CARE HOME ADULTS 18-65
St Anne`s Alcohol Services - Leeds Ashton House 186 Woodhouse Lane Leeds West Yorkshire LS2 9DX Lead Inspector
Sue Dunn Key Unannounced Inspection 15th January 2007 11:40 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.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 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.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. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Anne`s Alcohol Services - Leeds Address Ashton House 186 Woodhouse Lane Leeds West Yorkshire LS2 9DX 0113 2434486 0113 2451526 detox@st-annes.org.uk jenkinlodge@st-annes.org.uk St Anne`s Community Services 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) Mr Jonathan Philpott Care Home 27 Category(ies) of Past or present alcohol dependence (27) registration, with number of places St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: Leeds Alcohol Service provided by St Anne’s is situated in St Marks House, a large two storey detached Victorian house. Three of the 20 beds are currently used for acute detoxification and 17 for rehabilitation. This has been a reduction in the overall service due to the withdrawal of funding by the PCT. Offices, medication room and training rooms remain in the adjoining Ashton House. The purpose of the service is to provide acute nursing care and a structured programme of rehabilitation for people with alcohol related illnesses and associated problems. The care home is well located in the university area of Leeds within walking distance of the city centre. A fence around the property creates safe sitting areas for the service users. There is a small area for visitor parking in front of the building. All bedrooms are below the minimum size requirement but all offer single accommodation and are regarded as fit for purpose. St Marks House has two lounges, dining room and a games room, which offer communal space. A bed sitting unit offers a stepping stone for people preparing to move back out into the community. Meals are provided from a central kitchen in St Marks House with facilities to enable people to make their own drinks and snacks. The service has a trained nurse on duty for 24 hours working in partnership with a team of experienced alcohol support workers. The registered manager is supported by a deputy nurse manager and has overall responsibility for the service. The fees for the home range from £478 to £1400 per week. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcomes for service users. The inspection report is divided into separate sections with judgements made for each outcome group. The judgements reflect how well the service delivers outcomes to the people using the service. The categories are “excellent”, “good”, “adequate” and “poor”. More detailed information about these changes is available on our website – www.csci.org.uk. The last key inspection was carried out in January 2006. The manager completed a pre-inspection questionnaire and this with information supplied by the home during the course of the year was used as part of the inspection process. Comment cards were sent to service users (8 were completed and returned) and social care professionals, whose views have been included in the inspection report. One inspector carried out the inspection visit which started at 11.40 am and finished at 16.50 pm. After a short period of detoxification the service offers a 13 week structured programme of rehabilitation. People are accepted for rehabilitation subject to a commitment to adhere to the programme. It is made clear at the outset that there will be some restrictions on choices during their stay. The managers were said to have worked ‘fantastically’ well to change and develop the home into an effective rehabilitation unit with support pathways in and out of the unit. What the service does well:
The Statement of Purpose is regularly reviewed to make sure the information it contains is up to date. Service user guides for both services make it clear to anyone reading them exactly what to expect from the service. The manager has made links with other professionals working in the community so that they are able to give accurate information to prospective service users. There is clear evidence to show that people are involved in and agreed to their care programme. Everyone follows the same standardised care plan process for detoxification and rehabilitation. The differences were in the support people received to manage their personal lives. The programme fills each weekday and provides opportunities for developing personal and life skills, making lifestyle changes and joining in social and recreational activities. Service users
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 6 discussed their daily programmes and were very positive. Returned questionnaires showed people accepted they had choice in the evening and at weekends but had to follow a programme during the week. Service users said they felt they benefited from the support of each other as well as the staff. They said the company of others was enjoyable and agreed there was ‘a lot of laughter’. Comments were made such as ‘its given me back self-respect’ and ‘I’ve learnt to laugh again’. People have 1 to 1 support from staff as well as group activities. A balanced diet is seen as an important part of recovery. The cook was cheerful and approachable and responded positively to requests. People were seen to approach her directly regarding their lunchtime preferences. Facilities were available for making hot and cold drinks and snacks and fresh fruit was left in the dining area for people to help themselves. As people move into the rehabilitation programme health care needs are met by their own GP’s and community services. Out of hours cover is provided through Care Direct. This keeps their own GP involved and up to date for when they return to the community. The home has a good history of thoroughly investigating any complaints, from any source. Service users were kept informed about any events which may affect them and were encouraged to express their views. There is an ongoing programme of repairs and maintenance. The home has recently been awarded some funding for improvements and plans include replacing window frames, which were warped and ill fitting, upgrading the central heating system, refitting the bathrooms, furniture and floor coverings and improving the kitchen. The managers were said to have worked ‘fantastically’ well to change and develop the home into an effective rehabilitation unit with support pathways in and out of the unit. What has improved since the last inspection?
