Inspection on 30/12/08 for St Davids

This inspection was carried out on 30th December 2008.

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

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

St Davids 09/01/07

St Davids 21/02/06

St Davids 07/10/05

St Davids 20/12/04

St Davids 14/06/04

St Davids 10/03/04

Similar services:

Clouds House

Clouds House

Closereach

Closereach

Chandos House

Chandos House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Davids 50 Walliscote Road Weston Super Mare North Somerset BS23 1XF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Juanita Glass     Date: 3 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: St Davids 50 Walliscote Road Weston Super Mare North Somerset BS23 1XF 01934412643 01934620575 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Western Counselling Services Limited care home 12 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Additional conditions: 12 12 May accommodate up to 12 persons aged 17 - 64 years Date of last inspection Brief description of the care home Western Counselling Services is registered with the Commission for Social Care Inspection (CSCI) and provides primary and secondary programmes of rehabilitation for up to 65 people between the ages of 17 and 64 years who have alcohol and/or drug dependencies. The bulk of the primary counselling programme takes place at a day centre and there are two houses (Meijer and St Davids), which provide accommodation for mixed sex groups on primary programmes. St Davids provides up to twelve places. Two other houses, Kintyre and Clarence Park Lodge provide accommodation for single sex groups receiving secondary programmes. The counselling is based upon the twelve-step Minnesota model. These homes have a private arrangement with a local GP practice to provide medical support and assessments, especially for those who are in the initial part of the primary programme. The fees for the home are negotiable with the funding authority. Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 23rd January 2007. This inspection took place over two days and a total of twelve hours were spent in the home. To gather enough evidence to support our judgments for this inspection, We The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. Care Homes for Adults (18-65 years) Page 6 of 32 We also looked at surveys returned to us by people living in the home and people with an interest such as relatives, social workers and GPs. We received 5 surveys from people following the treatment program. Once we had received this information we carried out a visit to the home. We requested the assistance of an Expert by Experience who is someone who has experienced the type of care and support provided by a Rehabilitation Centre. The Expert spoke to people living there and asked for their opinions of the way the service was provided. Whilst in the home we also looked at documents maintained for the dayto-day running of the service. These included care plans, staff recruitment, training and supervision, service records and health and safety. Following our initial visit we requested a CSCI Pharmacy Inspector visit the home to look at the management of medication. The Expert by Experience introduced himself to people at the treatment centre. On arrival all of the residents were in a group so I had the opportunity to explore the house and garden. The house itself is well kept and I was told the residents have the responsibility of the upkeep of the house. When the group finished I was introduced to one of the senior members of the house and he was very welcoming. The residents were informed that there was an inspection being carried out and I was part of that process. I took the opportunity to introduce myself to them in their break and explain my role as an Expert by Experience. As I did this the residents seemed to understand what was going on today and the majority of residents said they would be happy to give me their comments and feedback on the service. What the care home does well: What has improved since the last inspection? What they could do better: The expert by experience made three recommendations to support good practice one of these was made as a recomendation the other two were recorded in the body of this report. There were a few ideas that the residents would like to have considered, so maybe there could be more open discussion regarding weekend and evening activities to allow for more personal choice. Activities could revolve around socialising skills that many users in rehab or detox do not have, socialising being a large part in your ability Care Homes for Adults (18-65 years) Page 8 of 32 to stay free of drugs in the future. It was clear the residents understood these activities couldnt be done every week but its something they would like to be considered. I would like to recommend that some trust exercises are included within the treatment programme so the residents can learn to trust and be trusted throughout their treatment and beyond. I would like to recommend some support to be put into place for current and future residents by way of a basic numeracy and literacy skills workshop this could be carried out in free time in the evenings so it did not obstruct the running of the home. The Pharmacy inspector also made two requirments and one recommendation; These referred to the provision of suitable storage for controlled drugs and the correct handling of medication at the treatment centre. