience adequate quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People who use this service have satisfactory information about the home in order to make an informed decision about whether or not the service is right for them. The needs assessment means that people’s diverse needs are not always identified or fully assessed and planned for before they move to the home, but their rehabilitation needs are, so people know these at least will be met. EVIDENCE: Discussion with people and the management team, and viewing of files with permission, reveals that people have assessments undertaken and are provided with sufficient information about the place to enable them to make a decision on whether or not they wish to stay there, before they begin their programme of rehabilitation in the home. The home’s statement of purpose and its service user guide have been changed since the last inspection and copies have been sent to the Commission for scrutiny, in July 2007. However, these documents have not been received according to the Commission’s database. In view of there being a new staff member taken on recently and the changes in making contact with Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 13 the Commission, information documents need to be updated and new copies sent to us. Assessment documents carried out by the home focus mainly on alcohol dependence of people and are comprehensive in this area, but they do not include all of the other items listed in standard 2.3. Where an item is not applicable the assessment document needs to make clear it has not been assessed and why. Both the placing authority and the home’s own assessment documents are held in files and people spoken to are clearly aware of the information held on them and in what format. They are fully consulted and in agreement with the contents of the programmes they have in place. Before a placement begins emphasis is placed on establishing a prospective person’s motivation for undertaking the programme of rehabilitation. The assessments are carried out with the prospective person when they visit the home prior to admission. One person said they had researched the home and other places before making a decision where to undertake their rehabilitation, and chose The Haven because of the informality and relaxed approach outlined in the programme, as well as the fact that it was not a secure unit. Others said they are satisfied with the choice they made with assistance from social workers, as they found the home to be structured, but relaxed. People understand the ethos of the home to support them in their choices, but they also clearly understand where they stand in respect of following their programmes and the consequences of deviating from them. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 14 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 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People have good care plans that enable them to be independent and to make choices. People enjoy making their own decisions in life, with risk assessments being put into place where necessary, so they know their individual needs are met and their choices respected. EVIDENCE: Discussion with people and management, and viewing of case files with permission reveals there has been very little change to the processes of compiling care and rehabilitation programmes since the last inspection, and that generally people’s individual needs and choices are well met. Care plans are based on the twelve-step recovery programme, but peoples’ individual needs are also taken into account and identified. Care plans do not concentrate on any physical care needs, as this is only necessary in emergency situations. People are aware of their care plan and confirm that it is regularly discussed with them. Peoples’ needs are constantly changing as they progress Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 15 through the programme and consequently the care plans need to be regularly reviewed and updated, as part of the one-to-one sessions held and the counselling group sessions held. There is evidence in the care plans that this takes place. Peoples’ placing authorities also hold regular reviews although in some cases, due to the distance involved, these occasionally take place over the telephone. There are still ‘house rules’ in place that restrict peoples’ independence and choice. People read the house rules and sign a declaration they understand and will abide by them. People spoken to and the manager deem these necessary and particularly during the early stages of a programme of recovery. These restrictions are documented and explained to people prior to their admission into the home. People confirm this and state in their opinion restrictions are fair and sensible. As a person progresses through the programme so the restrictions are gradually lifted, eventually leading on discharge to having total independence. People are still breathalysed each morning as part of their agreement to adhere to the programme. There is still a recovery programme in place that consists of two stages: primary and secondary care. Primary care involves implementing the twelvestep recovery programme for which there is no time limit set, and people achieve each step at their own pace. People say that some of the ‘steps’ are difficult to accept but that staff are there to support them. They also commend the counsellor for spending time explaining the steps to make them more acceptable and meaningful. Secondary care involves providing people with opportunities to learn or relearn life skills including re-establishing relationships with friends and family although they continue to use the twelve steps in order to maintain their sobriety. During the second phase