Inspection on 17/12/09 for Stabilisation Services Passmores House

This inspection was carried out on 17th December 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stabilisation Services Passmores... 13/05/10

Stabilisation Services Passmores... 02/06/09

Similar services:

Nascent House

Hebron House

Vale House Stabillisation Services

Diana, Princess of Wales Treatment Centre

Palm Lodge

Grapecroft Care Home Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Stabilisation Services Passmores House Stabilisation Services Passmores House Third Avenue Harlow Essex CM18 6YL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carolyn Delaney     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Stabilisation Services Passmores House Stabilisation Services Passmores House Third Avenue Harlow Essex CM18 6YL 01992553173 01992509729 enquiries@valehouse.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Vale House Stabilisation Services Name of registered manager (if applicable) Ms Chris Hannaby Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following categories of service: care home with nursing - Code N to service users of the following gender: either. Whos primary care needs on admission to the home are within the following categories: Past or present Alcohol dependence - Code A. Past or present drug dependence Code D Date of last inspection Brief description of the care home 0 2 0 6 2 0 0 9 14 14 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 37 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: zero star poor 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 Quality Rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a second inspection carried, which included a visit made to the home out in line with out enforcement pathway for regulating services which provide poor outcomes for people. The last inspection was carried out on 2nd June 2009. In addition to the site visit, as part of the inspection process we reviewed information we had received about the service over the last twelve months including notifications sent to of any event in the home, which affects residents such as injuries, deaths and any outbreak of infectious diseases. We also looked at the information the manager provided us with in the homes Annual Quality Assurance Assessment. This document is a self-assessment, which the registered provider or owner is required by law to complete and tell us what they think they do well, how they evidence this and the Care Homes for Adults (18-65 years) Page 5 of 37 improvements made within the previous twelve months. We sent surveys to the home to distribute to residents and staff to complete and tell us what they think about the home. At the time of writing this report we had received surveys from nine residents living in the home and six members of staff. During the inspection we spoke with all eight residents, one member of staff and the three members of the management team relative, two members of staff and the manager. As part of the inspection process an Expert by Experience accompanied us on the site visit. This is an individual who has experience of using a social care service. An Expert by Experience is one of the resources we use as part of our methodology for engaging with people who use social care services. This person accompanied us on the inspection and spent time speaking with residents to obtain their views about their experience of living in the home. The views and comments made by residents were used in this report and to help us make judgements about outcomes for people living in the home. When we visited the home we looked at residents care plans and information available to staff to help them support residents. We looked at how staff were recruited to work in the home and how they were trained to support residents. We looked at how the home was managed and how residents were involved in this. We also observed how staff interacted with residents when supporting them with activities such as meals and providing recreation and stimulation. A brief tour of the premises was carried out and communal areas including lounge and bathrooms were viewed. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Care Homes for Adults (18-65 years) Page 6 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Information about the home could be reviewed so that it was more useful to people who were looking to move in for treatment. Some people feel that there is a lot of information to take in on the day of admission and that this is confusing to them. Some people say that the information, while detailed they receive does not tell them what to expect when they move in, which is what they feel they need. The way in which care plans are developed should be reviewed so that residents feel more involved in the process. Some people told us that they were unsure whether they had a care plan and said that they felt they would benefit from some evaluation of progress with their treatment. The programme for treating people with substance and alcohol dependency could be more clear as some residents told us that they were not sure about the programme and felt that some of the materials used such as DVDs were old and at times irrelevant. Complimentary therapies, which residents found very good, could be provided more regularly. Some people told us that they were regularly cancelled. Some restrictions to residents freedom should be based upon risks to the individual, Care Homes for Adults (18-65 years) Page 7 of 37 rather than a one size fits all approach so that the programme of treatment is more person centred. Complaints must be investigated more fully and dealt with so that people using the service felt more confident that their concerns were taken seriously. All of the appropriate checks including Criminal Records Bureau disclosures must be carried out for before they are employed to work in the home, so as to help safeguard the welfare and interests of people who use the service. