Inspection on 02/06/09 for Stabilisation Services Passmores House

This inspection was carried out on 2nd June 2009.

CQC found this care home to be providing an Poor 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

Stabilisation Services Passmores... 13/05/10

Stabilisation Services Passmores... 17/12/09

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 09/06/2011.

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: 0 2 0 6 2 0 0 9 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 31 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) 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 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 Ms Chris Hannaby care home 14 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : past or present alcohol dependence past or present drug dependence Number of places (if applicable): Under 65 14 14 Over 65 0 0 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 Date of last inspection: Brief description of the care home: D D M M Y Y Y Y Care Homes for Adults (18-65 years) Page 4 of 31 Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: zero star poor service Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This was the first inspection of the service since it was registered and opened in April 2009. Due to serious issues around how people were admitted to the unit when it first opened the planned inspection was brought forward. This meant that the service had only been opened for two months at the time of the inspection. As a result we did not have resident, relative or staff surveys or an Annual Quality Assurance Assessment. This is a document, which providers are required by regulation to provide us with. The document describes how the service is managed, provides evidence about what the Care Homes for Adults (18-65 years) Page 6 of 31 service does well and where improvements can be made. The unannounced inspection was carried out by lead inspector who was accompanied by, Healthcare Assessor Sue Fraser-Betts. The inspection was carried out on 2nd June between 10.30 am and 20.00 pm. When we visited the Passmores we looked at information provided to people who were looking for detoxification or rehabilitation services. We looked at how the needs of people moving into the home would be assessed and how their care and treatment would be delivered. We looked at how complaints and concerns were dealt with and the arrangements for safeguarding residents from abuse. We spoke with two residents about their experiences of moving in and using the service. We spoke with three members of staff about the training and support they received and we looked at how staff were recruited and trained. We looked at the environment and the layout of the home. We looked at residents accommodation and the communal areas available to them such as lounge, dining room, meeting rooms etc and the availability of equipment needed to treat and support residents. We looked at some of the policies and procedures, which underpinned the running of the home and we spent time speaking with the homes manager and the responsible individual. Following the inspection we reviewed all the evidence and information obtained during the visit. We used this to form judgements about how the service was delivered and outcomes and experiences for people who use it. We referred to the Key Lines Of Regulatory Activity (KLORA). These are designed to help us make judgements in a consistent, fair and proportionate manner. What the care home does well: What has improved since the last inspection? What they could do better: Information available about the services provided by Passmores must be reviewed so that it is correct in respect of who they can support and the number of places available. People must only be admitted for treatment following an assessment of their needs it is determined that those needs can be met. There should be a clear programme of care and treatment for each individual, which Care Homes for Adults (18-65 years) Page 7 of 31 sets out they are to be supported. These plans must be reviewed and amended to reflect progress and any changes to the persons treatment and their needs. Risks to each persons health, safety and welfare must be identified and appropriate plans put in place to manage them. The homes policies and procedures for dealing with complaints must be followed so that residents feel confident that their concerns will be taken seriously. The arrangements for safeguarding residents from potential abuse must be strengthened and this includes ensuring that all staff paid or voluntary are subject to appropriate checks before the are employed to work in the home. Staffing levels must be reviewed so that there are sufficient staff available to meet the needs of residents and that appropriate arrangements are in place for covering absences due to illness or holiday etc. The home must be managed more effectively and run in the interests of the people who use its services. 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 websitewww.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 31 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 10 Individual needs and choices (standards 6 – 10) ................................................... 13 Lifestyle (standards 11 – 17) .............................................................................. 15 Personal and healthcare support (standards 18 – 21) ............................................. 17 Concerns, complaints and protection (standards 22 – 23) ....................................... 19 Environment (standards 24 – 30) ........................................................................ 21 Staffing (standards 31 – 36)............................................................................... 22 Conduct and management of the home (standards 37 – 43) ................................... 24 Outstanding statutory requirements..................................................................... 26 Requirements and recommendations from this inspection ....................................... 