Inspection on 09/07/08 for Trevi House

This inspection was carried out on 9th July 2008.

CSCI found this care home to be providing an Poor 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trevi House 07/01/09

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 09/11/2008.

CARE HOME ADULTS 18-65 Trevi House 2/6 Endsleigh Gardens Mutley Plymouth Devon PL4 6DR Lead Inspector Stella Lindsay and Megan Walker Unannounced Inspection 9th July 2008 3:15 Trevi House DS0000003558.V365617.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.V365617.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.V365617.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 Ltd 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.V365617.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Female Only Age 18 to 60 years Date of last inspection 10th July 2007 Brief Description of the Service: Trevi House is registered 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 and tends to be 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. 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 provides counsellors and other support staff to maintain the programmes of care designed for the people who use the service. People using Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 5 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. 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. Residents 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 July 2008. 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.V365617.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 0 stars. This means the people who use this service experience poor quality outcomes. This was a Key Inspection. The fieldwork part of this inspection was an unannounced visit that took place over three days within a two-week period in July 2008. Two regulation inspectors conducted it. We talked with six people who were on treatment programmes at the time of this inspection. We also spoke to six staff who 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 eleven care plans, three staff files, medication and other records and documentation. There is currently no Registered Manager at Trevi House. The General Manager provided information about the day-to-day routines as well as the operational management of the home for the purposes of this inspection. There was also an opportunity for her to explain the proposed changes to the management structure and staffing of the project and its implications for improving outcomes for people who use the service. In addition other information used to inform this inspection: • The Annual Quality Assurance Assessment (AQAA) completed by the General Manager. • All information relating to Trevi House received by the CSCI since the last inspection. • Staff Surveys given out and returned during this inspection. • Relevant information from other organisations. 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 AQAA. There is one outstanding requirement from the last inspection. Eight requirements and five “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: The women staying at Trevi House told us anyone who chooses to undertake a treatment programme at Trevi House benefits from support staff and key workers who have a commitment to care for and support them. A staff member said that as the residents settle in and build up trust in the staff, they are able to reduce medication they are taking, their concerns reduce Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 7 and they begin to realise they ‘do not have to live in chaos’. A care manager told us that their client’s relationship with their child ‘improved tremendously’ during their stay. What has improved since the last inspection? What they could do better: Full assessment of residents’ needs including their plans for resettlement and after-care should be made before they move to Trevi house, in order that arrangements can be put in place to meet all their care needs. There was insufficient qualified counselling staff to run the groups and 1:1 sessions needed for the residents to make progress. There was no resettlement officer at the time of this inspection consequently the key workers were also responsible for enabling the women to plan their Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 8 resettlement. There was a lack of clarity between residents, keyworkers and the General Manager about responsibilities regarding resettlement. The aftercare programme had stopped because of staffing issues, and consequently women are leaving Trevi House without a planned support network. Suitable links should be promoted in the local community to help residents, when their key worker considers this appropriate, to work towards independent living. Disagreements between the General Manager and residents with regard to financial arrangements resulted in the General Manager giving residents notice to leave, without consulting the resident’s funder/care manager. Specific plans should be in place to ensure that children’s’ needs for family reintegration can be fully met, including children not living at the project if the long-term plans are for them to rejoin their mother. Due to the age of the complex, Trevi House struggles to be “fit for purpose” without extensive renovation. However the planned refurbishment of the kitchen and dining room must be carried out within the timescale proposed by the Devon and Cornwall Housing Association. This will provide a hygienic and attractive environment for the women and children. Redecoration should be carried out where required to make the environment more comfortable, bright and cheerful. Confidentiality of information cannot be guaranteed during 1:1 sessions; or sharing of information between staff because of use by residents of the staff office; or access to and storage of care plans (ie care plans out on desks) because of residents use of the staff office. Where bedrooms do not have locks on the doors, suitable locks should be fitted that are accessible by staff in an emergency. Risk assessments should be carried out and residents consulted about whether or not they would like a key to their bedroom doors to enhance privacy and provide security for their belongings, or a lockable facility for any valuable belongings if their treatment programme requires restrictions on locking doors. The Registered Person must introduce a system for reviewing and improving the quality of care provided at Trevi House, that seeks the views of residents, staff and all other stakeholders. Visits to the home on behalf of the company must be resumed at least once a month to monitor the standard of care and the state of the premises. Trevi House must have a Manager registered with the Commission for Social Care Inspection in accordance with the Care Standards Act 2000. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 9 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.V365617.R01.S.doc Version 5.2 Page 10 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.V365617.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 1,2,3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective clients cannot feel confident that their needs, including aftercare needs, will be fully assessed and met. EVIDENCE: Women are encouraged to visit Trevi House in person prior to admission being arranged. Sometimes, because of the distance that some people live from the project or because it is a condition of a court order to attend residential treatment programme, this is not possible. Some women told us that they had come on the recommendation of their care manager. One care manager confirmed that her client had visited the project before deciding it would not meet her needs. We looked at the care files of nine women living at Trevi House at the time of our visit, and two who had recently moved on to independent living. The records on each file were variable in quality and provision of information. There was some evidence of written and verbal information collected from Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 12 social and health care professionals involved in the person’s care before the residential treatment programme was agreed. Most had a Trevi Project referral pack, however these were either not completed at all, or only partially completed. Dates and signatures were missing. There was little evidence to show that pre-assessment information had been collected to ensure any of the women could be supported to make the best of their treatment. One survey returned to us said that the financial assessments are completed but the home is ‘in too much of a hurry to get people in…and significant issues such as mental health problems can be overlooked.’ Staff also verbally raised this concern with us during the inspection. Women had been alarmed as they felt their children were at risk when a newly admitted resident had a mental health episode that was not anticipated. An Out of Hours staff member found the situation very difficult to manage because they did not have the training to prepare them. However, one worker said the General Manager sorted out the issue promptly. We did not see evidence of planning for after-care being considered at this stage, or recording of arrangements to be made if a resident decided to leave earlier than planned. In some cases (where there was a court order) there was information about what should happen to any children in the event of their mother leaving the treatment programme earlier than planned. We saw copies of financial agreements on care files. They had been signed by the resident. We did not see any evidence that the funding authority also signed these agreements or any other written agreement where they were the referring agency. New residents had also been given a ‘Welcome Pack’ that included the ‘Rules of Trevi House’. These were about the boundaries and restrictions that were part of the treatment programme at Trevi House. Every new resident is told about the restrictions that must be agreed to as part of the treatment programme. This includes the grounds on which the treatment programme could be ended. The resident has to sign confirming that the “rules of Trevi House” were read out to them, and they have understood them. This is usually done as part of the admission process. We asked a staff member if these ‘rules’ were revisited after the person had been at Trevi House for a short time as a reminder/prompt. We were told that this did not happen. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using this service cannot be confident that their assessed needs and personal goals, including after-care plans, are reflected in their individual care plan. They are not supported to take risks within realistic goals of their treatment programme. They cannot be confident that information about them is handled appropriately. EVIDENCE: The eleven care plans we looked at in detail had information about problems identified between the key worker and resident as areas of concern for recovery, potential barriers that could hinder a successful outcome, and intervention/plan of action. We spoke collectively to five women about their views of the service and how it would help them achieve their goals. They told us about their treatment programme and how it was hindered by staff shortages. We found that admissions to the project had continued when there were not enough key workers (trained counsellors) to run the groups. The residents did not know what they were expecting as an outcome from using Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 14 this service. This was because they were all anxious about the lack of aftercare preparation time and support before they finished their programme. One woman, who had only recently started a treatment programme at Trevi House, was already anxious about what would happen when she was due to leave. She told us that she had witnessed the anxiety of women who had recently left, and the high levels of stress suffered by two women due to finish their treatment programme in the near future. In a survey completed by a staff member they wrote: “Not enough time due to staff shortages. Support has been sporadic, three management changes and style. The current style is more regimental and punishing instead of understanding and caring. This is particularly noticeable in the changes to former residents, the leaving stage and no aftercare group any more because there is no fee for this.” We saw on care files that as part of the treatment programme each woman had signed a contract agreeing to any necessary restrictions on their freedom and liberties. This was done when they arrived at Trevi House. The Annual Quality Assurance Assessment (AQAA) completed by the general manager states: “Restrictions and stipulations under court direction and Social Services are worked with proactively and not as punishment.” However, some staff expressed concern that the General Manager although not having clinical experience, would become involved when there was an incident, and had on occasions imposed consequences without being aware of progress or issues being worked