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 37 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 9 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into Passmores cannot always be assured that their needs will be met because the assessment process does not consistently cover all aspects of the individuals needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that they had a comprehensive assessment procedure, which allowed them to thoroughly look at the individual needs of clients. They told us that they worked very closely with referring agencies to identify any additional needs that the client may present before they were admitted. They said that this allowed them to carefully consider the needs of each prospective client and also allowed them to fully assess their capacity to treat the person. They told us that all their rehabilitation clients were allowed to tour the home prior to admission, to meet the current clients, staff, and to get a feel of the place before accepting any offer of a place in the service. They said that on admission clients were given a welcome pack, which contained among other things a copy the contract to Care Homes for Adults (18-65 years) Page 10 of 37 Evidence: occupy, the rules and procedures used in Passmores House, and how the service operated. We were told that there had been seventy-nine people admitted to the home since it opened in April 2009. Of these there had been twenty-four breakdowns in placement (Approx 30 ). This is where the placement was unsuccessful and a person will have left the home before their treatment programme was completed. Prior to visiting the service we received surveys from nine people who had used or were currently using the service. Each of the nine people told us that they had been asked if they wanted to move into the home and that they had received enough information about the home before they moved in to help them decide if it was the right place for them. When we visited the home the expert by experience spoke with all of the residents who were receiving treatment in the home. Residents told the expert that they received an information brochure about Passmores House before they moved in. They told the expert that they felt more information could have been provided to give them a better understanding of the treatment process and what to expect on arrival to Passmores. One resident commented The leaflet was ok but it didnt really tell me what I would get from coming here, which is what I wanted to know. When we visited the home we looked at the arrangements for assessing a persons needs so as to determine that the service would be able to support and treat individuals appropriately. The experiences of people who moved into the home for detoxification differed from those who were admitted for rehabilitation. Residents who were admitted to the home for detoxification told the expert that they felt the assessment process was comprehensive in terms of meeting their immediate clinical needs. Some residents informed us that they felt a lot of information was given at this stage and commented that this could be quite overwhelming. One resident commented The assessment was intense, lots of papers to sign and questions to answer but it was ok. Residents did also comment that they felt quite informed after the assessment process even though there was a lot of information given to them. Those residents who were admitted to the home for rehabilitation said the assessment process was comprehensive and covered a lot of different areas. Residents all agreed they felt informed about Passmores House and what was expected of them during their stay. Some residents did say there were a lot of questions that were asked during the process and at times found it difficult to understand why some of the questions were asked. One resident commented I found the assessment quite helpful and I went away with an understanding of Passmores and some encouragement to engage with treatment here. All residents we spoke with said there was a lot of Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: information given to them during the process and they felt quite informed afterwards. The manager explained the process for admitting people to the home for treatment. They told us that following the assessment carried out by staff at the home, that the assessment would be referred to Time Health Care to make the decisions as to whether the home would be able to meet the clinical needs of the individual. The manager told us that where it was possible people were offered the opportunity to visit the home before they moved in. We looked at the pre-admission assessments for two people who had been admitted to the home for detoxification treatment and two people who moved in for rehabilitation. An assessment had been completed for each person. Assessments for people admitted for detoxification treatment were detailed in respect of the persons substance misuse and the clinical, nursing and medical treatment each person required. There was very little information recorded about the individuals other needs such as social and emotional needs or welfare. Assessments for people who were admitted for rehabilitation had much more detailed assessments, which included details of usual daily routines etc. This additional information would be useful when assessing the needs of people who were admitted for detoxification so that staff could support them in a more individual and holistic way. We discussed with the management team during the inspection and they agreed with our views. We also noted that the assessment for one person who moved into the home for detoxification treatment had been carried out in September 2009. The person did not move into the home until December and there was no evidence that the information about the persons needs had been reviewed so as to determine if there were any changes or new relevant information to consider. Care Homes for Adults (18-65 years) Page 12 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not always able to make choices and decisions about their treatment and care. Evidence: The manager told us in the Annual Quality Assurance Assessment that care plans were