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Inspection on 30/04/09 for Haven Residential Rehabilitation Alcohol Dependency Unit The

Also see our care home review for Haven Residential Rehabilitation Alcohol Dependency Unit The for more information

This inspection was carried out on 30th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People always visit the service before they are admitted for rehabilitation. This gives them the chance to meet other people, and to see whether it will be a suitable place for them. It also gives staff the opportunity to see whether they have the right resources to meet the person`s apparent needs. People are told before they arrive about any house rules they will need to stick to in order to continue with their programme. This means the rules are no surprise to them. They understood these are for their own benefit, and why they are enforced. People get a programme of counselling which they say helps them work through the `Twelve Steps` towards sobriety. They have every confidence in the counsellor who supports them through this process. People are confident that their complaints would be listened to and acted upon, by staff who are approachable. National Vocational Qualifications in Care have been completed by two staff. This training gives them information about current good practice in care, that they can use in their daily work.

What has improved since the last inspection?

The service user`s guide has been updated so that it gives more accurate information about what the service provides. A new medicine cabinet has been purchased so that people`s medication can be stored more securely than before. One bathroom has been refurbished, to make it more pleasant for those who use it. The water system has been checked to make sure that it is being stored at the right temperature, and to make sure it does not put people at risk from infection.

What the care home could do better:

The assessment people get before they are admitted could cover areas of need other than their alcohol dependency. This assessment could include obtaining the current care plan from their funding authority. People could be involved in the development of their subsequent in house assessment, rather than using pre printed documents. By doing so, they could be more individual to the person, and help to develop their care plan in a more person centred way. Risks to each individual could be clearly identified, and a care plan developed, and agreed with the person, to identify how each risk will be managed. People could have a nutritional assessment completed when they arrive, to check what dietary risks they may be subject to, so measures can be put into place to reduce these. Plans about people`s care could be written with the person, and in such a way that identifies their needs and goals, so that these can be worked towards during the courseof their stay. Clear details about people`s health care needs, and how they are to be met, could be recorded in their care plan, including information about support and advice provided by other professionals in order to meet their changing health care needs. A daily record could be kept to help show people`s changing needs and behaviours as they follow their rehabilitation programme, and how staff have supported them during this time. This would make such information more easily accessible, and easier to relate to when their care is reviewed. People`s medication could be managed in a safer way, and, to help staff to do this, they could all receive up to date training on the subject. This would make sure that people using the service are protected by the safe recording, handling, safekeeping, safe administration and disposal of medicines. A record could be kept of the menu provided for people, so sufficient detail is recorded of what meals people have been provided with over time. This would make is easier to confirm that their diet is nutritious, balanced, and that it meets people`s dietary requirements. The means for recording complaints could be reviewed so that the action taken is easy to see, and allows staff to identify any common trends. And all staff could receive training in safeguarding, linked to the role of the local authority. This will make sure that each staff member knows what to do, and who to report to, should they witness, or be told about, abuse that may happen within the service. All areas of the premises could be kept clean, so people can live in a pleasant environment where the risk to cross infection is kept to a minimum. The service could be staffed at all times. This is so that there is always someone to support people to meet their needs, and to be available to manage emergency situations. For all staff working at the home who do not have one, an application could be made for an enhanced Criminal Records Bureau check, so that their details can be checked against the POVAFirst List. This would confirm whether the staff members are suitable to work with vulnerable people, or whether they have been barred from providing care. References for the most recent employee could be requested in retrospect. In the absence of these, the registered provider could make a written statement vouching for the person`s suitability for the post, and their integrity. Staff could receive induction training to Drug and Alcohol National Occupational standards, so that they have a common understanding from the offset about the needs of people who have an alcohol dependency. There could be an organised programme of training in place so that staff do not fall behind with compulsory training, and so that they each receive training opportunities linked to the aims of the service and the needs of those who use it. Supervision records could be kept on staff files so that they can be referred to when focusing on future supervision and training needs to meet thepurpose of the service, and the needs of the people receiving rehabilitation there. A risk assessment could be completed to check what level of first aid is needed at the service over a twenty four hour period. In the absence of such an assessment, a first aid qualified person must be available at all times. By doing so, people will get the right support in an emergency requiring first aid attention. The most recent report from the Fire Officer and Environmental Health Officer could be submitted to the commission so we can be assured that each organisation is satisfied that any requirements made by them are met, or are being addressed, in order to keep the environment safe and well managed. Copies of the fire alarm certificate, fixed wiring certificate and the gas certificate could be sent to the commission so we can be assured that each of the certificates are up to date, to confirm that these systems have been approved as working safely. A risk assessment, based on the needs of each individual, could be completed to check