People referred for the rehabilitation service have the opportunity to visit the home and speak to staff and other service users before committing themselves to the programme. There was a reduction in the level of smoking as people were occupied during the day. This, and the fact people have daily cleaning chores, has had a positive effect on the cleanliness of the home and the appearance of the furnishings and fittings. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 7 The admitting GP is a local GP employed through an agency. His visits are arranged around planned admissions and in between if someone is admitted for detoxification. (The home has a budget to employ a doctor for the service and have advertised the post, so far without success). A Registered Mental Nurse (RMN) with counselling skills had been appointed as the deputy manager. This appointment provides stability for the clinical supervision of nursing staff. He had improved the organisation of the clinical area and medication systems, putting safe systems in place for the receipt, storage and disposal of medication. Over bath showers had been fitted and service users were benefiting from the improved bathroom facilities. Service users felt that the facilities in the home were good. One person said ‘its like a palace if you have been sleeping rough’. Other comments were, ‘its clean warm and comfortable and you get three good meals a day.’ Staff recruitment and selection procedures, inspected centrally by a representative of the CSCI, were found to follow good practice guidance and meet the standards. What they could do better:
There should be clearer recording to show the reason behind decisions for people moving through each stage of the detoxification programme. The nursing staff should make sure the contractors responsible for the disposal of medication follow their procedures so that their records can be audited against the home’s medication disposal records. There should be a system in place to ensure all staff receive updated training on the topics covered by the initial induction-training course. During a tour of the building the laundry door had again been propped open by a chair, despite a large notice saying the door must be kept closed for fire safety reasons. It is recommended that the door be fitted with a hold open device linked to the fire alarm system. The frequency of staff supervision had slipped. This must be undertaken a minimum of 6 times a year. The only negative comments from service users were about the loss of the Ashton House facility. Meetings are to take place regarding the future of Ashton House. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 8 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. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 9 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 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4 and 5. Quality outcomes in this area were good. This judgement has been made using all the available evidence which included information provided by the manager, comments and discussion with service users, inspection of documentation and a visit to the service. Prospective service users and their representatives have the information they need to allow them to make an informed decision to use the service. A licensing agreement clearly tells them about their own and the home’s responsibilities. EVIDENCE: The Statement of Purpose had been updated to include details of the Deputy Nurse Manager who had been in post since September 2006. Service User Guides for the detoxification service and the rehabilitation service were very informative, making it clear to anyone reading them exactly what to expect from each service. The manager had been working with the community alcohol services so that social workers were aware of the structured nature of the programmes and could discuss this with anyone needing the service. Some people who were
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 11 referred for rehabilitation after detoxification in hospital had the opportunity to spend a couple of day visits at the unit to allow them time to make a decision about committing to the programme. Others were assessed over the telephone on referral and a date agreed for admission when a more detailed assessment was carried out. The assessment process included a ‘readiness to change’ questionnaire, as only people who show a readiness to do so are accepted on the programme. Every service user signs a licensing agreement at the start of their programme. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10. Quality in this outcome area was good This judgement has been made using all the available evidence, which included examination of documentation, discussion with service users, the manager and staff as well as a visit to the service. Individuals make a positive decision to follow the structured care programme and are supported to take an active part in making decisions about their future lives. EVIDENCE: Three care files were inspected, one for a person on the detoxification programme. The files included a full assessment with details of past history of drinking and expectations. The service user had signed the assessments and the agreement to the programme of care. The rooms used for people on the detoxification programme are in the same building as rehabilitation, therefore new service users are asked to stay in
