Inspection on 12/11/07 for Littledale Hall Therapeutic Community

This inspection was carried out on 12th November 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Littledale Hall Therapeutic... 30/10/06

Similar services:

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

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

CARE HOME ADULTS 18-65 Littledale Hall Therapeutic Community Littledale Hall Littledale Lancaster Lancashire LA2 9EY Lead Inspector Mrs Gwen Miller Unannounced Inspection 12th & 13 November 2007 10:00 th Littledale Hall Therapeutic Community DS0000067186.V350541.R02.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 Littledale Hall Therapeutic Community DS0000067186.V350541.R02.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. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littledale Hall Therapeutic Community Address Littledale Hall Littledale Lancaster Lancashire LA2 9EY 01524 771400 01524 771553 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) Littledale Hall Therapeutic Community Limited Mr Keith Andrew Robertson Care Home 31 Category(ies) of Past or present alcohol dependence (31), Past or registration, with number present drug dependence (31) of places Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 31 service users to include up to 31 service users in the category D (drug dependent past/present) aged 18 years and over and up to 31 service users in the category A (alcohol dependence past/present) aged 18 years and over. 30th October 2006 Date of last inspection Brief Description of the Service: Littledale Hall is a therapeutic community set in a two hundred acre estate in the Trough of Bowland near Lancaster. Littledale Hall Therapeutic Community provides services to people whose lives have been adversely affected by their substance misuse. The home seeks to offer a safe, supportive environment where people can address emotional, psychological and social issues linked to their substance misuse. Littledale Hall Therapeutic Community has a strong theoretical base which focuses on the positive attributes people have, gradually building self efficiency through delivering treatment which is supportive and resident focused. Residents are supported to overcome their physical, psychological and emotional dependency on their chosen substance ( or substances) enabling them to strive towards independent ways of living in the community. The programme used at this home is based upon a model proposed by Rex Haigh and is built around five stages of Belonging, Safety, Openness, Participation, Citizenship and Empowerment. A further eight core elements and four other elements are available to all residents but may not be accessed by everyone. The home is managed by Keith Robertson who has good experience in working in the field of drug and alcohol misuse. Accommodation of the home is detailed in the Environment section of this report, activities and leisure opportunities are listed in the Lifestyle section. At the time of this visit, (12th November 2007) the information given to the Commission for Social Care Inspection, showed that the fees for care at the home are £390 per week, with added expenses for tobacco and tuck shop. This fee now includes 12 months aftercare support. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this home has been carried out over the period since the previous inspection in September 2006. This is to give an overall picture of using evidence and information gathering, in the form of a pre inspection questionnaire, letters to and from the home during that period, discussions and interviews with residents, management and staff. The inspection also included two site visits on separate days, time was spent talking with residents and observing the day to day routines of the home and care staff, as they provided support. We (CSCI) attended morning staff handover and therapeutic group work sessions. During the visits we spoke with residents, staff and the manager and examined a number of documents including resident’s individual care plans and staff personnel files. We also carried out a tour of the building looking at resident’s communal living areas and private bedrooms. We also sent some written questionnaires to residents and their social workers or care managers asking them about their opinions of standards within the home. A total of 30 were returned to us. Throughout the report there are references to ‘case tracking’, this is a method whereby the inspector focuses on a small number of residents, all relevant records relating to them are examined, from their initial assessment, throughout their period of care, to the current time. This was carried out for five residents. There were 29 residents living at Littledale Hall at the time of the visit. What the service does well: It is the policy of Littledale Hall Therapeutic Community to actively seek to attract all groups that are underrepresented in treatment, regardless of background, gender disability or ethnicity and to make sure that there is equal Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 6 care given to all residents, considering their individual needs and addictions by giving equal support to all, irrespective of their race, gender, disability, sexuality, age, religion or beliefs. All staff understand and adhere to LHTC policy and procedures re equality and diversity. Staff have undertaken specific pieces of work with residents to develop a greater understanding of equality and diversity issues. Staff and residents challenge inappropriate behaviour and comments as a routine part of the daily life of the community. Comments from social workers were “I believe that equality of opportunity is fully exercised at the therapeutic community”. There is equal consideration given to prospective employees in that there are male, female, younger and older staff between the ages of 18 and 65 years working at the home, training and development programmes are offered to all staff. The home has facilities for those with mobility problems, these are on the ground floor. Those with different eating choices are enabled to receive a nutritious diet and people who find writing a problem are encouraged to express their feelings in