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Haven Residential Rehabilitation Alcohol Dependency Unit The The Haven 5-7 Marshall Avenue Bridlington East Yorkshire YO15 2DT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 42 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: Haven Residential Rehabilitation Alcohol Dependency Unit The 5-7 Marshall Avenue The Haven Bridlington East Yorkshire YO15 2DT 01262400329 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : havenalcoholinfo@yahoo.co.uk Mr Cyril Herbert Dennis Marsburg care home 10 Number of places (if applicable): Under 65 Over 65 0 past or present alcohol dependence Additional conditions: Date of last inspection Brief description of the care home 10 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. The staff team currently consists of the registered provider, the manager (not registered with the commission), a qualified counsellor and one care worker. 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. Permit car parking is available outside. Otherwise there is a car park near by. 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 Care Homes for Adults (18-65 years) Page 4 of 42 Brief description of the care home detoxification is not provided. People are given a copy of the service users guide when they contact the serivice. The inspection report is also available for anyone who wishes to see it. The manager said on the day of the site visit that the current weekly fees are 450 pounds. People pay extra for their personal toiletries. Care Homes for Adults (18-65 years) Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for the service took place on 2 May 2008. This key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Adults (18-65 years) Page 6 of 42 Comment cards from five people using the service. A site visit to the service carried out by two inspectors, and which lasted for six and a half hours. During the visit to the service, the majority of the people using it, the manager and the registered provider were spoken with. Two care plans were looked at in detail, as well as two staff recruitment files, some policies and procedures, and some records about health and safety. The manager was available throughout the day. Feedback was provided to her over the course of the day, although there were some things that we needed the manager to get on with quickly as a result of our visit, so we left earlier than planned, and spoke to her again the following week. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only where it is considered that people are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The assessment people get before they are admitted could cover areas of need other than their alcohol dependency. This assessment could include obtaining the current care plan from their funding authority. People could be involved in the development of their subsequent in house assessment, rather than using pre printed documents. By doing so, they could be more individual to the person, and help to develop their care plan in a more person centred way. Risks to each individual could be clearly identified, and a care plan developed, and agreed with the person, to identify how each risk will be managed. People could have a nutritional assessment completed when they arrive, to check what dietary risks they may be subject to, so measures can be put into place to reduce these. Plans about peoples care could be written with the person, and in such a way that identifies their needs and goals, so that these can be worked towards during the course Care Homes for Adults (18-65 years) Page 8 of 42 of their stay. Clear details about peoples health care needs, and how they are to be met, could be recorded in their care plan, including information about support and advice provided by other professionals in order to meet their changing health care needs. A daily record could be kept to help show peoples changing needs and behaviours as they follow their rehabilitation programme, and how staff have supported them during this time. This would make such information more easily accessible, and easier to relate to when their care is reviewed. Peoples medication could be managed in a safer way, and, to help staff to do this, they could all receive up to date training on the subject. This would make sure that people using the service are protected by the safe recording, handling, safekeeping, safe administration and disposal of medicines. A record could be kept of the menu provided for people, so sufficient detail is recorded of what meals people have been provided with over time. This would make is easier to confirm that their diet is nutritious, balanced, and that it meets peoples dietary requirements. The means for recording complaints could be reviewed so that the action taken is easy to see, and allows staff to identify any common trends. And all staff could receive training in safeguarding, linked to the role of the local authority. This will make sure that each staff member knows what to do, and who to report to, should they witness, or be told about, abuse that may happen within the service. All areas of the premises could be kept clean, so people can live in a pleasant environment where the risk to cross infection is kept to a minimum. The service could be staffed at all times. This is so that there is always someone to support people to meet their needs, and to be available to manage emergency situations. For all staff working at the home who do not have one, an application could be made for an enhanced Criminal Records Bureau check, so that their details can be checked against the POVAFirst List. This would confirm whether the staff members are suitable to work with vulnerable people, or whether they have been barred from providing care. References for the most recent employee could be requested in retrospect. In the absence of these, the registered provider could make a written statement vouching for the persons suitability for the post, and their integrity. Staff could receive induction training to Drug and Alcohol National Occupational standards, so that they have a common understanding from the offset about the needs of people who have an alcohol dependency. There could be an organised programme of training in place so that staff do not fall behind with compulsory training, and so that they each receive training opportunities linked to the aims of the service and the needs of those who use it. Supervision records could be kept on staff files so that they can be referred to when focusing on future supervision and training needs to meet the Care Homes for Adults (18-65 years) Page 9 of 42 purpose of the service, and the needs of the people receiving rehabilitation there. A risk assessment could be completed to check what level of first aid is needed at the service over a twenty four hour period. In the absence of such an assessment, a first aid qualified person must be available at all times. By doing so, people will get the right support in an emergency requiring first aid attention. The most recent report from the Fire Officer and Environmental Health Officer could be submitted to the commission so we can be assured that each organisation is satisfied that any requirements made by them are met, or are being addressed, in order to keep the environment safe and well managed. Copies of the fire alarm certificate, fixed wiring certificate and the gas certificate could be sent to the commission so we can be assured that each of the certificates are up to date, to confirm that these systems have been approved as working safely. A risk assessment, based on the needs of each individual, could be completed to check that it is safe for hazardous chemicals not to be locked away. In the absence of such an assessment, safe lockable storage facilities must be provided. The recording of weekly checks of the fire alarm and hot water supply could be kept up to date as evidence that these checks have been completed, and also to help identify problems quickly where patterns in faults may emerge. The manager should submit their application to become registered with the commission by 30 June 2009. She could seek some current training specific to the needs of people with alcohol problems, so she is able to cascade down current good practice to other staff members, and further structure peoples support plans on what she has learnt. Ways of auditing the different areas of the service, such as care planning, medication, environment, could be developed, so any shortfalls can be addressed quickly, or otherwise put right before they arise. And more could be done with the collective information collected from peoples surveys, to identify where they think improvements to the service could be made. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 42 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs about their alcohol addiction are understood before they arrive. But other aspects of their care and rehabilitation may be overlooked during their assessment. Evidence: Before people arrive, they are given information about what the service does. Those people surveyed agreed that they were given enough information, and that they were asked if they wanted to stay at the service. One person said I was given a brochure/booklet with information which helped me to decide. Everyone visits the service before a decision is made about whether they will be admitted for rehabilitation there. This visit includes a discussion with the manager. People also meet others who have already commenced their rehabilitation. This gives the person the opportunity to experience what the community feels like, and what it might be like to stay there. Care Homes for Adults (18-65 years) Page 12 of 42 Evidence: When someone visits, the manager gathers as much information as she can to help understand what support the person will need. This information is based mainly around the persons alcohol addiction, and how it is affecting their life. The paperwork she uses does not lead her to discuss, in any depth, other information, such as facts about peoples physical and emotional needs, and aspects of their life which may affect their future stay. This was discussed with the manager at the last key inspection as an area needing improvement. However, the manager has not made the changes she told us she would make, in her improvement plan following the last inspection. One person said that they would not feel well enough at this early stage to discuss these factors in any detail. They said their main priority was just to get help. Because of this, it is very important that the manager obtains the care plan completed by the persons care manager before the admission is agreed. The manager agreed that this did not always happen. The care manager may have had more opportunity to find out more about the persons individual needs. This could include important information about secondary mental health needs, which may need specialist support whilst the person uses the service. This is of particular relevance where the person lives too far away to access their normal support services. People often have a period of detoxification before they are admitted. This means that when they are finally admitted, they will have abstained from drinking alcohol for a period of time. Therefore, it is at this point that a more detailed assessment takes place. Again, the information gathered tends to centre around the persons alcohol problem, rather than any other needs they may have. And this information is not used in any depth to develop the persons subsequent care plan. Instead, a pre printed care plan and risk assessment is used, which is the same for everyone. This means that the care plan does not focus on the specific needs of and risks to the person concerned, nor can it be developed with their involvement. There was no assessment completed to check whether people were at risk from malnutrition. It would be good practice to do this assessment, as people will often have neglected their diet for some time, and it is likely that they may need extra support to regain nutritional health. The manager has updated the service users guide so that the written information people receive is more accurate. People told us they are also made fully aware of any house rules, and restrictions to their liberty, that have been established to help restructure their lives. People accepted these rules, and saw them as the only way to regain some normality in their routine during their recovery. One person said Rules help you when you are back out. Another said that the service runs on trust, and that people get the tools in here to learn to trust people again. People sign to say that Care Homes for Adults (18-65 years) Page 13 of 42 Evidence: they agree with these rules, and understood that they were there for the right reasons. Following admission, people begin to work through the Twelve Steps towards sobriety, guided by weekly one to one counselling sessions and daily group activities, where people said they support each other during their recovery. Care Homes for Adults (18-65 years) Page 14 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples overall needs may be understood, but they are neither reflected nor reported on in any detail in their plan of care. Evidence: People have an assessment completed when they arrive. After this, a pre printed care plan and risk assessment is completed. Each of the care plans seen were identical, therefore they did not reflect the needs and aspirations of the individual concerned. For instance, whilst their assessment may include that a person suffers from long term depression, or may be particularly vulnerable, there was no plan in place to see how they could be supported. The plans were not developed from the care management assessment, or from any assessment completed by the service, and they were not written with, or signed by, the person to whom they belonged. Neither the care plan nor the risk assessment had been changed over the course of the persons stay. Due to the nature of the Care Homes for Adults (18-65 years) Page 15 of 42 Evidence: admission, peoples needs and progress will be changing all the time. However, this was not reflected. The risk assessment for when people leave the building was also pre printed. In one, the manager had forgotten to change the name of the person, so it looked as if it referred to another person. This is not good, nor does it provide any reassurance that risks to individuals, and their welfare, have been taken seriously. Restrictions to individuals freedom were not clear. It appeared, from the care plan information, that the service operates a one size fits all approach, and there were no daily records kept to show how one day was different from the next for each individual concerned. The manager told us that such records were not kept, and only events such as doctors visits were recorded in a diary. Recording private information about different people in the same place does not protect their right to confidentiality, and should cease. Despite the above shortfalls, people were very satisfied with the service that they get at The Haven. Without exception, they said that they were supported by the counsellor throughout their programme. People all agreed that this support was exceptional, that the counsellor had a gift, and that without this person their programme towards achieving sobriety would not be so successful. They said their counsellor is honest and open, which allows them to face their addiction, and progress through the twelve steps successfully. This included making informal decisions about risk taking, and reestablishing themselves in the local community. The average length of stay is between three and six months. Peoples