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 13 their room until they have a negative breath reading. This separates people who have been drinking from those on the rehabilitation programme. The programme is explained again verbally on the second day of admission. This was all recorded in the daily notes Care files showed the standard plan of care for each of the three stages for detoxification. Daily 1 to1 meetings with a nurse reviewed the service users progress before they moved to the next stage. It was not clear on reading the notes how decisions were reached for the person to move on a stage. It simply stated ‘moved to stage 2’. The recording by nurses should make this clear. In one file an additional care plan was added to the standard format for rehabilitation to show how the service user was to be supported with other problems. The individual rehabilitation programme for this person showed it was built into the week. Each service user had a copy of their programme plan, which was being used to guide day-to-day activities. Five service users spoken with gave their views and felt the service was good. They accepted that there was a need to follow the programme, albeit with some reluctance at times. One person said ‘it is sometimes difficult to see the purpose of some of the things we do but at about week 7 it suddenly all starts to click into place’. Service users said they felt they benefited from the support of each other as well as the staff. Another said the company of others was enjoyable and there was a lot of laughter for the first time for years. The commissioners, who provide funding for the service, had met with large numbers of service users and received no negative comments. People who had used the service in the past were able to make favourable comparisons with the present. There was one person living independently in the rehabilitation flat doing his own shopping, cooking and care in preparation for his return to the community. A photograph of each service was held on the medication records kept in the medication room. All personal information was held securely in lockable filing cabinets. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent This judgement was made using all the available evidence which included information provided by the manager, discussion with service users, examination of care files, observation and a visit to the service. The structured programme of practical social and leisure activities helps service users to develop skills and make lifestyle changes. They are kept informed and given opportunities to express their views individually and as a group about the menus and any other matters which affect their daily life within the home. EVIDENCE: Service users’ discussed their daily programmes and were very positive. Returned questionnaires showed people accepted they had choice in the evening and at weekends but had to follow a programme during the week.
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 15 Weekly social and educational activities included daily cleaning chores, dining club (which helps develop shopping and cooking skills), computer skills, numeric and literacy skills, art and craft, books, music (one person was seen practising the guitar), cinema, television and DVD, cinema, darts, snooker, use of leisure cards, working on the allotment, voluntary work, college access, (changes in further education policy has affected opportunities for people to ‘sample’ courses). Individuals were seen to have appointments during the day with the skills tutor and administrator for assistance with practical matters. One person was talking about a job application. A ‘Me, Myself and I’ group was running during the afternoon. This was designed to give people training to use their own resources for occupation. One person felt this was rather ‘boring’. There was a reduction in smoking as people were occupied during the day. This has had a positive effect on the appearance of the home’s furnishings and fittings Comments were made such as ‘its given me back self-respect’ and ‘I’ve learnt to laugh again’. A balanced diet is seen as an important part of recovery. The cook was cheerful and approachable and responded positively to requests. People were seen to approach her directly regarding their lunch preferences. Lunch included a range of choices of hot and cold sandwiches and, omelettes. A large bowl of fresh fruit was placed in the dining room for people to help themselves. Facilities for making hot and cold drinks were also available. People made their choice of main meal from daily menu sheets which, through meetings, included their own suggestions. The nurse said that the cook could provide for special diets such as for coeliac disease. The manager said that several ex service users attended the Christmas party. Christmas can be a difficult time and none of the service users chose to go on home leave during the Xmas period. This was seen as a positive commitment to the programme. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 16 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 and 20. Quality in this outcome area was good. This judgement was made using all the available evidence including examination of documentation, discussion with service users, the nurse manager, observation and a visit to the service. The health and personal care that people received was based on a standard programme for alcohol withdrawal and rehabilitation with the addition of a plan of care based on individual needs. The principles of respect, dignity and privacy were put into practice. EVIDENCE: A standard 3- stage nursing plan was used for people admitted for alcohol withdrawal. They were assessed on admission, seen by the GP and remained under close observation by a trained nurse for stage 1 of the programme whilst withdrawing from alcohol. Daily records showed the move from one stage to the next but it was not clear how the decision was reached that people were ready to move to the next stage.