art work, in their personal progress file and daily diaries. On this site visit we found the home to be bright, well decorated, pleasantly furnished and generally well presented but with the client’s needs in mind. The grounds give opportunity for outdoor activities on site and provide a safe place, away from Lancaster pubs and contact with those who abuse drugs and alcohol in the community. Residents spoken with on this visit spoke well of the staff, programme and daily living at the home. Comments included: “The staff at Littledale Hall are a credit to their profession. In my opinion I receive the best care in the country”, and “the service is second to none”, also” the Littledale programme and dedication of staff is exemplary”. Care managers commented: The service “carefully assesses suitable people who are sufficiently motivated to access abstinence based treatment” and “gently introduces treatment philosophy, appropriately challenges when progress needs to move on” and “works well with funders in providing up to date progress reports”. What has improved since the last inspection? Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 7 The following changes have been made as a result of listening to residents: Incorporated new illicit dependency sessions into the programme (twice a week). Introduced a system whereby residents can have early nights. Purchasing local papers for those looking for employment and accommodation. Provided move on accommodation as part of resident’s progression to independence. Increased number of mixed gender advice and guidance sessions. Improvements include: Littledale Hall now includes up to 12 months aftercare support in its fees. A policy and procedure is in place for self discharge at short notice. The manager has invested in staff development and training for all staff to provide a well qualified staff team with variety of skills to meet the diverse needs of the residents. There is a structured approach to recruiting and supporting volunteers. They have developed student placements (social work and counselling). They have introduced a comprehensive case management system. Developed a structured, client centred assessment process, which includes day visits and feedback from current residents and staff about prospective residents. The programme has been appropriately changed to ensure residents are offered a structured and individual care package. They have developed close links with a local GP, dentist and external healthcare professionals (including mental health). They have implemented a comprehensive system to monitor concerns or complaints. What they could do better: 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. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is excellent. Written and verbal information is provided by the home, this allows people to make informed choices whether or not the home will meet their needs. Full assessments of needs are carried out for all prospective residents to ensure the home is the right place for them and provide them with the right sort of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced very good written information which contains all the relevant information needed for prospective residents to make an informed choice when they are considering using the service for their rehabilitation from drugs or alcohol. Information packs are given to each resident and sent to prospective purchasers of the service. Information provided by the home prior to this inspection stated that: We have developed a service that is grounded in a clear treatment philosophy and approach based on and theory for practice (e.g psychosocial and Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 10 psychodramatic). We have a robust assessment process. Provide comprehensive written information (e.g. brochure) to inform service user and commisisoner choice. Prospective residents are offered day visits, which provides them with an opportunity to assess the suitability of LHTC to meets their needs. We accommodate a diverse group of residents in relation to age, gender, sexuality and primary alcohol or drug mis-use. We have developed professional links with a wide range of external agencies including: commissioners (e.g. new funding authorities) and providers (e.g. adult education). We (CSCI) found: Potential residents have an interview with the Admissions Coordinator who assesses the individual’s psychological, emotional needs and their suitability as a community resident. This also provides an opportunity for prospective residents to ask questions and get information about the treatment process. If the assessment concludes the service would benefit the person, once funding is approved, an admission date is offered. During case tracking, files seen, contained full assessments of resident’s needs, these had been completed prior to admission, to ensure that Littledale Hall was the right place for that person, and that the home could provide the right care for them. Assessments are well detailed and provide a good picture of the individual, including their strengths and weaknesses. They are completed with the resident, sometimes including their social worker, probation staff, funders or any one else involved with their care. During case tracking, it was clear that residents case files held written contracts between themselves and Littledale Therapeutic Community, stating clearly what was and was not included in the cost of staying at the home, the expectancy of their behaviour and their rights as residents of the home. Some residents said they had the opportunity to visit the home prior to their admission, others who lived too far away could not do so, but added they felt able to contact the home by telephone and ask questions prior to making their decision. Comments from residents included: “I am in treatment on a voluntary basis, when exploring the possibility of residential treatment I was given three different care facilities to consider”. “I had an assessment, then a day visits to go round the house and make my own decision”. “I was able to get a feel of the place and get a resident’s Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 11 perspective of the place”. “Everybody made me feel very welcome on my day visit and they convinced me to try to get in here as I had never been in treatment before.” “Staff were willing to answer all my questions” and “lots of info and input from other residents”. Someone who had completed the programme added “I looked at a number of treatment methods and programs and based my decision to come here on the information I had been given and from coming to the place for a day placement.” Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 12 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): 6,7,9 Quality in this outcome area is excellent Personal support in this home is aimed to promote resident’s successful rehabilitation which includes the promotion of their independence so they may return to working and living in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information received from the home prior to this visit included: We provide structured individual tailored packages of care. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 13 Offer a programme that enables people to understand what is required if they are to progress through the various stages of treatment. Work to empower residents to increasingly manage and make choices about their life. Confidentiality policy and organisational practice (e.g. limits of information sharing associated with particular groups). We found: Case tracking and records again on this visit, showed very detailed care plans for all residents, including comprehensive risk assessments, these were completed with, and signed by residents, together with their key workers, they are also signed by the manager to show his agreement. Care plans address changing needs and constantly changing goals as residents progress through the programme. Residents also complete their own Personal Progress File, which provides a useful tool for personal reflection and a living record of individual’s progress. Residents regularly carry out their own self assessments as they progress into their next stage. These may be completed including artwork thereby not disadvantaging those who have difficulty expressing themselves in words. The rules of the treatment programme are such that residents are not always able to make independent decisions, as a member of the house “community”, (which is the terminology used for the group living together), residents are given specific tasks and responsibilities to undertake. However residents are able to determine whether or not to participate in certain therapeutic interventions. We found there was no pressure on them if they chose to decline. Residents did say they acknowledged the restrictions imposed as a necessary part of the programme. Such restrictions include not leaving the house without permission and not to have spontaneous visits from friends and family. Rules and boundaries are clearly documented in the home’s information and residents sign to confirm they understand them and agree to abide by them. When asked, “do you make decisions about what you do each day”, comments included: “Everyday I live in an environment where I am responsible for my behaviour and I am responsible for my actions”. And Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 14 “I am free to leave at any time”. One person said “There is a structure in the house but it runs well with each resident giving his / her own input”. On completion of the programme, one resident added “with the exception of groups and educational classes, I made choices for myself most of the time”. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 15 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): 12,13,14,15,16,17. Quality in this outcome area is excellent Links with families and community life, are in place, these support and enrich resident’s rehabilitation. Meals offer choice and variety but also cater for those with special needs. Activities are in place to enable residents to enjoy their leisure time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager (Keith Robertson) informed us that “We offer a wide range of opporunties to enable residents to develop and maintain their physical health, social life and personal development by providing a comprehensive programme of: education opportunities (on and off site); leisure activities (National Trust); health (e.g. supporting residents to access specialist healthcare); access to Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 16 sports (on and off site) and support as they re-engage with their families (e.g. family mediation). He gave a list of activities undertaken by residents: • • • • • • • • • • 5 day visit to Base Camp in High Wray, Ambleside – where residents work alongside the National Trust doing activities such as dry stonewalling, path laying and forest clearing. Monthly visits to Base Camp – working on above activities. Weekly visits to the local sports centre, for badminton and swimming. Volunteering for on site farm work, such as fielding chickens etc. Residents are also able to access fishing on site – but must provide their own equipment. Local college provides education courses in-house which include: Expressive Art, Creative Writing, Poetry, Maths, English, Spanish, IT, African Drumming, Pottery, Regular Walks/hikes are accessible with a trained guide in many different locations across the Northwest. Gender specific activities are available to encourage same-sex camaraderie, these include pampering sessions, theatre visits, meals at restaurants, visits to football museums etc. LHTC also hosts an open day once a year where both local and national professionals are invited, family and friends of current residents Local professionals deliver fortnightly seminars on a variety of subjects to provide information to residents – these have included ‘blood borne viruses’, ‘therapeutic communities’, ‘Community of Communities’ and ‘my experiences in treatment’. Residents are also encouraged to give presentations to external establishments to inform students and professionals about their experiences as service users. Residents are able to access the on-site gym facilities Residents towards the latter stages of treatment are also encouraged to volunteer for local organisations along with accessing college courses