home is often some distance from the service. On these occasions, the review with their care manager will take place over the telephone. Unfortunately this arrangement makes it more difficult for the person receiving the service to be involved in the review. However, a record of regular reviews were seen for one person, which had included their care manager. The records were detailed, and showed that the persons ongoing progress was being carefully monitored. As well as in house support, people attend a local Alcoholics Anonymous group. This is a compulsory part of their rehabilitation programme. The home has no involvement in peoples personal finances. Care Homes for Adults (18-65 years) Page 16 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The opportunities offered to people are appropriate to the rehabilitation programme they sign up to. Evidence: It is not always appropriate for people to look for employment when they first use the service. However, there are a range of social and educational opportunities which have been set up for people. And future life plans are discussed later in a persons stay. For instance, one person had organised to do voluntary work once they leave. They were looking forward to becoming part of the community again, which they have not felt able to join for some time prior to admission to The Haven. The service has developed close links with the local college. There are specific training groups which people have attended which help them back into society, such as a Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: stress buster course. People also attend social activities as a group. On the suggestion of someone who has used the service, there is now a small room with gym equipment to help people keep fit. People also enjoy walking along the sea front. One person said that they were so happy and content here. There is also a daily routine, and a busy programme which people must attend. People saw this as part of their preparation to return home. It includes twice daily meetings and weekly one to one counselling. People also have to complete written work as part of their twelve steps programme. They discuss this with the counsellor, who guides them through each of the steps. People accept that they will not always be able to make decisions about what they do each day. One reflected that often, when they are attending meetings, they wish they could be on the beach. But accepted that in order to achieve sobriety their programme must take priority. There is no cleaner at the home. So it is also part of the programme that those who live there are responsible for keeping all communal areas of the premises clean and tidy, as well as looking after their own laundry, cleaning their own room, and helping with kitchen tasks. Once people have completed the early stages of their programme, they have more freedom to go out alone. This helps them to face normality, and the temptations that they will face once they are discharged. They agreed that discussing these temptations with their counsellor helped them get the support they needed. As their programme progresses, people can go home for the weekend. One person commented that whilst this is nice, they are always ready to come back to the security and structure of the unit, to be amongst people who have a common understanding of what they are facing during their recovery. Peoples families do not often visit. The manager said that they often do not wish to. However, so long as the visits are agreed, and are in line with the recovery programme, people can have their family to visit. Family therapy can also be provided. But again, this is rarely wanted by the individual, or their family. Neither is there any evidence that this is offered or advertised during the pre admission assessment. People are told before they arrive that intimate relationships between those receiving rehabilitation are not allowed. This would be seen as a distraction from the strict programme that people follow, and on which they need to focus all their concentration. The dining room has single tables which a maximum of two people share. This helps people, who may have not eaten properly for some time, to concentrate on their meal. Although, people can share if they choose. Care Homes for Adults (18-65 years) Page 18 of 42 Evidence: The owner of the home or one of the staff cooks the main meal, which is served at lunch time. People using the service prepare the tea time meal. People can ask for a sandwich at suppertime if they wish. They can make their own, but the registered provider said that they must ask first. People can also make drinks whenever they wish. The kitchen is generally locked after 9pm, but this arrangement is kept flexible, depending upon which group of clients is currently using the service. There is no advertised menu, no advertised choice, and there is no record kept of what people have eaten. This makes it difficult to see, over time, whether there has been enough choice provided to ensure that the meal is varied and sufficiently nutritious. From discussion with the registered provider it appeared that the menu is repeated weekly. This could be repetitious for some people. Although people spoken with said that the meals were nice, and that there was plenty of fresh fruit and vegetables available. The registered provider said that these were purchased on a daily basis. The registered provider was asked about peoples specific nutritional needs, as these are not assessed or recorded by the service. He said that people were happy, and would say if they were not. We were told that the menu is discussed at the weekly meetings. And one person said that they had got the menu changed after they gave their views at on such meeting. However, better measures could be put into place to evidence that people are getting the nourishment they need whilst staying at Haven. Care Homes for Adults (18-65 years) Page 19 of 42 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health needs may be met, but are not appropriately recorded. The way that medication is handled on their behalf puts people at unnecessary risk. Evidence: People admitted to the service are usually self caring, capable of independence, and rarely need support with their personal care. They said they do however sometimes need encouragement to be motivated to look after themselves better, and added that without a doubt their privacy and dignity is respected by staff. One said they had received the right support, when they moved to The Haven, to get them back on their feet. The routines of the home and the support of others staying there help people to re-establish daily routines. People said this was an essential part of their programme. However, personal care needs are not formally assessed before or after people are admitted. Therefore it may rely on the person telling staff that they need help at the time, rather than this need being already identified from the persons assessment, and planned for. Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: Everyone who stays at The Haven has to register with the local General Practitioner (GP). People are accompanied on all visits to health professionals by a member of staff from the service. The manager told us in the written information she provided before we visited, that the initial assessment by the GP also includes an appointment with the practice nurse who does a health check. The manager has decided that the home will no longer offer a detoxification service, which would involve close involvement from the GP during this process. Instead, it is the expectation that this part of peoples treatment will be completed before they arrive, in a setting more readily equipped to deal with medical situations. The claim that this service is offered should therefore be removed from the service user guide. The care plans do not give any personal details about when people have visited the GP, what advice they have given, and how this should be incorporated into their programme or plan of care. This is important information about the persons healthcare needs during their stay, which should be written down. Nobody self medicates. Staff medication practice at the service was poor and was found to be unsafe. The manager was informed in writing at the time of the site visit that this must improve immediately. A follow up letter has also been sent to the registered provider outlining the areas of concern which needed to be addressed, and which included the following: The manager prepares peoples medication in dosette strips. These strips have individual compartments for the tablets to be taken from at breakfast, dinner, tea and supper. Some of the labels on these strips had worn off. The dosette boxes are prepared a week ahead, ready for another staff member to administer at a later date. This is called secondary dispensing. It is not safe practice, and increases the risk from error. In fact, one person had taken their tea time tablets on the morning, because they had been taken from the wrong end of the dosette strip. This is of serious concern. The manager signs for all the tablets that she prepares, even though she has not given them to people. This is not good practice. The person who gives out the medication should sign at the point they are administered. This means that the record is a true account of what people have taken, what they have refused, and when. A medication prescribed three times a day had automatically been signed for four times a day, and in advance, by the manager. This means that the record is not correct. Nor does it give the GP any indication on review about how often the medication is being taken, and how well it is working for the person concerned. Care Homes for Adults (18-65 years) Page 21 of 42 Evidence: The manager writes out the Medication Administration Records by hand. She had not followed the instructions given by the doctor for one person, so one of their medications was written up wrongly. All hand written entries should be countersigned and dated after a suitably trained person has double checked that what has been written actually tallies with what has been prescribed. Because of the seriousness of the medication errors, the manager was asked to contact the community pharmacist for advice whilst we were present. This advice has been provided. The pharmacy team have since visited the service to give advice on current good practice, which the manager states she is now implementing. Only the manager has completed training in the safe administration of medications, and this training took place seven years ago. She, along with all of the other staff at the home who have any responsibilities for the administration of medication, including the counsellor and the registered provider, must complete training if they are to continue with these duties. This was a requirement at the key inspection last year, and has not been met, despite the improvement plan completed by the manager telling us otherwise. Providing this training would make sure that staff have the skills and competence to manage peoples medication safely. However, since the last key inspection, better, safer storage facilities have been provided in which peoples medication is stored. The exception to this is storage facilities for the safe storage of medicines which need to be kept cold. These are being stored in the domestic fridge in a lockable box because, we are informed, a dedicated fridge would rarely be needed. We asked the manager to invite the community pharmacist to visit the service to check the systems in place. They have visited, carried out an inspection, and have made recommendations which they will be following up. A pharmacy inspector from the commission has also visited the service following this site visit. He has confirmed that the home has acted quickly to address the shortfalls identified, which are being addressed. The home will receive a seperate report outlining the findings of his visit. Care Homes for Adults (18-65 years) Page 22 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain, but in the absence of training, staff may not know what to do, and who to tell, should they suspect, or be told, that abuse has happened. Evidence: People were very clear that, should they have any concerns or complaints, the manager or the counsellor would listen to these and act upon them. One said they only had to knock on the managers door and she was there to give help and advice. Those who returned their surveys all agreed they knew how to complain, and who to speak to if necessary. One person commented The staff are very helpful and approachable. People get a copy of the service users guide before they are admitted. This guide gives information about how people can complain, who to, and how long they can expect to wait before they will get a response following any investigation. The procedure is also displayed in a public area of the service. Since the last site visit, the manager has devised a way of logging any complaints. This is good practice, but there wasnt enough space for her to be able to report about what the complaint was about, what she had done in order to investigate the complaint, what the outcome of the complaint was, and whether or not the complainant was satisfied. This needs to be changed so that she has a clear record of what she has done about any matters brought to her attention. Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: There have been no complaints made to the commission during the period since the last key inspection in May 2008. And there were no complaints written in the complaints log kept at the service. There is a clear abuse policy at the home, which follows the guidelines set by the local authority, who lead in all safeguarding investigations. The manager said in her Annual Quality Assurance Assessment that all staff at the home have completed training in safeguarding. We could evidence that this was the case for one member of staff, who completed this training in November 2008, but not for the remaining three staff. This training must be organised so that all staff are very clear about what action they must take in the event of an allegation being made to them, or should they believe that someone using the service is being abused. Care Homes for Adults (18-65 years) Page 24 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further planned refurbishment plans should improve the fabric of the environment for people. However, the level of cleanliness of the premises needs further attention. Evidence: The service is situated in the centre of Bridlington, close to the sea and the many leisure amenities that a seaside town provides. People said that the amenities were very challenging to their condition, and a temptation that they had learnt to cope with, and which had made them stronger in their recovery. The service itself is provided over three floors. One part of the premises is the private accommodation of the registered provider, who lives on site. On the ground floor there is a sitting area where group meetings take place. There is also office accommodation, a dining room and kitchen and laundry. There is a separate smoking lounge, behind which there is a quiet room and a fitness area. The communal areas are provided with comfortable seating for people, and there is sufficient space for them to meet as a group, or privately with their counsellor. Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: Two peoples rooms were looked at. They contained some of their own belongings, call bell access, a sink and lockable facilities in which to store their valuables. These rooms appeared reasonably decorated and relatively clean, although the lighting over the sink in one room did not work. The manager said that she would get this replaced. One person said that they had found their room to be very nice over the course of their stay. We were told that there is a plan of redecoration in place, but that this plan is not written down. One of the communal bathrooms has been refurbished since the last key inspection. There are plans to complete the refurbishment of a second bathroom. This will greatly improve the bathing facilities for people. One of the communal toilet locks was not working. This must be repaired so that peoples privacy can be assured when using these facilities. The communal bathrooms had not been properly cleaned. The vinyl floor covering was not clean behind the toilet areas. There were dirty sponges and cleaning cloths left in these areas, along with a mop and bucket. None of the toilets had a supply of soap, or any form of towel so people could not dry their hands. The manager said that these were not provided because in the past they have been stolen. She said that people have to take their own soap and towel into the bathroom area. This is not acceptable, because it does not help to reinforce good infection control, nor does it respect peoples dignity. Whilst it is accepted that it is part of peoples programme to clean the premises, it must also be recognised that the home is only half full, which puts a lot of responsibility on these people to keep the premises reasonably clean, whilst also having a busy rehabilitation schedule to follow. The manager was told that these areas need a deep clean, and that this should be done regularly, so that the cleanliness of the home is kept at an acceptable standard. The laundry is sited at the rear of the building, separate to the area where food is prepared. The facilities are satisfactory, although, again, the floor could have been cleaner. We were not able to see either the latest report from the fire officer, or from the Environmental Health Officer. The manager could not find these, but we have asked that a copy be sent to the commission. This will help us to check that their requirements and recommendations have been followed. Care Homes for Adults (18-65 years) Page 26 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure is not sufficiently robust to offer people protection from potentially unsuitable workers. Evidence: Four staff work at the service. This comprises of the manager, a counsellor, the registered provider and his relative. The manager and counsellor work Monday to Friday. The registered provider and his relative cover the weekend, and share evening and sleeping in cover. Out of normal office hours, and at a weekend, there is one member of staff available. There are no waking night staff. Staff and people using the service prepare the meals. There are no cleaners. The people using the service complete the cleaning tasks. There is now a duty rota available, which is meant to show who is working and when. This was not dated, nor was it correct, as it suggested that there was no-one on duty at all during the day at the weekend. We have been informed that this is not the case, and that the rota has now been amended. It was implied at the last key inspection that sometimes the home is left without any staff at all at a weekend when the lone staff member may go out to the shops. The Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: registered manager confirmed at this site visit that this still does occasionally happen, despite the service users guide giving reassurance that the service provides 24 hour cover. She was told that it is not acceptable that the service should be left without staff in attendance. She has since given assurance that this no longer happens. This will help to make sure that people using the service have the right supervision and support at all times, and that there is always a member of staff available to deal with emergencies, such as a fire. We were told by the manager that she is a qualified counsellor, but that the responsibility for peoples counselling lies with the second qualified counsellor. People said that the counsellor is extremely approachable, communicates well with them, and supports them whenever needed. They also said that the managers door is always open if they need to speak to her, and that they have had no problems with the remaining staff, who are also there if needed. Of the five people who returned their surveys, two said the staff always treat them well, and listen and act on what they say. The remainder said this was usually the case. People said that there were enough staff available to meet their needs. They said they rely not only on the staff, but also on each other for the psychological support they need. And there are always other people about to go to for this support, they said. One continued We are all mini counsellors. It was noted at the last key inspection that the recruitment process was poor, and requirements were made accordingly. There have been no further new recruits since then. Therefore the manager has not had the opportunity to show that the recruitment systems have improved based on these requirements. However, more could have been done to confirm, in retrospect, that staff who have already been recruited, are suitable workers. For instance: It was noted at the last key inspection that the most recent employee had no recruitment checks in place at all. Whilst a standard Criminal Records Bureau check has now been completed, this, as well as the standard check completed for the second employee, is not sufficient. An enhanced check needs to be done so that a check against the Protection of Vulnerable Adults List can be made, to confirm that the staff concerned are not barred from providing care. This must be done retrospectively. No references have been requested in retrospect from the most recent employees previous employer, neither has the registered provider for The Haven completed any form of written statement to vouch for this persons good integrity in the meantime. There was evidence however that this person had received an induction. But this did Care Homes for Adults (18-65 years) Page 28 of 42 Evidence: not include the Drug and Alcohol National Occupational Standards modules specific to this type of service. The manager told us in her improvement plan that staff are trained to DANOS standard. However, at this site visit she confirmed that staff had not completed this induction. She agreed to access the induction material from the internet and implement it. We were told that the staff receive regular supervision. However, the supervision records were not available to see. We were told that the staff concerned had handed the documentation to the NVQ (National Vocational Qualification) assessor. A copy could have been kept on the staff files, so they remained up to date, and as a useful tool to focus future supervisions. There is no training schedule in