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from sufficient information in an appropriate format to help them make an informed choice of rehabilitation centre. They can visit to see how the centre is run when a full assessment of their needs can be made. If they are not in a position to visit the centre an assessment is carried out over the telephone. Evidence: We asked for a copy of the current Statement of Purpose and Service user Guide, they were readily available and easy to read. We noted that they contained all the information we would expect to see to show people how the service is run and what they wanted to achieve. The Expert by Experience spoke to people at the treatment centre about the information they received. All of the residents that I spoke with came to Western Counselling through similar referral routes, one resident said I was well pleased with the assessment, for once it felt like I was listened to. The majority of residents did say that they had enough information on the rehab before beginning their treatment there. I spoke with one resident and they gave me the following feedback on the information they received and how they understood it. I was quite Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: pleased with the amount of information I received before I got here, it really helped me decide on which rehab to apply for and I found the service user guide really helpful and easy to understand because it explains what the rehab actually does and the type of treatment they give to people. It also shows what is expected of me and what I can expect from being here, without the guide I dont think I would of decided to come here I also took the opportunity to read the service user guide and I found it very helpful and easy to understand. There was one resident that wasnt happy with the assessment process; they had their assessment over the phone whilst still in prison and didnt feel it covered very much at all, it seemed very basic and the amount of information I received was minimal and the phone call lasted about 20 minutes. During our visit we observed the manager organising a visit for a prospective client who would then have seen the treament centre, accomodation and have a face to face assessment, however they did not turn up, nobody commented on visits to the Western Counselling. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from clear personal plans that have been discussed and agreed with them, showing that they are consulted and make decisions about their treatment. They also benefit from clear risk assessments that identify areas that they may need assistance with during primary treatment. Evidence: We looked at the care plans that indicate how a person is going to progress through treatment and what progress they have made. We noted that although they had the potential to become generic they were personal to the individual. They showed us that people had agreed their treatment plan and they had signed them to show that they agreed to any restrictions that the treatment might impose such as not having mobile phones and any limitations to visiting in the early stages. The expert by experience spoke to people about their care plans and what they understood. I am confident in saying that all of the residents I spoke with did speak Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: very highly of the treatment programme and the rehab itself, different residents commented on different things: The structure here is great, the last place I went to you were allowed to keep your mobile phone and as soon as the staff went off everyone was either sat on their phones or using the phones to score. All the residents also had more or less the same comments about their involvement in their treatment and the involvement they had in terms of their care plan and they all felt their needs were being met at the time. There was one resident that stood out as having totally different feelings about this service and stated: I dont feel my needs are being met at the moment, I came here from prison and I had already completed Steps 1-5 whilst in prison and I dont feel that was taken into account when I got here because I started on step one again. I didnt have any involvement in making a care plan, my counsellor did it and I just signed it. We spoke to the manager about this person and they indicated that following their move into the home and assessment it was felt they would benefit from working through the programme from step 1 with their peer group. We saw risk assessments that indicated whether a person had additional needs that may put them or the group at risk, such as challenging behaviours or mental health problems, these showed plans of how the home would support them in managing these risks through their treatment. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from appropriate liesure and social activities within the contraints of primary treatment in a rehabilitation centre. They may benefit from numeracy and literacy skills sessions. They maintain contact with families and are encouraged to strengthen the bonds as their treatment progresses. They are supported to be as independent as they can within the program and are involved in all areas of daily living in the home. People benefit from a healthy and nutritious diet however more cultural needs could be included. Evidence: We looked at surveys received from people in the home, they stated that they understood the need for a very structured activities and liesure program at their stage in treatment. They indicated that they could watch TV or DVDs and go for walks at the weekend. Records showed that people had been encouraged to maintain family Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: contacts and visits had been arranged both in the home and away. The expert by experience spoke to people about the availability of activities, access to educational sessions and the standard of food for people on the program. There was a common theme with three of the residents and that was the fact that they had little or no reading or writing skills. I experienced the same issue during my addiction and treatment and it was one of the hardest things to admit in a setting such as a rehab so I really