Inspection on 12/07/05 for Nelson House

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nelson House 19/09/07

Nelson House 05/12/06

Nelson House 23/11/05

Nelson House 24/02/05

Nelson House 04/11/04

Nelson House 08/03/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

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

CARE HOME ADULTS 18-65 Nelson House Brimscombe Hill Stroud Gloucestershire GL5 2QP Lead Inspector Sheila Reynolds Announced 12 July 2005; 9:30 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 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 Stationary 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. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Nelson House Address Brimscombe Hill Stroud Gloucestershire GL5 2QP 01453 887721 01453 889949 office@nelsontrust.com Nelson House Recovery Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sean OBrien Corbett Care Home - Care Home only 16 Category(ies) of Alcohol dependence past/present (A) - 16 registration, with number Drug dependence past/present (D) - 16 of places Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th February 2005 Brief Description of the Service: Nelson House is an adapted Grade II listed building and is registered to accommodate up to 16 adults who are recovering from drug and/or alcohol addiction. Accommodation is provided over three floors with a range of communal rooms. All bedrooms are doubles as it is considered part of the rehabilitative process that residents must share to avoid isolation. The counselling programme is delivered at a nearby adapted old school building and the Trust also runs a training and education centre close by. Nelson House is part of the Nelson House Recovery Trust which comprises the residential care home and also a number of supported housing projects in Stroud and Gloucester. Residents from these houses may also attend the counselling facilities and the training and education centre. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place between 9.30 am and 3.00 pm. Three people living at the home were spoken with individually. The registered manager was present throughout the inspection and a number of administrative staff were spoken with. None of the counselling staff were spoken with during this inspection as they were all committed to the counselling timetable. A full tour of the premises was not undertaken at this inspection, although a newly refurbished bathroom, one bedroom and the kitchen was seen. The records of three residents who were at different stages of their programme were seen. These included assessment information, care plans, reviews and other reports. Other records examined included staff files and some health and safety records What the service does well: What has improved since the last inspection? What they could do better: There were some shortfalls in the recruitment process of staff, which could mean people are appointed without proper checks about their suitability. The organisation must adopt a rigorous and transparent recruitment process and not rely on previous knowledge of individuals. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 6 The organisation must ensure that monthly unannounced visits are made to the home by its representatives and that a copy of the report is forwarded to the Commission. 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. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) 2 The assessment process is carried out by appropriately experienced staff and fully involves the resident, ensuring that they have an opportunity to express their views and aspirations. EVIDENCE: The admission process would normally include completion of an application form and an initial assessment by a member of the counselling team. This would be supported by information from the previous placement, where relevant, and a care plan and/or assessment from the placing authority. Evidence from residents’ files showed that 3 out of the 3 files seen contained an assessment completed by a member of the counselling team. Other aspects of the admission procedure were mixed, with 2 of the 3 files having a completed application form, 1 had information from the previous placement and 1 had a care plan from the placing authority. Nelson House has a thorough admissions process and it is recommended that a more consistent approach is adopted to ensure all of the possible information available is captured. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) 6 The care planning system clearly involves and supports the individual to make progress towards their stated aims. EVIDENCE: Of those files seen, all contained care plans which had been drawn up in consultation with the service user. There was evidence of regular reviews which included self-assessment and also peer assessment. This was all well documented and supported by additional reports from the training and education centre. The home has begun to use a risk assessment process but this was being completed to varying degrees. The registered manager explained that the process was to be introduced formally in the near future with clear guidelines for staff about how to complete the assessment. The importance of good risk assessments cannot be underestimated, in terms of identifying the nature and likelihood of a risk factor occurring, and the resulting protection of the resident, staff and other residents. Examples were seen in the initial assessment information where good risk assessments would be essential. The risk assessment process will be examined in some detail at the next inspection, when the new system will have had time to bed down. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) 16 There is a range of structured opportunities for residents to discuss, practice and explore their rights and responsibilities, enabling residents to acquire new skills and understanding. EVIDENCE: Standards 12, 13 and 15 are not specifically relevant to this client group. During their stay at Nelson House, residents are expected to comply with a tightly structured timetable which does not encourage interaction with the local community to any great degree. Visits by or to family and friends are closely monitored. Residents confirmed that they are able to contribute to the running of the home through weekly community meetings and monthly Service User Group meetings. These meetings provide a regular venue for highlighting and discussing any issues of concern to the residents. Residents said that they were useful and that the organisation listened to any concerns and gave prompt feedback. In addition, residents can also discuss issues with their named counsellor. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 11 The home also has clearly defined household tasks that residents are expected to share equally with their peers that promote their own sense of responsibility. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) EVIDENCE: This section was not assessed on this occasion. At the previous inspection, it had been identified that the home needed to introduce a system for recording when prescribed medication was not taken or refused. A new system has been introduced. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) 22, 23 The emphasis on ensuring that every new resident has a copy of the complaints procedure, coupled with the listening approach of the organisation, encourages service users to express any concerns or complaints. The home has a good understanding of the issues of abuse and promotes a culture of openness and sharing which contributes to the ensuring the safety of residents. EVIDENCE: Service users confirmed that they had received a copy of the complaints procedure in their information pack, given to them at the point of admission to the home. They also confirmed that they knew who to approach if they had any concerns and that they felt confident about doing that. The home has an appropriate adult protection policy and procedures and staff have undertaken relevant training. There is also a detailed Whistle-blowing policy. See also Staffing section. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 standard(s) EVIDENCE: This section was not fully assessed at this inspection. However, a newly re-furbished bathroom, one bedroom and the kitchen were seen. A number of new windows have also been fitted. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 Recruitment practice is not sufficiently robust which may put residents at risk from staff who have not undergone proper checks regarding their suitability. The Trust is committed to ensuring its staff team are regularly and appropriately trained, which contributes to the professional and caring service offered to residents. EVIDENCE: The staff records of 3 people were examined, although only one works in the registered care home. This file contained an old CRB from a previous employment, although an application for a new CRB had been submitted. There was no POVAfirst check and no written references. Recruitment practice for other staff in the organisation also showed shortcomings. The home explained that frequently people employed to work in the home are already well-known to the organisation as they may have attended as part of a rehabilitation programme. However, in terms of the protection of other service users and staff, it is essential that the home gathers all relevant information and can demonstrate that it complies with the appropriate Regulation. The home agreed to update it procedures immediately and this will be re-assessed at the next inspection. All existing staff have the required references and CRBs. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 16 The home has expanded its use of volunteers and they are subject to the same recruitment process as permanent staff, including references and CRB checks. Statutory training is being offered on a regular basis. First aid has been undertaken by most staff and 2 people have done the 4-day training. Fire safety training was due to take place on 21st July and night staff are trained every 3 months. 2 members of staff who have a responsibility for the administration of medication have received accredited training and are keen to extend their knowledge through further courses. The organisation employs a considerable number of staff and it is recommended that a database is introduced, that clearly shows which staff have undertaken what training and when a refresher is due. This should ensure that no-one slips through the net and receives the right training at the right time. It is widely accepted that NVQs in care are not particularly relevant to this client group or their carers. DANOS (Drug and Alcohol National Occupational Standards) related NVQs are being developed which will be far more appropriate, although there has been considerable delay in implementing these. The Trust, together with other organisations in the region are supporting each other to agree appropriate training requirements, pending the issue of the DANOS scheme. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 By not undertaking regular monthly visits, the Trust is failing to make use of a quality assurance tool that enables those who have a responsibility for running the home to have direct experience of the home and for service users and staff to air their views. EVIDENCE: At the previous inspection it had been identified that The Trust had not been carrying out unannounced monthly visit by a representative of the organisation, as required under Regulation 26. Since the last inspection the CSCI has not received any reports from these visits. These visits provide an essential opportunity for those responsible for running the home to observe and comment upon what is happening in the home and to provide an additional opportunity for residents and staff to give their views. The Trust must take steps to ensure this is done and that a copy of the report produced is forwarded to the Commission. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 18 The organisation does advise the Commission monthly of the number of new admissions and the number of planned and unplanned discharges. Health and safety checks were not fully inspected at this visit, with the exception of the fire log. This showed that maintenance, tests and drills were being carried out at appropriate intervals. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 19 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 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x N/A N/A x N/A 4 x Standard No 31 32 33 34 35 36 Score x x x 1 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Nelson House Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 1 x x x x D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 20 Yes 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 34 Regulation 19 Requirement The home must ensure that 2 written references and a CRB check is received before a new member of staff takes up their duties. In exceptional circumstances, the member of staff may need to commence their duties before the CRB is returned, in which case the home must obtain a POVAfirst check, complete a risk assessment for the person and ensure that they do not work unsupervised, or have access to medication or money, until the full CRB is received. The home must ensure that monthly, unannounced visits are carried out by representatives of the Nelson House Recovery Trust and a copy of the written report forwarded to the CSCI. (Previous timescale of 31/03/05 not met). Timescale for action 12/07/05 2. 39 26 31/08/05 Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 2 35 Good Practice Recommendations Ensure that homes own admission procedures are consistently followed. Compile a data base of staff training to show what training has been undertaken, when, and to include dates for refresher training. Nelson House D51 D03_s16507 Nelson House v198266_120705 Stage4.doc Version 1.40 Page 22 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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