27 Care Homes for Adults (18-65 years) Page 9 of 31 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 who use the 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 move into Passmores cannot always be assured that their assessed needs will be met. Evidence: When we visited Passmores we looked the arrangements in place for assessing a persons needs before they moved in. We also looked at the information available to people who were looking for a detoxification or rehabilitation services to see how this described the service in order to assist the person decide if it would be suitable. There were three slightly different versions of the statement of purpose and the most detailed and current copy, dated March 2009 was not the one contained in the residents welcome pack, which they provided for us to examine. The statement of purpose did not include all of the information as required under current regulations. There was little information about the qualifications and experience of staff and the document contained incorrect information about arrangements for the use of doctors in the detoxification unit. Information about the number of beds registered and the organisation stated that this was due to the discrepancy between the number of beds applied for at registration and the agreed number of beds at registration. We were provided with a copy of the brochure for the home. The manager told us that this formed part of the welcome pack given to people when they moved into the home. The document provided some background information about stabilisation services and the organisation’s other service, Vale House. It included a four page section about Passmores House. Some of the information included in the document was Care Homes for Adults (18-65 years) Page 10 of 31 incorrect, for example the brochure indicated that the unit included a four bedded ward. These four beds were not registered and did not form part of the service at the time of the site visit but had been included in the original application. The document also stated that a service was provided to people with all levels of dependency. However due to recent problems with admissions to the detoxification unit, commissioners (people who purchase services) were not placing people with acute conditions who needed a higher degree of medical and nursing intervention. Passmores had a service level agreement with Time Team (locum service) for the doctors services. There was no information available as to the relevant experience or qualifications of doctors supplied to support the unit. Due to the nature of the service provided it is especially important that accurate information is available. We spoke with the member of staff in charge of the detoxification unit and a nurse working on the unit. They said that they felt they would need more staff and more staff training before they could accept people with higher levels of dependency. The manager told us that the admission process differs for people requiring detoxification and rehabilitation. Where a person needed to come to Passmores House for detoxification a referral would be made to the unit and the bed manager would arrange for the person to come in. These admissions tended to be made within a shorter time frame and it was not always possible for an assessment to be carried out until such time as the person arrived at the unit. This stated process differed from that described in the home’s pre – admission and admission procedure, which described the various stages involved in assessing the needs of a person before they moved into the home for a period of treatment. The manager told us that people who use the service for rehabilitation come to Passmores House for an interview and assessment. Assessments for people being admitted for detoxification covered details of the substances being misused, the method of administration of these substances, any medical, physical or mental health issues and any legal issues such as pending court dates or court orders. The assessment for people looking for rehabilitation covered substance misuse history, any previous treatments, details of a persons typical day and information about social support and childcare if appropriate. We looked at the assessments for two people, one person who had been admitted for detoxification and another who had come for rehabilitation treatment. Documents were not dated so it was not possible to determine that the assessments had been completed before the people moved in for treatment. There was information recorded about type and level of substance misuse and how this affected the individual and how they spent their days. There were no risk assessments around individuals specific needs such as risks associated with pregnancy. Shortly after the service opened we had been informed that four residents needed to be moved from Passmores to another treatment facility as the doctor appointed was not able to prescribe medicines necessary for the management of substance withdrawal. Discussions with the manager and staff it showed that five people had been admitted to the unit on the day in question. Subsequent discussions with the provider indicated that they had made alternative arrangements to support residents following these admissions. Staff we spoke with during the inspection visit reported to us that admissions had been poorly planned and that people had been admitted to the home without the proper preparation to be able to support them properly. One member of Care Homes for Adults (18-65 years) Page 11 of 31 staff and two residents told us that there had been some conflicting information about one resident who had recently moved into the home. The member of staff said that they had refused to accept the person onto the detoxification unit as they had no information or case notes about them and there was no doctor on site so as to prescribe medicines. One resident told us that when they moved into the home that there was nobody to prescribe Methadone and this made me panic. When we spoke with the resident they told us that they were moved into the rehabilitation unit when they arrived and spent three days there despite needing detoxification treatment. Another person told us that they were due to move from the detoxification unit to the rehabilitation unit within the next few days. However they said that this unit was full so they were unsure what would happen and this was causing them some stress. We discussed this with the manager who said that the person could sleep in the detoxification unit and spend their days in the rehabilitation unit. This was in conflict with the homes practice for segregating both client groups. We saw that when a person moved into the service that they received and agreed a licence agreement. This was a document, which set out each persons responsibilities, the limitation placed upon them in respect of the choices they make and contact with people outside of the unit. We looked at the agreements in place for two residents and both of these were signed