Inspection on 15/09/06 for The Salvation Army (Bristol) Bridge Programme Detox

This inspection was carried out on 15th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Salvation Army (Bristol)... 09/09/08

The Salvation Army (Bristol)... 27/09/07

The Salvation Army (Bristol)... 28/02/06

The Salvation Army (Bristol)... 21/09/05

The Salvation Army (Bristol)... 18/01/05

The Salvation Army (Bristol)... 26/10/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Salvation Army (Bristol) Bridge Programme Detox Social Services Centre, Logos House 2 Little George Street St Judes Bristol BS2 9EL Lead Inspector Sandra Gibson Key Unannounced Inspection 15th September 2006 09:45p The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Salvation Army (Bristol) Bridge Programme Detox Social Services Centre, Logos House 2 Little George Street St Judes Bristol BS2 9EL 0117 9550074 Address 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) Salvation Army Justine Lewis Care Home 4 Category(ies) of Past or present alcohol dependence (4), Past or registration, with number present drug dependence (4) of places The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2006 Brief Description of the Service: The Salvation Army Bridge Programme Detox Unit is registered by The Commission for Social Care Inspection to provide detoxification treatment for up to four service users (male or female) aged 18- 64 years who are addicted to alcohol or drugs. The management team are committed to provide temporary accommodation and a medical based detoxification treatment for homeless people with an alcohol and/or drug addiction. As a Christian Organisation, The Salvation Army believes in an approach which covers every aspect of a persons life including physical, social, emotional and spiritual needs. The Community Detoxification Unit offers an 8 to 12 day treatment depending on assessed needs. There is a designated Doctor attached to the unit. The service users are expected to participate in therapeutic groups as well as activities groups and life skills groups. The unit is located in The Salvation Army Hostel, which is situated close to the City Centre and major transport routes. The Salvation Army Bridge Programme is an addiction service for homeless people in Bristol and also offers Outreach support, Stage 1 Preparation, and Stage 3 Rehabilitation, none of which are registered services. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced key inspection conducted midweek between the hours of 9:45am and 4:30pm. Evidence was gathered from: Examining previous correspondence with the home, inspection reports, information from pre-inspection questionnaire, residents surveys (3) (4) talking to/observing service user, talking to new nominated responsible individual, talking to the registered manager /talking to The Salvation Army Centre manager / talking to the Bridge Programme Manager talking to staff/ volunteer, talking to and case tracking one service user, examining records, policies and procedures. What the service does well: The arrangements in place to assess service users needs prior to admission are good so that the individual and the home can be sure the placement is appropriate. There is a clear care planning system in place, which ensures that service users’ needs are fully met. Service users are well supported by the staff team and have the opportunity to learn to take greater personal responsibility for themselves and their recovery. Confidentiality safeguards are in place which safeguards service users interests. The intensive support provided to service users during the detoxification treatment programme is good. Restrictions on choice and freedom are made clear to service users at the beginning of the programme. Consequently service users can make an informed choice about the suitability of the treatment provided by this unit. The Salvation Army Bridge Detox Unit is kept under constant review and development by the experienced management team, which ensures that the residents benefit from a well run home. The management of health and safety records is good. The systems in place ensure that the health and safety of service users and staff is promoted. Service users’ physical care and emotional health needs are fully met and support and treatment is delivered in a way that meets individuals’ assessed needs. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 6 Arrangements for protecting residents are satisfactory. Procedures in place ensure that services users are protected from harm. What has improved since the last inspection? What they could do better: 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 Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 7 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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The information about the Salvation Army Detox Unit provided to service users and their representatives may be misleading. Urgent attention is required so that a person can make an informed decision about whether the unit can meet their individual care needs. The arrangements in place to assess service users needs prior to admission are good so that the individual and the home can be sure the placement is appropriate EVIDENCE: The statement of purpose and service users guide were both examined. These documents have been combined and can be found in a document called The Salvation Army Bristol (UK) Bridge Programme Information. The manager explained that this booklet was due to be reviewed in the next few months. