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Inspection on 09/09/08 for The Salvation Army (Bristol) Bridge Programme Detox

Also see our care home review for The Salvation Army (Bristol) Bridge Programme Detox for more information

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments through surveys were received about the unit from people using the service. Their comments included `A very good detox service` and `The staff treat me well.` Through the AQAA the manager said that `the service treats clients individually, identifying specific needs. The staff are trained and committed to the welfare of its service users. The views of clients are respected and actively sought to inform development.` People using the service made positive comments about the detox unit to The `Expert by Experience.` People reported that en-suite facilities were good and they were clear about the restrictions imposed by the programme.

What has improved since the last inspection?

The manager reported in the AQAA that the service had improved in the follow ways. `Joint working protocols with other agencies and care coordinators. More service user involvement.` The Statement of Purpose and Service User guide were reviewed and steps are being taken to make it more accessible. This will ensure that the people for whom its intended can understand it. Care planning systems have also improved since the last inspection.

What the care home could do better:

There are two requirements made at this inspection and one is a repeated from the previous inspection. A change of rating and/or enforcement action may be taken for non-compliance of requirements. Individual`s privacy is compromised by the use of CCTV cameras that are directed into the personal space of people in the detox unit. The repositioning/removal of the cameras was the focus of the last inspection and the manager has failed to action this requirement. The manager must ensure that risk assessments are completed for staff that have declared convictions through the application form. This will ensure that staff that are suitable to work with vulnerable adults are employed.

