Inspection on 03/12/08 for Nascent House

This inspection was carried out on 3rd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nascent House 06/12/06

Nascent House 25/01/06

Nascent House 27/09/05

Nascent House 25/02/05

Nascent House 17/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nascent House London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julia Bradshaw     Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Nascent House London Road Apsley Hemel Hempstead Hertfordshire HP3 9ST 01442251366 01442251366 nascenthouse@druglink.ltd.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Jeanette Mandiville Type of registration: Number of places registered: Druglink Limited care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: This home is registered for 8 people with drug or alcohol dependence. Date of last inspection Brief description of the care home Nascent House is a Stabilisation Unit providing short-term accommodation and therapeutic 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. An up to date copy of both the Statement of Purpose and Service User Guide can be located within the main office of Nascent House. A copy of the latest inspection report can also be obtained from the office. The weekly standard fee is £616.00. Care Homes for Adults (18-65 years) Page 4 of 26 8 8 Over 65 0 0 Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Nascent House was carried out on the 6th December 2006 and an Annual Service Review was completed on the 27th February 2008. This key inspection report draws on information obtained from the recent Annual Quality Assurance Assessment ( AQQA ) completed by the manager and from a full inspection visit carried out on the 3rd December 2008. The inspection process included speaking to people using the service, staff on duty and a full inspection of records relating to care planning, medication, health and safety, staff records and training and the general management of the service. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: There is very little that Nascent House needs to do to improve the service, opportunities and support offered. However the landlords of this property, must ensure that all aspects of repairs and maintenance are attended to promptly and effectively in order to ensure the people living within this service are not inconvenienced by an ineffective and sub standard heating system. On the day of this inspection the house Care Homes for Adults (18-65 years) Page 7 of 26 was cold and there was limited amounts of hot water due to a faulty boiler. The manager stated that this issue had been a long standing one and was still unresolved, to the detriment of the people living within the service, staff and visitors. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is kept up to date and provided for all prospective users of this service and everyone wishing to enter the home has a full assessment of need completed. This ensures that all parties can be sure the service can meet all individual needs. The terms and conditions of the service are agreed in writing so that people are clear about the roles and responsibilities of all those within the service. Evidence: Initial referrals are received by telephone where basic details of the prospective service user are taken. A thorough assessment is carried out where information is gained about the person and any potential risks are identified. If risks such as history of violence are identified, the person will not be accepted for the service as this could create risks to other service users and staff. The prospective service user is invited to look around the home and meet the staff and current service users prior to admission. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be very confident that the care plans reflect a detailed and comprehensive record of peoples needs, which ensures that service users are assessed, reviewed and safe from risk. Evidence: Four service plans were inspected in detail and were found to provide a detailed and comprehensive insight into each individuals needs. Individual notes and guidelines for people were observed within the service. Everyone living at Nascent house is supported within both the internal review framework of one to one support and also through regular community meetings to ensure changing needs are continuously assessed and reviewed. Three monthly reviews occur with the placing authority for the individual service user. People confirmed that they been involved in the development of their support plans and consulted in the way that care is received in terms of preserving peoples rights and dignity. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Ranges of risk assessments are completed within the service and actions points recorded. These risk assessments are very detailed and contain all the required information. Service users are restricted in many ways by their admission agreement . However all survive users spoken during this inspection confirmed that they had been fully consulted about these restriction prior to moving into Nascent House. Several people commented that they felt these rules were necessary in achieving the aims and objectives of their placement and contributed to their rehabilitation. Rules and restrictions also provide a safe and supportive environment in which people can live and assist people in developing and maintaining the self help and life skills required for a more positive and more meaningful life, beyond the placement at Nascent House. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service at Nascent House can feel assured that they will have a diverse range of daily and life skill opportunities offered as part of their rehabilitation programme in order to support their recovery and enhance their life skills Evidence: Nascent house should be congratulated on the variety of opportunities they provided to people which are a combination of in house theraputic groups i.e. Art therapy, life story sessions and some holistic therapies are also provided. The service has links with the local church who make donations of toiletries and items to enhance peoples bedrooms, during their stay. People are encouraged and supported to embark on a period of voluntary work within the local community which includes helping out within Hemel Hempstead Hospital or assisting in local charity shops. There is also a rota for day to day responsibilities i.e. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: cooking and shopping, clearing the tables and washing/drying up. This is a regime that people are supported to adhere to as part of their placement and their recovery programme. Service users decide on a weekly menu, taking into account peoples likes and dislikes. Each day a different person has the responsibility of choosing and preparing the meal. for the whole group. The inspector joined the staff team and one service user who was off sick from their voluntary placement whilst they were finishing their meal and enjoyed an informal and general discussion about the service and the forthcoming arrangements for Christmas. This inspection took place two weeks before Christmas, which can prove particularly challenging and difficult for people with addictions. Therefore the manager and staff had drawn up a notice and Christmas programme for everyone to understand and adhere to. Again this programme could appear very restrictive and compromising for people using the service users but the underpinning knowledge and expertise that the staff team possess confirm that these restrictions are necessary to ensure the best possible support networks and boundaries are in place to prevent a relapse in a persons rehabilitation. The main restrictions during the Christmas and New Year period focus on set times for visitors, service users remaining in the house throughout Christmas eve and any donations of alcohol free food are donated to the house for everyone to enjoy and not to individuals. Nascent House provides an open House on the 1st January from 10.30 a.m. and service users are able to go out with their visitors from 7.30 p.m. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can be assured that staff have the underpinning knowledge and expertise to support their health, welfare and emotional needs in a non judgemental way in order to assist them in managing their long standing issues. Evidence: Each person at Nascent House has a care plan which is devised upon entry into Nascent House. This is reviewed in conjunction with the person using the service, the staff team at Nascent House and with the placing authority. Each service user at Nascent house completes a daily journal and staff maintain daily progress notes. As the programme the care plan progresses the care plan includes the implementation of day, overnight and weekend visits and highlights any particular interests. The manager and staff team work extremely hard to ensure all the mechanisms are in place to support the service user through their rehabilitation placement and also to prepare them for moving on. This was further evidenced by speaking to people during this inspection who stated staff are tough but fair, supportive and respectful when things are proving difficult. My placement here has been very useful and helped me get through a very difficult time in my life. Now I am ready to go back home and do it for Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: myself. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this service can be assured that they will be protected from abuse and that they will be listened to if they raise any concerns or make a complaint about any aspect of their care. Evidence: The service has a detailed complaints procedure in place. A record is maintained within the service of any complaints made detailing actions and outcomes as necessary. People using the service have been informed about the complaints procedure. The AQAA stated that no complaints have been received since the last inspection was carried out. A detailed procedure is in place to ensure that people using the service are protected from abuse and harm. Staff receive suitable and adequate safeguarding training. Staff employed within the home are all subject to enhanced Criminal Records Bureau disclosure. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nascent House offers a homely and therapeutic environment to its service users, providing a positive group living style atmosphere, encouraging people to complete their programme. Evidence: Several areas of the home have been decorated since the last inspection took place in December 2006, including re-decoration of the communal areas, the hall ,stairs and landing areas, the dining room lounge and kitchen. Nascent house provides a welcoming and homely environment which is respected and valued by the people who use this service. The inspector was shown around the main areas of the service but not in the bedrooms of the other service users as permission had not been obtained prior to the inspection taking place. However the person who kindly showed the inspector around was happy to show them their own bedroom which presented as a cosy space in which service users have an opportunity to some privacy. The manager stated that there has been an on going problem with the boiler/heating system which has affected the temperature of the house, causing people to be cold and without a regular supply of hot water. This problem should be rectified by the managing agent of the property as soon as possible in order to prevent any more inconvenience to both service users and staff. Everyone using this service has a single bedroom and shared bathroom and Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: toilet facilities. There are eight bedrooms in total and women are provided with bedrooms on the ground floor and the mens bedrooms are upstairs. A door alarm is fitted to the downstairs connecting door, which separates the womens bedrooms from the mens bedrooms. All areas of the home were maintained to a high level of cleanliness. All health and safety documentation was seen and completed to a satisfactory standard, this included fire checks. The manager is in the process of applying to increase the occupancy of the service by extending the existing building to accommodate an extra bedroom and extend the office space currently provided. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that a loyal, experienced and well-trained staff team, who have been robustly recruited to ensure their continued safety, will support them. Evidence: The manager and staff work extremely hard to provide a safe, supportive, therapeutic and non judgemental environment for people using this service. Recording systems, support plans, staff training and supervisions are all provided to a good standard. During this inspection there were several examples observed where staff clearly demonstrated their commitment to their work in caring for the people who use the service. Two members of staff spoken to during this inspection stated that they found the manager approachable and the training opportunities were very good. Recent training includes, Developing healthy relationships, first aid, how does spirituality fit into recovery, working with people with eating disorders and personality disorders. The rota was checked on the day of this inspection and the service demonstrated that adequate staffing is provided on both day and night shifts. This cover provides between 3 or 4 staff on each shift, depending on the needs of the people using the service. The recruitment records of 3 staff, including the most recent appointment Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: were viewed; evidence demonstrates that there are good recruitment practices within this service, which means that people living at the Nascent House can be reassured they are protected by the effective recruitment systems in place. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Nascent house can feel very confident that they are living within a service that is exceptionally well managed. Health and safety systems are in place which ensures people are protected. Evidence: People living within Nascent House are provided with excellent information that has been produced in a format that is both detailed and comprehensive. Both the Statement of Purpose and Service User Guide have were updated in October 2008. The manager ensures that supervisions and staff training are held regularly and two staff spoken to on the day of this inspection staff confirmed that they feel very supported and respected by the registered manager. People are safeguarded from harm by the homes recruitment procedures, safeguarding training and the complaints procedure. The manager and staff strive to further develop the quality assurance system in all aspects of the service in order to ensure there is regular monitoring and reviewing to improve areas of development, with a particular focus on service user involvement. All records inspected were secure and were up to date and held in accordance with the Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Data Protection Act 1998 ensuring that peoples rights and best interests are safe guarded by the homes polices and procedures. Individual and generic risk assessments have greatly improved and have been further developed to ensure people living at Nascent House are safe and protected. The general standard of fire checks/recording is excellent and fire records on the day of the inspection were up to date and recorded accurate. There are systems in place in order to ensure that everyone living, working or visiting this service are protected from cross infection and hygiene standards throughout the home were good. The inspector would like to thank the resident who took the time to show them around the home and to the staff for making this visit a very enjoyable, interesting and thought provoking one. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The owners of the property 28/02/2009 must ensure that there is an effective, reliable and well maintained heating system in place. To ensure people living at Nascent House have a warm home in which to live and that there is constant access to adequate hot water. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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!