by the individuals. Care Homes for Adults (18-65 years) Page 12 of 31 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 who use the 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 using this service cannot always be assured that their individual needs will be met. Evidence: When we visited Passmores we looked at how staff supported residents to achieve their personal goals, make decisions about their care and treatment and to take appropriate risks. We looked at the care plans for four residents. Within the care plans residents goals were recorded, including living lives free from dependency and misuse of substances. Care plans were devised into sections with some information around risks, therapies and counselling sessions. However there was no clear plan in respect of each persons treatment and information was fragmented, with assessments and review documents incomplete and missing in some cases. Residents progress and treatment should be reviewed after seven days and thereafter on a regular basis. However there was little evidence to show that this happened. We spoke with two residents. One person told us I have been in here for eleven days and I have not had a counselling session yet. We looked at the records for this person and there was no evidence that they had received any counselling. The other person said I have had one counselling session in 2 weeks I am supposed to have them twice Care Homes for Adults (18-65 years) Page 13 of 31 a week When we discussed this with the manager they could not tell us how often residents were to receive counselling or participate in group work. When a person moved into Passmores for treatment they signed and agreed a licence agreement, which described the limitations on the choices the person could make while they were staying at the home. There were specific restrictions on engaging in contact with people outside of the home, receiving mail and telephone calls. We saw that each of the four people had signed to agree to these conditions and the restrictions it placed on their choices and decision making. Due to the nature of the treatment programme residents are not supported in taking risks as this may have an impact on their recovery. We looked at how risks to a persons health and safety were assessed and the actions taken to minimise these. There was no consistent risk management strategy. Risks of self harm, depression, and suicide were identified for some people. However how these risks were to be managed effectively was not evident. Other risks were not considered such as risks around treatment in pregnant women. Care Homes for Adults (18-65 years) Page 14 of 31 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 who use the 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. Evidence: When we visited Passmores we looked at how people staying there were enabled to experience a lifestyle which suited their needs and reflected their individuality. 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 Care Homes for Adults (18-65 years) Page 15 of 31 homes continuing care programme. 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 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 16 of 31 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 who use the 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 using the service do not always receive support according to their needs. Evidence: When we visited Passmores we looked at the care and treatment plans for residents and how staff supported people for their personal and health care needs. The people who were staying at the home at the time of the inspection were generally self caring for their personal care needs and were provided with appropriate washing facilities. One female resident we spoke with told us that when they needed to go to hospital they were escorted by a male member of staff. They told us that this person did not leave them while the hospital doctor carried out an intimate examination. The person told us that they felt humiliated by the experience. We discussed this with the manager and they told us that it was the policy of the home that residents would not be left unsupervised when they left the home, even if this was to attend hospital. They told us that staff remained with the resident so as to ensure that the doctor did not give them (resident) anything. We asked why a female member of staff had not accompanied the person and we were told that it is not always possible to have gender specific staff on duty. The manager stated that the male member of staff had reported that he had turned his back during the examination. The manager did not appear to see that this situation compromised the dignity of the resident. We looked at the care plan for this individual and there was no information recorded around the support this person may need around their pregnancy or issues relating to support relating to male members of staff. We looked at how residents were supported for their health care needs. There were no clear treatment plans or pathways in respect of the support and treatment that Care Homes for Adults (18-65 years) Page 17 of 31 Residents received. A doctor visited the home on three days per week to coincide with the days on which people are admitted and to check on individuals progress with their treatment. There was no information recorded in residents care plans about their progress with treatment. We looked at information about the medical assessments and support residents received. Each person should have a medical assessment completed when they moved into the home. None of the four residents who we looked at had a completed doctor’s assessment and blank assessments were in these files. We pointed this out to the manager at the time of the inspection visit. At a subsequent meeting with the manager and other representatives from the organisation they indicated that felt the information was in the home on the day of the inspection. However it was not available for us on that day. Nursing staff administer medicines to people who are completing the detoxification part of their programme. There were prescribing protocols in place. However one nurse we spoke with said that more information and clarification was needed in respect of this treatment. The manager of the unit confirmed that more staff and training were required should the unit be required to take people with more complex needs (as the unit was designed and set up to provide and as described in information about the service). When we met with the manager after the