of the recovery programme people are encouraged to make decisions for themselves. All people in the home are expected to follow their programme, support one another in sharing household chores and responsibilities, and to adhere to the house rules. Those spoken to talk about team work, trusting one another, and also reprimanding each other if they do not ‘work’ at achieving their individual programmes. People choose entirely what they want to do and where they want to go once the first two weeks of their programme has passed. During this time they remain in the house for a week and then go out, only when accompanied, for another week. They also make informed decisions about adhering to the programme, taking part in group meetings and one-to-one counselling sessions. These activities and taking a daily breathalyser test are compulsory. The service is very much people-led, and staff tend only to be there to offer support and advice, facilitate ‘treatment’ and ensure medication is administered. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 16 Later into peoples’ programmes they are able to take up recreational and voluntary employment opportunities, if they wish. People are encouraged to take risks at this stage also, the main one being exposure to the community where alcohol is available. As they say in interview, alcohol will be available to them in many settings once they return home and to their usual routines, so they feel it is a good idea to confront it all the time they are working through their programme. There are individual risk assessments in place to help reduce and contain risk and these are primarily to do with avoiding access to alcohol. The home maintains high levels of confidentiality in delivering its programme and treatment and people are careful to make sure they only disclose what they want to and at the time they feel to be right. Records are discreetly maintained in the format of private notes between the counsellor and the individual. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 17 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): 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home offers appropriate opportunities for people to engage in activities and pastimes, to maintain contact with family and friends and to eat healthily, so people enjoy satisfying lifestyles of their choosing, with support from staff where necessary. EVIDENCE: Discussion with people and management and viewing of records held in the home, and case files with permission, reveals people do lead independent lifestyles once the initial stage of their programme has been achieved. People say in interview they have opportunities to engage in educational and occupational pastimes, but mainly there is plenty to do in the home in respect of completing individual programmes. People must attend twice-daily meetings, go to AA meetings in-house and in Bridlington and complete written work and personal assignments, which aids recovery and shows commitment. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 18 People are able to attend photography and IT classes etc., and as part of their rehabilitation, go on courses held at Christchurch Community Services etc., on such as ‘eating well’ and so on. People have also done ‘health and nutrition,’ ‘how to deal with debt’ and had extra counselling on particular topics if deemed necessary. People are also encouraged to join in with community activities if they wish, take walks round the harbour or on the beach, and to socialise at local events. Links with family and friends are only encouraged after an initial six-week period of no contact with them. After that people can go home every other weekend if they wish. People do consider leaving the home to see family in the first six weeks, but say geography sometimes puts them off, and the thought of not being allowed back onto the programme is a strong deterrent as well as such a waste of a life-changing opportunity. They acknowledge the benefits of complying with rules of the programme and of the house, even though they may not like complying with them. Three people were preparing to go home for the weekend on the day of the site visit, and had left or were leaving before it was completed. Everyone is expected to engage in daily chores and routines, but in their early days are given a ‘buddy’ to work with, as the sheer physical exertions after coming off detoxification, coupled with the initial stages of the counselling and programme work, can be exhausting. There is no cook employed in the home at the moment. Although the manager explains that one of the staff usually cooks the main meal of the day at lunchtime, people do engage in cooking chores for the whole group, but this is mostly the teatime meal. They have a roster for it and see it as one of the group responsibilities. They also share responsibility for clearing up after meals and cleaning dishes. People also keep their rooms tidy and clean, and the vacuum cleaner could be heard in use early in the afternoon of the site visit. The decision to agree to engage in household chores is usually made at the assessment stage, before the placement begins. The reason for taking part is to re-learn skills of ordinary living, and to take responsibility for oneself and one’s lifestyle. There is a designated smoke room and people respect the rules on smoking, which are stated in the terms and conditions of residence. Three meals a day are provided in The Haven, of which the midday meal is the main meal. People are encouraged to eat healthily and regularly. Menus are compiled and anyone wishing to have an alternative is able to do so. There is now a good supply of fresh fruit available, in the main lounge (smoke lounge) and people can take it at will. There is a dining room near to the kitchen with Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 19 individual dining tables. There are no complaints or adverse comments about the food provision. One person staying in the home at the moment is a trained chef and is using his skills to assist with food provision and to maintain his skills. Anyone providing food for people in the home should have a basic food hygiene certificate as a minimum, and this is a recommendation of this report. All hygiene certificates for staff should be updated three yearly. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 20 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy a good level of support and protection with their health care, and with receiving of their medicines, so they know their health care needs are met, but systems for handling and storing medication are not good enough to ensure safe practices at all times. EVIDENCE: Discussion with people and management and viewing of some documents and records, with permission where necessary, reveals generally peoples’ personal and healthcare needs are met, but that there is still room for some improvement in medication administration. Usually people do not require physical personal care from staff. Their main need is that they require support to develop and maintain a healthy lifestyle: have good hygiene, engage in good routines of daily living, make and attend healthcare appointments and eat well. People spoken to say they find it difficult at first to establish routines and to set up such as sight or hearing tests or dental appointments etc. and value the support from each other as well as from staff. People register with a local GP for the length of their stay in Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 21 the home and attend appointments as necessary. Files contain details of appointments and visits to health professionals and people back up such activities in conversation. People are capable of making their own choices when visits to the doctor or hospital are needed and generally use common sense to deal with health issues. The whole system of medication storage and handling requires some attention. There is a medication administration policy, last reviewed March 2008, and drugs are stored in a locked filing cabinet in the office. It would be better if drugs were stored in a dedicated medication cabinet, fixed to the wall. This was discussed and recommended at the last inspection and in view of there being no change is now a requirement of this report. There should also be a cold storage facility for any medication requiring lower temperature storage. The manager should check all medications administered and provide a medication fridge where any state a cooler temperature is necessary. The prescribing GP surgery now supplies all medication to the home, and the manager is therefore unable to access any monitored dosage system because of this. The surgery refuses to release any prescriptions for taking elsewhere and so choice of how the medicines are dispensed is denied. Because all medication is dispensed in bottles and packets the manager should make sure there is a stock control system in place, and make sure this is recorded and understood. Medication administration record (MAR) sheets were viewed and found to be completed in advance of the weekend for some people, but the manager explains that they are signed as given when medication is handed to people that leave for the weekend, and take their medication with them. This is considered satisfactory. However, there are signatures of the newest staff member ranging back nearly two weeks, even though information is that he only began in post four days prior to the site visit. Admittedly three days had been signed in advance for those having gone home for the weekend, showing his presence for a week. This was discussed with the manager, but no explanation could be found. The manager had counter signed the three days in advance to supervise the new staff member. The anomaly must be investigated and a change in practice instigated if necessary. All staff responsible for giving out medication must have accredited medication administration training. Evidence of this should be supplied to the Commission. There are usually no returned medicines to the pharmacist and therefore no return record is held. A record should be set up however, in the event drugs will be returned to the pharmacist. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 22 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. People that use the service experience adequate quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People have access to complaint and protection systems within the home, but these are out of date and the culture in the home is not always open and transparent, so people cannot always be are confident their concerns will be dealt with appropriately and that they will be protected from harm or neglect. EVIDENCE: Discussion with people and the management, viewing of some of the homes records and documents with permission and considering the information known to the Commission over the last twelve months reveal there is no reason to believe people are not able to make concerns known to the home manager and counsellor or to make representations to their councils. However, there is no evidence in the form of complaint and allegation records, or to show that people are consulted regularly on the running of the home or the quality of the service, and the culture in the home may not always be open and transparent. People spoken to are quite satisfied with the service of support they receive. They express confidence in the counsellor and the provider to listen to their concerns or allegations, and say