place. This makes it difficult for the manager to see when training needs to be updated. All four staff, including the registered provider, need to be included in compulsory training, as well as sessions to keep them updated with current good practice. However, since the last site visit, the manager has been encouraging the staff to attend some training so their practice in supporting people can be measured against current minimum standards. The counsellor has completed a level 3 National Vocational Qualification in Care. While another member of staff has just completed this qualification at level 2. There are only four staff working at the home, so the process of making sure that the recruitment procedure is thorough, and that subsequent training and supervision is kept up to date, should be relatively simple. Further work needs to be done to make sure staff are suitably recruited and qualified to provide a safe consistent service for people. Care Homes for Adults (18-65 years) Page 29 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of clear management auditing systems, robust quality assurance, and shortfalls in some health and safety information, mean that it is not possible to confirm that the service is being run in the best interests of the people who use it. Evidence: The manager has completed the Registered Manager Award and will shortly be embarking on a leadership and management training course. Due to unforeseen circumstances she has not yet submitted her application to become registered with the commission. However, she had an appointment the week after this site visit so that she had all the information she needed to submit this. The application should be submitted by 30 June 2009. The manager has a lot of understanding about the supervision and support that people with an alcohol problem need. However, she has not attended any formal training in order to underpin the knowledge she has. It is recommended that she source some training, from which she and other staff could update their skills about current Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: recognised good practice. There are no regular audits done of the home, and there is no robust quality assurance system. People are given surveys at the end of their placement so that the manager can get their views about how the service operates. The results of these were not available, because they could not be found. The manager said that she has not collated this information to see if there are any trends, or similar feedback. These surveys, together with the views of professionals who visit the service, should be used to help measure what the service is doing well, and where it needs to improve. Some of the information the manager assured us was being done in the improvement plan following the last key inspection we found not to be done. And some of the information she provided in the Annual Quality Assurance Assessment before this key inspection was different again. This does not give the commission confidence that shortfalls previously identified have been taken seriously and acted upon. The were were a number of matters which affect peoples health and safety, which need to be put right, or which were brought to the managers attention on the day of the site visit: One of the staff is the appointed first aider. They are the only staff member with a first aid qualification. However, they are not in the building all the time, and none of the other staff have up to date training in first aid. A risk assessment must be completed to see what level of first aid is needed at the service over a twenty four hour period, after which this should be provided. In the absence of a first aid risk assessment, there must be a first aider available at all times. Not all the staff have kept up to date with compulsory training in fire safety, moving and handling, food hygiene and infection control. And there was no records to show when these were last done. The manager said that staff do not carry out moving and handling tasks. This assumption should be risk assessed to check that it is true, and to check that the employer is meeting their legal responsibilities in protecting staff and people from avoidable injury. However, staff need to know what to do should fire break out, how to handle food in order to meet current Environmental Health standards, and they also need to know how to prevent the spread of infection. There was no recent gas certificate. The manager said that the gas had been recently checked. We smelled gas from the boiler at the site visit. We asked the manager to contact the appropriate person to check that the system was safe. She has fed back that this visit took place soon after we left the building and that there was no sign of a gas leak. A copy of the gas certificate must be forwarded to the commission. Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: There was no current periodic electrical fixed wiring certificate available. Nor was there a copy of the most recent fire alarm service certificate. A copy of these must also be sent to the commission as confirmation that these systems have been maintained. We were told that weekly checks are carried out to make sure that the fire alarm is in full working order, and that the hot water is kept at an acceptable temperature. However, the records to evidence that these checks had been done were not kept up to date, because they had not been signed for a month. Although some people at the home were able to tell us that they have heard the fire alarm sounding recently, both these checks need to be recorded to show they have been done, as evidence that people are being safeguarded from the risk from fire, and from scalding water. There were several hazardous chemicals in both the bathrooms and the laundry. But they were not locked away, and no assessment had been completed to check that this arrangement did not expose people to undue harm, based on their own personal risks. The manager has removed these pending this assessment. Care Homes for Adults (18-65 years) Page 32 of 42 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 42 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 20 13 The following actions must be taken with immediate effect: Check people have received the correct medication. Consult with the General Practitioner where they have not. Check that peoples Medication Administration Records provide the right information about what people are prescribed, and get this information checked by someone with the skills to do so. Cease secondary dispensing. Organise training for all staff who handle peoples medication. Contact the community pharmacist for interim advice, and act upon it. This will make sure that people using the service are protected by the safe recording, handling, safekeeping, safe administration and disposal of medicines. 01/05/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Care Homes for Adults (18-65 years) Page 34 of 42 Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Risks to each individual 30/06/2009 must be clearly identified, and a care plan developed, and agreed with the person, to identify how each risk will be managed. This is so that action can be taken, and a plan agreed, which minimises risk to the person, and which promotes their independence wherever possible. 2 17 17 A record must be kept of the 30/06/2009 meals provided for people. This is so sufficient detail is kept of what meals people have been provided with over time, so it is easier to confirm that their diet is nutritious, balanced, and that it meets peoples dietary requirements. 