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 17 The admitting GP is a local GP employed through an agency. He visits the home every 10 days for planned admissions and in between if someone is admitted for detoxification. (The home has a budget to employ a doctor for the service and have advertised the post, without success). As people move into the rehabilitation programme health care needs are met by their own GP’s and community services. Out of hours cover is provided through Care Direct. The manager described the care of an ex service user with special health care needs who was cared for with the assistance of the district nursing team. A Registered Mental Nurse (RMN) with counselling skills had been appointed as the deputy manager. Since taking up post he had made changes to the way medication was stored and handled and reorganised the clinic room to make all equipment is easily accessible. Safe systems were in place for the receipt storage and disposal of medication and for medication taken by people going on home leave. Controlled drugs were safely monitored and disposed of. Medication disposal was through a contracting company. Systems were in place for auditing the unused medication. However the contractors had not followed their usual procedure of faxing confirmation of the last batch of medication to enable this to be audited against the home’s disposal book. The deputy manager said he was following this up. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 18 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 and 23. Quality in this outcome area was excellent. This judgement was made using all the available evidence including information from the home’s manager during the course of the year, discussion with service users, the manager and staff, returned questionnaires and a visit to the service. Service users and staff were able to express their views and concerns and were protected by a robust and effective complaints procedure. EVIDENCE: All the people who returned questionnaires said they had been told about the complaints procedure and would know who to talk to if they had any concerns. It was apparent during the visit and from the returned questionnaires that nobody wished to remain anonymous and people were not afraid to express their views. The commissioning service has received no negative comments The home has a good history of thoroughly investigating any complaints, from any source. A member of staff was recently referred to the Nursing and Midwifery Council (NMC) and the Protection of Vulnerable Adults register (POVA) following a complaint investigation. The organisation provides induction training for all staff, which includes Adult Protection training. A member of staff who had been employed for several years had not had an update for 7 years. The home also liaises with the Child Protection agency. Staff last had training on this 2 years ago.
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28 and 30 Quality in this area was good. This judgement was made using all the available evidence, which included discussion with the manager and service users, a tour of the building and a visit to the service. The manager was aware of the work needed to maintain standards. A planned and ongoing programme of maintenance and refurbishment kept the environment to a satisfactory standard. Service users were benefiting from the improved bathroom facilities and cleanliness of the building since the last inspection. Fire safety in the laundry area continued to be a concern. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 20 EVIDENCE: There was a significant improvement in the overall standard of cleanliness of the building as service users now share domestic chores as part of their daily programme. This had led to people taking more responsibility and pride in their surroundings whilst developing self-care skills. The reduction of smoking in the building had also prolonged the appearance of redecorated and carpeted areas previously damaged by smoke and marks from high levels of cigarette smoking. Further improvements to the building included the fitting of over bath showers. The manager said the home had been allocated some ‘Safer Leeds’ finance, which was to be used to improve the environment. The manager’s wish list included, replacing window frames which were warped and ill fitting, upgrading the central heating system, refitting the bathrooms, furniture and floor coverings and improving the kitchen. During a tour of the building the laundry door was found propped open by a chair, despite a large notice saying the door must be kept closed for fire safety reasons. It is recommended that the door be fitted with a hold open device linked to the fire alarm system. Meetings are to take place regarding the future of Ashton House. The manager felt that the detoxification programme was working well in St Marks House. However, the only negative comments from service users were about the loss of the Ashton House facility. Service users felt that the facilities in the home were good. One person said ‘its like a palace if you have been sleeping rough’. Other comments were, ‘its clean warm and comfortable and you get three good meals a day.’ St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 34, 35 and 36 Quality in this outcome area was good. This judgement was based on all the available information which included discussion with staff, information received from the manager and Provider Relationship Manager (PRM), discussion with the deputy nurse manager, discussion with and information from service users and a visit to the service. Service users benefit from a trained and competent staff team who are able to work within a structured programme whilst retaining a person centred approach. EVIDENCE: The organisation provides a standard training package for all staff, this was followed by additional training relevant to the work staff carried out. The deputy nurse manager had developed an additional induction specifically for new nurses. One nurse was in the process of going through this. Three new nurses with experience of addiction services had been appointed and were to start once the CRB checks had been completed. A Registered General Nurse on the staff team was able to give guidance on physical care needs.