there have been no major issues taken via these routes. The complaint procedure is out of date in respect of how and who people should contact, and it needs reviewing to include the new Commission contact details in Newcastle. More importantly it needs updating to show how to Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 23 contact each relevant placing local authority complaint department, as well as the East Riding of Yorkshire Council complaint body. The manager explains there are no recorded complaints in the record, as none have been received. The record was not provided for viewing. There has been one complaint and one provision of information received at the East Riding of Yorkshire Council Adults’ Services since the last key inspection though and both were brought to the attention of the Commission. The complaint was looked at during a visit from two council officers, but the manager has not been open or transparent about this. The information received has been checked out and discussed in respect of staffing levels during this inspection. Neither has been substantiated, but there is a need to review the staffing deployment and to look at providing a second counsellor, as mentioned in the section on ‘staffing’ in this report. The manager also explains there are no recorded allegations of abuse or referrals to the safeguarding adults team, as none of these have been received or made either. Again the record was not provided for viewing and again three allegations have been made since the last key inspection to the East Riding of Yorkshire Council Adults’ Services. These were also discussed during a visit from council officers and one was clarified after the Commission’s receipt of information from the provider in August 2007. This was second checked in discussion during this inspection in respect of recruitment of staff. Although none have been substantiated, the manager has not been open or transparent about them. The manager was asked about staff having completed safeguarding adults’ training and informs the Commission that only the counsellor has done this. She was informed to contact the Hull & East Riding Safeguarding Adults Board Manager, to discuss and set up some training for her and the staff group. This is an essential part of any care worker or manager’s training and development, and therefore a requirement to complete this is made in this report. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 24 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 and 30. People that use the service experience adequate quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People enjoy a satisfactory level of cleanliness and hygiene within the home, but not all of the fabric of the building is well maintained, so people are not always confident they have a good home to live/stay in. EVIDENCE: Discussion with people and viewing of a couple of the rooms and some records held in the home reveals the house is generally suited to its stated purpose of providing accommodation to people wanting to complete a programme of treatment to reduce and remove their dependency on alcohol. However there are some areas that would benefit from a clear and written programme of maintenance and redecoration. The house is situated in the centre of the town of Bridlington in the East Riding of Yorkshire, close to and in walking distance of central amenities, shops and facilities etc. It is a double-fronted property that has a ground, first and Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 25 second floor. All ten registered places are in rooms of single occupancy and are fitted with furnishings and fittings that meet the requirements of the standards. Rooms are personalised if people wish to make them so. They do not have locks fitted as standard, as the trust evoked in learning to live and rehabilitate together means other peoples’ possessions are respected. Privacy is also respected and though there is CCTV operating in the home it is isolated to the front door, reception and rear of the property only, for purposes of security. There is no garden to the home, but people are within walking distance of the harbour and beach area. There is no written programme of maintenance and renewal for the fabric and decoration of the building, even though it is acknowledged that repairs and renewal are carried out: new window frames with double glazing have been fitted in the last 18 months and some rooms have been redecorated in respect of paint and emulsion. Following a brief tour of the home it was observed that minor and major repairs needed to the property include refitting of a lock to the gentleman’s first floor bathroom and renewal of bathroom suites, replacement of bathroom floor and wall covering and redecoration of bathrooms, on the first floor. The manager should audit bathroom and toilet facilities throughout the home and refurbish as necessary. The laundry was observed to be satisfactory, with floor and walls being of suitable standard for cleaning and maintaining hygiene. Equipment appears to meet the requirements of the Water Supply (Water Fittings) Regulations 1999. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 26 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. People that use the service experience poor quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Staff are not sufficiently qualified and do not receive adequate training to do their job. Recruitment, and selection procedures are not robust so people may be at risk of harm or abuse and do not know they will be protected. EVIDENCE: Discussion with management and obtaining verbal information only on some issues, and viewing of some documents and staff files with permission reveals staffing levels may not be sufficient to meet peoples’ needs, that training and development is of a low priority and that recruitment practices are not of a good enough standard to meet the requirements. The staffing team consists of one counsellor and one newly recruited carer/programme worker. The registered provider and the unregistered manager also work hands-on, as part of the team, but the provider’s role is mainly advisory at times when the manager and other staff are not on duty. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 27 The counsellor has the Certificate in Therapy Counselling and a food hygiene certificate, and has several years experience working with people that have an alcohol dependence. She has worked on a project for four years doing some ‘transactional analysis’ work and has much insight into the life of an alcoholic. She is very keen to progress her learning and development and is very interested in the competence qualifications set by the Drug and Alcohol National Occupational Standards (DANOS). The manager is required to obtain and use the DANOS information and recommendations, to assess and verify the competences of staff employed in counselling roles. The newly recruited carer/programme worker has no experience working with people in this field and has no formal qualification or training experience either. The AQAA shows no one has achieved the recommended NVQ qualifications, with the exception of the manager. Standard 32 is not met. There is no written staff roster held in the home, but four staff is deemed sufficient for one person with high dependency and six people with low dependency living in the home according to the Residential Staffing Forum recommendations. The Forum recommends there should be 139.86 care/support hours provided each week. The information received from the manager suggests there are 172 waking support hours and 42 sleeping support hours per week. The information taken from the AQAA states there are 200 support hours provided per week. None of these hours include ‘personal care,’ as no one requires personal care of any sort. Standard 33 is met if the guidelines and figures represented meet the needs of the people rehabilitating in the home. However, the manager states there are times, specifically during the weekend, when only the provider is available on the premises. It is also implied he has vacated the building for short periods of time during weekends. The counsellor states she is the sole person at the moment counselling seven people and this would seem to be too much for one person to maintain. The manager must review the staffing deployment situation to ensure a more even balance of staff available to people throughout the whole week is achieved, and also to include some more qualified counselling support to ease the potential burden currently placed on one person. There is also a lack of good recruitment practice in respect of the newest staff member. No file exists yet and there has been no security checks completed, showing the requirements of regulations 18 and 19 and schedule 2 are not being adhered to. The staff member is a direct relative of the provider though and therefore he must vouch for his honesty and integrity in the meantime. The manager is advised to take urgent action to have the person properly security checked through the required channels, the Criminal Records Bureau. This was a requirement of the last inspection for newly recruited staff and remains a requirement of this inspection. All staff must be recruited in line Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 28 with the requirements of the regulations so that people in the home are protected from the risk of harm or abuse. Standard 34 is not met. Training and development of staff is an area that requires updating, as there is no evidence to show staff undertake any mandatory training in such as fire safety, first aid, medication administration, infection control, safeguarding adults or health and safety etc. and especially in the care of people with alcohol dependency. The manager is recommended to provide evidence of all training undertaken by her and staff in the twelve months prior to the date of the site visit. Standard 35 is not met. Standard 36 on staff supervision was also discussed in this section. The counsellor receives formal and recorded clinical supervision from an external source and pays for this herself. It is the responsibility of the provider to make sure all staff have appropriate supervision and therefore if this can only be sourced externally it is also his responsibility to pay. It is also recommended that a log of the supervision sessions showing date, length of time and briefly what was discussed, be held in the home. The person providing the supervision may hold the actual supervision minutes/records privately. There must be systems set up for all other staff to receive supervision and such sessions must meet the requirements of the standard and be recorded. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 29 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, 39, 42 and 43. People that use the service experience adequate quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People benefit from having a manager in the home that maintains consistency of the service as it is, but the manager is not registered, so people are not confident she is running the home as well as it should be run. People enjoy some protection from harm under the home’s health and safety measures in place and the practices carried out to maintain their health, safety and welfare, and that of the staff, but these measures are not entirely satisfactory. EVIDENCE: Discussion with management and sample viewing of some records and safety and maintenance documentation and certificates reveals the conduct and management of the home requires some attention and improvement. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 30 There is no registered manager in post, quality assuring of the service cannot be judged as it was not assessed, and the health safety and welfare of people and staff is satisfactory. The effective financial viability of the service still needs to be evidenced. The manager is not yet registered with the Commission, but has made attempts to become so in the last eighteen months. Due to personal circumstances she has been unable to submit her application to register. This is now seen as requiring urgent attention and must be submitted as a matter of priority. She is advised to seek information from the Commission’s regional registration team via the Newcastle contact number, to determine what must be done and when to make the application. A separate letter will be sent to the provider requesting an application be made to register the manager. The manager has achieved the National Diploma in Social Care, NVQ level 4 in Management, the NVQ level 4 Registered Manager’s Award, and a food hygiene certificate. She now has four years experience working with people that have alcohol dependency, and is considered suitable for the position. She must become registered. The quality assurance system was not assessed at this site visit and therefore cannot be judged. It is therefore recorded as not assessed on this inspection report. Standard 42 was assessed by sampling some of the areas listed there, and it was found that some issues require attention to ensure the health, safety and welfare of people and staff are promoted and protected. There are thermostatic temperature controls on hot water outlets; showers and baths and these are regularly checked, but temperatures are not recorded in a log. There has been a legionella water test completed on the hot water storage system, but it is more than three years old now, and therefore needs re-doing. Fire safety systems are in place and a company called CBA Domestics last maintained them on 21/04/08. This included completing a portable appliance test on 23/04/08 and the same company also did a service on the gas boiler and fire on 27/02/08. There is a fire risk assessment document in place and records are kept of the weekly fire equipment and monthly fire drill tests completed in the home. It is recommended that names of staff and people in the home present at any fire training drill be recorded on the record. Cleaning products are carefully stored, but people rehabilitating in the home do have some access to these for completing domestic chores etc. They are used in accordance with the recommended dilution instructions stated on labels and control of substances hazardous to health legislation is followed. Where people Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 31 in the home do use such products during their rehabilitation risk assessments need to be in place. Standard 43 was briefly discussed and the provider states the business is financially viable, so the Commission should like to recommend evidence be sent to us that the home is subject to financial accounting systems and is viable. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 32 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000019743.V363886.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X X X X 2 3 Version 5.2 Page 33 Haven Residential Rehabilitation Alcohol Dependency Unit The Are there any outstanding requirements from the last inspection? Yes. The first 2 requirements are outstanding. 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 4, 5 and 6 Requirement The registered provider must make sure the Service User Guide and Statement of Purpose accurately reflect the service provided, the staffing and management arrangements, as well as the contact details of the CSCI and placing L/As, so people know they have accurate information and can make representations to the right organisation. Copy of amended documents to be sent to the CSCI by date for action. Previous requirement timescales of 01/11/06 and 01/09/07 not met. The registered provider must make sure that only in exceptional circumstances where a member of staff is employed prior to obtaining a CRB check, a POVA First is obtained and appropriate supervision arrangements put in place so that people know they are being protected. This was a requirement at the last inspection and the previous DS0000019743.V363886.R01.S.doc Timescale for action 30/06/08 2 YA34 19 31/05/08 Haven Residential Rehabilitation Alcohol Dependency Unit The Version 5.2 Page 34 timescale of 01/06/07 was not met. A new staff member has been recruited, again without any of the required checks being in place first. 3 YA2 14 The registered provider must make sure people are fully assessed according to the list at standard 2.3, so they are confident their individual needs are met. The registered provider must make sure medicines received into the home are stored safely in a wall mounted cabinet and in line with the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs Act 1971, so people know their medicines are being safely handled. The registered provider must make sure all staff administering medication have accredited medication administration training so people know their medicines are being safely administered. Evidence of this should be sent to the CSCI. 31/05/08 4 YA20 13(2) 31/07/08 5 YA20 13(2) 30/06/08 6 YA22 22 The registered provider must 30/06/08 make sure the complaint procedure is amended to include details of how to contact the East Riding of Yorkshire Council and placing L/As, so people know how to make concerns known to the right organisations/bodies. The registered provider must make sure all complaints are recorded in a dedicated complaint register/log, which shows what, when and how DS0000019743.V363886.R01.S.doc 7 YA22 22 30/06/08 Haven Residential Rehabilitation Alcohol Dependency Unit The Version 5.2 Page 35 complaints are dealt with and whether or not people are satisfied with the outcomes. He must encourage the manager and staff to exercise an open and transparent approach to dealing with issues raised, so that people know their concerns are taken seriously and are dealt with effectively and efficiently. 