developed and agreed with clients, using outcome profiles. They told us that plans were updated regularly as the client passed through different stages of the programme and the client was central in each review of his/her plan. They told us that they also work through a thorough risk assessment with each client. They told us that at the point of admission that people who moved into the home for detoxification treatment were made aware of the limitations and boundaries that they place around their behaviour and activities within the service, both for their own and others protection. We received surveys from nine people who had used the service. Three people told us that they could always make decisions about what they did each day. Two said that Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: they usually could. People commented that there was a rules programme. One person said This is a rehab and we have daily programme. Another said that they were allowed two hours out a day within the rules. One person said This is a detox facility with a positive programme free time is included. When we visited the home residents spoke with the expert by experience about care planning. Residents in the detoxification unit told the expert that they were not sure if they had a care plan in place. One resident commented Ive signed so many bits of paper one of them may have been a care plan. Another resident said Im not aware of a care plan being in place for my treatment but it would be useful to see what I have achieved. Residents told the expert that they felt it would be beneficial to them to be involved in the care planning process. Four of the six residents who were receiving rehabilitation treatment told the expert that they had a care plan and that they had a leading role in developing their care. We looked at care plans and information recorded for two people who were admitted for detoxification and two people who were admitted for rehabilitation. There were clear plans in place around how both people who were undergoing detoxification. There was up to date information describing the persons progress with treatment, which included how they were feeling both physically and emotionally. However there was no care plan available for both people who were admitted for rehabilitation. The manager told us that people who were admitted for rehabilitation were given a period to settle into the home and that care plans were written after seven days. However this meant that there was very limited if any information recorded about individuals progress during the crucial first stage of their programme. It may also account for some of the comments made by residents who felt that they did not have a care plan and would benefit from being involved more in the process. On the morning of the site visit the manager told us that some residents were out shopping for Christmas. Some of the people who spoke with the expert by experience commented about some of the rules. One person commented that they could not go for a cigarette after 11pm at night. They told the expert that they found these restrictions particularly difficult. They said I struggle at night and sometimes want to smoke but I am unable to as the smoking room is locked at 11.30 so it can be difficult to cope. We discussed the comments made by residents with the management team. They told us that the programme was structured and that the rules were designed to assist residents with their recovery. We saw a copy of the daily programme for residents. We saw that there was a programme of events every day, including group sessions one to one time and therapies. From the daily programme we saw that Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: residents had free time during the day, in the evenings and more at weekends. Residents were expected to retire to bed by 11.30 at night during the week and 00.30 at weekends. One person told us Most days are the same there isnt much to do and the groups are the same issues being discussed. From looking at the plan and speaking with residents we could not see that the rules were relaxed for those people who were nearing the end of their treatment programme so that it would more reflect their daily lives outside of the home. We discussed this with the management team. There appeared to be a blanket approach to the how people were supported and how risks were managed. Residents were required to hand over all toiletries, shaving razors etc. The manager admitted that this was done without assessing risks to individuals. Residents who spoke with the expert by experience also commented that they found some aspects of their treatment programme confusing. They said that it involved some but not all aspects of the Twelve Step programme. We had some discussions with the management team around the programmes used to support people who were admitted to the service. The manager said It is a programme I have put together, which has worked well in other places. They could not tell us or explain to the expert the exact nature of the programme when questioned. Residents said that they found the complimentary therapies provided very helpful. However some people said that these were not always available as expected or planned. One person told us had one complimentary therapy session during my first few days and it was really helpful, Ive not had one since and I thought it was part of the detox package, every time I ask if the therapist is coming in I get told its cancelled or they are off sick. It is frustrating because that one session helped me a lot. On the day of the inspection complimentary treatments were planned, however the manager told us that the therapist had telephoned in to say that they were unwell so a group session had been arranged in place of this. Care Homes for Adults (18-65 years) Page 15 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lifestyles are restricted in line with the agreed licence to receive treatment in Passmores, however the one size fits all approach means that some freedoms may be restricted unnecessarily. Evidence: The manager told us in the Annual Quality Assurance Assessment that the principal purpose of both the detoxification and rehabilitation programmes was to assist clients to improve the quality of their lives by ending their dependence on drugs and/or alcohol. They told us clients were able to access services in the local community such as garden centres, swimming pools, library, and community shops for both leisure and contributory purposes. They said that they were acutely aware that many of their clients had very low self esteem. They said that they offered them opportunities to see themselves as contributing members of the community, with a valued role to play. They told us that clients were actively encouraged to seek the support of their families Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: whilst in treatment and that part of the treatment program looked specifically at relationship issues and how these could be addressed. They said that where reconciliation was wished for, families were encouraged to visit weekly, write letters, and where applicable were invited to access family or couple counselling sessions. When a person moved into Passmores they agreed to a strict set of rules some of which related to daily life and lifestyle choices. Residents agreed to spend the days in communal areas and not to sleep during the day. Residents agreed to get up and be dressed by 8am and retire to bed by 11.30pm on weekdays and 12.30 at weekends. Contact with people outside of the home was restricted as was access to the community. There were restrictions imposed upon time spent watching television and DVDs etc. Residents agreed to having their personal belongings and bedrooms searched by staff and to drug testing. Due to the nature of the treatment programme residents were not permitted to access the local community or amenities unaccompanied by staff, particularly during the early stages of treatment. The manager told us that as part of the programme that people would be supported to find employment should this be appropriate, as part of the homes continuing care programme. Residents who spoke with the expert by experience told him that they felt that staff and managers did not trust them. They felt that some of the rules and restrictions were unnecessary. They particularly commented at not being able to speak with case workers, or families on the telephone without a member of staff being present. The manager said that these measures were in place to protect and support residents. They said Staff member will always be present during any phonecall as they will be highly emotional and vulnerable and need support. They further went on to say that there had to be a staff member present during any phonecalls, with case manager, family, children etc or there would be a stream of dealers coming to the door. We looked at care plans and assessments for four people who were receiving treatment and support in the home. There was no assessment of risks around the issues contact with family or case workers for these people. This meant that the restrictions impose on residents were not based upon assessed risks for each individual as part of a person centred approach to care. One resident who spoke with the expert by experience said that Most days are the same there isnt much to do and the groups are the same issues being discussed. We looked at how meals were provided for residents. Staff told us that residents meet with the chef to discuss and plan menus. Both residents we spoke with told us that Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: they enjoyed the food. We saw that there was a well equipped kitchen area and residents help prepare the evening meal. Care Homes for Adults (18-65 years) Page 18 of 37 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 who move into the home can be assured that they will be assisted and supported for their assessed health and personal care needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that where a client was admitted, initially, for detoxification, they were seen by a doctor on admission. The doctor would assess their health needs, both for specific medication during detoxification and also for any other health needs. They told us that during their period of detoxification clients were provided with a 24 hour nursing service, and their care plan would include specific nursing attendance required. They told us that on admission for rehabilitation the client was taken at the first opportunity to the local GP for a medical review, where medication and physical ailments could be seen and remedied, or if necessary further referrals could be made. They told us that through care planning with the client they ensured that their physical and emotional needs were met and that they received support in the way they prefer. They told us that they offered a full range of complementary therapies, and placed client choice at the fore front of any of their health or personal support issues so long Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: as this did not impact upon the health and safety of the client. The manager told us that they ensured that all requirements relating to the safe storage, handling and administration of medication were adhered to at all times and they provided staff training in this area as part of the induction. They told us that the site managed controlled drugs and had robust procedures to cover this. People who move into Passmores House are generally self caring for their personal care needs and do not rely on staff for support. We saw from records and assessments that when people move into the home for detoxification treatment that they are assessed by a doctor upon admission and that the appropriate medical treatment to minimise the symptoms of substance withdrawal is prescribed and outsmarted as per the planned treatment regime. We looked at care plans and other records maintained by staff for people who were undergoing their detoxification. Staff recorded detailed information about the observations they made for people during the first twenty-four