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 22 The home has a trained nurse on duty at all times supported by alcohol support workers who had developed their knowledge, experience and skills after years of experience working in this changing and developing service. One support worker spoken with had in addition to mandatory training done a one day child protection training, had just enrolled on (National Vocational Qualification) NVQ and was booked to do a drugs awareness course. Another support worker was awaiting verification of the NVQ award. This had taken a year to complete as the assessor left and she had to restart. Five staff were doing auricular acupuncture training, an art therapy course was planned and diversity and equality training was planned as part of the service users’ programme. The manager should make sure that staff who did their induction training several years ago receive routine training updates. A project worker based at the unit was working with people with a dual diagnosis of mental health illness and alcohol abuse. Recruitment and selection procedures were inspected by the provider relationship manager for all the organisation’s services, who noted their good practice. This confirmed the findings of previous inspections. Staff spoken with were very confident and clear about their roles. Service users said they were prepared to listen and assist as required. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 23 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, 38, 39, 40, 41, 42 and 43 Quality in this outcome area was good. This judgement was made using all the available evidence which included, information from the PRM, information and discussion with the manager, discussion with staff and service users, examination of documentation observation and a visit to the service. The management of the home gave service users the opportunity to express their views and take an active part in their recovery programme. Effective systems were in place for the management and development of the service in response to the needs of service users. EVIDENCE: A well-qualified deputy nurse manager had been appointed to support the manager and provide clinical support for the nursing team. A trained RMN, he
St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 24 had worked at the unit as an agency nurse, completed a degree in Psychiatric Health and had a counselling background which allowed him to lead the group therapy sessions which service users found so valuable. He was receiving external supervisory support for his counselling role. The appointment of a permanent team of nurses, once all are in post, will allow the manager time to complete the last units of NVQ level 4, which he anticipates completing by the end of March. He can then go on to start the long awaited Diploma in Addiction. The manager had supervision from his line manager on the day of the visit. He admitted that staff supervision has not met the required 6 times a year due to the staffing issues since financing for the nursing service had been withdrawn. Service users had the benefit of 2 weekly meetings and 1 to1 support during their programme, which enabled them to express their views. None of the people who returned questionnaires wished to remain anonymous which spoke well for the open attitude within the home. With changes to the way finances are paid the home does not handle any personal money. Client valuables, left for safekeeping, were well recorded and signed for. An activities fund was available to assist people with subscriptions for such things as hobbies and equipment. People in the dining club and the person in the training flat, received money from petty cash to purchase food. A dedicated support worker had the task of supporting people to sort out any debts. After a financial assessment Social Services administers any rent collection and rate payments The home had systems in place for routine safety checks, which were recorded. There were no hazards noted during this visit other than the laundry door, as mentioned earlier in the report. St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 25 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 4 2 3 3 3 4 3 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 4 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 4 3 3 3 2 3 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA24 YA42 Regulation 23 Requirement The registered manager must protect the welfare of staff and service users from risk of fire by ensuring the laundry door is not propped open Staff supervision must be undertaken a minimum of 6 times a year. Timescale for action 31/03/07 2. YA36 18 31/12/07 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 27 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 Refer to Standard YA20 Good Practice Recommendations Staff should make sure that the contractors responsible for the disposal of medication follow their procedures so that their records can be audited against the home’s medication disposal records. The reason behind decisions for people moving through each stage of the detoxification programme should be recorded more clearly in the care files. It is recommended that the laundry door be fitted with a hold open device linked to the fire alarm system. Staff training should include updates (particularly for staff who have been in post several years) on topics covered in the induction. 2 3 4. YA6 YA19 YA41 YA42 YA35 St Anne`s Alcohol Services - Leeds DS0000001352.V326470.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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
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