CARE HOME ADULTS 18-65
Nascent House London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST Lead Inspector
Alison Jessop Unannounced Inspection 27th September 2005 10:00 Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 1 Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 2 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 Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 3 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. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Name of service Nascent House Address London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST 01442 251366 01442 251366 nascenthouse@druglink.ltd.uk 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) Druglink Limited Ms Jeanette Mandiville Care Home 8 Category(ies) of Past or present alcohol dependence (8), Past or registration, with number present drug dependence (8) of places Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 5 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 8 people with drug or alcohol dependence. Date of last inspection 25th February 2005 Brief Description of the Service: Nascent House is a Stabilisation Unit providing short term accommodation and theraputic support to up to eight service users with past or present alcohol or drug dependency. The house is in keeping with the local community and is situated in Apsley, close to a small selection of local shops. It is also allocated near to the town of Hemel Hempstead, which has excellent shopping and leisure facilities. It provides eight single occupancy rooms. The home retains a waiting list and reports a high retention and success rate. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried out this inspection over half a day. The Inspector was made to feel very welcome by both the staff and service users and felt privileged to be invited into the morning group therapy session. Most of the time was spent talking to staff and service users. The inspector also chatted to service users over lunch, which is eaten around the large dining table. Some time was also spent in the office observing records and in discussion with the Manager and her Deputy. What the service does well: What has improved since the last inspection?
The new kitchen offers a spacious, practical and safe area for food preparation. It is attractively decorated and has plenty of storage space. A new range cooker has been installed away from the door as previously situated, is useful Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 7 for catering for large groups. It has however been faulty and the home is waiting for the contractor to resolve this matter with the manufacturer. Risk Assessments have been completed for the hot water and notices in relation to health and safety were observed around the home. 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. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 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 Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 4 The robust admission procedure ensures that prospective service users understand the terms and conditions of the home. It also ensures that people starting the programme of rehabilitation have a wish to succeed, this ensures that valuable resources are facilitated correctly. EVIDENCE: Initial referrals are received by telephone where basic details of the prospective service user are taken. It is established whether the person has a history of violence or has perpetrated sexual abuse, or has not undergone Detox. If so they will not be accepted for the service as this could create risks to other service users. The prospective service user will then be invited to look around the home and meet the staff and current service users. The manager stated that she would ask a group of current service users to meet with the prospective service user to give them a view from someone currently residing at Nascent House. They later feed back to the manager about the conversation and from this can establish is the person was serious about succeeding. If questions like ‘how can you get hold of drugs’ are asked then this person is unlikely to be accepted onto the programme at this point. If new service users enter the home and have recently ‘used’, they are asked to stay in their room for a period of 24 hours, so that they can undertake Detoxification. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 10 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): 7,8 &10 Although strict restrictions are in place, service users make decisions and have involvement in the day-to-day running of the home. They are also encouraged to take some responsibilities, which is in preparation for when they leave the programme. EVIDENCE: Service users are restricted in many ways however all spoken to confirm that they were aware of the restrictions before they moved to Nascent House. Household tasks are shared with service users, which helps prepare them for a life in the community. Service users when it is felt that they are ready are supported initially to do the food shopping for the house. Once this has been achieved and they feel ready, staff give the money to the service users to do this without support. For most this is quite a challenge as they would have in the past spent all their income on drugs or alcohol, however a great sense of achievement assists in building self confidence and again prepares them for moving on. Random urine and breath tests are carried out and should a positive result be found the service user is immediately evicted from the programme. The strict
Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 11 regime reflects the success rate, as service users are aware that this may the only opportunity they will get to overcome their addiction. On arrival to the home staff were doing morning handover, staff were observed to respect the confidentiality in accordance with homes polices and procedures and the Data Protection Act. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 12 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): 11,12,13,14,16 & 17 Staff at Nascent House, ensure that service users participate and engage in the local community. This prepares them when they move on as it raises awareness of acceptable social skills. EVIDENCE: Recently the service users were given the opportunity to visit the local church. The church donates introduction packs, which contain items such as toiletries and small items to make their room look homely. The deputy manager was invited to the church to speak to the parish about the service provided at Nascent House and to thank them for their contribution. Service users appeared to have enjoyed this as the manager stated that they were accepted and welcomed to the church without any prejudice and were non-judgmental. Service users had also attended the Harvest Festival. Other activities that are held on a regular basis are leaving parties when someone completes the programme. The service user is awarded a certificate of success. Weekly trips to the gym and swimming pool are arranged; also exercise classes are carried out within the home.
Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 13 On the day of the inspection, the afternoon therapy session was relaxation and Auricular Acupuncture. A member of staff who has completed training in this complementary therapy carries this out. Service users are given the choice as to whether they would like to receive this. Service users lie on large cushions in the lounge whilst relaxation tapes are played. One service user said that his family have been to visit him at the weekend, he appeared to enjoy this time with them and enjoyed sharing his story about the visit with the other service users over lunch. Service users with staff support decide a weekly menu and each person has responsibility of cooking the meal of their choice once a week. Service users invited the inspector to join them for lunch where jacket potatoes, cold meats, salad and bread was served. This was very appetising and the homely, family atmosphere around the dining table is another important part of the programme. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 14 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): 18, 19 & 20 The knowledge and experience of the staff offers a meaningful, supportive environment to the emotional well being of service users. Staff are nonjudgemental in their approach, which encourages service users to deal with long standing issues that they need to approach in order to move forward. EVIDENCE: On the day of the inspection one service user went into the morning sessions to read his life story to the other service users. This was a huge step and staff were observed to be supportive and reassuring throughout. Service users wishes and preferences were also observed and respected. Procedures for the storage, recording and handling of medications were adequate. Service users are responsible for administering their own medication however this is stored securely in the office and staff observe and record. PRN homely remedies are safely stored and recorded. A monthly medication audit is carried out by staff. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 15 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 Additional complaints monitoring systems could ensure that complaints are dealt with in accordance with the Complaints Procedure. EVIDENCE: One complaint has been received by the home since the last inspection. This was from a service user who was concerned about another service users behaviour in public. The home had kept records of the complaint and this had been fully resolved. It was suggested that a record is maintained in the complaints file detailing the date the complaint was received and the date that it was fully resolved. This would ensure that complaints are dealt with in accordance with the allocated timescale on the Complaints Procedure but could also help to identify if common themes begin to appear. No issues had been reported to POVA since the last inspection report and a copy of the Protection of Vulnerable Adults Procedure was observed in the office. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 16 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): 24,25,26,27,28 & 30 Nascent House offers a homely and therapeutic environment to its service users, providing a positive family atmosphere, encouraging service users to complete the programme. EVIDENCE: The lounge and dining room are appropriately furnished with comfortable, domestic style furniture and furnishings. On the day of the inspection the home was clean and tidy. It is a domestic style house and is not suitable for wheelchair users. A programme of redevelopment is well underway and a new kitchen and two toilets have been fitted. A new bathroom is due to be fitted soon. A plastic ventilation pipe, which now protrudes the original tiled roof looks unsightly and is not in keeping with the rest of the house. A new domestic style kitchen has been fitted and provides a spacious, practical and safe area for food preparation. It is attractively decorated and has plenty of storage space. A newly fitted range cooker has been installed away from the door as previously situated, is useful for catering for large groups. It has however been faulty and the home is waiting for the contractor to resolve this matter with the manufacturer. Several snagging items are outstanding, including the fitting of new door fittings and re-varnishing of the fire door.
Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 17 On the day of the inspection the manager met with the contractor and High Town Pretorian Surveyor to arrange a date for these to be completed. Two new toilets with new hand basins have been fitted. Although the rooms were re-decorated, parts of this look shoddy and unprofessional. A new bathroom is due be installed in the near future. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 18 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): 32,33,35 & 36 The staff team are enthusiastic and appear to take great pride in their work. This creates a positive atmosphere to service users, who can at times be very vulnerable. EVIDENCE: Staff spoken to confirm they receive formal one to one supervision with their manager and group meetings are held regularly. One member of staff said that when he has a difficult day due to the intensity of service users issues, he feels that he can talk to his manager or team at any time. Regular handover meetings ensure that staff off load and share the issues throughout the team. Service users spoken to confirmed that they felt supported by staff who have expertise, and knowledge of their issues. Staff also share experiences between each other in order to ensure that all aspects are considered. Each worker has the responsibility of a particular role within the house. One member of staff on duty was responsible for ensuring that a comprehensive training plan is devised. Staff appear to receive a lot of mandatory and specialised training and certificates are displayed in the hallway. Recently the team had completed Food Hygiene and Fire Safety training. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 19 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): 37, 38, 41, 42 & 43 The home is managed in an open, positive and inclusive manner, however with very strict rules and boundaries. This appears to contribute to the high level of completion and success rates. EVIDENCE: It has been recognised that an application for a Responsible Individual has not been received since the Registration of the Manager in 2002. It is required that an application be made within four weeks of receipt of this report. The manager is very clear about the rules and boundaries within the home, which appears to be effective. The staff also feel that they can approach the manager at any time if they have concerns. The weekly house meetings ensure that service users are able to air their views and discuss any concerns. Interaction between the manager and service users was positive and service users appeared to respect the style of management within the home. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 20 Service users collect their weekly income and are expected to pay a contribution towards their food. Staff were observed collecting this from service users, which was recorded and stored securely along with food shopping money. Generic risk assessments were observed for Hot water and COSHH. Several health and safety notices were observed around the home however these did not appear obtrusive. Cleaning products are stored securely in a cupboard and staff monitor service users when these are being used. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 21 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 3 3 3 X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 3 X 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 3 CONDUCT AND MANAGEMENT 3OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Nascent House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 3 3 DS0000019478.V254119.R01.S.doc Version 5.0 Page 22 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 37 Regulation 7(2)(c) Requirement A application for Responsible Individual must be sent to CSCI. Timescale for action 04/11/05 No. 1 Refer to Standard 22 Good Practice Recommendations It is recommended that all complaints be recorded with dates the complaint was received and fully resolved. Nascent House DS0000019478.V254119.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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