hours. We saw that staff monitored residents closely during this period to observe for signs of ill health. In addition to the prescribed medical treatments residents were offered complimentary therapies including acupuncture, aromatherapy and massage and reflexology. We saw detailed records around the treatments provided and the benefits to the persons physical and emotional wellbeing. We looked at the arrangements for storing and administering medicines. We saw that there were appropriate storage facilities for medicines on both units. Staff were trained to administer medicines and medication administration records were well maintained. Care Homes for Adults (18-65 years) Page 20 of 37 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be assured that their complaints and concerns will be taken seriously or that arrangements for safeguarding people who may be vulnerable are robust. Evidence: The manager told us in the Annual Quality Assurance Assessment that they provided clients with a full copy of the complaints procedure in their welcome pack. They told us that this also included the rules, timetable and general information relating to their stay. They told us that at the assessment stage, these issues will be discussed at length so that clients were fully aware and supported to raise any concerns or complaints. They told us that they provided opportunities for clients to express their concerns in a safe and confidential way through house group, one to ones, group therapy sessions. They told us that they had received six complaints and that all of these had been investigated and responded to within twenty-eight days. The manager told us that staff were trained in key areas such as whistle blowing and POVA (Protection of Vulnerable Adults) through focused staff training sessions. They also told us that all new staff were subject to Criminal Records Bureau disclosures as part of the homes recruitment process. Prior to the inspection we received surveys from nine people who had used the service. Each of the nine said that they knew who to speak to if they were unhappy Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: and how to make a complaint. Each of the six members of staff who completed surveys told us that they knew what to do if someone had concerns about the home. Shortly before we visited the home we received an anonymous complaint about the home. The complainant alleged that residents could not complain and that the manager dismisses their views. The complainant also alleged that there were six people working in the home who did not have Criminal Records Bureau disclosures. When we visited the home the manager showed a copy of the homes complaints policy and procedure, which had been amended and updated since the last key inspection. There was clear information recorded as to how someone could make a complaint if they were unhappy. However during the inspection two residents told the expert by experience that they were unaware of any complaints procedure being in place until the morning of the inspection. One person told the expert Staff came around this morning and put these up on the notice boards and even after reading it I doubt that happens. Of the six people who were undergoing rehabilitation, three told the expert that while they were aware of how to complain that they did not have confidence to complain, without it affecting their stay at the home. This is particularly an issue as people in the home do not have access to advocates and have very limited access to people outside of the home. One person commented So many different things were spoken about when I arrived here, its difficult to take everything in and I dont remember if the complaint procedure was spoken about. The other three people did not make any comment. We brought this to the attention of the manager and they confirmed that policy had only been displayed in the detoxification unit on the morning of the inspection, but that it had been displayed in the rehabilitation unit for a number of days. One resident told the expert that they had made a complaint and felt it took a long time to be addressed. We looked at how the complaints received had been received, investigated and responded to. We saw that where complaints had been made that these were recorded and investigated by the homes manager, responsible individual and in one instance an external consultant. Each person who had made a complaint had received a response in writing. However in some instances all of the elements of the complaint had not been responded to. For example one person as part of a complaint made told us that proper arrangements for the latter stage of their rehabilitation had not been made according to their care plan. They told us that they had been assessed at Vale House but were admitted to Passmores House and no explanation was provided. They said that they had arranged a meeting to discuss this with the manager but that this had not happened, which made them angry. In response the manager did not address the issues as to why the person had been Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: assessed at Vale House and then moved to Passmores House, other than to say Your placement at Passmores House was arranged with your key worker (name). In response to the issues around the person moving on to the third stage of their treatment they said There are four beds in third stage. If there is a place when you leave and your funder is willing to fund you, you may go there. At the present there are no spaces. This is what was discussed with everyone at the beginning of your stay. The issues around the persons experience and how this affected them was not addressed in the response to the persons complaint. One person complained that they were not supported for their aftercare needs as described in the homes brochure. They said that they had questioned the manager about their housing arrangements when they were told leave the home. They said that the manager responded by saying It is not down to Passmores House to deal with housing issues, that is up to your