Inspection on 09/09/08 for T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit

This inspection was carried out on 9th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Hamer Cottage

Turning Point (Hoole Road)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit Witton Bank Witton Spring Lane Blackburn BB2 2PW Lead Inspector Jane Craig Unannounced Inspection 9th September 2008 10:30 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit Address Witton Bank Witton Spring Lane Blackburn BB2 2PW 01254 59240 01254 56884 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) T.H.O.M.A.S (Those on the Margins of a Society) Mrs Catherine Victoria Woolham Care Home 21 Category(ies) of Past or present alcohol dependence (21), Past or registration, with number present drug dependence (21) of places T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence- Code A The maximum number of people who can be accommodated is: 21 Date of last inspection New Service Brief Description of the Service: T.H.O.M.A.S Witton Bank is a care home offering rehabilitation for adults with a history of drug and/or alcohol dependency. The service can offer 24-hour personal care and accommodation for up to 21 people. The rehabilitation programme runs for 26 weeks and is based on the 12-step philosophy, combined with cognitive and psychotherapy techniques. The home has a garden and there are several car parking spaces. It is situated in a residential area approximately two miles from the centre of Blackburn, which has a full range of community facilities and access to transport networks. The house has a mix of single and shared bedrooms. Most of the bedrooms do not have en-suite facilities but there are sufficient toilets and bathrooms situated around the home. Communal rooms include three large lounges, a dining room, a group room and kitchen. Information about the home is given to prospective service users on referral. The registered manager confirmed that the fees at 9th September 2008 were £395 per week. The fee did not include personal toiletries, magazines and papers. People using the service were sometimes asked for a contribution towards activities outside the home. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at T.H.O.M.A.S. Witton Bank on the 9th September 2008. At the time of the visit there were 14 people accommodated. They wished to be referred to as service users. The inspector met several in a group situation and asked about their views and experiences of the service. Some of their comments are included in this report. Four people living at the home and five members of the staff team completed surveys about the home. Their responses were taken into account when compiling the report. During the visit discussions were held with the registered manager, the responsible individual and two staff. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager completes and sends to the Commission every year. What the service does well: The service user’s guide gave comprehensive information about the service and what people could expect. Service users said that they were also given a basic rundown during the assessment process. They said the information was accurate and staff were “up front”. In order to help them to make a decision about admission, people thinking of using the service were able to have a trial visit, where they could talk to staff and gain the views of other service users. Within the first week of admission everyone was given an Individual Service Agreement, which included the terms and conditions of the placement. Service users were involved in all aspects of planning their programme. Staff encouraged them to set their own goals and review their progress towards meeting them. They were encouraged to make decisions and take responsible risks in their daily lives. One service user wrote, “Staff help me in the right direction with my decisions,” and another wrote, “each day brings different challenges and it is my decision what I do with them.” T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 6 Service users said that staff always gave them reasons for restricting choices or decision making. One service user said they found it difficult at first adhering to a strict routine but soon realised how helpful it was. Another wrote, “There are certain guidelines here because people are here to change.” Service users were happy with the way the menus were chosen and how the cooking was organised. The manager oversaw the meals to ensure that everyone received a balanced diet. There was a clear complaints procedure that was understood by all the service users. They were confident that any complaints would be listened to and acted upon. One wrote, “The manager is always willing to listen to problems and will help if she can.” Another said, “Staff are open minded and willing to listen and find a solution so it never gets to be a complaint.” There had been no complaints since the service opened. The home was well maintained. The décor and furnishings were homely and comfortable. The group took responsibility for most of the cleaning and at the time of the visit the home was clean and tidy. One service user commented, “The facilities are spotless and extremely comfortable.” Service users were very positive about the staff team. One wrote that staff treated them with respect. Another wrote that they were, “polite and friendly.” Staff had good opportunities to attend training and all had undertaken courses that were relevant to their role. Most of the staff held an NVQ level 3, which is a nationally recognised qualification in health and care. Service users had opportunities to influence the way the service was being developed. They had regular meetings where they could put their views and suggestions forward. What has improved since the last inspection? What they could do better: Risk assessments should be more thorough and the judgement about the level of risk should only be made after taking into account all of the available information. The manager must ensure that any service users who have physical or mental health care needs have an appropriate care plan in place. This is to ensure that staff know exactly what support the service user may need. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 7 Not all practices for managing medication were safe. The policies needed to be further developed to reflect current practice. There should be assessments and care plans to show the level of assistance service users needed to manage their medication. The records were not complete, which meant there was no audit trail to minimise the risk of mishandling. In order to safeguard service users the manager must ensure that all new staff have all the required pre-employment checks. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process was thorough and ensured that the service user had enough information to make an informed choice as to whether the service could meet their needs. EVIDENCE: The statement of purpose and service user’s guide were sent out when people were referred to the service. The service user’s guide provided clear information about the service and what people could expect. There were plans to produce the information in a DVD format for people who may have difficulty reading the current guide. Service users said the information they received in the service user’s guide and during their assessment was clear and accurate. One said that staff were, “up front about everything.” Another wrote, “They gave me the necessary information and support that I needed.” Everyone was assessed before admission either via the telephone or during a visit to the home. Where possible the manager obtained assessment information from other services but in practice this did not always happen. For example, one person who was referred by social services did not have a care management assessment. In these instances the home’s assessment may not T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 10 include sufficient information about the service user’s history and current needs. The improvement plan for the service showed that the assessment process was due to be reviewed in the next month. Trial visits were encouraged wherever possible. A service user was allocated to show people round. The new person was introduced to staff and given the opportunity to talk to other service users. Following the assessment and trial visit the manager sent a letter to the service user confirming that the service could meet their needs. Individual service agreements, which include the terms and conditions of the placement, were given out within the first week. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were involved in setting their own goals and were supported to maximise their independence by making decisions but risk assessments were not always robust enough. EVIDENCE: Service users said they were consulted about everything connected to their programme. For example, they were involved in drawing up their support plan, which helped them to identify the intended outcomes of the placement. Service users had monthly review meetings with their key workers where they were able to measure their achievements and agree targets for the following month. Service users were responsible for keeping up to date with their step work and writing up significant event diaries. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 12 Service users said that they received as much help from their key worker and other staff as they needed to help them work towards their goals. One service user said that staff helped with anything they were struggling with, for example, cooking and budgeting. Another said that staff were getting him a Dictaphone because he was not good with reading and writing and he did not want to fall behind with his step work. Service users who completed surveys indicated that although there was a structure to each day they were able to make some decisions about what they did. For example, one person wrote that he decided how to spend his free time. Another wrote that he decided when to do his step work, which meetings he went to and what he did at weekends. The manager discussed the importance of encouraging people to take responsibility and make decisions within a safe environment, where the group could help them to explore unwise decisions. There was a regular ‘choices and consequences’ group, which helped with people with decision-making. A risk assessment was carried out with everyone prior to his admission. The assessment document gave a judgement on the level of risk in a number of areas, for example, risk of harm to self or others. However, the assessor did not use a validated assessment tool, nor did they always use all available information to make a decision about the final risk level. For example, one person was judged as being low risk of suicide but the assessment was incomplete and a previous suicide attempt had not been into account. Strategies were in place to control identified risks. Service users were encouraged to explore any risks associated with activities such as going on home leave. They said that their key worker would make sure that their assessments were realistic to ensure that they had strategies in place to try to minimise the risks. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service assisted people to make desired changes to their lifestyle and provided a good balance between freedom of choice and restrictions. EVIDENCE: There was a structured daily programme with set times for getting up and going to bed. Some of the programme was non-negotiable and people were expected to attend groups and keep their step work up to date. One person said that they found it difficult at first because they were not used to any kind of routine but soon realised how helpful it was. Service users knew before admission that they were expected to work in the kitchen, do their own laundry and domestic tasks. Support plans for two people showed that part of their programme was to develop domestic skills. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 14 One person said that over a short period of time he had learned many new skills. Service users also had time for social and recreational activities, both group and individual. The group said that there was generally a good balance and they had enough free time to themselves. Service users went out regularly into the local community with staff or peer escorts. One person wrote that they went to the gym regularly. There was a strong commitment to developing people beyond their rehabilitation programme. The organisation was looking towards people gaining accreditation for the learning they completed during their stay. The aim was to gain a qualification that could eventually lead on to further education or employment. There was a list of house rules. Service users were given a copy before they came in and signed their agreement to abide by the rules. The rules outlined restrictions to service users’ freedom and rights. For example, they were not able to open their own post in private. There were small fines for breaking rules. The key worker or the group decided the fines and money was used towards communal activities. For more serious breaches of rules the service user was given warnings and could ultimately be discharged from the programme. One service user said, “there is a good balance of responsibility and restrictions, it works.” There were also rules about visitors and contact with family and friends. Service users said they could not go on home leave for the first three months. They were also discouraged from developing intimate relationships whilst on the programme because of their emotional vulnerability. Service users said they understood and accepted the need for these rules. Although there was a strong emphasis on group living people said they were able to have some private time and space. One said, “The house is big enough to be able to get away if you need to.” Another said they went to their bedroom in the evening if they wanted some privacy. There was a decision not to put locks on bedroom doors to foster trust and honesty. Service users said that was all right and they still gave each other privacy when they were in their own rooms. The group decided on the weekly menu and there was a rota for shopping and cooking. People who needed help to develop their skills were paired with more experienced and skilled cooks. The manager oversaw the menu and meals to ensure that everyone was receiving a balanced diet. There was also information about healthy eating on display. Service users cooked alternative meals for anyone with allergies or who had a different diet. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ were assisted to meet their health care needs but some medication practices were not completely safe and could place people at risk. EVIDENCE: None of the current service users needed assistance with personal care, although staff support was available if needed. The service user’s initial assessment indicated whether they had any ongoing health care needs. The manager said that none of the current service users needed any assistance from staff to manage any physical or mental health needs except to assist with making appointments and escort to GP or hospital appointments. One person had a potential heart condition that staff needed to be aware of. The manager had given information to staff immediately the condition became known. However, there was no ongoing care plan or directions to instruct new staff or remind others what signs and symptoms to look out for or how to respond if the person became ill. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 16 There was a policy for managing medication. However, not all aspects were detailed enough and it did not cover all areas of practice. For example, there were some homely remedies but no guidance for staff as to how they should be managed. With some prompting from staff, service users took responsibility for ordering their own medication. Medication was stored safely in a locked cupboard in a staff office. Service users asked for their tablets when they were due and took them under the supervision of staff. There were no assessments to show whether service users needed help to do this safely. For example, one person sometimes forgot that he had to take his medicine in the morning but this had not been documented and there was no care plan in place to alert staff to remind him. There were no records of medication received, or returned to pharmacy, which meant there was no audit trail. Each service user had an individual record of the medication he was prescribed but there was only one, shared record of medicines administered. Each person taking the medicines and the member of staff supervising them signed the record. This use of a joint recording document made it difficult for staff to see whether anyone was continually missing their medication. The record did not have the dose or times that the medicines were taken, which could increase the risk of some medicines, such as paracetamol, being given too soon after the previous dose. The manager was in the process of arranging medication training for staff, which should improve the way medicines were managed in the home. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were confident that their concerns would be listened to and acted upon. Procedures and training were in place to safeguard service users. EVIDENCE: The service user’s guide included information on how to make a complaint and how it would be dealt with. Staff who returned surveys indicated that they knew what to do if anyone raised concerns about the service. Service users said they understood how to make a complaint. One wrote, “This was explained to me, although I have never had to use it.” Another said, “They are open minded and willing to listen and find a solution so it never gets to be a complaint.” The annual quality assurance assessment (AQAA) showed there had been no complaints since the service opened. Staff had received training in safeguarding and had access to the Blackburn with Darwen safeguarding policy. The policy for the service included clear steps for reporting both inside the home and to outside agencies. The manager and staff were aware of their responsibilities to report any suspected or actual abuse. Service users said they felt safe at the home. One said that although they felt quite vulnerable at times, they did not feel as though anyone would take advantage. Service users signed to acknowledge that they had read the complaints and safeguarding policy. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained and provided people with a comfortable and homely place to stay. EVIDENCE: The premises were suitable for purpose. It was apparent from a walk around the building that the home was well maintained, although there was water damage in three of the rooms following a leak in the roof space. There were systems in place for reporting minor faults and all maintenance work was contracted out. There were sufficient lounges and other communal rooms for group meetings and recreational activities. The lounges were furnished and decorated in a homely and comfortable way and to a good standard. There were seven single and seven shared rooms. Information about room sharing and rooms sizes were included in the statement of purpose. The manager discussed that room sharing had a therapeutic purpose and she T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 19 would usually put a new service user in a shared room to prevent them feeling isolated. Service users were able to personalise their rooms with pictures and other small items. There were fluorescent lights in the bedrooms. The manager said that these would eventually be replaced with more domestic style lighting. Only one of the rooms had en-suite facilities. A new shower had been put in to ensure that there were sufficient bathing facilities on each floor. The shower cubicle had been erected in a bedroom with very little change to the rest of the room and might benefit from further design. At the time of the visit the home was clean and tidy. Domestic tasks were mostly managed by the group and overseen by the manager. A service user wrote, “The residents clean personal and communal areas as part of therapeutic duties.” Another commented, “The facilities are spotless and extremely comfortable.” There was no specific infection control procedure, although some of the other policies included protocols for reducing the risk of spread of infection. Staff had not received formal training but the manager said that all staff were aware of and used universal precautions. The AQAA indicated that the manager had an action plan with regard to infection control. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although service users were supported by a qualified and competent staff team, which helped to ensure their needs were understood and met, the recruitment practices did not provide complete safeguards. EVIDENCE: Service users said there were enough staff on duty to give them any assistance they needed and staff confirmed there was flexibility to increase staffing levels if needed. Service users talked about the good relationships they had with staff. One of the group described staff as “passionate.” Another said, “Our key workers are in recovery so they understand.” Those who returned surveys were also positive about the staff team, who they said treated them well and listened to them. One wrote that the staff treated him with, “care and respect and treated me as a person.” T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 21 The files of two new staff were inspected. Both had CRB disclosures before starting work but not all other required information and documents were in place. For example, one member of staff only had one reference and this was not from an impartial source. Another did not have an employment history. A number of staff had a history of criminal offences related to prior drug use. The manager advised that their history was looked at carefully and weighed against the safety of the service users before a decision was made as to whether they would be employed. However, there was no set criteria or risk assessment in place to ensure that this process was carried out fairly and with regard to equal opportunities. New staff completed an induction programme. This included an introduction and orientation to the service then a number of ongoing sessions relevant to the service user group. Not all of the topics covered in the common induction standards were included in the induction programme. For example, staff did not receive awareness training in the safe working practice topics such as infection control and basic food hygiene. As soon as possible staff were enrolled onto NVQ training. The AQAA showed that 84 of staff had achieved NVQ level 3, which incorporates a number of the units from the drug and alcohol national occupational standards (DANOS). One member of staff said his assessor had helped him to choose units that were relevant to his current role. All staff had also completed counselling courses and a number had undertaken courses arranged by the Federation of Drug and Alcohol Practitioners (FDAP). Staff who completed surveys indicated that they received training relevant to their role. One person wrote, “We have up to date training and can bring anything to the table that we feel would be beneficial to work practice.” The manager discussed that the organisation has a commitment to developing the staff team. Staff had regular supervision with their line manager. The annual improvement plan showed that the manager also planned to introduce staff appraisals. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run in the best interests of service users and in a way that protected the health and safety of everyone living and working there. EVIDENCE: The registered manager has a number of qualifications relevant to drug and alcohol rehabilitation. She has a level 3 management qualification and is in the process of undertaking a level 4. The manager is in charge of the home on a day-to-day basis and is supported in her role by the responsible individual who is on site for most of the time. The manager is experienced in running supported living and day services in the drug and alcohol field but not a residential service. Shortfalls identified during the inspection, such as medication and recruitment, may be as a result of this lack of experience. Both the manager and the responsible individual confirmed T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 23 their commitment to improving services to ensure the safety of service users. The service had an improvement plan, which clearly showed how the service plans to move forward over the next year. Staff and service users said the manager was open and supportive and they appreciated her informality. A number of service users commented that the responsible individual was also approachable and a member of staff described him as inspirational. One service user remarked that management treated everyone the same. There were a number of systems in place to monitor and improve the quality of the service. There were regular service user meetings and staff meetings. Service users said they could make suggestions and the responsible individual confirmed that the weekend structure had been changed in response to requests from service users. The service had started to give out client satisfaction surveys. The AQAA showed that the manager plans to publish comments in the service user’s guide to help people who were thinking of using the service. Servicing and testing of the fire system, equipment and alarms was up to date. Staff had received fire safety training and attended regular practice drills. Maintenance and servicing of other installations and equipment was up to date. There were environmental risk assessments and regular health and safety checks throughout the building. On admission service users were given a document briefly summarising some of the health and safety procedures relating to the tasks and activities they took part in. They signed to confirm that they had read and understood the fire safety procedure. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 3 X T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 15 Requirement Care plans must include directions for staff to assist the service user to meet any physical or mental healthcare needs. Timescale for action 31/10/08 2. YA20 13(2) In order to ensure there is an 30/09/08 audit trail and to reduce the risk of mishandling, there must be accurate and complete records of medicines received, administered and returned to pharmacy. Each service user must be assessed as to their capability to partially self medicate. Any assistance they require must be recorded on their individual plan. 30/09/08 3. YA20 13(2) 4. YA34 19 & Schedule 2 In order to protect service users 30/09/08 and show that staff are suitable to be employed, they must have 2 references, preferably from impartial sources. Other required information and documents must be obtained and retained on file. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations For people referred through care management arrangement, the manager should obtain the assessment and care plan before the service user is admitted to the home. Risk assessments should be more thorough. Judgements about the level of risk should only be made after all available information has been taken into account. The policy for managing medication should be further developed to ensure it addresses all areas of current practice and is in accordance with the latest guidelines of the Royal Pharmaceutical Society. Each service user should have an individual record of medicines they have taken. This should include the dosage and time they have taken them. In order to protect people living and working at the home, staff should have training and written guidance on infection control procedures. To protect people living at the home, a risk assessment should be carried out if an employee has previous criminal convictions on their CRB disclosure. Staff should receive training in the safe working practice topics in so far as they are relevant to their role. 2. YA9 3. YA20 4. YA20 5. YA30 6. YA34 7. YA35 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V367130.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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