externally. Each evening residents are encouraged to devise ‘Activities’ for the community on a rota basis – these have included charades, team quizzes, ‘X Factor’, plays – but are for too extensive to list Sports Days Visits to hair salon/ on-site hairdresser Bar-b-q’s during summer months • • • • • • • We found residents to be very positive about how they spent their leisure time. They said that although their days were structured to ensure they get the most from their treatments, staff would listen to any suggestions or opinions they had on the structure and also on their free time. They added again “even Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 17 though I am in an environment where there is structure, I am not forced to do anything, its my choice”. We found that the large amount of rooms in the home, gave opportunity for both communal activities and areas for quieter letter writing and paper work. Residents seemed to enjoy the outdoor opportunities especially, some said they had never seen such wildlife nor had the chance to be involved in working on a farm or fishing. Whilst restrictions are in place, residents maintain family relationships, visits by families usually take place at weekends so as not to interfere with daily programmes of the rehabilitation. Families can be picked up in Lancaster or helped with arranging accommodation, if they need. The meals served on both days of this site visit, looked appetising and were served in a pleasant setting. A choice was offered between hot and cold food and residents, staff and visitors shared theirs meals together. The dining room is large enough for all to eat at one sitting. The resident in charge of the kitchen and foods, said there was always enough food stocks to provide meals for everyone. All residents said they enjoyed their meals although one resident was unclear why the food was prepared by themselves, this, as with the whole structure of the programme is set out in the information about the service. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 18 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): 18,19,20 Quality in this outcome area is excellent On admission residents are registered with a local doctor, thereby ensuring their health needs are met. Medication systems are safe ensuring the resident’s safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is not always possible for residents to receive personal support in the way they prefer as the nature of the rehabilitation programme includes bringing back order and structure into their lives, therefore routines cannot be flexible. This is explained in the home’s information, on initial visits and is re enforced during stages of the programme. Residents said this had been explained to them and they understood the reasoning for this. The manager stated in his information to us: Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 19 We offer a comprehensive personal healthcare support package which takes account of individual physical and psychological needs. We provide residents with the opportunity to access a range of psyhcological treatment (e.g. Counselling and Psychodrama) Each resident is assessed by the local G.P to acertain current and future health needs. We support service users by accompanying them to attend external specialist health appointments. We work closely with the G.P to make sure residents receive appropriate medication. We administer and record residents medication. Case tracking again on thisvisit, showed that care and personal support is provided in keeping with the changing needs of the resident, as they proceed through the programme. Residents also complete their own written records in the form of a Personal Progress File these can be both positive and negative opinions and are shared with others in the community. We found that during group work, resident’s support varied according to their individual need. All the staff we observed were constructive in their discussions with residents. Many thank you cards were seen from former residents, families and those who fund residents, all confirmed that the support provided by staff had been excellent. On admission, residents become patients attached to the local surgery. The GP carries out his medical assessment for the individual and will prescribe any medication necessary which may be administered by trained members of staff. It was noted that staff accompany residents to GP or hospital appointments. It is not always possible for residents to retain, administer and control their own medication in the way they prefer, as the nature of the rehabilitation programme does not allow this. The home has a good medication policy and systems, medication appears to be stored safely and medication records were seen to be up to date. We looked at records of accidents and incidents relating to residents, the manager was reminded to inform us in writing of any incidents and accidents which affect the well being of the resident. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 20 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): 22,23 Quality in this outcome area is excellent The home uses a good clear robust complaints procedure, there is evidence that residents feel their views will be acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said he thought the home did well in this area by: Advice and Guidance system (slips, sessions and groups). Clear information provided to residents about who they can contact if they have any concerns. Operate as an open therapeutic community and welcome visits from external professionals. Now implemented a comprehensive system to monitor any concerns or complaints. We found: Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 21 The home uses a good clear robust complaints procedure which is included in the home’s Service User Guide. All comment cards received from residents confirmed that they knew who to speak to if they were not happy, added comments were “I don’t feel judged or treated any different when bringing concerns to staff” and “there are outside bodies I could complain to, yet I have never had to complain”. Residents also confirmed they knew how to make a complaint. Regular resident surveys were used to assess the quality and usefulness of therapies used in the programme. All staff were trained and aware of safeguarding adults issues. The Commission for Social Care Inspection has received no complaints / concerns since the previous inspection. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 22 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): 24,27,30 Quality in this outcome area is excellent The residents are provided with a good standard and comfortable environment, where bedrooms are well personalised. This means that residents will feel at home with their belongings around them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Littledale Hall is a Grade 2 Listed Building dating back to the 18th Century. It is set in 200 acres of woodland and open countryside on Quernmore, near Lancaster. This very large house is accessed via a private long drive and is very secluded, thereby providing a tranquil environment for those rehabilitating from drug or alcohol addiction plus causing no nuisance value to neighbours. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 23 Littledale Hall has a total of 10 bedrooms, 9 on the first floor and 1 on the ground floor which has wheelchair access and facilities for people with disabilities. (The fire requirements of this room and some others, have resulted in some internal doors being very heavy to manage, these would require a wheelchair user to be assisted in opening them, this needs to be included in the home’s information). All bedrooms are very large and will accommodate between 2 to 4 persons easily without any overcrowding and allowing for privacy. All bedrooms have matching bedding and curtains, wardrobes and storage facilities, chairs, wood flooring or carpets. Rooms have been decorated and furnished in modern style, none are overlooked, most offer extensive views over the countryside. Bedrooms are well personalised and all residents spoke well of their accommodation at the home. A total of 7 bathrooms with toilet, 4 shower rooms with toilet and 1 separate toilet provide adequate facilities for up to 31 residents, the maximum residents the home is registered for. The living space includes of 2 large lounge areas, 1 smoking and 1 non smoking, both furnished to a good standard. There is a very large dining room where all 31 residents can be accommodated at one sitting, crockery, glassware and matching table linens have been purchased. Other smaller rooms on the ground floor are used for one to one counselling sessions. The extensive grounds cover 200 acres and allow for gardening and outdoor pursuits as well as providing privacy for visits from family and friends. Access to the outdoor areas is by front and back doors and through French windows in each lounge. A ramp is in place at the front entrance. The kitchen is again very large and fitted with the equipment needed for up to 31 residents. Various store rooms for food stuffs both fresh and frozen allow for bulk buying from food stores. Local butchers and bakers are used. The residents purchase and prepare all their own foods and meals as part of their rehabilitation programme. Laundry is completed by the residents using domestic washers and driers. Residents keep the home and their own rooms clean and tidy, cleaning materials are provided and stored appropriately. Domestic waste is disposed by the local authority, there is no clinical waste, sharps or other specialist waste products. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 24 When asked what the home does well in this area, the manager said: Provide residents with a homely, comfortable and safe environment. Service users are able to personalise their rooms. Provide a mix of shared spaces to enable residents to undertake a range of activities. We provide a smoking room for residents. Offer a welcoming and safe environment for guests and visitors. And that since the previous inspection, Littledale Hall has: Installed new bathrooms and showers. Purchased more new wardrobes and sofas. Decorated areas (e.g. living room). We found the home to be clean and warm, the grounds were well maintained. All residents were pleased with their accommodation, their bedrooms were well personalised. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 25 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): 31,32,34,35,36 Quality in this outcome area is excellent The numbers of staff on duty were satisfactory to meet the needs of the people living at the home. Staff are trained in the problems suffered by those in rehabilitation, this means that staff will be more aware of the needs of residents at Littledale Hall. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided the following information prior to this visit. All staff undertake regular formal and informal supervsion. Staff are able to access external time limited counselling if required when they are co-facilitating the psychodrama group. External training and development is provided to all staff. LHTC has a comprehansive annual training and development plan. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 26 Staff are able to share pratice issues in regular daily and weekly meetings. The staff team at LHTC includes a range of professionals, which ensures LHTC staff can meet diverse service user needs. All Treatment Practitioners have either completed or are undertaking NVQ3 DANOS Training. LHTC staff are highly motivated, experienced and committed to meeting residents needs. Staff are supportive of each other. Staff recognise their colleagues skills, knowledge and experience and utilise these in order to meet residents complex needs. Provide placements for student Social Workers and counsellors. Provide learning opportunities for external professionals and volunteers. We found that all staff had a contract of employment and a job description, all spoken with said that they could approach the manager for advice and guidance at any time. Staff were observed during the two days, all treated the residents with dignity and respect. Residents are assigned to their own key worker, case tracking showed that key workers are involved in reviews of care, together with their residents. Residents said they felt well supported by