social worker. Passmores are only here for your residential treatment. When the resident said had they known that they would have chosen another rehab unit they allege that the manager responded So you just came here for your housing. They said that they found this offensive as the manager had witnessed the effort and changes they had made during their recovery and was aware of the need for them to have appropriate accommodation when they left the home. They complained that the managers response contradicts the information in the homes brochure, which said that follow on care, in terms of housing links, safe accommodation etc is provided for or assisted with. We looked at the response made to the complaint. The manager wrote to the complainant stating Our philosophy on housing is clearly stated in our brochures. We will help with housing issues. This, your key worker has done and is still doing. The response did not address the residents complaint about their experience of discussing their issues with the manager or how the manager spoke to them. We looked at the arrangements for safeguarding people who may be vulnerable from risks of abuse or harm. We saw that staff had access to the homes policy and procedure and that there was a copy of the local safeguarding team policy and procedure, which gave specific details of how to refer allegations appropriately. We saw that staff had received training around safeguarding and whistle blowing. However staff were reluctant to speak with inspectors. One member of staff said I have to be careful that they dont hear me. They then went on to say that they had been coached by the manager as to what to say when questioned by inspectors. This behaviour did not assure inspectors that staff would necessarily report issues appropriately or that they felt confident to raise issues in line with the homes whistle blowing procedure. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: As part of assessing how the home protected the interests and welfare of people using the service we looked at the arrangements for recruiting staff to work in the home. We asked the management team for Criminal Records Bureau disclosures for all of the staff working in the home on the day of the inspection. A number of files were provided and all had copies of the disclosures. However on checking these people against the rota for staff on duty we noted that we had not been provided for with the information asked for. On further questioning we saw files for six people who were employed at the home and who did not have Criminal Records Bureau disclosures in place. The responsible individual told us that these had been applied for and had not been returned. Care Homes for Adults (18-65 years) Page 24 of 37 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. The home provides clean, safe and well maintained personal and communal spaces,which suits the needs of people who use the service. Evidence: The manager told us in the Annual Quality Assurance Assessment that they offered a homely and therapeutic environment to the clients, which encouraged a positive family atmosphere and enhanced the programme. They told us that each client was provided with a single lockable room with necessary furnishings i.e. bed wardrobe TV etc. They told us that the clients were actively encouraged to bring personal belongings such as photographs, pictures, personal music systems etc to personalise their room. They said that there were a number of lounges for the clients to use, fitted with comfortable furniture and TVs etc and a kitchen area. The dining room catered for all clients. They said that the home was cleaned daily and maintained to a high standard of cleanliness at all times. Each of the nine people who completed surveys told us that the home was always fresh and clean. When we visited the home we looked the accommodation provided. Each person had a single bedroom with ensuite shower. Rooms were clean and well maintained. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: Communal areas were clean and comfortably furnished. There were lounge areas and rooms where residents participated in group therapies. There home has a dedicated clinical room where the doctor can consult with and examine residents. There is also treatment room for complimentary therapies such as acupuncture, aromatherapy and massage. Some residents who spoke with the expert by experience commented that they did not always feel comfortable with the closed circuit television monitoring in communal areas such as the lounge. Some people commented that they felt that they were always being watched. The management team told us that this was used so as to monitor residents behaviour and to minimise incidents or risks of violence. The homes statement of purpose does include information around the use of CCTV in some parts of the home and the reasoning behind this. Care Homes for Adults (18-65 years) Page 26 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment process is not consistent and this may affect how people are supported by staff. Evidence: The manager told us in the Annual Quality Assurance Assessment that they maintained a high staff retention rate. They said that all staff were fully trained and this contributed directly to the high success rate of the service. The manager told us that they look at training needs of staff on an on-going basis and ensure that training is available to maintain both statutory training requirements and development activities for staff to increase their knowledge and skills. They told us that they work to a robust recruitment and selection procedure, which allowed them to pick new staff from a wide field of experienced candidates. They said that on commencement of employment they provided a thorough induction procedure. They told us that all staff were CRB checked. They said that they held a weekly staff team meeting, which was attended by all staff involved with the unit. They said that these were client focused and allowed them to look at each clients progress and also allowed the staff the opportunity to