Inspection on 21/11/06 for Sefton Park Residential Care Home

This inspection was carried out on 21st November 2006.

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

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

Other inspections for this house

Sefton Park Residential Care Home 01/11/07

Sefton Park Residential Care Home 12/01/06

Sefton Park Residential Care Home 01/09/05

Sefton Park Residential Care Home 24/03/05

Sefton Park Residential Care Home 17/07/04

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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 Sefton Park Residential Care Home 10 Royal Crescent Weston Super Mare North Somerset BS23 2AX Lead Inspector Nicola Hill Unannounced Inspection 21st & 24 November 2006 09:30 th Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sefton Park Residential Care Home Address 10 Royal Crescent Weston Super Mare North Somerset BS23 2AX 01934 626371 01934 626371 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) Mercia Care Homes Limited Mr Adrian Patrick Cole Care Home 28 Category(ies) of Past or present alcohol dependence (28), Past or registration, with number present drug dependence (28) of places Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to two residents who are over 65 years of age. Date of last inspection 12th January 2006 Brief Description of the Service: Sefton Park provides a residential therapeutic program for up to 24 people aged 18 - 64 years who have alcohol or drug dependency issues. The home is an attractive spacious property situated near the seafront within walking distance of the town centre. The home provides a variety of well furnished communal areas; there are eight double bedrooms (all en-suite) and ten single rooms. The fees are £545 for week one then £495 thereafter. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection at Sefton Park took place over two days. At the time of the inspection there were 19 people in residence. Several of the residents and three members of staff were spoken with, the registered manager was not available for the first visit, but was able to discuss aspects of the service provision with the inspector on the second visit. The inspector gathered evidence for the report from residents, staff, and documentation held at the home. The home has been assessed as providing a good level of service What the service does well: Sefton Park provides a robust treatment programme for those addicted to drugs or alcohol. The service provision meets criteria identified in research by the National Treatment Agency (NTA) to promote retention of service users in treatment, in that it is a small home with a good staff/service user ratio. The quality of support from the counsellors and support workers was noted by residents and appreciated. The accommodation, whilst communal, is of good quality and there are a variety of facilities available. The residents have regular house meetings to raise any concerns and speak directly to staff or other residents in order to find a resolution to issues. The residents stated that programme allowed flexibility with very clear boundaries. The group therapy approach supported the continuation of the key themes of the programme in the absence of formal groups. One resident commented that they had heard that the home was like a “boot camp” However having adjusted to the programme and house rules recognised that the boundaries were necessary and were what supported the residents to follow the programme successfully. The comments from residents also included a view on activities, in that the programme during the week was very full, however at weekends there was sufficient free time to allow residents to complete their files and any other personal chores such as laundry. Overall the comments from the residents were very positive, and several stated that they would recommend Sefton Park. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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 Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. A skilled and experienced member of staff always undertakes the assessment. EVIDENCE: The manager has revised the service information, which sets out in plain English the programme and its contractual expectations. All the residents have an assessment undertaken prior to admission, which covers all aspects of their life including any mental health issues. It is from this information that a decision is made to offer a place on the programme. The residents currently in Sefton Park told the inspector that they had a choice of home to go to, however Sefton Park was chosen either because of the personal recommendation, either from care managers or from people who had already been through the programme. The residents also demonstrated an awareness of the funding issues, and that an individual contract for them between the service commissioner and Sefton Park existed. The group of residents were of a wide age range; the gender ratio was 4:1 male to female; the group was of mixed ethnicity. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 9 Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are aware of current good practice. Their practised promotes individuals to develop skills, including for some residents, independent living skills. EVIDENCE: All of the residents have an individual care file. The residents had their individual needs reflected on the care plans, and there was evidence that plans were reviewed and evaluated on a regular basis. The residents have responsibility to produce written work appropriate to where they are in the programme i.e. life histories. In addition to this the counsellors keep records of therapy sessions. The home also records any visits to other agencies such as GP, or probation officer. The care documentation at the home links together and can be used to track a residents progress from the initial referral with the presenting care Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 11 needs to working through the programme, and the after care required on discharge e.g. housing. The planned discharge arrangements supports residents to take responsibility for moving on from Sefton Park. Residents can access the Internet and use the telephone to make enquiries and set up appointments. The home must formalise the risk assessment part of the care assessment to demonstrate good practise and reflection of NTA guidance. This identifies potential risks and possible triggers that may cause relapse or disciplinary discharge. Risk assessments should outline strategies for safeguarding the health and welfare of service users after discharge. Individual choice and decision making is subject to the limitations of the programme, however, all the residents stated they were treated as individuals and supported as such. The strict routine and house rules do require a period of adjustment, which varies with the individual. Within the home there are personal choices made about meals etc, and all residents can leave the programme if they wish to. However the predominant view was that the residents understood the house rules were for their own good, and that it enabled them to focus on their progress through the programme. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling residents to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals and work to achieve them. EVIDENCE: As part of the programme the residents can attend Alcoholics Anonymous and Narcotics Anonymous meetings. The home operates a programme of group therapy and group support so that the residents learn to deal with issues that arise for them and to support others. The resident group at Sefton Park stated that they had learnt about themselves, especially through doing their life story, and by receiving feedback from their peers. The group support also ensures that people cannot isolate themselves when there are no planned therapy groups, and that untoward behaviour is challenged. The residents felt that on their arrival to the home this felt quite strange, however the benefits of having Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 13 a peer group/buddy often more advanced in the programme than themselves was very positive. It allowed them to express ideas/concerns as they occurred rather than having to wait until there were counsellors in the home. The residents were also very aware that the programme at Sefton Park although quite intensive had a high success rate. Within the group there is also a responsibility toward others, and one resident commented that they felt safe within the group and that what was discussed in sessions was confidential and not taken to outside agencies. The inspector asked the residents about the programme, in particular the challenging of each other by the group. Initially this was found to be very uncomfortable. However by reflecting on responses and views expressed by peers, the residents stated they felt that it was an essential part of the programme. Residents take responsibility for the day to day running of the household and all have allocated tasks. The home pays a nominal amount each week to those who participate. The residents stated they were not involved in meal planning, although took part in the preparation and serving of meals. The food was stated to be good, however the menu did not reflect the ethnicity of the resident group. This was brought to the attention of the manager and the inspector suggested it be included as a standing item in the weekly house meetings. One resident also suggested that the home could be recycling to reduce the amount of rubbish produced. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. EVIDENCE: All the residents require support through the programme, which is provided through counselling on a one-to-one basis and through group therapy. The house rules dictate that residents are well groomed and wear clean clothing in order to develop their personal-care skills and their sense of self respect and respect towards their peers. Some of the residents have health care needs which require external appointments such as hospital treatment, these needs are assessed on admission and local services accessed when necessary. The residents are supported to achieve optimum health and well being. Medication at the home is minimal; the inspector was able to review the system and records which were accurate at the time. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 15 Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture, which enables residents to express their views, and concerns in a safe and non blame environment. Residents and others associated with the service state that they are very satisfied with the service provision. They feel very safe and well supported by an organisation that has their protection and safety as a priority. EVIDENCE: Sefton Park ensures that all residents receive a copy of the complaint procedure. No complaints had been recorded at the home. Two counsellors have has recently attended the No Secrets training; there have been no adult protection issues at the home. The residents were able to confirm that the systems at the home support them when raising issues; none of the residents who spoke with the inspector expressed any dissatisfaction or concerns about the home. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and is suitable for its stated purpose. EVIDENCE: The building was toured on the last visit. On this visit the inspector confirmed with the residents that the home was well maintained and that no hazards had been identified. Residents also confirmed that any issues of maintenance were raised at the weekly meeting and addressed quickly. The manager has an ongoing plan for redecoration and refurbishment, subject to funds and availability of premises. Laundry facilities were available for residents to use, and were stated to be in working order and sufficient to meet the needs of the client group. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff rotas take into account the needs and routines of the people who use the service. The skills and training of the staff team are planned as to meet the needs of the service users. EVIDENCE: The home is staffed on a 24-hour basis; out of hours staffing is by support workers, whilst counsellors are on call. The statutory training for staff generally was up-to-date. The specialist skills training requirements, linked to the DANOS recommendations for support staff working in drug and alcohol rehabilitation, had been met as staff either had or were working toward equivalent counselling qualifications. The support workers at the home were praised by residents for their skill and understanding approach, however they mostly work on their own any should be given the opportunity for supportive supervision. The inspector and manager agreed that the support workers currently only received informal supervision during handovers and debrief at the start and finish of shifts. This is not recorded supervision. Currently there are no support staff meetings but this can be introduced as a group supervision format and minutes taken. The external supervision for clinical staff is continuing, and this is supplemented internally, by clinical staff group meetings. The minutes from the meetings Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 19 were too brief for them to be a record of a group supervision, however the manager will address this. The manager must also introduce a formal supervision/appraisal system in order to identify individual training needs for all staff. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is person centred in their approach and leads the staff team who have been recruited and trained to meet occupational standards. EVIDENCE: The inspector and manager discussed management training appropriate to job role and personal development. This may be a DANOS training programme or a public sector CMS/DMS which could be accessed locally. The quality assurance carried out at the home includes collation of information relating to retention rates, service user satisfaction and completion rates. The home also holds regular reunions, which are well attended and give an indicator to the success of the programme. Regulation 26 visits are being undertaken by Elizabeth Maguire. Records of these visits are held at the home. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 21 The manager was advised to read the regulation to ensure that the records reflect what is required. The homes policies and procedures are reviewed on a regular basis and reflect current legislation and good practice guidance for rehabilitation programmes. The record keeping at the home is maintained by the staff; residents are aware that they have the right to see all records held on them. The arrangements for the general administration of all documentation, apart from financial records, was discussed with the manager. The home may benefit from introducing more organisation to the systems used to avoid duplication and making information easier to find. Whilst at the home there were no areas of concern about the health and safety implementation. The inspector was able to see records of testing and maintenance of equipment. The fire alarm system testing had been implemented appropriately, with regular testing of equipment and drills. The inspector reviewed the accident records for residents/staff, which indicated seven minor incidents since April 06, which was not predictable and therefore not preventable. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 12(1)a Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users. This relates to the completion of risk assessments for all service users and reflect guidance from NTA in respect of discharge planning (section 2). The registered person shall, ensure that persons working at the care home are appropriately supervised. This relates to the introduction of formal internal management supervision for all staff (section 7). Timescale for action 24/11/06 3. YA36 18 (2) 24/03/07 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 Good Practice Recommendations DS0000050772.V319316.R01.S.doc Version 5.2 Page 24 Sefton Park Residential Care Home 1 Standard YA41 The manager as the home may benefit from introducing more organisation to the systems used to avoid duplication and making information easier to find. Sefton Park Residential Care Home DS0000050772.V319316.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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