inspection they told us that nursing staff had received training around detoxification as part of their induction and that they were experienced and skilled in supporting people during the detoxification stages of treatment. However while we saw that there had been some training around supporting people during their induction we had no evidence as to the content and scope of this training. Additionally while we acknowledge that nurses will have skills and experience in the administration of medicines, that they may need clarification and training around the specific needs of the people they support. During the inspection and through discussion with support staff we saw that non nursing staff were administering medicines to people who were undertaking rehabilitation. These staff had not received any medication training and the manager told us that this was planned for the future. The manager did not appear to see that there was a problem with staff administering medicines without appropriate training. In addition to the medical treatments the home provides complimentary treatments and therapy including massage and aromatherapy. The manager told us that residents could request these at anytime. Care plans did not include specific details of the complimentary treatments as part of each individuals overall programme of care. Care Homes for Adults (18-65 years) Page 18 of 31 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 who use the 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 Passmores cannot be assured that their complaints and concerns will be dealt with or that they will be safeguarded from harm. Evidence: When we visited Passmores we looked at the arrangements in place for dealing with complaints and safeguarding people who use the service from harm. We looked at policies and procedures and we spoke with management team, staff and some people who were using the service at the time of the inspection. We were provided with a copy of the complaints policy and procedure. This was a lengthy fifteen page document which contained some brief information about how complaints could be made and how they were to be dealt with by staff and management team. The policy referred throughout to Vale House not Passmores. Within the principles section of the document it was recorded that a person may may complain orally or in writing and that all complaints should be recorded. It was also recorded that the policy should be clear and easily understood by staff. We looked at the information about complaints within the residents handbook. There was very limited information recorded here. This document stated During your treatment at Passmores there may be occasions where you have concerns about some aspect of your treatment. Usually these can be resolved through discussion with your key worker, or if they not available any member of the senior staff team. There was insufficient information describing how to complain or how complaints would be dealt with. The policy did not comply with regulation or meet the needs of residents as it was not clear as to how complaints would be received and dealt with. The manager told us that there were regular house meetings and we saw evidence that these were held weekly. The manager felt that this was a forum where residents could raise concerns or make complaints. However this is not appropriate as residents may feel uncomfortable in complaining within the group setting. Care Homes for Adults (18-65 years) Page 19 of 31 We spoke with one member of staff who told us that people were generally satisfied with the service. They told us that they were aware of one unofficial complaint where a person felt that the food was not great. They confirmed that this had not been recorded or dealt with as a complaint. We spoke with one resident who told us that they had raised some concerns with the manager regarding privacy and dignity. They told us that they were not aware of the complaints procedure and that the manager made them feel stupid when they spoke with her. They also told us that they felt intimidated by the manager. We asked the manager if we could see how the concerns had been dealt with. The incident had not been recorded as complaint or concern. The manager told us that the person had not made a complaint. She said if (resident) had said they were making a complaint I would have dealt with it as such. However due to the nature of the concerns raised this should have been dealt with more appropriately in line with the organisations policy and procedure. There were policies and procedures in place for maintaining the confidentiality of sensitive information. However both staff and residents told of three recent occasions where confidentiality had been breached. Two residents and one member of staff told us that information about a person who was due to move into the home was shared with other residents. On another occasion a resident found a document with confidential information about residents, which was left unsecured. We looked at how people were safeguarded. We saw that as part of their initial induction that staff had undertaken training and there were policies and procedures available, including a whistle blowing policy. This was designed to assure staff that they would not face recriminations should they need to raise concerns. However one member of staff we spoke with said that they had raised concerns about the lack of appropriate training, equipment and information about planned treatments. They felt that these concerns were not taken seriously and despite asking the manager for appropriate detoxification training and clarification about roles that this had not been provided. We spoke with two residents about how staff treated them. Both people told us that they felt that there would be recriminations as a result of their speaking with us. One person said They (manager and responsible individual) are outside listening.. I dont feel safe here. Both residents told us that they did not feel that they could speak to the manager about the issues they had. We looked at how staff were recruited to work in the service. We saw that before staff commenced work that checks including Criminal Records Bureau disclosures and references from each persons previous employers ad been obtained and that staff had been interviewed to help determine their fitness to work in the service. However we also saw that people were working in the home on a voluntary basis for whom no checks had been carried out. One of these people had been providing treatments such as