share ideas and offer feedback therefore promoting continuity in the deliverance of the service. We received surveys from six members of staff and they told us that all of the checks Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: including references and Criminal Records Bureau disclosures were obtained before they commenced work at the home. Each of the six told us that they received training, which was relevant to their roles, helped them understand the needs of the people the supported and kept them up to date with new ways of working. They told us that there were always enough staff to meet the needs of people in the home and that the manager supported them. When we visited the home we looked at the arrangements for recruiting, training and deploying staff. We looked at the recruitment file for the new manager who had been employed since the last inspection. This person had been recruited via an employment agency. There were some references on file. Two of these were dated from 2007 and one from 2009. Where references were dated from 2007 there was a handwritten note indicating that the registered manager had contacted referees to validate these. The registered manager wrote on these references Contacted by telephone, positive, excellent reference given. There was a copy of an employment contract and offer letter and various training certificates for a period of eight years. We saw that six people had been employed at the home without Criminal Records Bureau disclosures. The manager told us that these checks had been applied for but had not been returned. However it is the responsibility of the management team to ensure that all of the checks as to the fitness of each person before they are employed in the home and this practice is contrary to the homes recruitment policy and procedure and the information provided in the Annual Quail Assurance Assessment and does not help to safeguard the welfare of people who use the service. Other information including references from previous employers was available in staff files we looked at. We looked at the information provided by the manager around staff training. We were given copies of training records for all staff. In addition to the training provided at induction just prior to the home opening there was an ongoing training and development programme in place for all staff. This included training in fire safety, food hygiene, safeguarding people from harm and first aid. Six members of staff had been enrolled to undertake National Vocational Qualification training in Social Care. Two members of nursing staff had undertaken training around the progression of alcohol dependency and two staff were undertaking training around alcohol and substance misuse, stimulant users and working with people who self harm. We saw evidence that staff met regularly with the manager to discuss work and training. In addition we saw in the training plan that more training around dealing with issues such as child protection, domestic violence and care planning was to be provided in the future. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: Staff appeared reluctant to speak with us during the inspection. We attempted to speak with two members of staff who were working on the detoxification unit. One person said I have to be careful that they (managers) do not hear me indicating that they did not feel free to speak openly to us. They did say that they had concerns about the lack of training around safe detoxification. They asked if they could contact us after the inspection to discuss their concerns but then failed to do so. We looked at staff rotas to see the numbers of staff employed to support people using the service. When a person moves into the home for detoxification they receive twenty four hour nursing support. Staff rotas were not clear in respect of staff roles, be it case managers, support workers or other therapists. It was not clear from rotas who covered shifts where members of staff were identified as being off sick. There was so much handwriting on some of the rotas that it was not possible to determine where staff were working. It appeared from the rotas provided that between three and five staff employed during the day. There was no indication as to how staffing levels were determined. Care Homes for Adults (18-65 years) Page 29 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot always be assured that it is managed in an open and positive manner Evidence: The manager told us in the Annual Quality Assurance Assessment that the house was managed in an open, positive and inclusive manner. They said that staff joined the clients for dinner and participated in the various activities organised. They said that they created an environment where they promoted team work for all involved in the home. We were told that the manager used a person centred approach to the job role and led a staff team who had been recruited and trained to a high level. They told us that their high success rates with our clients demonstrated that the home was well managed and that this was additionally shown through the ethos, leadership and management. The manager told us that they maintained a robust and full policies and procedures manual, which supported the management of the home. They said that all staff adhered to the policies and procedures and that training was offered where applicable. They told us that they maintained full monthly health and safety checks and also daily checks through staff handover where any potential health and safety Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: risks were identified and reported accordingly. When we visited the home we were informed that a new manager had been employed and that they were in the process of submitting their application to be registered as manager with the Care Quality Commission. The current registered manager was present during the inspection, as was the new manager and the organisations responsible individual. The management team told us of the improvements made to the service since the last key inspection. This included