understood how these residents felt. It was also quite clear that the residents felt uncomfortable with relying on other residents to assist them with writing life stories and other pieces of homework they get throughout the primary phase of treatment and they also felt dependant on other residents to assist them. I would like to recommend some support to be put into place for current and future residents with the same issue by way of a basic numeracy and literacy skills workshop this can be carried out in free time in the evenings so it does not obstruct the running of the home. Activities were a popular topic that was discussed and the residents felt there could be more activities to do. At present residents fed back that they had access to a TV during the evenings, a choice of DVD at the weekends and or going for a walk. Some of the residents did feel the activities were quite restricted as not everyone had the same taste in films and not everyone enjoyed going for a walk when its cold outside. There were a few ideas that the residents would like to have considered, so maybe there could be more open discussion regarding weekend and evening activities to allow for more personal choice. Activities could revolve around socialising skills that many users in rehab or detox do not have, socialising being a large part in their ability to stay free of drugs in the future. It was clear the residents understood these activities couldnt be done every week as they cost money and they needed to concentrate on their homework for the treatment program, but its something they would like to be considered. During the week they are allowed to go to the shops under escort to spend the money they are permitted each week, there was a mixed opinion around the amount of money but I felt it was generally positive. One of the female residents did say, It can be a struggle with the money when I need to buy certain things at the time of the month, could you mention this please? We felt that it may be good for the home to stock a few of these personal items in case money was tight for someone or they forgot to buy them or if their menstrual cycle was erratic as it is when you stop using drugs. All of the residents I spent time with also spoke very highly of the food they received at Western Counselling, they all commented on the variety and quality of the food on offer and there were no complaints in this area. Residents also liked the fact they could help themselves to hot and cold drinks and snacks throughout the course of the day. One resident said to me that they didnt feel the service catered for their cultural needs in terms of food as they would like to have had Jamaican cheese, chicken, juice etc, as they felt it was all food for English people, however I did get a different Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: perspective from the manager of the service as I was concerned about the issue she raised. I was reassured that every effort was made to meet residents cultural needs and every effort was made to cater for those needs within the current budget of the service. During the assessment period of every resident they were all asked about dietary and cultural needs and in this particular case there was evidence to show that these were not applicable at the time of assessment. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from personal and specialist healthcare support that is provided in a personal way respecting their rights within the constraints of primary treatment. Improvements have been made in the management of medicines in this service. However further action is needed to ensure that clients health is better protected. Evidence: We looked at the care records for people following the primary treatment program they showed us that their needs were considered on an individual basis and that as well as the primary detox and counselling program they were directed to health care specialists such as the dentist, opitician and GP and were assisted to attend outpatient appointments identifying both physical and mental health needs. The expert by experience spoke to people about their perceptions of the treatment they were receiving. My overall opinion of the treatment that is provided at Western Counselling is a good one, all the residents that gave me their time to answer questions spoke positively of the group work, one to one sessions counsellors and the Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: workshops and they all seemed to enjoy and benefit from them in their own ways. There were a couple of things that I picked up on whilst spending time with the residents and the first one is the appreciation they had for the structure of the service and the fact that they knew what they were doing each day, the residents all seemed to like having the structure in place and a number of residents said it is what they need. The other fact is that they all respected each other and the peer element of the rehab was a strong one and it was quite visible that the residents supported each other throughout the programme.This has been the best move for me, Ive tried everything in the community services and never got anywhere, Ive done my detox and now I can concentrate on my life without having to worry about whats going on back home I really like it here because everyone gets along and the groups are very helpful and the staff are very supportive yet they want you to be independent. There were also discussions of residents being involved in trust exercises as some didnt feel as though they could trust other residents when it came to disclosing or talking about things in group work. They felt it would help to build that trust not just so they could talk in groups but enable them to build meaningful relationships whilst in treatment and when they left treatment. I would like to recommend that some trust