Inspection on 21/09/05 for The Salvation Army (Bristol) Bridge Programme Detox

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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

The Salvation Army (Bristol)... 15/09/06

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

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

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

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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 Detox Unit 2 Little George Street St Judes Bristol BS2 9EL Lead Inspector Sandra Gibson Unannounced 21 September 2005 11:30 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 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 Stationary 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 Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 3 SERVICE INFORMATION Name of service The Salvation Army Bristol Bridge Detox Unit Address 2 Little George Street St Judes Bristol BS2 9EL 0117 9550074 Telephone number Fax number Email 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 to be appointed PC Care Home 4 Category(ies) of D Drug dependence past/present (4) registration, with number of places The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 4 SERVICE INFORMATION Conditions of registration: A Clinic facility for the detoxification of clients with alcoholism or drug dependency Staffing Notice dated 04/09/2001 applies Manager must be RN on Part 1, 3, 5, 12, 13 or 14 of the NMC register Date of last inspection 18-Jan-2005 The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 5 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 accomodation 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 a 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 service is staffed by qualified nurses during the day and there are unqualified care assisstants who provide support at night.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 Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place mid week between 11.30am and 5.30pm.It generally focussed on the care of adults who are undergoing treatment for drug or alcohol addiction. At the time of the inspection there were only two service users receiving treatment in the four bedded unit. Two service users were spoken to. One service user said “ There are no problems with the staff or the set up”. Two members of staff and one agency member of staff were spoken to and a wide range of documents was examined including care and medication records, complaint log, accident and health and safety records. What the service does well: The admission procedure in place is good. It ensures that a person’s needs have been fully assessed prior to moving into the Unit so that each individual’s needs can be fully met. There is a clear care planning system in place to provide staff with the information they need to satisfactorily meet service users’ needs. Service users are well supported by the staff team of The Salvation Army Bridge Detoxification Unit who enable them to gain knowledge and understanding of the condition of addiction. As a consequence service users have the opportunity to learn to take greater personal responsibility for themselves and their recovery. Confidentiality safeguards are in place which protect service users’ personal information. The intensive support provided to service users during the detoxification treatment programme is good. There are restrictions on choice and freedom. However, these restrictions are made clear to service users at the beginning of the programme so that service users can make an informed choice about the suitability of the treatment provided by this unit. Meals are well managed and provide daily variation, good nutrition, and social contact for residents. Service users’ physical care and emotional health needs are fully met and support and treatment is delivered in a way that meets the individuals’ assessed needs. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 7 What has improved since the last inspection? What they could do better: On the whole the information about the Salvation Army Detox Unit provided to service users and their representatives is very good. However, a review of the information needs to take place to ensure it is up to date so that a person can make an informed decision about whether the unit can meet their individual care needs. The medication administration system in place is not satisfactory. It must be improved to protect service users and safeguard staff. An update of the complaints procedure needs to take place to ensure that service users are fully protected. Arrangements for protecting residents from harm are partially satisfactory but staff recruitment procedures must be improved to protect service users from harm. The Salvation Army Detox Unit House continues to be a clean, comfortable, safe home. However some review of the comfort of the home is needed to ensure that residents are kept safe and comfortable at all times. Service users on the whole benefit from an experienced, effective staff team that safeguards their rights and interests. However, as a result of recent staff shortages support to service users and staff has reduced. The staff recruitment procedure needs to be improved to ensure that all service users are protected at all times. The management of the Salvation Army Detox Unit is currently undergoing a major change. Improvements to the monitoring process organised by the senior management team needs to take place to ensure that service users continue to benefit from a well run home. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 8 The management of health and safety records is reasonably good. However further improvement is needed in respect of maintaining medication administration records, to ensure that service users and staff are fully protected from risk of harm. 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 Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 9 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 Standards Statutory Requirements Identified During the Inspection The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 10 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 standard(s) 1,2,3,4,5 The information about the Salvation Army Detox Unit provided to service users and their representatives is generally very good. However, a review of the information needs to take place to ensure it is up to date, so that a person can make an informed decision about whether the unit can meet their individual care needs. The admission procedure in place is good. It ensures that a person’s needs have been fully assessed prior to moving into the Unit so that they can be fully met. EVIDENCE: The Statement of purpose and service users’ guide were examined. It was noted that details of the new manager the complaints procedure and details of the Commission for Social Care Inspection are not included. Records inspected confirmed that service users are provided with a written contract/statement of terms and conditions and details of all costs which they are required to sign on admission. It was noted that this information contains the rules of the house, service users’ rights and obligations. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 11 Two service users accommodated in the detoxification Unit on the day of the inspection were spoken to. Both of their care files contained up to date needs assessments. The assessments had been completed prior to admission by a qualified nurse, in consultation with the two service users. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 12 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 standard(s) 6,7,8,9,10 There is a clear care planning system in place to provide staff with the information they need to satisfactorily meet service users needs. Service users are well supported by the staff team of The Salvation Army Detox Unit who enable them to gain knowledge and understanding of addiction. As a consequence service users have the opportunity to learn to take greater personal responsibility for themselves and their recovery. Confidentiality safeguards are in place that protects service users’ personal information. EVIDENCE: The care plans for two service users accommodated on the unit were examined It was noted that these plans of care also contained details of a treatment programme which had been discussed and agreed with the service users. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 13 Care records start during the outreach stage before the service user is admitted to the unit and follow them through to rehabilitation. Care plans were concise and included reviews by qualified staff, with agreed outcomes for the service user. One service user spoken to said that staff had agreed the 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. One of person seen during the inspection talked about the house rules seen in the service user guide. He confirmed that he had no problems with house rules. He told the inspector “ I have no problems with staff or set up. I am here of my own free will and the rules are there to help me”. All one to one meetings are carried out in private rooms and all records are stored in locked cupboards. Service users are made aware of their rights to confidentiality on admission and staff spoken to were also aware of the importance of this. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 14 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 standard(s) 11,12,13,14,15,16,17 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 are well managed and provide daily variation, good nutrition, and social contact for residents. 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. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 15 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 qualified member of staff on duty said that these trips were not as frequent as usual due to staff shortages. There is a volunteer who works on the unit who supports service users when they want to go out. It was observed that one service user was escorted to the bank during the time of the inspection. Another 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. We went out the other day in a car to do some shopping go the bank and enjoyed a Mac Donalds”. There are facilities to watch DVD/Video TV and one service showed the inspector the Game Boy and guitar he was using to pass the time when not involved in groups. There are restrictions on freedom when a service user is in the unit. For example if a service user wishes to go out, s/he must be escorted by a member of staff. 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. Meals are supplied by the main hostel and staff 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. The inspector joined one service user and two members of staff for lunch. It was noted that the hot meals provided were made of fresh ingredients and were nutritious. There were also a range of cold meals, drinks and snacks. Three meals a day are served in the canteen and there are also facilities for making hot drinks and snacks located in the lounge/dining area at any time of the day. One service user said that the food was good and he enjoyed helping himself to the snacks available including fresh fruit daily. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 16 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 standard(s) 18,19,20 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 medication administration system in place is not satisfactory. It must be improved to protect service users and safeguard staff. 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”. 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). The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 17 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 registered nurse 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. 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, plus trained nurses that have qualifications in mental health. 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 not correct on two accounts. The controlled medication book was checked and was noted to be satisfactory. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 18 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 standard(s) 22,23 An update of the complaints procedure needs to take place to ensure that service users are fully protected. Arrangements for protecting residents are partially satisfactory but staff recruitment procedures must be improved to protect services users from harm. EVIDENCE: A service user confirmed that a complaints procedure is in place that he was familiar with, as a copy is supplied to all service users on admission. However, it was noted there are some gaps in information found in this procedure including the details of the Commission for Social Care Inspection and the response time for dealing with a complaint. It was noted that service users attend a meeting every morning where they are encouraged to raise any concerns. This information must be provided to service users in the Statement of purpose/service users guide as discussed in section one of this report. A service users feedback book is in place that was used as a compliments/complaints book , but evidence indicates that this stopped being monitored fully by staff in October 2004. One of the service users asked the inspector to look at the book and it was noted that the last entries were very complimentary about the staff and volunteer who works on the unit. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 19 The nurse in charge of the shift said that there had here have been no formal complaints received by the acting manager of The Salvation Army Detoxification Unit or The Commission for Social Care inspection since the last inspection. 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. It was noted that the Protection of Vulnerable Adults list check is not accessed prior to a new member of staff starting employment. This will be discussed further in the section on staffing. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 20 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 standard(s) 24,25,26,27,28,29,30 The Salvation Army Detox Unit House continues to be a clean, comfortable, safe home. However, there needs to be a review of the comfort of the home to ensure that residents are kept safe and comfortable at all times. EVIDENCE: The Salvation Army detoxification unit 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. It was noted that scaffolding is still in place as the refurbishment of the whole building is still in the process of being completed. 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. It was noted that they were tastefully furnished and the majority contained all equipment as outlined in the National minimum standards. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 21 One service user did not have a bedside lamp and said he had been using the bathroom light at night so that he could read. The shared bathroom / toilet facilities are good , but it was noted that the bathroom ceiling needed attention as there was a small amount damage to the area. The unit has a communal area, that will have access to a paved garden when the building work has finished. 