staff. All staff are qualified as a minimum to the equivalent of National Vocational Training level 2. Staff are well qualified in the field of Substance Misuse, all have up to date first aid training, safe food handling and undergo induction training that meets the National Minimum Standards for this client group. Comments from care managers and social workers confirmed that staff have the right skills and experience to support individual’s social and health care needs. They added that feedback at residents reviews, showed they had 100 confidence in the skills of staff and they had developed very open and trusting relationships with their counsellors. Staff files seen held two references, Protection of Vulnerable Adult checks and employment histories. Residents are involved when prospective staff are interviewed, their opinion is included. All residents spoke well of the staff, their comments included: “The staff are very caring and have our best interests at heart”. “Staff are so passionate about me, this place is great”. “our staff are the best”. When asked ‘do the carers listen and act on what you say?’ all answered “always” or “usually” and added “not always possible but concerns and ideas are considered”. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 27 We found that staff and residents meet each morning to share their thoughts and experiences of the previous day and what the current day had in store for them. Records seen showed that staff are supervised appropriately, their key working practices for each resident are also monitored by the manager and signed to show his approval. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 28 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): 37,39,41,42,43 Quality in this outcome area is excellent, The home reviews aspects of its performance through consultation, which includes seeking the views of residents, thereby ensuring the home is run in their best interests. Good procedures are in place to safeguard the financial interest of residents and the management ensures up to date maintenance in the home, this is to protect the health, safety and welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager feel the home does well in this area in that: The staff team at LHTC has many years experience and the registered Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 29 manager has extensive knowledge and expertise in the development and delivery of Therapeutic Communities. Residents recognise that LHTC policies and procedures contribute to them feeling safe and secure. Residents views and opinions are listened too and this helps inform service delivery and development. There is a clear management structure at LHTC which enables staff and residents to be aware of the lines of accountability and decison making. All health and safety systems are operational and strictly adhered too. We found: The Home is well managed and run on a daily basis by Keith Robertson who is well qualified and has good experience and knowledge of many of the problems that those who misuse drugs or alcohol develop. Residents and staff respect and like him and find him approachable and friendly. All staff feel well supported by the manager and their individual views are actively sought in the running of the home and the care provision to the residents. They feel clear in the roles they carry out and able to suggest good practice or alternative suggestions in caring for the residents they key work. Residents feel able to approach all staff and management at all times for further support or to challenge care practice. Paper work included up to date maintenance certification and associated records. Policies and procedures are in place and used in the daily running of the home. Gas central heating is provided from 3 separate gas boilers, all radiators are fitted with individual thermostats. All rooms have wired smoke / heat and sounds systems “LI alarm systems” installed. A certificate has been received to confirm compliance with Food Safety Act 1990, Health and Safety Act 1974,and Environmental Health. Electrical, and gas safety certificates are in place and up to date. Fire risk assessments are in place. A certificate has been received to confirm compliance with Food Safety Act 1990, Health and Safety Act 1974,and Environmental Health. A dedicated staff member deals with the charges and payments, the home uses its own accountant The residents feel that the home is run well and in their best interests, their comments included: “although at times it has been hard, I cannot say enough good things about the staff team and the programme. It has totally changed Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 30 my life”. And “The treatment here is brilliant, it’s a lovely home and a brilliant place to be”. Residents said their views were sought frequently and we saw many testimonials from parents, funders and residents who had completed their programmes. A report of the findings by ‘Members of the Community of Communities’ based on the ‘Service Standards for Addiction Therapeutic Communities’, showed good outcomes those people using the service at Littledale Hall. Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 31 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 3 2 4 3 4 4 4 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 4 28 X 29 X 30 4 STAFFING Standard No Score 31 4 32 4 33 X 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X 4 4 4 Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 32 No Are there any outstanding requirements from the last inspection? 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 Requirement The registered person must ensure that facilities included in the statement of purpose are correct in that wheelchair users would need assistance to open the heavy doors. Must notify the CSCI of and event which adversely effects the well being or safety of any service user (accidents or incidents) Timescale for action 31/12/06 2 YA42 37 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Littledale Hall Therapeutic Community DS0000067186.V350541.R02.S.doc Version 5.2 Page 34 - 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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