exercises are included within the treatment programme so the residents can learn to trust and be trusted throughout their treatment and beyond. The manager commented that trust exercises were available at a later stage in the 12 week treatment programme and that those people who felt they needed trust exercises may have been at an ealier stage in their treatment. Following our visit to the treatment centre we asked the CSCI pharmacy inspector to visit, their findings were. Clients are registered with a local doctors practice. Most medicines are prescribed by the doctor using an NHS prescription and supplied by a local pharmacy using a monthly blister pack system. At present some medicines are supplied separately by the doctor in a weekly tray. We saw one tray in current use. The labelling for this medicine did not meet the legal requirements and administration records showed that staff were unable to read the name of the medicine. This could result in medicines being given incorrectly. To safeguard clients health, action must be taken to ensure that all medicines are given from appropriately labelled containers that meet current legislation and include full dosage instructions. A medication policy is in place and needs to be updated to reflect current practice. The manager must also ensure that all staff involved with looking after medicines in the home have access to, and have read, the policy. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: A homely remedy policy (for treating minor ailments) is in place and medicines are agreed with each clients doctor. Prescription only medicines must not be used in this way. Staff need to ensure that the methods of ordering homely remedies and distributing them to the separate registered houses meet legal requirements and professional guidance for good practice. We checked the current records of homely remedies. It appeared that some staff were unclear as to how to complete the record and it was not possible to audit the stock. A system is required which allows staff to audit the stock to make sure that it has been used appropriately and as recorded by staff. Secure storage is available for medicines in 18 Whitecross Road. Some medicines require additional secure storage, as described in the Misuse of Drugs Act (safe Custody) regulations 1973. Suitable storage is not available for these medicines in any of the registered houses. A suitable cupboard must be available wherever these medicines are stored. Some medicines need to be transferred between houses. It is recommended that staff discuss with their pharmacist and their doctors how medicines could be supplied to minimise this transfer. If medicines do need to be transferred it is important that suitable procedures and risk assesments are in place to make this process as safe as possible. Staff look after and give all medicines to clients who are receiving primary care. However records indicated that some clients may give their own inhalers and creams. Medicines administration Record (MAR) sheets are handwritten by care staff. These often did not include the full dosage instructions and had not been signed and dated by the person writing them or checked by a second member of staff. Staff said that they are intending to approach their pharmacy to see if they will be able to print the MAR sheets for staff to complete. This is to reduce the risk of mistakes being made on handwritten charts. At the time of the inspection records were not kept of the medicines which are recieved into the home and action is needed to address this. Records must be kept of the receipt of all medicines. This is so that there is a clear audit trail to show that medicines have been given safely, as prescribed by the doctor. Staff told us that records are kept of the disposal of medicines. There is no process in place to prepare people to be able, safely, to take care of their own medicines when they leave the service completely. It is recommended that staff also consider this aspect of care. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: The registered manager told us that staff involved with medication had attended a day training course last year, provided by a pharmacy company. There is no system in place for assessing the competence of staff involved with giving medicines to ensure they are safe to carry out this task. Action should be taken to address this and to ensure that staff are aware of the homes medicines policies and procedures. The home recently appointed a Medical Liaison Officer who is working to improve the medicines systems in place. When deciding the rating for this outcome group we looked at the overall outcomes for people in primary treatment at Western Counselling. Although they had not met the National Minimum Standard for The Administration of Medication we still felt the overall outcome was good. Care Homes for Adults (18-65 years) Page 21 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware through training of the procedures to follow to protect people from abuse. Evidence: Copies of the homes complaints policy and procedure are included with the Service User Guide and made available for peole to consult. Surveys received said people knew who to talk to and indicated that they felt they could talk to all staff and had house leaders who would also direct their concerns to house managers. The policy also provides the address and contact details for CSCI and the provider. The manager maintains a record of all compliments and complaints received. We saw a copy of the North Somerset policy and procedure for Safeguarding Adults under No Secrets, which is available for all staff to read. Staff said they knew who to inform if they suspected abuse and they all knew about the homes whistle-blowing policy. Staff records showed that they had all received appropriate training in Safeguarding Adults. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a comfortable, well-equipped and homely environment, which is well maintained and decorated with access to garden areas and local parks. People are protected by staff awareness of appropriate infection control guidelines. Evidence: We carried out a tour of the premises; St Davids is one of the two homes people live in whilst taking part in the primary stages of their treatment program. The home was well maintained and provided comfortable and appropriate accomodation. People spend the day time hours at the treament centre and are only in the seperate homes when they have completed their day. The expert by expeirence asked about the accomodation. Living conditions was another area I discussed with residents and again there were no negative comments on the condition of the houses, some residents felt it could do with a lick of paint but it was not that important to them to lead them to wish to make a formal complaint. There were no complaints from residents about carrying out the housekeeping duties and some of the residents stated that they took pride in keeping the houses tidy. Staff records showed thet they were kept up to date with infection control guidance Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: and the manager could contact the relevant agencies if thought necessary. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff team who are competent and qualified and trained to meet the needs of people attending a treatment centre for Drug and Alcohol Dependency. They are also protected by clear policies and procedures for the recruitment of new staff and supervision of existing staff in the home. Evidence: We looked at the personnel files and they showed that all staff had a job description, which clearly stated what their roles and responsibilities were to support people in achieving the treatment program. Records to evidence that people had been encouraged to attend training were in place and showed us that they had all attended both mandatory training and training relevant to their role at the treatment centre or the house people are accomodated in. People demonstrated that they were well aware of the needs of people in the centre and how to meet them. The expert by experience said that people indicated staff were knowledgeable and helped them in the program. Surveys we received said that staff were excellent and understood their roles as counsellors and support workers. Records kept by the manager following the recruitment of staff showed that Western Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Counselling followed very strict policies and procedures ensuring that all the appropriate checks are carried out before a person starts work at either the treatment centre or the individual houses. Staff records also confirmed that they received regular supervision from management and we saw documentation that showed all staff had attended supervision meetings, counsellors are also able to attend counselling sessions run by an outside organisation. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is well managed in an open and approachable way, which considers peoples personal input into the day to day running of the home as far as is possible within the constraints of the centre. Health and safety practices in the home safeguard people living there. Evidence: The registered manager for the home is Dr Evans he is very experienced and continues to work closely with the client group in the primary stage of treatment. The managing director Amanda Lea has worked within the addiction field since 1993 and has extensive knowledge and experience of treatment services and their management. Amanda has been awarded the Registered Managers Award NVQ4, she is primarily responsible for the assessment and admission of clients, treatment and quality of care. Quality Assurance in the home includes client satisfaction surveys on completion or on leaving treatment. The managing directors use these to assess what changes can be implimented to improve the quality of care they provide. The Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: organisation also keeps a record of retention and completion rates. Monthly audits are undertaken and these also contribute to a complete overview of the home, the quality of care and the progress of people who have completed primary stage and moved on to secondary treatment. Clients are encouraged to meet and discuss the service provided and any variations or considerations they would like made at any point during their treatment programme. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly. A review of the firelog showed all tests, training and drills were being carried out to Local Fire Brigade guidelines. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Controlled Drugs must be stored in a metal cupboard, which complies with the Misuse of Drugs Act (safe custody) Regulations 1973. To meet legal requirements and ensure these medicines are stored securely. 24/03/2009 2 20 13 Action must be taken to ensure that medicines are always given safely and accurate records kept. This refers to: Keeping records, receipt of medicines. Completion of adminstration records. Handling of homely remedies. Policy for selfmedication. 24/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Adults (18-65 years) Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 12 The provider needs to look at ways of providing a numeracy and literacy workshop. This is to help people manage the written work needed for their treatment program. There is no process in place to prepare people to be able, safely, to take care of their own medicines when they leave the service completely. It is recommended that staff also consider this aspect of care. 2 20 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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