Inspection on 07/01/09 for Trevi House

This inspection was carried out on 7th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trevi House 09/07/08

Trevi House 10/07/07

Trevi House 29/01/07

Trevi House 02/03/06

Trevi House 28/06/05

Trevi House 18/01/05

Trevi House 16/06/04

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 19/06/2009.

CARE HOME ADULTS 18-65 Trevi House 2/6 Endsleigh Gardens Mutley Plymouth Devon PL4 6DR Lead Inspector Megan Walker and Stella Lindsay Unannounced Inspection 7th January 2009 10:00 Trevi House DS0000003558.V373746.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 Trevi House DS0000003558.V373746.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. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trevi House Address 2/6 Endsleigh Gardens Mutley Plymouth Devon PL4 6DR 01752 255758 01752 255758 office@trevihouse.org www.treviproject.org Trevi House Limited 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) Manager post vacant Care Home 13 Category(ies) of Past or present alcohol dependence (13), Past or registration, with number present drug dependence (13) of places Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Female Only Age18 to 60 years Date of last inspection 9th July 2008 Brief Description of the Service: Trevi House is registered with the Commission for Social care Inspection (CSCI) as a care home for the first stage treatment of alcohol and drug dependence for up to thirteen women, between the ages of 18 and 60. In partnership with a local GP they provide a reduction programme, managed by staff at Trevi House under the supervision of a local GP. The home is not registered to provide nursing care and does not provide a detoxification service. The length of each treatment programme depends on individual assessment of care needs. Generally this is between three to six months. All the women have young children, under the age of 8, who are also accommodated with them at the project. Trevi House has a nursery for the children, regulated by Ofsted, and children of school age attend local schools. Trevi House is run by Trevi House Ltd., a ‘not for profit’ organisation. It was established in 1994. The premises are owned by the Devon and Cornwall Housing Association (DCHA). Due to the expansion and development of Plymouth University, the university campus now surrounds Trevi House. The project is physically enclosed from the nearby area for security and there is an intercom system at the main gate. It is close to Plymouth city centre and all public amenities. There are five two-storey houses, three of which are terraced, arranged as a cul-de-sac. Each house has bedrooms designed to accommodate one adult as well as their children, although there are also separate bedrooms for children if this is required. Four of the bedrooms have en-suite toilets and baths. Other bathing/showering and toilet facilities are available in every house, close to bedrooms and communal rooms. There is a communal lounge and dining room where people using this service are expected to socialise. Each house has kitchen facilities for people to use. Smoking is not permitted inside any of the buildings but people may smoke in a designated outside area. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 5 Trevi House provides counsellors and other support staff to maintain the programmes of care designed for the people who use the service. People using this service are expected to abstain from taking drugs and/or alcohol throughout their stay except for any medication prescribed by a doctor for health care reasons. Fees are £769.98 per week for a service user, and £468.22 for one child under the age of 2, or £425.38 over age 2. There may be a £450 one-off detox charge. These charges are due to be revised on 1st April 2009. There are incidental charges that include matters relating to courts, drug tests, transport and escort to appointments and overnight stays for visiting siblings. Fees do not include toiletries, nappies, clothes and other personal purchases. Women on treatment programmes at Trevi House are expected to make a contribution to their residential fee according to a financial assessment by the referring agency. Information about charges was provided to the CSCI in January 2009. Detailed information about fees and the project, as well as copies of inspection reports, can be obtained from Trevi House, or on their website at www.treviproject.org Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was a Key Inspection undertaken by two regulation inspectors and a pharmacist inspector. The fieldwork part of this inspection was an unannounced visit that took place on Wednesday 7th January 2009 between 10:30 and 19:45. We talked with three people who were on treatment programmes at the time of this inspection. We also spoke to seven staff that work there, and observed interactions between people using this service and the staff working there. There was also a tour of the premises, and inspection of three care plans, medication and other records and documentation. Trevi House is in the process of restructure in order to improve the programme offered at the project. For the purposes of this inspection, information about the daily routines as well as the general operational management of the home was provided to us by the General Manager during this visit. Additional information and clarity in particular about the current restructuring programme, was provided to us by the Responsible Individual and two representatives of the Board of Trustees at a later date. In addition other information used to inform this inspection: • Following a safeguarding alert a Random Inspection was carried out on 16th October 2008 to check compliance with regulations. • All information relating to Trevi House received by the CSCI since the last inspection. • Relevant information from other organisations and agencies. People who use this service are variously referred to as residents, clients or service users. For the purpose of this report, we shall use ‘resident’, as this term was used in the report for the last Key Inspection. There is one outstanding requirement from the last inspection. Two new requirements and eight “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: The women staying at Trevi House told us that all the staff working there were approachable and supportive. One woman told us that she had gained confidence in herself and for her future after she left Trevi House. She told us that the staff support had enabled her to make choices and decisions that were right for her. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 7 Trevi House provides women with a sanctuary whilst they start to recover from problem drug and alcohol use, and learn how to care for themselves and their children. The service continues to provide a safe system for the administration of medicines and keeps it under constant review. What has improved since the last inspection? Since the last inspection all the requirements including the additional ones from the Random Inspection have been met or partially met. A significant amount of work is ongoing to ensure these continue to be met. The person with day to day responsibility and a supportive staff group are commended for their progress in moving forward with improving Trevi House for everyone who uses this service. We found the residents were calmer, confident about their programmes, and discussing their future plans when they left Trevi House. This is a significant improvement since the last inspection when we witnessed the anxiety of residents and found they did not know what they were expecting as an outcome from using this service. There is currently no Registered Manager at Trevi House, however, since the last inspection the General Manager has started the process required for an application to the CSCI to register as a manager. This person has been in post twelve months and has day to day responsibility for the project. A new comprehensive Pre-Assessment Form and Risk Assessment have been devised. These can be downloaded from the Trevi House website by prospective residents/agencies looking for a placement at Trevi House. A new Resettlement Worker has been appointed and aftercare planning has become pro-active from the start of each resident’s treatment programme. A new chef has been appointed. He works pro-actively with the women teaching them basic cooking skills and menu planning. He has also introduced a structure and routine into the general running of the kitchen and mealtimes. This has benefited the residents in learning about organising themselves and their children. The residents benefit from the opportunity to attend outside groups such as “Alcoholics Anonymous” (AA) and “Narcotics Anonymous” (NA). Links are being built up within the local community so the women are able to have opportunities for more independence to learn coping strategies without resorting to drugs and alcohol. This means that suitable links and support networks are being promoted in the local community to help residents, when their key worker considers this appropriate as part of their individual treatment programme, to work towards independent living. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 8 All support staff and nursery staff are booked on various safeguarding (adult and child protection) training courses. They are also due to attend training sessions about “Hidden Harm”. This means the staff will have a better understanding on the needs of children of problem drug users and the serious negative affects such use has on children from conception to adulthood. Residents are now restricted in the access they have to the staff office. This means that confidentiality of information can be guaranteed when staff are sharing information or may have care plans out on desks in the staff office. The planned refurbishment of the kitchen has been carried out. This means the residents have a hygienic area that is also safe for their children. 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 summary of this inspection report can be made available in other formats on request. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4, 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective clients can feel confident that their needs will be assessed before starting a treatment programme at Trevi House and that they can have the information they need to make an informed choice about the project. EVIDENCE: Since the last inspection a comprehensive pre-assessment admission form and risk assessment for admission form have been introduced. These are available on the Trevi House website and prospective residents/care managers can download these to complete. Although the initial contact can be via email, a signed ‘hard copy’ is required for the application to progress. This ensures that the prospective resident has signed the consent form for the staff at Trevi House to gather information from health and social care professionals. At the time of this visit there were four residents at Trevi House and a fifth person arrived during our visit. We inspected three care files. They all had a completed pre-assessment and a care plan. One full asessment of need was ongoing as the person had not been at Trevi House very long. Each preassessment included the persons medical history, including any mental health Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 11 issues, family background, clinical interventions, and offending histories. The records showed that the staff team