massage and aromatherapy to residents. We discussed the implications of this practice and how it put people who were vulnerable at risk. Care Homes for Adults (18-65 years) Page 20 of 31 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 who use the 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 use the services of Passmores enjoy a comfortable environment which is suited to their needs. Evidence: When we visited the home we looked at the accommodation provided for residents. The home is a listed building set in beautiful grounds on the outskirts of Harlow Town. The home comprised of two units. There was a detoxification unit, which provided treatment for up to seven people, and a rehabilitation unit, which accommodated up to seven people. This unit was furnished with equipment to provide initial support to people in an medical emergency situation such as seizure or cardio-pulmonary resuscitation. There was a portable defibrillator and grab bag which included airways, pocket masks and rectal diazepam. There was also an Electrocardiogram machine to monitor residents during the initial stages of detoxification. Residents in each area had access to large, clean and bright communal areas such as dining rooms, lounge area and dedicated smoking areas. Each resident had their own private bedroom equipped with en suite shower or bathing facilities. There was a treatment room, which was used by the doctor when they visited. There was a therapy room equipped with massage table and other equipment. There was ample space for group treatment, counselling sessions and meetings. Residents access to some areas of the home were restricted in line with the homes policies for segregating people receiving detoxification from those in the rehabilitation stage of their recovery. Residents we spoke with commented on the layout of the home and said that they were happy with their accommodation. Care Homes for Adults (18-65 years) Page 21 of 31 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 who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of specialist training may mean that residents are not supported according to their needs. Evidence: When we visited Passmores we looked at how people who use the service were supported by staff. We looked at how staff were recruited, trained and supervised to be able to meet residents needs. We were provided with copies of staff duty rotas. These did not reflect an accurate picture of staff working in the home. Where staff were absent due to illness or planned holidays etc, this was not recorded nor were the arrangements for providing staff cover in these instances. The manager told us that they filled in when needed. They also told us I have not had a day off in three months, not a weekend or a bank holiday and I am exhausted. Another member of staff told us that they would have to find cover for when they took leave. We saw from the rotas that on there was always a minimum of one nurse on duty on the detoxification unit. Some staff raised concerns that staffing levels were insufficient. The management team said that they felt confident that staffing levels were appropriate. There was no tool in place for determining the dependency levels of people using the service or reviewing the staffing levels and skills mix to support people for their assessed needs, and the manager confirmed this during the site visit and at the subsequent meeting held to discuss the inspection report. This and the fact that the manager had no days off since the home opened was a cause for concern as this may impact upon the support that residents receive. We looked at the recruitment files for five people who had been recruited to work in the home. We saw that candidates had completed an application form and provided Care Homes for Adults (18-65 years) Page 22 of 31 detailed information about their previous employment. Checks including references and Criminal Records Bureau disclosures had been obtained and candidates had been interviewed to help determine their suitability to work in the home. While appropriate checks had been carried out for paid staff these checks had not been completed for two members of staff who worked there on a voluntary basis despite the fact that they had unsupervised access to residents including providing treatments such as aromatherapy and massage. We looked at the home’s recruitment policy and procedure, which was provided for us during the inspection. This included a section on the use of volunteer workers and the importance of carrying out appropriate checks before people worked in the home. This was in contrast to the practices for employing volunteers in the home. One nurse we spoke with said ‘We have no job descriptions’. We looked at the staff files for five members of staff. Of the five only one person (the unit manager for the detoxification unit) had a job description to define their roles and responsibilities. We looked at the arrangements for training and supporting staff to enable them to care for residents. The home had only been open since April 2009. Prior to the opening staff attended a month long induction, which included training. We looked at the training plan. We saw that staff within this month had completed training in Health and Safety, Group Therapy, Assessment and urinalysis, First Aid, Safeguarding, Drug and Alcohol Awareness, Motivational Training Therapy, Food Safety and training around detoxification. Information about training was presented in the form of a list. Staff did not have certificates and there was no evidence that staff had undergone any assessment of competencies in relation to the tasks, which staff were expected to carry out in particular in respect of detoxification treatment. While there was some evidence that staff undertook training around detoxification there was no indication as to the dept or content of the training provided We asked the manager and the responsible individual what training staff had in this area. The responsible individual said They will have had the minimum standard. However when further questioned he was unable to clarify what this minimum standard was. One member of staff told us that they felt that the training provided was inadequate. They said ‘They (management) have not got a clue. Training was geared to counselling. None of the nurses have had detoxification training. The training during induction was from the priory 3 hours, we asked for further clarification but we have not received any. We also observed that some staff who were administering medicines to