3 19 12 Clear details about peoples 31/05/2009 health care needs, and how they are being met, must be recorded in their care plan. This is so that the support people require is clear to staff as their needs change during their rehabilitation. 4 20 13 Safe medication practices must be restored and maintained. This includes safe and suitable arrangements with 31/05/2009 Care Homes for Adults (18-65 years) Page 35 of 42 regards to the recording, handling, safekeeping, safe administration and disposal of medicines. 5 22 3 The communal toilets must 09/06/2009 be provided with appropriate hand washing and drying facilities. This will help to maintain good hygiene standards and infection control. 6 22 2 All areas of the premises must be kept clean. This is so people live in a pleasant environment where the risk to cross infection is kept to a minimum 7 22 1 The most recent report from 09/06/2009 the Fire Officer and Environmental Health Officer must be submitted to the commission. This is to confirm that each organisation is satisfied that any requirements made by them are being met, or are being addressed, in order to keep the environment safe and well managed. 8 23 13 All staff must complete 31/07/2009 safeguarding adults training. This is so they are fully conversant about what to do, and who to go to, should they need to report an allegation of abuse at the service. 09/06/2009 Care Homes for Adults (18-65 years) Page 36 of 42 9 33 18 As stated at the site visit, the service must be staffed at all times. This is so that there is always a staff member to support people, and to be available to manage emergency situations. 20/05/2009 10 34 19 For all staff working at the 31/05/2009 home who do not have one, an application must be made for an Enhanced Criminal Records Bureau check to be completed so that their details can be checked against the POVAFirst list. This will confirm whether the staff members are suitable to work with vulnerable people, or whether they have been barred from working with them. 11 39 24 There must be better 31/07/2009 systems in place for auditing and reviewing each area of the home, the quality of the service, and staff training. This should include the views of people using the services and others with an interest in it, such as visiting professionals. This will assist in the effective management of the home, and will help to make sure it is run in peoples best interests. 12 42 12 A risk assessment, based on 31/05/2009 the needs of each individual, must be completed to check Care Homes for Adults (18-65 years) Page 37 of 42 that it is safe for hazardous chemicals not to be locked away. In the absence of such an assessment, safe lockable storage facilities must be provided. This is to check that people are not at risk from the current arrangements in place. 13 42 13 It must be checked that the 30/06/2009 following have been serviced within the recommended timescales, and action must be taken to get the service done where they have not. Copies of each of the certificates must be sent to the commission: Fire alarm maintenance certificate Gas service certificate Electrical fixed wiring certificate. This is to confirm that these systems are being maintained in safe working order by suitably qualified professionals. 14 42 13 Compulsory training must be 31/07/2009 organised or updated where required for all four staff in fire safety, infection control, food safety and, where assessed as necessary, moving and handling. This will make sure that at Care Homes for Adults (18-65 years) Page 38 of 42 all times, people can be assured that they are being supported by staff who know how to work in a safe way which complies with the law. 15 42 13 A risk assessment must be completed to check what level of first aid is needed at the service over a twenty four hour period. In the absence of such an assessment, a first aid qualified person must be available at all times. By doing so, there will be suitably qualified staff available to give the right support in an emergency requiring first aid attention. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 So that an appropriate support package, including the right support services, can be in place for when the individual arrives, peoples pre admission assessment should cover other areas of need, and should not focus solely upon their alcohol dependency. This should include obtaining the current care plan from their funding authority. The further assessment and risk assessments completed on admission should be devised with the person concerned, rather than using pre printed assessments. By doing so, the assessment will become more individual to the person, and will help to develop their care plan in a more person centred way. People should have a nutritional assessment completed when they arrive, to check what dietary risks they may be subject to, and so measures can be put into place to reduce any risks. Care Homes for Adults (18-65 years) Page 39 of 42 2 6 Plans about peoples care should be written with the person, and in such a way that the plan identifies the individuals needs and goals, so that these can be worked towards during the course of their stay. Records should be kept in peoples individual files, and not in collective records, to record their daily progress, health professional input, and other major events that happen over the course of their stay. This will make the information more easily accessible, and easier to relate to when their care is reviewed. 3 22 The means for recording complaints should be reviewed so that the documentation gives enough room for a clear record to be made about the content of the complaint, the action taken, including any investigation, the outcome of the complaint and also whether the complainant was satisfied. This will help to audit better peoples satisfaction of the service, and to identify common trends. References for the most recent employee should be requested in retrospect. In the absence of these the registered provider should make a written statement vouching for the persons suitability for the post, and their integrity. Staff should receive induction training to Drug and Alcohol National Occupational Standards (DANOS), so that they have a common understanding about the needs of people who have an alcohol dependency. There should be an organised programme of training in place so that staff do not fall behind with compulsory training, and so that they each receive training opportunities linked to the aims of the service and the needs of those who use it. 4 34 5 35 6 36 Supervision records should be kept on staff files so that they can be referred to when focusing on future supervision and training needs, to meet the purpose of the service, and the needs of the people receiving rehabilitation there. The manager should submit their application to become registered with the commission by 30 June 2009. It is is recommended that the manager seeks training specific to the needs of people with alcohol problems, so she is able to cascade down current good practice to other staff members, and further structure peoples support plans on what she has learnt. 7 37 8 42 The recording of weekly checks of the fire alarm and hot water supply should be kept up to date as evidence that Care Homes for Adults (18-65 years) Page 40 of 42 these have been completed, and also to help identify problems quickly where patterns in faults may emerge. Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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