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 9 This information is not clear or easily accessible for prospective service users to use. There are gaps in the information provided and misleading references to the detoxification unit being a clinic and not a care home and qualified nurses being available during the day. Service users comments included, “I did not get enough information about the home before moving in. I was desperate”. Another service user said, “my key worker from my hostel told me about this place. I did not get any written information before I came”. On the day of the site visit there was only one person accommodated. This person was interviewed and their individual records case tracked. Evidence confirmed that the assessment process starts at the referral stage where as much background information as possible is obtained by the detox unit staff in consultation with the prospective service user. Prior to a place being offered thorough needs assessment is conducted, which considers whether prospective service users have a mental health, needs as well as an addiction. A medical assessment is conducted prior to admission. The staff team have received training in working with service users with mental health needs as well as addiction. Evidence confirmed that prospective service users are involved with the whole assessment process and a risk assessment is completed prior to admission. One service user said, “The staff are great. My assessment went well and I felt involved” A contract /care agreement for service users taking part in drug or alcohol detoxification was seen and evidence confirmed that its contents are agreed by service users. Potential restrictions on choice and freedom are set out. This includes restrictions on visitors, circumstances under which service users may leave the premises during treatment and discharge arrangements. Comments such as “I cannot always do what I want because I am on restrictions to keep me safe” and we can do what we want within reason as we are detoxing and decisions are not always the right ones, so yes as long as it keeps us safe. It had rules, which was needed for me” Once again reference is made in this document to the nurse in charge and unit senior nurse. This needs to be reviewed as it may be misleading to residents who are undergoing treatment. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a clear care planning system in place, which ensures that service users’ needs are fully met. Service users are well supported by the staff team and have the opportunity to learn to take greater personal responsibility for themselves and their recovery. Confidentiality safeguards are in place which safeguards service users interests EVIDENCE: The care plans for one service user accommodated on the unit were examined Evidence confirmed that this plan of care also contained details of a treatment programme which had been discussed and agreed with the service user. Care records start during the outreach stage before the service user is admitted to the unit and follow them through to rehabilitation. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 11 The care plan examined was concise and included reviews by staff, with agreed outcomes for the service user. The one service user spoken to said that staff had agreed his care plans with him and that he was kept informed at all times. Any limitations are agreed with service users and recorded in the care plan agreement. Service users are made aware of their rights to confidentiality on admission and staff spoken to be also aware of the importance of this. One service user said, “I feel they respect confidentiality”. Another said, “I trust them”. All one to one meetings are carried out in private rooms and all records are stored in locked cupboards. Consent is also gained at the point of referral for sharing information with agencies that are providing treatment. However there was no reference to The Commission for Social Care Inspection noted. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,12,13,14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The intensive support provided to service users during the detoxification treatment programme is good. Restrictions on choice and freedom are made clear to service users at the beginning of the programme. Consequently service users can make an informed choice about the suitability of the treatment provided by this unit. Meals provided are not wholly satisfactory. The arrangements in place need to be urgently reviewed to ensure that the meals are well managed and provide daily variation, good nutrition, and social contact for residents. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 13 EVIDENCE: The unit concentrates on the detoxification part of the programme. Service users are encouraged to attend group sessions and they can also attend art therapy, IT skills and cookery sessions. A programme of these sessions was seen in the service users guide and it was observed that life skills and development groups such as cooking and art were on offer. Drop in sessions such as Narcotics anonymous and Alcoholics anonymous are also held that service users are expected to attend during the programme. Unit trips are arranged at the weekends that include: visits to the cinema, places of interest and bowling. The manager said that these trips were not as frequent as usual due to staff shortages. There are restrictions on freedom when a service user is in the unit. For example if a service user wishes to go out, a member of staff must escort him. During the first two weeks service users are not allowed visitors or phone calls unless it is an emergency. And despite the unit being registered to accommodate male and female service users, there can be no admission to bedrooms of the opposite sex or any sexual relationships during the course of the programme. There is a volunteer who works on the unit who supports service users when they want to go out. One service user was escorted to the Department of Works and Pension during the time of the inspection. This service user said: “It is brilliant here. They will do anything for you. Staff will take you to the park for a walk or to go shopping. It is nice to go out and buy stuff. A volunteer always escorts me or one of the other members of staff. Support to go out at night is also available”. There are facilities to watch DVD/Video /TV and listen to music in the communal lounge /dining area. This entertainment is screened to ensure that it does not put substance misuse in a favourable light. There are also board games, jigsaws, books and a games console for service users to use. Meals are supplied by a catering service to the main hostel and staff from the detox unit escort service users to the canteen. Other people using this canteen include people accommodated in the hostel and on the rehabilitation programme and members of staff. A range of hot meals, cold meals, drinks and snacks are served in the canteen three times a day. There is currently no self-catering provision in the Detox unit or in The Salvation Army Hostel. Facilities are however available to make light snacks and hot drinks at any time of the day or night in the lounge /dining area on the detox unit. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 14 During the course of the inspection the inspector heard about informal concerns and complaints that had been raised about the freshness of the evening meals, which are prepared earlier in the day. Evidence confirmed that this matter has been now referred to the compliance and monitoring unit based at The Salvation Army Head quarters to investigate. The manager explained that the compliance and monitoring unit were also planning to look at the nutritional value of the food that is served in the canteen and another member of the centre staff was also planning to look at nutritional value of the snacks provided in the deter unit. It was understood that service users would be consulted as part of this process. One member of staff is due to attend a course on recovering from drug and alcohol addiction. nutrition for service users A complaint about an allegation of uncooked meat being served in the canteen was also discussed during the inspection, which the management team did not appear to be aware of and there was no formal record available. It was understood that this had been a single incident and that no other complaints had been made. It was recommended that this incident was followed up with the catering company and all complaints formally recorded in future. During the course of the inspection comments were received such as “Food is great “and “Food is okay for institutionalised food”. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ physical care and emotional health needs are fully met and support and treatment is delivered in a way that meets individuals’ assessed needs. EVIDENCE: The unit aims to provide a medical based detoxification programme, which offers spiritual, emotional and psychological support. This was confirmed by a service user seen during the inspection who said that he was not religious but felt supported by all members of staff including the volunteer. He said “the Salvation Army do not push religion at you”. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 16 One service user said “ I felt they always had time for me. They would sit and just talk. Explain why they came to a decision and to see how we are feeling. Very informative. Got treated like a human being” Service users are expected to participate fully in all programme activities and medical treatment (after admission by the detox unit’s doctor, unless a medical exemption has been gained). It was noted that the detoxification process for all service users includes mandatory urine testing and/or breathalysing throughout the stay and an agreement to abstain from all drugs, alcohol and medication that has not been agreed by the unit Doctor. All medications/herbal extracts that the service user brought with them are handed to the member of staff on duty at admission. The unit does not provide nursing care, but service users do have access to a doctor 24 hours/day either on site or contactable by telephone in an emergency. A District Nurse is also available if the need is identified. The inspector saw evidence of access to Optician, Dentist and a GP. The admission process includes registration with a local GP and the unit also has a consultant psychiatrist who comes in to see service users twice a week. One service user said, “staff will accompany you if you need to attend any appointments”. Other qualified staff are on duty during the day including the part time doctor attached to the unit who monitors levels of alcohol and drug use and service users general condition. There are also two members of staff who are trained nurses that have qualifications in mental health. A third member of staff who is to join the unit after the inspection also has a mental health qualification. The medication administration system was examined. A sample check of homely remedies was completed and it was noted that the medication recorded as being held was up to date and accurate. The controlled medication book was checked and was noted to be satisfactory. A check of the medication held for the one service user accommodated in the unit was conducted and this was found to be satisfactory. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure has improved since the last inspection but further development needs to take place to ensure that service users feel their views are listened to and acted upon. Arrangements for protecting residents are satisfactory. Procedures in place ensure that services users are protected from harm. EVIDENCE: Three service users confirmed that there is a complaints procedure is in place that that they were familiar with the procedure, as a copy is supplied to all service users on admission. The complaints procedure includes a response time and full details of The Commission for Social Care Inspection. Comments received from service users included: The detox unit felt a safe place to show my emotions. Easy to complain, Easy to talk to staff. You can tell the staff cares about our welfare. Nothing but praise for them.” Service users attend a meeting every morning where they are encouraged to raise any concerns. Three complaints have been raised with the manager since the last inspection and evidence confirmed that these complaints had been resolved satisfactorily. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 18 However, as discussed in the section on meal provision it was highlighted that not all complaints ware brought to the attention of the management team. This situation must be reviewed to ensure that all complaints are formally recorded. One service user said that they knew how to make a complaint “but it’s not really that good as it takes too long to be dealt with” There is an adult protection policy and procedure in place and the home hold a copy of ‘No Secrets in Bristol’. The staff team have experience and knowledge of adult abuse and what guidelines are in place to protect a service user from harm. Service users’ valuables are held securely in The Salvation Army Hostel facilities and not in the unit. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The standard of the cleanliness, comfort and safety of The Salvation Army detox unit has improved since the last inspection. However, it may benefit from a review of the arrangements in place for service users privacy to ensure that arrangements are in place to meet service users individual needs. EVIDENCE: The Salvation Army Bridge detox is housed in a new building, which has been designed with specific reference to the National Minimum Standards. There is wheelchair access to all areas, it is secure and there are CCTV cameras in the hostel, although not in the unit. The whole building has recently undergone a refurbishment programme. This work was completed in December 2005. Following this refurbishment access arrangements were changed to improve health and safety arrangements for service users and staff. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 20 Service users who are accommodated in the detox unit now access the unit via the main reception to The Salvation Army Hostel that ensures that everybody signs in and out of the building at one point and any visitors can wait in a waiting room. The main reception is staffed 24 Hours of the day seven days a week. All four rooms are en suite and well furnished; due to the short stay element of the unit service users do not bring their own furniture. A sample of two rooms was seen and it was noted that they are comfortably furnished and they contained furniture/equipment as outlined in the National minimum standards. During the course of the inspection it came to the attention of the inspector that service users would benefit from voile or net curtains being installed in bedroom windows to improve privacy. Bedrooms are situated on the ground floor and some overlook public roads. Venetian blinds are in place but are dark in colour. Therefore if a service users wishes to spend some private time in their bedroom, they cannot enjoy natural light and privacy, as they have to choose to close the blinds or be in public view. The shared bathroom / toilet facilities are good. satisfactory. Hygiene standards are The unit has a communal area. A private patio area has now been built which service users can access from the lounge. Service users can make snacks and drinks in this communal area. It was noted to be clean, comfortable and homely. It contained DVD/Video TV and music facilities. The unit was found to be clean and tidy. The inspector saw evidence of infection control guidelines being observed by staff and noted that the domestic support staff was engaged in cleaning the unit during the course of the inspection. Comments from service users received included: “It was clean and fresh”. Another service user said “ I took responsibility to keep the home clean and fresh as well, but any time I needed clean sheets they were there and a cleaner came in daily to make sure everything was up to scratch”. A member of staff team confirmed, “The cleaning has improved”. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Following the last inspection the experienced, effective staff team remain under pressure due to a staff shortage. This situation needs to be urgently addressed to ensure that resident’s rights and interests are safeguarded and staff are well supported. The staff recruitment procedure has improved considerably since the last inspection. However the procedure would benefit further from more effective communication to ensure that all service users are protected at all times. EVIDENCE: The registered manager was present during the inspection. There is one other permanent member of staff and following a period of secondment a new member of staff has recently been appointed. There is also a drug and alcohol worker who support service users in the evening and a volunteer who support service users in the day either through group work or escorting them to go to the shops or get involved in an activity such as going to the cinema, or bowling. There is an office administrator who supports the staff team. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 22 There was evidence to confirm that the staff team have been under pressure due to staff shortages which will hopefully be resolved following the appointment of a third member of staff during the day. Agency staff has filled gaps in the rota. However evidence confirms that this does not provided a consistent service and not all agency staff have the appropriate experience to work in this setting. One service user said:” We can usually make decisions about what we do each day, if there is enough staff on”. The manager confirmed that” last year was very difficult due to staffing problems. Only recently started supervision again”. This staffing situation is discussed further in the management section. The unit is not staffed at night, but three night project workers staff are available in the main reception of The Salvation Army Centre if service users need emotional support or medication. The service user consulted during this inspection confirmed this information. He said that staff respond very quickly if you need help. There is a telephone facility in the lounge if service users needed to contact staff at night. The staffing situation is currently under formal review with The Commission for Social Inspection following a review of the registration in May 2006. A request was made for the information in respect of the proposed staffing levels day /night to be put in writing and sent to CSCI as soon as possible. Both the manager and the other member of staff have experience in the drug and alcohol addiction field. They have both attended the TOPPS foundation course and there was evidence of ongoing training for all staff, relevant to both service user needs and the unit. The manager receives supervision from a member of the Bristol Drug and Alcohol Strategy team. The other member of staff and volunteer now receive more regular supervision from the registered manager. Staff / volunteer on duty confirmed this information and said they felt well supported. A sample of three staff files was examined and it was observed that the appropriate checks had been completed. These included two written references, proof of identification, work experience and a Criminal Records Bureau check. Arrangements are also now in place to check The Protection of Vulnerable Adults register for new members of staff. A member of the senior management team confirmed this during the course of the inspection. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 23 However, it was observed that the communication between the personnel department and the registered manager was not always satisfactory with a result that the manager was sometimes not aware what recruitment checks had been completed and if any were outstanding. For example the member of staff who was due to start a permanent position the following week after a period of secondment had had a satisfactory Criminal Records Bureau / Protection Of Vulnerable Adult check completed through the placing University. On appointment to the permanent position arrangements had been made for these checks to be completed through The Salvation Army Personnel Department. However, these checks had not returned and a POVA first disclosure check had not been completed. There was also no risk assessment in place. Consequently urgent arrangements were made on the day of the inspection for a POVA First check and a risk assessment to be completed prior to the member of staff starting work the following week. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The Salvation Army Bridge Detox Unit is kept under constant review and development by the experienced management team, which ensures that the residents benefit from a well run home. The management of health and safety records is good. The systems in place ensure that the health and safety of service users and staff is promoted. EVIDENCE: The management of the home is currently undergoing a further change following the retirement of the nominated responsible individual and an internal appointment to the post. The new nominated responsible individual was available during the inspection and demonstrated his awareness of the 2006/2007-business plan for the Bridge Programme and a recent review of the service. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 25 Evidence all confirmed that The Salvation Army are looking at new methods of self-assessment of the services they provide to improve quality assurance. This is good practice. Prior to this inspection there was evidence of monthly monitoring visits conducted by the nominated responsible individual. Staff shortages and the effect on the unit has been an on going concern during the last two inspections. However as discussed in the staffing section following the recent appointment of another member of staff it is hoped that this situation will now be resolved. The information about staff shortages was confirmed by the member of staff on duty and service users seen at the time of inspection. However service users confirmed that they had no complaints about the management of the Unit and said that they “felt safe” and “well looked after by all members of staff.” The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 26 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 1 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000020366.V310039.R01.S.doc 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Salvation Army (Bristol) Bridge Programme Detox Score 3 3 3 3 3 3 3 3 3 3 3 Version 5.2 Page 27 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 YA1 Regulation 6 Requirement The statement of purpose must be reviewed to ensure that it up to date and accurate and fully reflects the service provided in The Salvation Army Bridge Detox Unit. For example any reference to nursing care being provided / clinic must be removed A copy must be sent to The Commission for Social Care Inspection The service users guide must be reviewed to ensure that it is up to date and accurate. It must set out clear accessible information as outlined in NMS Standard 1. A copy must be made available to service users/representatives in a format suitable for the people for whom the home is intended. Plain English must be used at all times unless a translated copy is needed. A copy must be sent to The Commission for Social Care Inspection The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 28 Timescale for action 15/12/06 2. YA1 6 15/12/06 3. YA5 5 The contract / statement of terms and conditions must be reviewed to ensure that there is no reference to clinic or nursing care. A copy of the review of the catering arrangements in place for The Bridge detox unit must be sent to The Commission for Social care inspection. This must include information in respect of: • the Canteen service provision • and snacks / hot drinks provided in the communal lounge Consideration must be given to quality, nutritional value and cultural and religious requirements of meals and snacks/hot drinks The complaints procedure must be kept under review to ensure that all complaints are formally logged and fully investigated and that the management team are kept informed of every concern / complaint received Service users bedroom windows which are overlooked must have voile or net curtains in place to ensure residents can enjoy privacy and natural light at all times Staffing levels must be kept under constant review to ensure that the day to day running of the home meets the individual needs of service users and staff have the opportunity to receive the support they need to fulfil their role (such as regular supervision) A system must be put in place DS0000020366.V310039.R01.S.doc 15/12/06 4. YA17 16 (2)(i) 15/01/07 5. YA22 22 15/11/06 6. YA24 12(4)(a) 15/11/06 7. YA33 18 15/12/06 8 YA34 19 31/10/06 Page 29 The Salvation Army (Bristol) Bridge Programme Detox Version 5.2 to improve communication between Personnel department and the registered manager to ensure that full and satisfactory information and all recruitment checks/ risk assessments are in place before staff members/ volunteers commence work 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 YA1 Good Practice Recommendations The use of photographs / pictures and comments from previous service users would greatly improve the service users guide The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V310039.R01.S.doc Version 5.2 Page 31 - 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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