residents had not received medication training. One member of staff told us that Training is planned, I have not had training but I feel comfortable providing medication. We aw evidence that staff received supervision on a regular basis. This covered residents and their progress with treatments, time management and any other issues, which were relevant. Care Homes for Adults (18-65 years) Page 23 of 31 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 who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not well managed or run in the interests of the people who use it. Evidence: When we visited the home we looked at the management arrangements and the ways in which people who used the service were consulted with about their views and opinions. We spoke with the manager. She told us said I have had enough. She told us that she had worked continuously for three months without a day off. She said that they were looking for another person to manage the home so that she could concentrate on their other role as chief executive of stabilisation services. She said This role is a lot on top. I need to be marketing and strategic work cannot do at this moment in time. One member of staff and two residents indicated that they did not have confidence in how the service was managed. One member of staff we spoke with told us that the service was not being managed properly. They said ‘They (managers) are not learning or listening’ We spoke with the manager and responsible individual about how the views of people who use the services were obtained and acted upon. They told us that there was an evaluation, which residents who were admitted for detoxification completed at the end of their treatment but as nobody had completed their programme as yet so there were none available. They told us that residents who were admitted for rehabilitation would complete an evaluation after a period of three months. We saw that residents had the opportunity to raise issues at weekly house meetings. Where suggestions were made Care Homes for Adults (18-65 years) Page 24 of 31 these were recorded as action points and allocated to staff to complete. We looked at records for these meetings and saw that residents made suggestions about meals, activities and the environment and that these were actioned promptly. We looked at a number of documents including policies and procedures, which underpinned the management of the home. As described within other areas of the report some policies and procedures did not reflect some practices and some were not specific to the service and the people who use it. Record keeping in respect of the residents needs and the treatment they received were poorly maintained and did not evidence how needs were assessed, reviewed or met. The premises were well maintained and complied with local building and fire authorities. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes 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 Care Homes for Adults (18-65 years) Page 26 of 31 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 1 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 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 1 4 Information about the home must be reviewed and amended so that it accurately reflects the service and the conditions of registration. This will ensure that those people who are looking for detoxification or rehabilitation services will have enough information about Passmores to help them decide that it will be suitable. 17/07/2009 2 2 14 People must only be admitted for treatment or rehabilitation following completion of a detailed assessment of their needs 21/08/2009 Care Homes for Adults (18-65 years) Page 27 of 31 and the determination that the unit is suitable. This is to ensure that the person can be assured that the service will meet their needs. 3 6 15 Each person must have a 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. 4 9 13 Risks to the health and safety or welfare of people who use the service must be assessed and plans put into place to minimise these. 26/06/2009 21/08/2009 5 18 12 This is so as to help ensure the health, safety and general welfare of people who use the service. Where residents are to be 31/07/2009 supported for personal care or intimate treatments this must be done so as to protect the persons privacy and dignity. This to ensure that residents are treated well and their privacy and dignity is respected and promoted. The provision for health and medical care and treatment must be clear and appropriate assessments must be completed and kept under review. 6 19 12 30/07/2009 Care Homes for Adults (18-65 years) Page 28 of 31 7 22 22 This is to ensure that people using the service receive the treatment they need as part of their individual treatment programme. 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. The home must be managed so that the dignity of service users is protected at all times. This is to ensure that residents privacy and dignity are protected and that confidential information remains so. Staff must be employed in sufficient numbers, which are reviewed according to the needs of people using the service and take into account staffs need for appropriate time off work. This would help ensure that residents needs are met by a competent staff team. Staff must receive training in respect of their roles and the needs of people living in the home. This refers to training in detoxification and the care of people who are undertaking a programme in withdrawal from substance misuse. This will ensure that residents receive the level of 15/07/2009 8 23 12 01/07/2009 9 33 18 31/07/2009 10 34 18 31/07/2009 Care Homes for Adults (18-65 years) Page 29 of 31 11 34 19 support and treatment they need. Staff (including those 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. The service must be managed in line with current regulatory requirements and its statement of purpose. This is to ensure that the service is run in the interests of the people who use it. Records must be kept in good order and reviewed when necessary. This is to ensure that records and information reflects the service provided to people who stay there. 31/07/2009 12 37 4 28/08/2009 13 41 17 02/09/2009 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. No. Refer to Standard Good Practice Recommendations 1 31 All staff should have clear job descriptions so that they are clear in respect of their roles and responsibilities. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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