CARE HOME ADULTS 18-65
Longreach 7 Hartley Road Hartley Plymouth Devon PL3 5LW Lead Inspector
Brendan Hannon Unannounced Inspection 28th October 2005 09:50 Longreach DS0000003446.V252472.R01.S.doc Version 5.0 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 Longreach DS0000003446.V252472.R01.S.doc Version 5.0 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. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Longreach Address 7 Hartley Road Hartley Plymouth Devon PL3 5LW 01752 788699 01752 789980 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) Broadreach House Ms Wendy Van Der Niet Care Home 20 Category(ies) of Past or present alcohol dependence (20), Past or registration, with number present drug dependence (20) of places Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Female only Age 16-64yrs Date of last inspection Brief Description of the Service: Longreach is a large unit providing second stage treatment for women between the ages of 16 and 64 years of age who are pursuing rehabilitation from drugs and alcohol. Longreach does not provide a detoxification service. Treatment is by means of counselling and mutual support. The service requires total abstinence from all clients throughout their stay. The unit can accommodate up to twenty clients at any one time. The unit is housed in a large detached house and a separate cottage building. The house has the majority of the accommodation which is made up of six double bedrooms and one single bedroom. The cottage is completely separate living space including a kitchen and lounge and can accommodate up to five clients in two double bedrooms and one single bedroom. The cottage is usually reserved for clients moving towards the end of their stay at Longreach. There is a large garden to the rear of the building. There are a number of offices and purpose built counselling rooms separate from the homes two main lounges. Longreach is located in the Hartley area of central Plymouth. It is close to Mutley Plain shopping precinct and there is easy access to the central area and other parts of Plymouth by bus. The home is part of the Broadreach charitable group. The organisation provides a variety of alcohol and drug rehabilitation services in Plymouth but is open to people from all over the country. The Broadreach group is part of EATA, The European Alcohol Treatment Association. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was the second statutory inspection of the year following the comprehensive inspection of 7th June 2005. Preparation for the inspection included analysis of the previous inspection report and contact with the home over the last 12 months. An inspection plan was developed from this information. The inspector was in the home from 9.50am to 12.30pm. The inspector spent time with or spoke to ten of the seventeen clients. The clients requested that they were all spoken to as a group. The registered manager, two counsellors, the office administrator and the cook were all spoken to during the inspection. The registered manager was spoken to at length. Client files including support worker notes, medication records, and health and safety records were inspected. What the service does well:
The service carries out thorough assessments for all potential clients before admission which helps to ensure that all the client’s needs can be met and that the likelihood of successful completion of the treatment programme is good. The standard required by standard 2 was exceeded and the unit was commended for this part of the service. The delivery of resident’s care and treatment is supported by the homes individual client risk assessments. The unit uses risk assessment effectively so that a judgement can be made on whether the unit can continue to manage a clients individual risk issues. The standard required by standard 9 was exceeded and the unit was commended for this part of the service. The unit has stated clearly the restrictions that must be agreed to by potential new clients and these are signed for before admission in a contract of terms and conditions. This includes the grounds on which the treatment programme might be ended. However despite the restrictions necessary for a successful treatment programme the clients’ quality of life is good and as much individual freedom as possible has been given. This has helped to maintain clients existing skills and independence. The standard required by standard 7 was exceeded and the unit was commended for this part of the service. Respect for client’s rights combined with the treatment programme, and the further development of groups, such as parenting skills, cooking and nutrition, enables the unit to successfully support clients to manage in the wider community after their treatment is complete. The standard required by standard 11 was exceeded and the unit was commended for this part of the service. The clients are provided with plenty of, varied, good food. The unit consults with the clients on the menu, takes into account preferences and is now working effectively to support clients with eating disorders. The standard required by standard 17 was exceeded and the unit was commended for this part of the service.
Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 6 The clients benefit from homely, clean and well maintained buildings. The unit supports client’s to receive their medication and to meet their health needs. Enough well trained staff meets the clients’ needs. The standard of the training for the counsellors and support staff is very good. The present clients said that the staff are good at their jobs and are very supportive. The standard required by standard 35 was exceeded and the unit was commended for this part of the service. The management of the home is effective and the quality of the service continues to develop so that clients needs continue to be met successfully. What has improved since the last inspection? 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. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 7 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 Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5 The home provides good information about the service to all potential new clients and their representatives. The service assesses potential clients needs before admission and recognises the needs that it can meet. These processes increase the likelihood of successful completion of the treatment programme. EVIDENCE: The service has updated the Service Users Guide with the latest additions to its service including EMDR (Eye Movement Desensitisation and Reprocessing) for alleviating post traumatic stress, auricular acupuncture detoxification, parenting skills groups and management of eating disorders. The home carries out a thorough admission assessment process before admission is agreed, involving both consultation with the care manager and usually a meeting with the prospective service user. An assessment pack is jointly sent to both parties. A general risk assessment is carried out for all prospective service users. The pre admission process is of very good quality and the unit has exceeded standard 2. The contract between the home and the client very clearly states all the restrictions agreed as part of treatment at Longreach. This document includes the grounds for ending the treatment programme before it is complete. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 The delivery of client’s care and treatment is well supported by the homes individual client risk assessments. The client’s quality of life is improved by receiving as much freedom and choice as possible within the necessary restrictions of the treatment programme. EVIDENCE: Individual client risk assessments identify all risks affecting the client. The unit has been particularly good in addressing mental health issues early. Identified mental health issues were supported by contingency mental health planning from purchasing authority areas. Mental health risk assessments are reviewed as required by the counsellor group during the treatment programme. The active use of risk assessment to enable client’s interests to be protected has exceeded the standard required by standard 9. Clients are also supported to manage their own daily routines and personal decision making within the restrictions of the treatment programme. In the latter stages of treatment active change is made to the treatment programme to give more time to the client to fill with learning activities and leisure as they feel will help their development. The empowering style of the treatment programme has exceeded the standard required by standard 7. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,14,17 Clients have enough leisure activity to ensure a good quality of life while living at the home. Clients have considerable access to opportunities for personal development, which will help during and after the treatment programme. Clients receive plenty of, varied, good food. EVIDENCE: Throughout the inspection information both on the leisure activities and the personal development activities engaged in by the clients, was given by the Registered Manager, and was shown in records. The clients are given free bus passes for travel within Plymouth at arrival in the home. This helps them to access facilities and services in the city including NA/AA sessions, the gym, and various workshops. Within the home aerobics, karate, relaxation therapy, Indian head massage, cooking and nutrition, and computing sessions are taking place at present. The Broadreach group has developed a number of new support systems over the past months, which the clients at Longreach are actively using to assist their rehabilitation. A new Broadreach centre at Wyndam Square is providing parenting skills programmes and a crèche as well as outreach for clients after ending treatment. Parenting skills sessions are being delivered to the clients weekly, supporting the clients skill development in this area. The combination
Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 11 of the treatment programme, which was praised by the clients during the inspection, and the opportunities for personal development made available to the clients, has exceeded the standard required by standard 11, skills development opportunities. Longreach continues to provide good quality food with good variety. There is regular consultation with clients taking into account the clients preferences and special dietary needs, including eating disorders. The cook is qualified to teach basic food hygiene to the clients in support of their food preparation for the group at the unit. The cook also takes a weekly cooking and nutrition group which has improved the quality of client food provision to the group and supports client’s development of, basic living skills and parenting skills. The home continues to be recognised as having exceeded the required standard for Standard 17, provision of food in the home. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 Clients’ health is maintained by well managed administration of their medication. EVIDENCE: Self-administration of medication is restricted in the home. Only some inhalers are released into the care of clients based on risk assessment. The amounts of medication being prescribed to clients is maintained at as low a level as possible and it is a requirement of admission that all clients are assessed, and their medication reviewed, by a GP within six weeks of admission. Due to the limited quantity of medication and the independence of the clients the home does not operate a monitored dosage system of medication administration. The home does not ‘repot’ (secondary dispense) any medication. During the inspection clients were seen coming to the office, and requesting their prescribed medication. The homes medication storage facility is appropriate for the homes needs and was clean and ordered. The Medication Administration Record (MAR) sheets were reviewed and were adequate. Upon admission most clients become the patients of a specific local GP who has a close working relationship with the unit. As stated, medication is reviewed early, as is the health of the client through their new patient assessment. The unit supports clients’ continuing health treatment. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Complaints are properly managed by the home protecting the welfare of the residents. EVIDENCE: There is a good complaints procedure in place, which is clearly displayed in the home, and attached to the service users guide. Details of how to contact the CSCI locally are clearly stated in the procedure. The service users guide is given to all new clients entering the home. The Broadreach organisation has a ‘protection of adults at risk’ policy, which clearly states how an allegation or disclosure of possible abuse would be managed. Awareness of abuse is a central part of counsellor’s clinical training and new support workers induction. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The clients benefit from homely, comfortable, clean and well maintained buildings that meet their needs. EVIDENCE: The communal areas only were inspected during the inspection. The standard of decoration in these areas of the home is generally good. The communal areas, including the kitchen, were clean and odour free. There has been considerable refurbishment of the communal lounges, the service users bedrooms and the hallways of the building during the past two years. In the communal lounges all the seating has been replaced and in the two main lounges the floors have been sanded and polished. In the bedrooms the wardrobes, chests of drawers and bedside cabinets have been replaced. Half of the bedroom carpets and some of the corridor area carpets have been replaced. The bedrooms in the cottage have been painted. The hallways and main lounge in the main building have been painted during the last three months. This refurbishment has helped considerably to give the building a more domestic atmosphere and a better quality of living environment for the clients. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 Resident’s needs are met by enough trained staff. EVIDENCE: The staffing level continues to be the same as that in place since 2002.The registered manager is happy that there are enough counsellors in post to provide a thorough treatment programme and enough support workers covering evenings, nights and weekends to meet the clients needs. There is a duty system operated by the homes counsellors to ensure that there is always counsellor support available in an emergency. The induction delivered by the Broadreach organisation is thorough and gives a good set of basic skills to all new support staff. This training enables staff to successfully meet resident’s needs when they begin work with the organisation. Over the past year all staff have received, all of the mandatory basic training, as well as safe handling of medication, and fire awareness training. Additional training has been given to groups of staff during the past year including, Mental Health Awareness, working with self-harm, and child protection. Other examples of specialist courses followed included auricular acupuncture, supervision, advanced EMDR, and interventions for eating disorders. Longreach also supports a number of student placements including at present one student counsellor. Longreach has a commitment to training that exceeds the requirements of standard 35 and the unit is commended for training delivery.
Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,41 The management of the home is effective and continues to develop the quality of the service so that clients needs continue to be met. EVIDENCE: The registered manager, Wendy Van Der Niet, has been in post for the past three years. Good working relationships were seen between the counsellors, support staff, clients and the Registered Manager. These good relationships will promote better quality support for the clients. The organisation has an existing quality assurance system based upon questionnaires. Clients fill out these questionnaires when they are about to leave the unit, the information given is then analysed and returned to the Registered Manager. The unit and organisation collects statistics on completion rates of the treatment programme. The records seen throughout the inspection were being adequately maintained which helps the management of the unit to run the service efficiently. Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 4 3 X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 4 X 4 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 4 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 4 X CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Longreach Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X 3 X X 3 X X DS0000003446.V252472.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 Longreach DS0000003446.V252472.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