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 Jones Key Unannounced Inspection 9:30 9th September 2008 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.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.V368962.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.V368962.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 9552821 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) justine.lewis@salvationarmy.org Salvation Army Miss 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.V368962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Past or present drug dependence (Code D) 2. Past or present alcohol dependence (Code A) The maximum number of service users who can be accommodated is 4. Date of last inspection 27th September 2007 Brief Description of the Service: The Salvation Army Bridge Programme is an addiction treatment service for homeless people in Bristol. The treatment is described as being in four parts and the Detoxification (Detox) part of the programme takes place in a unit registered with us. The programme also offers Outreach support, PrePreparation, Preparation, and Rehabilitation, none of which are registered with us. As a Christian Organisation, The Salvation Army believes in an approach that covers every aspect of a persons life including physical, social, emotional and spiritual needs. The Detox unit provides temporary accommodation for ten to fourteen days and is located in The Salvation Army Hostel, which is situated close to the City Centre and major transport routes. The unit has designated qualified nurses and a Doctor attached to the unit. The people who use the service are expected to go off the registered premises and participate in therapeutic groups as well as activities groups and life skills groups. Fees for detox programme range from £234.00-£821.00 per week. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.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. This key inspection was conducted unannounced in September 2008 over one day and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. A completed Annual Quality Assurance Assessment was received from the home and this information was used to plan the inspection visit. “Have your say” surveys were sent to people living at the home and health care professionals. Two people living at the home and one health care professional returned completed surveys to CSCI. The unit can accommodate up to four individuals living and at the time of the inspection two people were accommodated and these were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. Policies and procedures were also used to confirm the findings. An Expert by Experience was used to gather information from the people using the service. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The information gathered by the Expert by Experience is included within the body of this report. What the service does well: Comments through surveys were received about the unit from people using the service. Their comments included ‘A very good detox service’ and ‘The staff treat me well.’ The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 6 Through the AQAA the manager said that ‘the service treats clients individually, identifying specific needs. The staff are trained and committed to the welfare of its service users. The views of clients are respected and actively sought to inform development.’ People using the service made positive comments about the detox unit to The ‘Expert by Experience.’ People reported that en-suite facilities were good and they were clear about the restrictions imposed by the programme. What has improved since the last inspection? What they could do better: There are two requirements made at this inspection and one is a repeated from the previous inspection. A change of rating and/or enforcement action may be taken for non-compliance of requirements. Individual’s privacy is compromised by the use of CCTV cameras that are directed into the personal space of people in the detox unit. The repositioning/removal of the cameras was the focus of the last inspection and the manager has failed to action this requirement. The manager must ensure that risk assessments are completed for staff that have declared convictions through the application form. This will ensure that staff that are suitable to work with vulnerable adults are employed. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 7 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. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.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): (2) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. The arrangements in place to assess the needs of people wishing to use the detox unit are good, ensuring that staff have the skills to meet the needs of the person. Information provided to people is sufficient for them to make decisions about the treatment programme available at the unit. EVIDENCE: The Statement of Purpose was updated in August 2008 by the manager and detailed are the aims and objectives, which is to provide a secure, confidential and respectful supervised environment in which people can detoxify from drugs and/or alcohol. The Admission process is outlined in the Statement of Purpose and confirms that referrals forms must be completed before assessments can take place. The purpose of the assessment is to gather information about the person’s medical health, background and previous treatment to then develop a detox programme. Admissions are based on accepting the Terms and Conditions, and the person must not be in a “state less” than at the interview stage, as The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 10 admission may not be possible. Following from the referral a nursing assessment is carried out and decisions about the best route for the person will then be made at the case conference. The manager said that the detox programme is generally for twelve days. Risk assessments that establish whether the needs of people with dual diagnosis can be met by the staff’s skills and staffing levels are completed. Through individual’s agreements, restrictions imposed are listed and there is an expectation that people comply. Restrictions are mainly based on not having mobile phones and being accompanied outside the home. Two surveys were received from people at the unit and their comments indicate that they received enough information to make decisions about going there. It is accepted that the people currently accommodated had arrived that day. For this reason the case records of the person most recently discharged were examined. The case record of the most recent admission was examined to establish the procedure followed by the staff. Referral and assessment forms were completed as stated in the procedures. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.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) & (9) Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. People’s goals about detoxification can be met through clear care planning systems, which are consistent with aims and objectives of the detox unit. EVIDENCE: The case records of the person case tracked included a Detox care agreement for drug and alcohol withdrawal. The agreement listed the expectations of both parties, the fees, the rules and responsibilities of the detox unit. The manager said that care plans follow the Drug Strategy Team in Bristol and are the leading base for all Bristol Drug Project, Bristol Specialist Drug and Alcohol service and Criminal Justice Intervention. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 12 Care plans are standard and follow set goals that focus solely on drug & alcohol and effects on their physical and psychological health, social and after care. Care plans are pre-populated with needs, goals and actions with an outcome section for staff to complete with comments. People at the home have input into their care plan and their signatures indicate agreement with the plan of action. Care plans are brief about other areas of need. While it is accepted that the people currently accommodated had moved to the unit in last forty-eight hours, information was not always consistent. For example, the pre-admission information had not been passed to the unit from the preparation unit (stage 1) and both files were not consistent with the forms kept in the file. The shared Value/Rule form in the case file is sectioned into key areas that include Programme, Shared Values/Rule and possible responses. Health & Safety, Substance Misuse, Group & Key Working, Personal Conduct, Relationships and Lifestyles are the focus of the key areas. Daily reports are completed by the staff to records tasks undertaken, observations of the person. The qualified nurse on duty giving feedback explained their responsibility towards care planning. This member of staff said keyworking people using the service and it involves undertaking 1:1 with people at the unit and accompanying people outside the home, also recording information. Risk assessments are completed about individual’s violent and aggressive past and present behaviours including self-injury, criminal background and aggression. There is a Discharge/Exit strategy plan completed for each person and used in the event of an unplanned discharge. The strategy is based on residency following detox, mode of transport, advocacy and support. People are responsible for their own finance. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.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) & (17). Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. There is intensive support provided to individuals during the detoxification treatment programme and restrictions on choice and freedom are made clear at the beginning of the programme. People can make an informed choice about the suitability of the treatment provided by this unit. EVIDENCE: An Expert by Experience was used during the key inspection visit of this unit. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 14 The following comments were made to the Expert by Experience by the two people at the unit. The two individuals were not able to fully comment on groupwork programmes, leisure activities and appropriateness of activities due to the short time they had spent in the programme. In the detox unit, there is an expectation that task-focused activities are undertaken including cleaning and therapeutic interventions based on goal setting, reflection groups and other structured activities that are offered daily. Groupwork is compulsory unless the service user has good reason not to attend. Groups are small due to capacity. Groups include peer support such as NA/AA and peer feedback groups. The manager said that rehabilitation groups for peer support that includes AA and NA are invited into the unit and it’s the individual’s choice if they want to attend. People using the detox unit are given information about the unit and house rules in the Preparation Stage of their treatment. People are searched when first attending the detox unit, they are required to hand in their mobile phones and if deemed necessary by the staff team, the dettox unit and bedrooms can be searched at any time. People do not get involved with the local community as their detoxification is intensive and this type of activity is not in line with the treatment programme. The unit has a good television room with a games machine, ‘Freeview’ box DVDs and videos are available to watch. There is a small selection of books. A football tournament was held involving staff and service users travelling to Birmingham by minibus. The visiting policy of the unit recognises the importance of maintaining relationships with children and visits can be arranged, visits from professionals are also welcome. The Expert by Experience reported that people at the unit are not encouraged to maintain close relationships whilst in the detox stage of the treatment programme, although they are encouraged to see probation and Criminal Justice Interventions Team staff. They are not allowed phone calls or visits although letters are permitted. Three meals were offered per day of a good size and standard. Religious and taste needs were catered for including vegetarian. Service users were able to cook snacks between meals which were supplied free of charge, including tuna, noodles and toast. One service user stated ‘I always get fed well – I can never eat it all’ The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 15 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): (18), (19) & (20) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People at the unit receive appropriate personal and health care support. Medication systems are safe. EVIDENCE: Personal care is not currently offered at the home, where necessary, staff will prompt people to complete hygiene tasks. The manager said that where personal needs are identified, it would form part of the person’s care plan. The manager said that people are encouraged to register with a local GP and to access NHS facilities. Its part of the agreement for staying at the unit that staff will accompany individuals on these visits. A record of the health care visits is maintained along the outcome and advice given. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 17 People at the unit can have input from Drug and Alcohol (D & A) social workers or Criminal Justice Intervention workers (Probation worker). It was understood that people would be supported to access D & A social workers so that they can continue with the treatments available at the unit. The Detox unit has stock medications that the on site doctor prescribes and members of staff will administer from the stock supply as prescribed by the doctor for each person. Other medications for insomnia, nausea, stomach cramps are also prescribed and administered when required. The manager said that medications for drug dependency and effects of drug dependency would be reduced and terminated by the end of the treatment. The Expert by Experience that visited the unit was told that ‘the treatment programme is split into three stages; preparation, detoxification and rehabilitation. One person that had attended the preparation unit and prescribed medication was reduced in preparation for detox said they were happy with the reduction regime. Homely remedies are also administered from a stock supply that includes analgesics. A record of medications no longer required at the unit is maintained and signed by the pharmacist to indicate receipt of the medication for disposal. There is an expectation that people hand prescribed medications for staff to administer. Qualified nurses administer medications and records of administration are signed by immediately after administering the medications. A comment card was received from the Doctor that visits the unit and it was stated that specialist advice is sought and incorporated into the care plans. It was also stated that medication is appropriately managed at the detox unit. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): (22) & (23) Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Individuals said that they know how to make complaints and the importance of feedback from people is recognised through the complaints procedure. Arrangements for protecting people are satisfactory. EVIDENCE: There is a Complaints procedure and it is appended onto the Statement of Purpose. It is clearly stated in the procedure that staff know its their responsibility to take complaints raised seriously and to resolve them to a satisfactorily outcome. This shows a commitment to acting on feedback received from people at the home. There were no complaints made at the unit since the last inspection. The two people that responded through surveys said that they know who to speak to if they are not happy and how to make a complaint. The Bristol City “No Secrets” guidance is followed at the unit and member of staff attend Safeguarding Adults training. The organisation has a Whistle Blowing policy that confirms staff’s will be protected from reprisals and specifies their responsibility to report poor practice. The manager said that there are no outstanding Safeguarding Adults referrals. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 19 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): (24) & (30). Quality in this outcome area is (poor) This judgement has been made using available evidence including a visit to this service. The detox unit is appropriate and homely for people on the detox programme. Individual’s privacy is compromised by the use of CCTV. EVIDENCE: The Salvation Army Hostel, Logos House 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 detox unit sits inside the hostel and provides single accommodations to four people. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 21 People accommodated in the detox unit access the unit via the main reception to The Salvation Army Hostel ensuring 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. The detox unit is arranged on one level with single bedrooms, lounge, bathroom and garden with laundry facilities. Bedrooms are single en-suite with a toilet and wash hand basin and lockable, the lounge has sufficient seating for the people in the unit to sit together, a television and refreshment making facilities and individuals can use the laundry for personal laundry. The Expert by Experience that was involved with seeking feedback from people at the unit about the facilities reported, that people are allowed to personalise their rooms and smoke (although is not permitted anywhere else in the unit except a small fenced off area (garden)). Individual’s privacy is compromised by the use of CCTV cameras that are directed into the personal space of people in the detox unit. The repositioning/removal of the cameras was focused on the last inspection and the manager has failed to action this requirement. Risk assessments must be completed for staff that have declared convictions through the application forms to ensure they are suitable to work with vulnerable adults. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (34) & (35) Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. Individuals benefit from receiving care from qualified and competent staff. The recruitment process must be more robust to ensure staff that are suitable to work with vulnerable adults are employed EVIDENCE: The manager was consulted about the recruitment process during the inspection visit. It was understood that short listing and participating in the interviews of candidates is part of the role. The Human Resources (HR) department will seek references and obtain Criminal Records Bureau (CRB) for candidates wishing to work at the unit. HR will then notify the manager about the outcome of the CRB disclosure and references received. Personnel files are held in the HR department of the hostel and the personnel files of the people at the detox unit were examined. Completed application forms and two written references are kept with other appropriate The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 23 documentation. Records of CRB disclosures are held separately and for one person, the disclosure was not for the Salvation Army. Also risk assessments are not completed for staff that have convictions and there are no arrangements for POVA first checks. The manager must ensure that risk assessments are completed for staff that have convictions. New staff undertake the induction programme and covers the Logos House, it is designed to provide staff with basic information to fulfil the role and follows the Skills for Care Common Induction Programme. There is an expectation that the programme is completed within four weeks of joining the team, with the first supervision on completion of the induction programme. Statutory training is provided and includes Safeguarding Adults, First Aid and Manual Handling. Qualified Nurses maintain their registration through PREP work. The qualified nurse on duty giving feedback about training said that training needs are usually discussed with the manger and is accessible to all staff. It was further stated that since the last inspection mental health refresher, listening skills, self-harm and motivation courses were attended. A comment card was received from the Homeless Health Service and positive comments were received including that staff demonstrate a clear understanding of the care needs of the people at the unit. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.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. JUDGEMENT – we looked at outcomes for the following standard(s): (37), (39) & (42) Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. Individuals can expect to stay in a safe environment and can be assured that standards will be subject to ongoing monitoring. The manager has failed to meet previous requirement. EVIDENCE: The registered manager was consulted about the leadership styles used to meet the homes aims and objectives and the needs of the people at the home. The manager said that a democratic style of management is used and the areas of responsibility were explained. Staff management including staff The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 25 supervision and, care planning systems, Health & Safety and assessments of needs are part of the role. Convening reviews, up to date information and personal development are the system used that ensure consistency. Through supervision, appraisals and staff meetings consistency of care is then maintained. A qualified nurse on duty was consulted about the style of management used and the way consistency of care is maintained at the unit. This member of staff said that the manager was approachable and there was an organised style of management used. Regarding consistency this member of staff said it is achieved through supervision both clinical and individual with the manager. Individual supervisions with the manager is six weekly and is based on personal issues, performance and role. Two surveys were received from people that have used the service and their comments indicate that they were always treated well by the staff. One person said that the carers always listen and act upon what they say and one person said this was sometimes. At the last inspection seven requirements were made which had to be actioned within the given timescale. The manager has actioned the requirements based on updating the Statement of Purpose and Service User Guide, displaying the CSCI certificate, care planning and meeting Equalities and Diversity needs. The manager has, however, failed to improve people’s privacy by removal/repositioning of the CCTV camera. The detox unit is staffed from 7:00am-7:00pm during weekdays and at weekends there is nursing cover between 7:00 am –2:00 pm. A manager is on call at all times and where necessary, the on-call manager will pass the information onto the appropriate person. Facilities for the safekeeping of cash exist at the hostel and because the people in the detox unit are also residing in the hostel they have access to this facility. The people currently accommodated in the hostel do not have money in safekeeping. Fire risk assessments were undertaken in July 2008 and included are the potential fire risks, preventative measures that include fire checks and practices. The manager also ensures that the unit complies with associated Health & Safety legislation, with annual checks of systems and appliances. There are annual checks of portable electrical equipment and gas boiler by appropriate contractors. The organisation operates a Quality Assurance system and an on-going action plan is in place, which is drawn together from feedback from people using the service and staff. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 26 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 27 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 X 2 3 3 X 4 X 5 X 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 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000020366.V368962.R01.S.doc X 2 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Salvation Army (Bristol) Bridge Programme Detox Score 3 3 3 X 2 X 3 X X 3 X Version 5.2 Page 28 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 YA34 Regulation 19 (5) (a) Requirement Risk assessments must be completed for individuals that declare convictions in their application form to ensure they are suitable to work with vulnerable adults Residents privacy will be improved by the removal/repositioning of the CCTV camera, which is, aimed at the individual’s bedrooms, lounge and bathroom doors. Timescale for action 30/11/08 2. OP24 12(4)(a) 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V368962.R01.S.doc Version 5.2 Page 30 - 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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