8 YA23 23 The registered provider must make sure all staff receive regular and updated safeguarding adults training, with an external organisation where possible, so people know they are protected from risk of abuse or harm. He must also maintain a safeguarding register/log and keep any issues raised or discussed in a more confidential format. The registered provider must make sure counselling staff are qualified to do the job and are competence checked according to the DANOS recommendations. 50 of staff should also have the required NVQ qualifications. This is so people are confident that qualified and trained staff are supporting them. The registered provider must make sure staff are recruited according to the requirements of regulation 19 and schedule 2, in respect of their identification and references etc., so people know that safe staff are supporting them in the home. The registered provider must make sure all staff working in the home, including the manager, receive training that equips them with the skills to do DS0000019743.V363886.R01.S.doc 31/07/08 9 YA32 32 30/09/08 10 YA34 19 30/06/08 11 YA35 YA37 18 and 9 30/09/08 Haven Residential Rehabilitation Alcohol Dependency Unit The Version 5.2 Page 36 the job they are employed for, so people know competent staff are supporting them in the home. All mandatory courses should be completed on an annual basis. 12 YA36 18 The registered provider must make sure all staff are appropriately supervised, that records of supervision are maintained and that where counsellors access external clinical supervision this is paid for them, so people know the staff that support them in the home are themselves well supported. 30/06/08 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 registered provider should make sure people’s care plans contain information on areas assessed as are listed in standard 2.3, even if only to state what is and what is not applicable to them, so they know their assessed needs are being met. The registered provider should encourage people to complete a basic food hygiene certificate if they are to prepare food in the home for other people staying there. He should also make sure staff update their food hygiene certificate on a three yearly basis. Both of these are recommended so people are confident their food is being prepared safely and hygienically and they are protected from risk of exposure to bacteria and food poisoning. The registered provider should make sure there is an understandable and recorded stock control system on all medicines received into the home and that any returned to DS0000019743.V363886.R01.S.doc Version 5.2 Page 37 2 YA17 3 YA20 Haven Residential Rehabilitation Alcohol Dependency Unit The the pharmacy is properly recorded in a log, so people know their medicines are being safely handled. 4 YA20 The registered provider should make sure there is appropriate cold storage for those medicines requiring cooler temperatures, so people know their medicines are being safely stored. The registered provider should make sure all parts of the home are maintained and kept reasonably decorated. The first floor gentleman’s single toilet requires the lock repairing. The first floor bathrooms require new bathroom suites, new floor covering and redecorating. An audit of all bathrooms should be carried out and any identified work completed. A written record of identified and completed maintenance should be kept. The registered provider should make sure the current level of staffing is kept under review to ensure that it is adequate to meet peoples’ needs at all times. It may be a matter of deploying staff more effectively throughout the week. A written roster would assist in determining the levels of staff needed and show accountability in covering shifts. The registered provider should consider employing a second counsellor to share the responsibility to support people through their rehabilitation programme and to conduct some of the one-to-one sessions and group meetings. The registered provider should make sure the names of staff and people involved in fire safety drills are recorded on the fire drill record. The registered provider should make sure that any checks made on the temperature of hot water at outlets is recorded on a log. The registered provider should make sure a legionella water test is carried out on the hot water storage every three years. The registered provider should make sure there is a risk assessment document completed for anyone (people staying in the home) using cleaning products when learning or re-learning living skills as part of their rehabilitation programme. DS0000019743.V363886.R01.S.doc Version 5.2 Page 38 5 YA24 6 YA33 7 YA33 8 YA42 9 YA42 10 YA42 11 YA42 Haven Residential Rehabilitation Alcohol Dependency Unit The 12 YA43 The registered provider should supply the CSCI with documentary evidence that effective financial accountability of the viability of the home is carried out. Haven Residential Rehabilitation Alcohol Dependency Unit The DS0000019743.V363886.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V363886.R01.S.doc Version 5.2 Page 40 - 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. 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