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. One service user said that another service user had complained of feeling cold on the unit. The heating for the unit does not come on until October. It was noted that the service users accommodated had been supplied with free standing heaters for use in their bedrooms but there was no extra heating in the communal areas or bathrooms. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 On the whole service users benefit from an experienced, effective staff team. However, as a result of recent staff shortages, support has reduced which has failed to safeguard service users’ rights and interests and support staff. The staff recruitment procedure needs to be improved to ensure that all service users are protected at all times. EVIDENCE: The Unit ‘s registered manager has recently left and a new manager has been appointed. Unfortunately the inspector did not meet the manager who was on leave of absence due to an injury. This manager who is a qualified registered nurse, is in the process of being registered by The Commission for Social Care Inspection. As this was an internal appointment there is currently only one other registered nurse on the depleted staff team. This member of staff was seen during the inspection and said that a third registered nurse had been appointed and was due to start at the beginning of October 2005. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 23 Agency staff and an agency registered nurse were seen on duty at this visit. It was understood that the staffing situation had been made temporarily worse due to the fact that the new manager had had to take time off work following an accident. There was evidence in place to confirm that the staffing levels were not adequate. However, it was noted that there was no staffing notice available for inspection and the nurse in charge was not aware of this or of its location. The qualified member of staff said that she had been working long hours and extra shifts due to staff shortages. Two service users said that there were staff shortages and confirmed that they were not always able to go out when they wanted to as a result. It was noted that the volunteer helps escort service users when he is able to. There is also an efficient office administrator who supports the staff team. This support was seen during the inspection. The unit is not staffed at night, but unqualified staff are available in the rehabilitation Unit if service users need emotional support or medication. This A service user confirmed this and said that there was a telephone facility in the lounge if service users needed to contact staff at night . He said that he had called staff the previous night when he could not sleep and they provided medication as prescribed for him by the doctor. Both the acting manager and the other qualified 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 has supervision provided by Bristol Drug and Alcohol Strategy team . The other qualified nurse has not received supervision since May 2005. The inspector viewed three of the paid staff/voluntary staff files and noted that the appropriate checks had been completed on all staff members. These included two written references, proof of identification, work experience and a Criminal Records Bureau check. However it was noted that the Protection of Vulnerable Adults register was not being checked 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 Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39, 40,41,42,43 The management of the Salvation Army Bridge Detoxification Unit is currently undergoing a major change. Improvements to the monitoring process organised by the senior management team needs to take place to ensure that service users continue to benefit from a well run home. The management of health and safety records is reasonably good. However further improvement is needed in respect of maintaining medication administration records to ensure that service users and staff are fully protected from risk of harm. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 25 EVIDENCE: The management of the home is currently undergoing a major change following the departure of the registered manager and an internal appointment to the post. This transition has been difficult due to staff shortages. A new member of staff is due to start on the unit and the qualified staff member on duty said once this person was in post it was expected that the staffing situation would improve. It was noted that the monthly monitoring visits by the nominated responsible individual were taking place but there was no reference to these management changes or the staff shortages and the effect on the unit. It was also noted that there was no record held of individual discussion with service users or staff members within the report. 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.” A sample of records were examined and it was noted that the majority of these were up to date except for the medication records as discussed previously. It was noted that the fire log was up to date and a fire risk assessment had been completed following the last inspection. The inspector noted that the fire procedures were in place and a service user consulted confirmed his awareness of this procedure and what to do in an emergency. The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 3 x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Salvation Army Bristol Bridge Detox Unit Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 2 2 Version 1.30 Page 27 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc 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 1 Regulation 5 Requirement A review of the statement of purpose must take place to include details of the new manager, complaints procedure and details of The Commission for Social Care Inspection. All medication held in the unit must be held securely and accurate records maintained The complaints procedure must be updated with details of the Commission for Social Care Inspection and also be included in the Statement of purpose. The complaints log must be put back into action again with details of any complaint and how they are resolved. The Protection of Vulnerable Adults register must be checked prior to a member of staff being employed in the unit The manager must review bedroom equipment and accessories to ensure that the national minimum standards are met The hole in the bathroom ceiling must be attended to Timescale for action 21/12/05 2. 3. 20 /42 22 13(2) 20 21/11/05 21/12/05 4. 23 and 34 19 21/11/05 5. 25 16(2)( C ) 21/12/05 6. 7. 24 23 (2)(b) 21/12/05 The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 28 8. 33 18(1)(a) 9. 10. 36 39 18(2) 26 The staffing situation must be reviewed and staff must be made aware of the staffing notice which is a condition of the registration All staff must receive supervision at least six times a year, The registered Provider who carries out the monthly visits must interview service users , their representatives and staff and inspect the premises, its record of events and any complaints 21/12/05 1/12/06 21/12/05 11. 12. 13. 14. 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. 2. 3. Refer to Standard 24 Good Practice Recommendations The time when the central heating is put on for the winter period should be regularly reviewed The Salvation Army Bristol Bridge Detox Unit Version 1.30 D56_S20366_SalvationArmy_V234233_060905_Stage 4.doc Page 29 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire 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. 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