introduction of a new care planning system, staff training, achieving the Investors in People Award and improvements to the admissions process. Residents who completed surveys told us what they felt the service did well. People said that the programme was good. People told us Information groups enable to address my addiction underlying issues. and I am making good progress in my recovery since starting at Passmores. One person said It has an after care programme that you dont get with all other homes Family liaison is very good. It has an extremely structured programme. Group therapy and one on one counselling is very thorough. The food / chef is second to none. It does its job generally very well. During and after the inspection we were provided with completed quality assurance surveys and letters from past service users complimenting the service and thanking staff and management for their support during their stay at Passmores. We considered these comments and those made by people we spoke with during our inspection visit. Overall the comments made by people who spoke with the expert by experience were positive and comments made as to how the service could be improved were passed on to the management team for consideration. During discussions with the management team their response to some of the issues raised was quite hostile. They did not accept some of the comments made by residents. At one point when the expert told the new manager that residents told him they felt that they were not trusted, they replied I am wondering if that is your perception?. We explained that we needed to make them aware of the issues raised by people using the service so that they could be considered and addressed. Following the inspection we were contacted by one of the residents. They told us that the manager had spoken with all of the residents about their conversation with the expert by experience when the inspectors had left the home and that they were unhappy with what residents had said to the Expert by Experience. This does not give us confidence that the service is managed in an open and positive way in the best interests of the people who use it or that people can speak freely about their experiences of using the service. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 15 Each person must have a 21/08/2009 plan, which describes their needs, the care, support and treatment they are to receive. Care plans must be reviewed so that they accurately reflect the needs of residents. This is so that staff have accurate and current information about the people they support and treat and residents have a clear plan in respect of their treatment. 2 22 22 Complaints and concerns must be received and dealt with in accordance with the policies and procedures for the service. This will ensure that all complaints are dealt with appropriately and assure people using the service that their concerns will be taken seriously. 15/07/2009 3 23 13 Staff must only work in the home once the appropriate checks have been carried out. This is to ensure that residents are safeguarded from potential harm. 19/06/2009 Care Homes for Adults (18-65 years) Page 32 of 37 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 4 34 19 Staff (including those 31/07/2009 employed on a voluntary basis)must only be employed to work in the home once all of the checks as to their fitness have been completed. This is to help ensure that residents are safeguarded and supported by suitable staff. Care Homes for Adults (18-65 years) Page 33 of 37 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 2 15 A detailed assessment of each persons individual needs must be carried out before they are offered a place in the home. This is to ensure that the home will be suitable and the person will be treated holistically. 31/03/2010 2 6 15 Each person who moves into 26/03/2010 the home must have a care plan developed with them, which describes how they are to be supported in line with their treatment programme. This must be done so that staff have up to date information about each persons progress with their treatment so as to best support the individual. Care Homes for Adults (18-65 years) Page 34 of 37 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 3 9 13 Risks to each persons health and safety must be assessed and appropriate action taken where risks are identified. This must be done so as to ensure that people can take appropriate risks within their treatment programme. 26/03/2010 4 22 22 Complaints must be 11/03/2010 investigated fully and responded to in line with the homes policy and procedure. This must be done so as to help assure residents that their complaints and concerns will be taken seriously 5 23 13 Appropriate measures must be taken, including robust recruitment of staff, to ensure that people who use the service are safeguarded from harm, abuse or neglect. These measures must be taken so that people who use the service can be assured that they will be treated well. 11/02/2010 6 34 19 People must only be employed to work in the home once all of the appropriate checks as to 31/03/2010 Care Homes for Adults (18-65 years) Page 35 of 37 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 their fitness including references and Criminal Records Bureau disclosures have been obtained. This must be done so as to help ensure that people who use the service are supported by suitable staff and are safeguarded from harm. 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. No Refer to Standard Good Practice Recommendations 1 1 Information provided about the home and the services offered could be more detailed in respect of treatments provided so that people who move in have a better understanding of what to inspect. More could be done so as to allow residents make decisions around their treatment depending on the stage of their recovery. Staff rotas should be more clear so as to show the numbers and qualifications of staff who are on duty to support residents. 2 7 3 33 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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