Inspection on 05/12/06 for Smithfield Detoxification Unit

This inspection was carried out on 5th December 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Smithfield Detoxification Unit 21/04/08

Smithfield Detoxification Unit 12/10/07

Smithfield Detoxification Unit 23/02/06

Smithfield Detoxification Unit 22/09/05

Smithfield Detoxification Unit 10/11/04

Smithfield Detoxification Unit 08/06/04

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Hamer Cottage

Turning Point (Hoole Road)

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

CARE HOME ADULTS 18-65 Smithfield Detoxification Unit Thompson Street Collyhurst Manchester M4 5FY Lead Inspector Val Bell Key Unannounced Inspection 5th December 2006 11:00 Smithfield Detoxification Unit DS0000021657.V313099.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 Smithfield Detoxification Unit DS0000021657.V313099.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. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smithfield Detoxification Unit Address Thompson Street Collyhurst Manchester M4 5FY 0161 839 8829 0161 839 8825 ruth.anson@turning_point.co.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) Turning Point Ruth Elizabeth Anson Care Home 32 Category(ies) of Past or present alcohol dependence (0), Past or registration, with number present alcohol dependence over 65 years of of places age (0), Past or present drug dependence (0), Past or present drug dependence over 65 years of age (0) Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users require care/treatment by reason of either past or present drug dependence (maximum 10 places) or past or present alcohol dependence (maximum 22 places) Service users requiring care by reason of past or present drug dependence will be accommodated for a maximum of one month. Service users requiring care by reason of past or present alcohol dependence will be accommodated for a maximum of ten days. 23rd February 2006 Date of last inspection Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 5 Brief Description of the Service: The Smithfield Project is a registered service providing a residential detoxification service with 22 places for people with primary alcohol problems, and 10 places for people with primary drug problems. The alcohol detoxification service is generally based on a 10-day programme. The drug detoxification service offers 10 places based on a 28-day programme and some clients are admitted to the drug detox for a 14-day stabilisation period. Referrals to the service are taken by the Care Pathway Co-ordinator, who prioritises need and either offers the client an assessment/admission date, or if there is no bed available, adds the client to a waiting list. The project is situated very close to Manchester City Centre, with easy access to public transport routes. The building also contains administrative offices. Bedroom accommodation is based on the ground floor and the first floor for the alcohol unit and the first floor for the drug unit. All bedrooms are single with hand washbasins. Communal space is provided in both units along with a range of kitchen and laundry facilities and a lift is provided for clients with restricted mobility. Both units are completely separate, although clients can attend all support groups or participate in the therapeutic programme, and share the communal day room. The project is staffed by Registered Nurses and Support Workers, throughout the 24-hour period. The fees charged for the service are £167 per night (contract price) and £205 per night (spot purchase price) Fees are usually paid by the relevant Primary Care Trust or, very occasionally privately. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over two days 5th and 15th December 2006. Various records, including care plans, were examined and conversations were held with management, three members of staff and three clients. What the service does well: What has improved since the last inspection? Timely action had been taken to address the three outstanding requirements. The medication policy had been reviewed and updated to include clear instructions on the administration of homely remedies to clients. Improvements had been made to the décor on the alcohol unit to provide a more pleasing living environment. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 7 Ongoing training and National Vocational Qualifications were available to support staff to ensure that they had the necessary skills and knowledge to meet the clients assessed needs. The employment of a Care Pathway Co-ordinator provided continuity of support for clients by providing the link with aftercare services following discharge. 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. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 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 Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A robust system of assessment ensures that individual clients needs are identified and recorded. This enables the home and clients to make a decision on whether the service will be able to meet individual’s needs. EVIDENCE: The home has a current referral and admission policy that clearly explains the criteria for providing an alcohol and drug detoxification service. The policy provides evidence that equality and diversity issues are recognised and valued to ensure that the service is flexible in meeting individual clients special needs such as mental ill-health and physical disability. The home accepts referrals from Tier 2/3 Community Drug and Alcohol Teams, Specialist Substance Misuse Workers and Drug and Outreach Workers. Selfreferrals are also accepted although the home recognises the benefits to clients in the support provided by having a discharge plan negotiated by the Tier 2/3 services. The home requires that all referrals complete a Smithfield Detoxification Referral form. Tier 2/3 referrals also provide a Community Care Plan, a current risk assessment, physicians report and a discharge plan. All referrals are screened by the Care Pathway Co-ordinator to decide if the referral is appropriate. People are then placed on the waiting list in order of Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 10 priority. At the appropriate time the client is invited to attend for an admission assessment and this may include the referrer and a family member or friend. The assessment looks closely at how the home can meet an individual’s needs and further develops the risk assessment and risk management plan. A final decision regarding admission is made following discussion with the staff team. Five clients’ files were examined and these contained completed assessments of need. These provided clear and comprehensive information. In conversation with three clients it was confirmed that they had been fully involved in their assessments of need and had received detailed information about the service prior to their admission. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 11 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): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A comprehensive system of care planning, monitoring and review ensures that clients assessed needs will be met. EVIDENCE: Five care plans were examined. These care plans had been developed from the assessments of need and clients had signed the care plans to indicate their agreement with the contents. Clients had been assigned keyworkers and were subject to very close monitoring throughout the detoxification programme and detailed outcomes were recorded in the daily notes. Their progress had been reviewed on the third and fifth day following admission. Clients confirmed that restrictions on choice and freedom imposed by the treatment programme had been clearly explained and their consent had been obtained. This was consistent with the purpose of the detoxification service. A Care Pathway Co-ordinator had been appointed for the purpose of screening referrals and to co-ordinate aftercare services. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 12 Clients retained control of their own finances and the home offered support for people to claim their entitlement to benefits. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Clients’ leisure and therapeutic needs are met and they enjoy a healthy and appetising diet during their stay in the home. EVIDENCE: The home provided therapeutic and leisure activities. Clients attended daily therapeutic groups and leisure activities included pool, table tennis, board games, computer groups, Sky TV and films. The views of clients’ family and friends were listened to and clients were encouraged to maintained their personal relationships during their stay in the home. One of the clients said that his brother had visited him in the home. Three clients confirmed that staff treated them with respect and that their rights were maintained. It was observed that staff interacted well with clients throughout the inspection, offering support and guidance as necessary. One of Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 14 the clients said, “I have been worried about how I am going to cope after discharge. My keyworker has been encouraging me to focus on activities that I used to enjoy. I think this might help. The staff are very good. They treat you like an equal.” Another client said, “This is a very good service. The staff are very helpful and understand my problems. I can talk to them if I am worried about something.” The home operates a four-weekly menu that provides a healthy and well balanced diet. A choice of three hot meals is available at lunchtime and clients can choose a hot meal, a salad or sandwiches for their evening meal. Special diets are catered for, such as vegan/vegetarian, low fat and diabetic meals. The cook also confirmed that that the home could accommodate the dietary needs of people from ethnic minority groups. The kitchen was being managed well and records required by food safety legislation were accurate and up to date. Food was stored appropriately and cleaning schedules for food storage and preparation areas were in place. Facilities were provided on each unit for clients to make their own drinks and snacks. Clients praised the quality of the food provided. One client said, “We get several choices and the meals are excellent. I wasn’t eating much before I was admitted, but I’ve got my appetite back because all the meals are so good.” Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home demonstrates respect and value in meeting clients’ diverse support needs. However, failure to accurately record the administration of medication to some clients potentially places the health and welfare of these individuals at risk. EVIDENCE: Care plans provided evidence that clients’ healthcare needs are carefully monitored, particularly in relation to assessing the effects of withdrawal. A general practitioner is in attendance at the home for six mornings and two afternoons per week. Consistency and continuity of support for clients was provided through designated keyworkers and partnerships with family, friends and relevant professionals outside the home. None of the clients in residence at the home required support with personal care although guidance on personal hygiene issues was available. It was observed that staff afforded clients privacy by knocking on their bedroom doors before entering. Three clients confirmed that their right to privacy and dignity was respected. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 16 The home arranged interpreter services for people whose `first language was not English. Examples of this included the provision of Somali and Arabic speaking interpreters for two clients admitted to the home. The medication policy had been reviewed and updated as required at the last inspection. The homes system of medication administration was assessed on one of the units. Medication was securely stored in the unit offices and administered by nursing staff. The medication records were generally accurate and up to date. However, it was noted that the records contained several gaps where medication had not been signed as administered. This places the health and welfare of some clients potentially at risk, as it was not clear if they had received their medication as prescribed. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A robust system for investigating complaints and procedures for dealing with allegations or suspicions of abuse afforded protection to client’s welfare and safety. EVIDENCE: The home had a complaints procedure and five complaints had been recorded in the previous twelve months. Records provided evidence that complaints were thoroughly investigated within the prescribed timescales. One of these complaints had been investigated by a senior manager although the registered manager had not been informed of this complaint. This denied the registered manager the opportunity to ensure that the complaint had been investigated thoroughly as required by regulations. Clients confirmed that they had been given information on how to make a complaint. The home had adopted Manchester local authority’s policy and procedures on the protection of vulnerable adults from abuse (POVA). Conversations with three members of staff confirmed that they had received training in the awareness of abuse and understood the correct procedures to follow if abuse was alleged or suspected. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home meets the accommodation needs of clients in line with the aims and objectives of the detoxification service. EVIDENCE: A tour of the home’s communal and private space was undertaken. The environment was clean and hygienic and improvements had been made to the décor as required at the last inspection. The manager said that a full refurbishment was planned and the funding was awaited. The home provides a variety of lounges and toilet and bathing facilities. A lounge for visitors with children was available. The home provides full access for people with a physical disability. Records provided evidence that the homes equipment had been serviced on a regular basis. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 19 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, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Clients could be confident that staff would be suitably qualified and experienced to meet their assessed needs. EVIDENCE: At the time of inspection the home employed fifteen first level registered nurses and nineteen support workers. Four of the support workers were working towards NVQ level 2 in care. On appointment staff underwent a structured modular induction programme covering corporate issues, health and safety, protection of vulnerable adults equality and diversity and finance and negotiation skills. A newly appointed nurse said that she had completed the first module and had been booked on the remaining three modules in January 2007. Ongoing training included group working, first aid in the workplace, fire awareness and core training. Further training had been planned in the areas of moving and handling, de-escalation and first aid. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 20 The home had a robust system of recruitment and selection. Personnel files contained copies of the required pre-employment checks. A social work student on work placement at the home said that the required preemployment checks had been obtained prior to the start of his placement. He also said that he had been provided with training opportunities and he praised the support that senior staff provided. Staff said that they received supervision on a regular basis. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 21 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, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well managed, clients’ views are listened to and action is taken to consistently make improvements for the benefit of people using the service. EVIDENCE: The registered manager is appropriately qualified and experienced and has responsibility for day-to-day operations and the clinical performance of both the drug and alcohol detoxification units. Each unit has an appointed manager. The home received a commendation for the effectiveness of its quality assurance and monitoring system, which is considered to be an example of best practice. Satisfaction surveys had been issued every three months. Statistics from client feedback had been produced and the overall average score clearly identified where improvements needed to be made. Comparison Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 22 of the previous two surveys scores demonstrated that this system of quality assurance had resulted in measurable outcomes of improvements to service provision. In addition to satisfaction surveys the home had adopted a quality assessment tool for auditing systems, policies and procedures on an annual basis. The most recent audit was conducted in March 2006. Furthermore, the home monitored clients’ compliments and concerns on a monthly basis. A sample of clients’ feedback included several expressions of thanks to staff and a poem written by a client and dedicated to staff. A sample of health and safety records was assessed. Records relating to the testing of gas and electrical appliances were accurate and up to date. Similarly, fire and the Control of Substances Hazardous to Health records were current. However, it was noted that there had been three referrals of clients to accident and emergency departments, which had not been notified to the Commission as required by regulation. Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 23 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 2 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 X 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 2 X 3 X 4 X X 2 X Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 24 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 13 (2) Requirement The registered person must ensure that medication is administered as prescribed and that any omissions are explained and recorded. The registered person must ensure that any complaint made under the complaints procedure is fully investigated. The registered person must give notice in writing to the Commission of any event that adversely affects the welfare of clients. Timescale for action 05/01/07 2. YA22 22 (3) 05/01/07 3. YA42 37 05/01/07 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 Standard Good Practice Recommendations Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Smithfield Detoxification Unit DS0000021657.V313099.R01.S.doc Version 5.2 Page 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!