had collected information about these three people to ensure they could be supported to make the best of their treatment. The detail of information is also sufficient to ensure admission would be safe and in the best interests of the woman and her child(ren), and the other residents and their child(ren). The keyworkers explained that when an enquiry is received, two keyworkers carry out the assessment. The admission form gives the opportunity for the key workers to request specific information if required. They also seek clarification if anything is vague or unclear. Prospective residents are encouraged to visit Trevi House (usually with a care manager) to have an assessment of their needs in person prior to admission being arranged. Sometimes because of the distance that some people live from the project this is not possible. The assessments in such cases are made by telephone. Written and verbal information is collected from social and health care professionals involved in the person’s care before the residential treatment programme is agreed. When the information has been gathered it is discussed amongst the staff team, including the nursery staff. This is all kept in a Referrals Folder until the woman arrives on the premises, at which point it is transferred into her personal care file. Arrangements for what was to happen on discharge was seen recorded, including arrangements for the child(ren), to cover the possibility of (1) a woman deciding to leave; (2) of the service finding that she had broken the terms of her residency; and (3) at the completion of her programme. Each prospective resident is sent a letter confirming acceptance of her application, offering her a place at Trevi House with a date and time to arrive. A contingency plan is also sent with this admission letter. Care and funding arrangements for children need to be agreed independently. Trevi Houses Statement of Purpose and Service Users Guide were being updated at the time of this visit. Once these are complete they will be available on the homes web site. The most recent CSCI report was on display in the home and we were told is available on the Trevi House website. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using this service know their assessed needs and personal goals, including after care plans, are reflected in their individual care plan. They are encouraged to make decisions about their lives with assistance as needed and within any restrictions of their treatment programme. They are supported to take risks within realistic goals of their treatment programme. EVIDENCE: One resident told us: “I cannot say enough for this place. It has changed my life, and my relationship with my daughter.” We looked at three care files. These were in an indexed binder file that makes information easy to find. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 13 One keyworker showed us a copy of a Newcomers Programme she had ready for her new clients. It included initial therapeutic work, with motivational and enhancing elements, and work on communication. On the afternoon of our visit the planned group work session was about change. Initially each resident is restricted to remain within the premises of Trevi House. At a later stage in their programme they are able to go out for a short time if this had been agreed with their key worker and subject to any other restrictions that is part of the person’s treatment programme. Restrictions on going out alone or accompanied were decided as part of the individual’s care plan. The contracts issued when a woman joined the project stated the restrictions that would apply during the programme. Usually they would not go out for at least the first two weeks to allow a settling in period. Personal telephone calls are also restricted during this period. The key workers told us that they were trying to introduce risk assessments into each care plan to allow each resident more independence and active choice. Since the last inspection Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups have been made available to the residents. Attendance at any of these groups is not compulsory and the residents’ sign up for the group they wish to attend. The residents are encouraged to take their children with them whenever possible. Following the child protection alert in October 2008 it was identified that children were potentially at risk if they were left with another resident whose own child/ren were on a care order. There has consequently been a fundamental change in the role of Out of Hours staff as they are now expected to look after children in the absence of the mother. Detailed plans had been drawn up before a residents discharge. Minutes of a meeting showed that the funders had agreed to the plan (although this had not been signed by the funders). The document included staff and the residents concerns and requirements, their goals including nursery groups, relapse groups, parenting skills, structured daily routines, and barriers to successful outcomes. There was also an agreed action plan. Both residents and staff alike were enthusiastic and positive about the appointment of a Resettlement Worker. They told us: We are happy about having more support for discharges We have a brilliant new Resettlement worker The Resettlement Worker gets people working on their plans as soon as they get here It has been recognised by the keyworkers that child minding is an essential requisite for successful discharge so that a mother can attend support groups. This is now being included in the resettlement packages. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 14 Confidentiality has improved as residents are no longer using the keyworkers office. Plans were being put into action to provide a pay phone for residents to use in a small room near reception for improved privacy. We spoke to all the residents collectively about their experiences at Trevi House. As they were each at different stages in their treatment programme some were already well ahead in planning what they would like to be doing once they leave Trevi House. All of them were positive about having an opportunity to learn and manage life skills such as child care, budgeting and cooking, and work towards indepedent living. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 15 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using this service have a variety of opportunities for personal development as well as leisure activities as part of their agreed treatment programme. They know their rights will be respected within the agreed constraints of the treatment programme. EVIDENCE: Since the last inspection the experience of living at Trevi House has improved considerably for the residents. The Resettlement Officer is appreciated for her knowledge and proactive work on behalf of the women, in particular with their housing plans. We saw the resettlement programme she had put together and this included budgetting, tax credits and benefits, tenancy maintenance, education and employment, and dealing with various practicalities and authorities. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 16 We spoke to all the residents collectively. They demonstrated increased confidence in themselves and their future plans. Two recently admitted residents had arrived at Trevi House in a state of trauma and disorientation. This was because of rapid discharges from hospital with new babies and being in very early stages of recovery after detoxification. The care plans reflected that each mother was to have time with her new baby, with support. The families had enjoyed Christmas and New Year together with the staff team. Outings had been arranged, including a trip to Crealy Park and Pennywell Farm. The nursery staff had also arranged ‘children specific’ outings. The chef had left food with instructions on cooking/re-heating and everyone had joined in preparing meals over the holiday period. One keyworker told us: Trevi used to be so insular…. “[Now] they [the women] are not leaving institutionalised” This is because the resettlement and aftercare is much more planned. The introduction of risk assessments means that the women have opportunities to go out and be allowed to get things wrong. Links are being built up within the local community so the women are able to have opportunities for more independence to learn coping strategies without resorting to drugs and alcohol. Since the last inspection the keyworkers have set up links with NA and AA groups. There are two very different NA groups and this suits different people. One group comes to Trevi House to support people. There are links with a domestic violence support group and an opportunity to participate in a conservation project. Other activities continue as at the time of our last visit such as gym sessions at a local centre one day a week and there are sailing and kayaking sessions at the Mount Batten Water Sports Centre. The residents are responsible for cleaning some parts of the premises as part of their therapeutic programme. They also do their own laundry. Trevi House has a nursery for the children, regulated by Ofsted. The nursery is open Monday to Friday from 0845 until 16h15. The nursery is staffed by dedicated nursery staff. Each mother is responsible for ensuring her child(ren) are up, washed and dressed, and had breakfast before dropping them at the nursery. She then collects her child (ren) at 16H15 and either goes out, if this is part of her programme plan, or cooks a meal for her child (ren) and herself. Each woman has a time slot when she is expected to prepare meals. After eating mothers and children spend time together until 1900. By this time all the children are expected to be in bed and the women join together in the lounge for evening activities. The women are provided with baby monitors so that they can hear their children whilst in the lounge. Children of school age attend local schools and where possible will join after school clubs so return to Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 17 Trevi House about the same time as the other children are collected from the nursery. Some staff were concerned that too much time is spent in the evenings watching television. We were told that in the past the Out of Hours staff organised a social activity one evening per week, a weekly DVD film show, and a monthly take-away supper. The residents also use the evening sessions, after their children have gone to bed, to write up their daily notes (a diary of their day) and to plan their weekend “pracs” (a dedicated session to plan the practicalities of Friday, Saturday and Sunday including menu planning and activities with their children). This apparently was ad hoc and in some cases not happening because residents were distracted by the television. On the day of our visit the residents were discussing a proposal by the keyworkers to restrict viewing times for two hours each evening. A new chef has been appointed since the last inspection. He was popular with the residents and the staff. He was clear about when the residents could go into the kitchen, and the staff told us that in general the residents appreciated having these boundaries. The chef provides a two course meal at lunchtime. For evenings and breakfast, he is responsible for ordering and providing the pre-planned ingredients the residents have requested. The residents are then responsible for cooking a light hot meal in the evenings, and organising breakfast between 8am and 9am for themselves and their child/ren. The chef additinally gives 1:1 cooking lessons, helping the residents to build their confidence as well as skills in the kitchen. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 18 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 adequate This judgement has been made using available evidence including a visit to this service. People using this service should be able to feel confident that a supportive and reliable staff team will meet their personal, physical and emotional health care needs. A core group of staff is resistive to the introduction of different styles of therapeutic work thereby undermining its potential gains. EVIDENCE: The wellbeing and safety of the women on treatment programmes at Trevi House is paramount from pre-assessment through to aftercare planning. There is now a protocol about gathering information about any dual diagnosis (i.e. recovery from problem drug and alcohol use, and physical and mental health care needs). More in-depth questions about blood borne viruses are now included in the pre-admission assessment. There are also questions about family background, any clinical interventions, and offending histories. Completion of detailed risk assesment is required as part of the application process for a place at Trevi House. From this the keyworkers work with the Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 19 residents to set up risk strategies within boundaries of the treament programme. A Blood Borne Disease Nurse generally visits fortnightly, or as needed. These visits offer women screening, and if a test proves positive, the woman is referred to the respective PCT services. This information is included in the care plan and kept under review by the nurse at Trevi House. The Blood Borne Disease Nurse can give Hepatitis ‘B’ inoculations. She also can carry out ‘HIV’ tests however there were no records to show if any counselling about the implications of such a test would be given beforehand. Staff we asked were unable to confirm this either. Everyone on a treatment programme at Trevi House is expected to attend group sessions as well as individual counselling sessions as part of their treatment programme. They also write a daily diary and these could be used in individual counselling sessions. The key workers were trying with a Sexually Transmitted Disease Advisor to set up links with external groups and counselling for residents to attend if they wished. They told us that they could use Eddystone Trust as a resource for anyone who was HIV positive. There is also access to a S.A.L.T. advisor who is available for 1:1 sessions with residents affected by sexual abuse and/or domestic violence. Staff can also use this advisor should they wish to talk through anything they maybe affected by or to seek advice for a counselling session with a resident. The care plans we looked at showed long-term aims as well as immediate issues. Generally after care was part of the assessment process so people started their treatment programme with an outcome in mind. We spoke to all the residents collectively about their experiences at Trevi House. Those nearing the end of their treatment programme talked about their aspirations for after the treatment programme and when they moved on from Trevi House. They felt they had been enabled to do this with an early resettlement plan and the ongoing support and motivation from the key workers and resettlement worker. We were told about other women who have left Trevi House since our last inspection and the aftercare support that was in place for some of these women. The key workers told us that child minding is an essential requisite for a successful discharge so that a mother can attend support groups and this is now being included in the resettlement packages. The key workers were frustrated that some local authorities agree to aftercare plans and then renegade on these once the woman and her child/ren leaves Trevi House. We found that there is a safe system for the administration of medicines and that medicines are stored securely. However we also found that there is no dedicated storage for controlled medicines that are sometimes used in the service. The person with day to day responsibility agreed an alternative appropriate method of storage during the inspection. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 20 We found that the person with day to day responsibility was in the process of revising the medicines policy for the home and had a plan in place for the introduction of this revised policy. We also saw that staff administering medicines had received training and been assessed as competent before they were allowed to administer the medicines. We also saw that a process was being put in place to monitor the competency of those administering medicines. We also saw that people are supported to look after their own medicines where appropriate within a risk assessment framework that also takes into account the risks and needs of other people living at the home. We were concerned that some staff were resistant to the changes being introduced such as links with outside support groups. We were concerned that women could be put at risk because their therapeutic programme risk assessments were not being followed by some staff. We were concerned that some staff were finding it difficult to manage medicines in line with the service’s medication policy in spite of recent training. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 21 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 adequate This judgement has been made using available evidence including a visit to this service. Measures are being put in place to ensure that people using this service are listened to and there are safeguarding procedures in place to protect them. EVIDENCE: Since the last inspection the CSCI has received a number of concerns about the administration and management of Trevi House. These were passed to the Registered Provider to investigate using the service’s Complaints Procedure. Two safeguarding alerts in October 2008 about restriction of liberty and insufficient food being provided at weekends prompted an unannounced visit by two Child Protection Social Workers to ensure the safety and well being of the children at Trevi House at that time. The CSCI did a random inspection at the same time to check that no one was being deprived of their liberty and that there was no other breach of regulations. The social workers reported afterwards that none of the women mentioned anything that gave cause for concern with regard to immediate child protection matters. The women were generally very positive about the care they received from all the staff, and considered that they and their children were treated with respect. The women acknowledged that there had been difficulties the week previous to the visit when another woman had decided to leave the project. The main concern was that it had caused a certain amount of tension for all the Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 22 other women on programmes at Trevi House. The women gave no indication any punitive measures had been put in place by staff for any of the women, including the woman wishing to leave the project. They confirmed no bedroom doors at Trevi House were lockable so no-one could be locked into a bedroom. With regard to the issue of food, a policy had been put in place whereby one person took responsibility for buying what was needed and for the first few weeks there were some teething problems, so not everyone got what they wanted. The person with day to day responsibility confirmed that there may have been one weekend when there had been less food than usual. She said this was due to a change of chef. In her opinion, the food provided at Trevi House was good, and the social workers reported that the women were generally enthusiastic about the food. It was identified that children were potentially at risk if they were left with another resident whose own child/ren were on a care order. Consequently the Out of Hours staff have had an amendment to their job description and are now expected to look after children in the absence of the mother. It was the conclusion of both social workers that the outcome of their visit was that there were no immediate child protection concerns requiring Social Services intervention. The inspection of the care records and the timescales showed that the funding authority had failed in its duty of care to respond in a timely manner to ensure the well being of the woman and her child. This consequently affected the emotional well being and care of the other women. The staff at Trevi House had been required to manage a volatile situation for an indefinite period of time. Since the random inspection the Plymouth local authority Child Protection Team has met with the person with day to day responsibility to formulise a child protection contingency plan. Another meeting is planned for February 2009. The Plymouth local authority Child Protection Team is informed when children are admitted to Trevi House if there is an interim care order. This is because when children subject to a care protection order are staying in the city, the local authority has a duty of care for the child/ren even if the child/ren is funded by another local authority. Plymouth local authority is thereby aware of any visiting child/ren and if contacted by the staff at Trevi House would be able to liaise with, and if required, intercede on behalf of the funding authority. Security measures have been explored by the registered provider along with DCHA. Consequently all the residents are given the ‘exit’ code to the gate and arrangements have been made with DCHA to fix an alternative type of bolt on the gates. In addition, for reasons of safety, children are not allowed to play unsupervised in the outside area near the gates. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 23 Since the last inspection a detailed training programme that runs through until May 2009 for various safeguarding courses has been put in place for all staff to attend. By the time of this inspection some staff had already attended safeguarding vulnerable adults training run by the local authority. Others were due to attend this month or next month. Child Protection training had also started. All support staff and nursery staff were booked on training courses about “Hidden Harm”. Within the framework of “Every Child Matters”, this is training initiated by the government and provided by local authorities. It is based on a report in June 2003 by the Advisory Council on the Misuse of Drugs (ACMD) on the needs of children of problem drug users and the serious negative affects such use has on children from conception to adulthood. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 24 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 adequate This judgement has been made using available evidence including a visit to this service. Trevi House is in need of refurbishment and re-decoration. It does not promote respect and a willingness to care for it. EVIDENCE: Trevi House consists of five houses, three of which are terraced. All the bedrooms are on the first floor level and the offices and communal areas are all on the ground floor. Devon and Cornwall Housing Association (DCHA) own the buildings and grounds therefore any major adaptations and renovations are subject to approval by the housing association. As on previous inspections, a tour of the premises found it generally to be tired and shabby. Although it was relatively tidy, some areas such as staircases, halls and landings, looked grubby even though they had been cleaned. The premises needed redecoration and refurbishment throughout, including new Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 25 flooring for small kitchens. The person with day to day responsibility for the project explained that due to the high cost of the kitchen refurbishment there was little money available for other refurbishment and decoration. She was however very much aware of the age of the complex and that it struggled to be “fit for purpose” without extensive renovation. Due to the rapid expansion of the university around the premises of Trevi House she suggested that relocation to a more suitable site away from the city centre would benefit the people who come to Trevi House. DCHA is apparently aware of this preference however at the time of this visit funding to facilitate such a move was restricted. Since the last inspection DCHA has completed refurbishment of the main kitchen. Stainless steel units, domestic ovens, a single gas hob and five rings and a central island for food preparation have been fitted. There is non-slip flooring. A child-gate has been fitted between the kitchen and the dining area. We were told that since its installation all the residents have complied with the safety rule that all children remain on the dining area side of the gate. However measures may need to be taken to ensure that older children cannot open it and let themselves and or others through the gate. At the time of this visit there was one long a refectory style table for everyone to sit around. There is a plan for the provision of smaller tables that can be arranged so families can sit together at a table. New flooring matching the kitchen floor had been ordered for the dining room and was due to be fitted in the near future. Pest control had been attending the house, but without full success, as mice had been seen recently, confirmed by staff and residents. The current domestic refrigerators were going to be replaced with industrial refrigerators to provide more robust equipment. This had not happened by the time of this inspection. We saw liquid soap and paper towels provided in the bathrooms. The laundry was clean and tidy with good walls and floor. There were two domestic style washing machines and two large tumble driers. One washing machine was out of action however we were told by a member of staff that an engineer had been requested. The sofas identified at the last inspection as being a fire risk have been removed from the premises. A wall-mounted plasma screen television has been installed in the lounge. The key workers’ office is no longer available to the residents and alternative arrangements were in place for them to make telephone calls to other Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 26 agencies, for example, care managers, probation officers and the Benefits Agency. The key workers told us that this was a significant benefit for how they manage their work and confidentiality. The care plans were seen kept in this office. They were in a lockable filing cupboard. The room was locked when there was no staff member using it. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The recruitment system is robust, and staff supervision and training is provided. Residents cannot be confident that an effective staff team will meet their needs because a core group of staff is resistive to the introduction of different styles of therapeutic work thereby undermining its potential gains. EVIDENCE: Although new staff have started work at Trevi House since the last inspection, we were shown their recruitment files then. These included police checks before the staff started work in the project, and two written references. The person with day to day responsibility confirmed that no other staff had been recruited since the last inspection. A Volunteer Counsellor started work on the day of this inspection. We did not look at their documentation. The person with Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 28 day to day responsibility said that the “normal robust procedure” had been followed. Following the child protection alert in October 2008 it was identified that children were potentially at risk if they were left with another resident whose own child/ren were on a care order. There has consequently been a fundamental change in the role of Out of Hours staff as they are now expected to look after children in the absence of the mother. It was unclear if these staff had received any child care training. One Out of Hours worker told us that she did not feel qualified to look after children. Following this visit we were able to confirm with the Board of Trustees that the restructuring plan includes child care training for all the Out of Hours staff because of the change to their job description. There was unease amongst the staff team due to the restructuring programme currently being implemented by the Board of Trustees. In order to ensure that this complies with legal and regulatory guidance, the Board of Trustees has brought in a local authority Human Resources Consultant. The staff have nominated a spokesperson for each staff group (Out of Hours, Nursery, and Day Programme) to collate ideas and suggestions. We were told by a representative group from the Board of Trustees that “extensive consultation has taken place with all the staff”. The person with day to day responsibility was asked not to attend trustees’ meetings. This is to ensure the process is seen as fair and open, and also protects her from being compromised if asked by other staff questions about the future of the project. As part of the restructuring programme a new post has been created for a Therapeutic Programme Manager. This post was being advertised at the time of this visit. This person will be expected to take on the supervision of all the therapeutic staff and the Out of Hours staff. The staff we talked to wished to reassure us that their unhappiness and feelings of “working on a roller coaster” did not have any negative impact on the outcomes for the residents and their children. When we spoke to the residents about their experiences of Trevi House generally no one mentioned anything about staff unrest rather they spoke highly of all the staff. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 29 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. The Registered Provider is putting robust systems in place for the benefit of the people using this service; however there is a strong element amongst the staff team that is challenging changes being implemented to improve the outcomes for the people who use this service. EVIDENCE: A significant amount of work has gone on to meet all the requirements and recommendations since the last inspection and the person with day to day responsibility along with a supportive staff group are commended for this. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 30 The person with day to day responsibility for the project is the General Manager who has been in post twelve months. Since the last inspection she has started the process required for an application to the CSCI to register as a manager. The Board of Trustees of Trevi House has a new Chairperson who has registered with the CSCI as the Responsible Individual for the Company. An accountant is employed two days per week to maintain good book keeping. The Trustees have put in process a re-structuring programme in order to maintain the business with outstanding funding issues. All the staff had been issued with “At Risk” notices however following this inspection we were informed that four job roles were safe and others were being considered. Throughout our visit we were conscious that the staff were affected by the uncertainty of their future working conditions. However there was no evidence this was affecting the residents. Feedback surveys are given to residents, funders, and other stakeholders after admission, during the programme, and at discharge. As this is in early stages these had not been collated by the time of our visit. Members of the Board have carried out monthly visits to the home up to November 2008, and sent copies of their reports (Regulation 26 Notifications) to the CSCI. All incidents that affect the health, safety and/or well being of people using this service are reported to the CSCI as required by Regulation 37 of the Care Homes Regulations 2001. The Fire Log showed that fire alarms and fire extinguishers were tested at regular intervals. All staff had fire safety and awareness training ongoing as part of their training programme. Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 31 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 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 x x 3 x Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 32 YES 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 YA32 Regulation 12 (5) Requirement Timescale for action 31/03/09 2 YA33 3 YA37 You must ensure that staff maintain good personal and professional relationships with each other in relation to the conduct of the care home. 12(1) You must ensure that the b18(1) a restructuring programme is carried out in such a way that ensures that residents continue to have an effective staff team available to meet their needs, and carry out the treatment programme safely. CSA As the care home is owned by a 2000,Ch.14 company, a Manager must be Part II registered with the CSCI. 11(1) 31/03/09 31/03/09 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 YA6 Good Practice Recommendations Pre-admission assessment should continue to be thorough DS0000003558.V373746.R01.S.doc Version 5.2 Page 33 Trevi House 2 YA9 and robust including consideration of dual diagnosis, medical assessment, and discharge arrangements, in conjunction with the purchasers of services, in order to safeguard residents. The management of the risk of relapse and early discharge should continue to be robust in the early stages of treatment. This should continue to be reviewed as the treatment programme progresses so that risk assessments reflect the aftercare plan and ultimately independent living. You should look at how controlled medication is to be stored when it is next received for people living at the home. You should ensure staff have and understand procedural guidance that clearly demonstrates the systems required in order to protect children and minimise the risk of abuse whilst the child is living in the home. This includes the care of children in the absence of their mother. You should continue to consider with Plymouth Childrens’ Services strategies for a joint Safeguarding Policy and procedures, and a joint contingency plan for any child (ren) should a placement become no longer viable. You should have routine links with other agencies concerned with child protection, and not work in isolation from them. The plan of redecoration and refurbishment should continue to make the environment more comfortable, bright and cheerful. Any information collected as part of a quality assurance review should be collated and the results made available to the people using this service and other stakeholders with an interest in the project. 3 YA20 4 YA23 5 YA23 6 YA23 7 8 YA24 YA39 Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 34 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 Trevi House DS0000003558.V373746.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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