through. This was felt by staff and residents to be leading to a punishment-based regime. Residents had confidence in the keyworkers who lead groups and give 1:1 counselling sessions. As described in the AQAA;“Staff will work with residents to enable and empower them whilst ‘pushing’ the resident to deal with issues by individual 1:1 therapy… Staff work with residents to Risk Assess their choices and realise ‘needs over wants’. We respect each individual choice and will where practicable work to this, however when necessary we negotiate with the resident to explore choice, expand learning and encourage self reflection around their choices.” The service supplied us with a copy of its Confidentiality Policy, but we did not see any signed copies on care plans. It would be good practice for this to be in place before any counselling sessions were started. The project had a policy on Missing Persons, but risk assessments were not seen on Care Plans about what to do if the person decided to leave before their programme was complete. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 15 A staff member told us that all the women’s monies and valuables were given for safe keeping with the staff team at Trevi House. There were no lockable facilities in individual bedrooms. We discussed this with a staff member who showed us lockers that were available for the women to use. These were on the landing, outside the bedrooms. The member of staff told us that the lockers were not used. The General Manager later advised us that these lockers were to be removed. Trevi House had maintained a holding account for residents’ money. At the time of this inspection this was being phased out. There had been disagreements recently with residents who disputed their bills. When the General Manager considered that residents had not paid the contribution to their fees that had been agreed, she had given them notice to leave in writing. Consultation with the funder/care managers had not taken place. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using this service have a limited variety of opportunities for personal development as well as leisure activities as part of their agreed treatment programme. The lack of specific plans to ensure that mother and children’s needs’ can be fully met hinders family integration. EVIDENCE: 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. The five women we spoke to told us that they are expected to plan their weekend “pracs” during the week. This was a dedicated session mid week to plan the practicalities of Friday, Saturday and Sunday. This included menu planning and activities with their children. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 17 We asked the key workers and the General Manager about access for the women to local support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups. We were told that this did not happen until four weeks before a woman was due to leave the project. We were advised that attendance at external support groups was not actively encouraged or supported as part of a treatment programme at Trevi House. We were also told that there is a ‘curfew’ of 19:00 for all the women. A Trustee told us that this is ‘to assist the women in establishing routines for themselves and their children’. The women are expected to feed their children and themselves, spend time with their children and put their children to bed between 16:00 and 19:00. The evening is then spent together, without children, in the lounge doing agreed activities. Anyone within the last four weeks of her programme is expected to plan and spend her evening on her own. She would not attend the group sessions. Two women who were due to leave the project shortly after this inspection found the prospect of evenings alone after 19:00 daunting. It was not evident that they felt prepared for their future lives. Residents may have other children not currently living with them. These children may visit overnight, usually at weekends, with the agreement of their own Social Worker. There is a charge, currently £52.15 per night for a child over 2 years old. One resident told us that she was unable to accommodate her children together at any one time because the fee for each additional child was prohibitive. Consequently the children did not have an opportunity to be together with their mother overnight and become accustomed to each other’s company as a family. They were able to spend time together during the day. We asked staff about this arrangement and who would be responsible for these payments. We were given different answers. The General Manager told us that additional children and overnight stays would need to be identified by the woman’s care manager at the time of the financial assessment by the purchasing body. If this did not happen or there was a later decision to allow this to happen, then the cost would be the responsibility of the woman, or her family if this were feasible. If the woman or her family were unable to pay then the children could ‘rotate’ i.e. the child who usually stayed at Trevi House with his/her mother would stay elsewhere overnight and a child who lived else where would stay at Trevi House with her/his mother. By doing this, there would be no extra charge because the treatment fee includes any child(ren) staying with their mother. A member of staff explained that at the time of this visit there were limited activities arranged outside Trevi House. Gym sessions were available at a local centre one day a week and there were sessions at the Mount Batten water sports centre. Some women have attended sessions at another local outreach project. A staff member told us they were wary about allowing women to go there because it is open to people using drugs and alcohol. We were told that there were plans to introduce attendance at external parenting classes. A key Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 18 worker told us that in-house parenting groups had been reduced from three groups a week to one group a fortnight. The direction of the group had also changed to look at parenting skills rather than as previously, to address subjects such as parenting issues of guilt, and putting drugs/alcohol before the needs of their children. Again, attendance at these groups would not be until the last four weeks before finishing the treatment programme. The General Manager supplied us with a Resettlement plan, called the ‘Move on Timeline’, that she was introducing. The residents get breakfast for themselves and their child(ren) before taking them to the nursery for 9:00. A cook provides a cooked meal in the dining room at lunchtime. During this inspection a mixed grill was provided, with eggs and baked beans, and plenty of meat, and there was a large bowl of fresh fruit. The cook leaves at 12 noon, leaving the food ready for the women to help themselves. For the evening meal, each woman booked food from the home’s store to prepare and eat with her child(ren) and has a 40-minute time slot in the kitchen in the house where she is staying. Two women had chosen to join their Sunday lunch slots together so that they could cook a roast meal. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Women on a treatment programme at Trevi House can feel uncertain that their personal, physical and emotional health care needs will be met because the lack of an aftercare plan early on in the treatment programme can be detrimental to their well-being in their recovery. The project has a safe system for dealing with medicines. EVIDENCE: The group of women we spoke to told us that everyone staying at Trevi House was expected to attend group sessions as well as individual counselling sessions as part of their treatment programme. They were positive about the groups and their counselling sessions although they were concerned how it was hindered by staff shortages. The eleven care plans we inspected showed immediate issues needing support to enable the women to change lifestyle patterns from a reliance on addictive substances towards establishing routines of daily living. Aftercare plans were not evident as part of the assessment process so women did not start their Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 20 treatment programme with an outcome in mind. The women we spoke to talked about their anxieties rather than their aspirations when they had finished their treatment programme. Those women who were due to leave the project in the near future felt that they and their children had been let down because planning towards leaving the project had been left to the end of their programmes. A key worker told us that for women who wished to re-locate to Plymouth this was mired due to long waiting lists for housing and the shortage of housing stock available in Plymouth. In her opinion, the short term planning (four weeks before the treatment programme was due to end) meant an application for housing at such short notice risked the local authority housing department allocating emergency temporary accommodation. For the women leaving the project the anxiety and stress created by the uncertainty was detrimental to their well-being in their recovery. One woman who had only recently joined the project told us that she would prefer to return to ‘known risks’ in her home town rather than the stress of not knowing if she would successfully be re-housed in Plymouth. At the time of this visit all the women staying at Trevi House were independent with their personal care. On arrival at Trevi House each woman and her child(ren) are registered with a local medical practice. Some care plans had information about mental and psychological health care needs as well an addiction to drugs and/or alcohol. There was not any evidence of a joint working plan, for example, a Mental Health Team working together with the Trevi House staff to support an individual in achieving her goals and aspirations. We saw evidence of a joint care plan for someone with a chronic medical care need. This was constructive for the staff because it provided information about how to manage this person to ensure that she stayed well. The Manager is currently reviewing the home’s medication policy. She had made changes to the arrangements with the pharmacy in order to provide a safe system. Staff training had been provided on 23/06/08. The records seen were clear and accurate. A new Controlled Drugs record was being obtained. Medication received by the home was checked in by a keyworker, including daily deliveries of methadone. Risk assessment and reasons for prescription were seen on a client’s file, as well as a checklist showing who had been informed. Medication is stored securely, and residents come to collect any prescribed drug at set times of day. Trevi House DS0000003558.V365617.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 and 23 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 are listened to by their keyworkers. Safeguarding procedures are being put in place to protect them. EVIDENCE: The group of women we asked about the home’s Complaints Procedure told us they would talk about anything they did not like or were unhappy about in one to one sessions with their key worker. They said they could also speak to the General Manager although there were mixed reactions about how she responded to them. One example given by a group of residents was that they had witnessed the General Manager reacting inappropriately to a complaint about money made by a former resident. The AQAA told us: “Our [complaints’] policy offers stages and stipulates feedback times. All residents receive a copy in the Welcome Pack, it is also on our website and in our application pack. Residents are encouraged to seek clarification to problems as they arise such as maintenance and minor issues which can occur daily.” The Complaints Policy was clearly displayed on a notice board near the reception office. The one written complaint that had been recorded was with regard to quality of food and the state of the kitchen. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 22 In surveys returned by staff, they told us that they had not had any recent safeguarding training either for child protection or adults. The General Manager confirmed that she had identified this gap in knowledge and training. She was setting up training sessions with the local authority as well as arranging in-house training, so that staff would be alert to any potential abuse, and know what action to take in the event of any allegation being made. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 23 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment at Trevi House is in need of refurbishment and redecoration. 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. 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, were dirty. The premises needed redecoration and refurbishment throughout, including new flooring for small kitchens. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 24 A recent Environmental Health report about the kitchen-dining area had been sent with recommendations to the DCHA. The General Manager told us that there was now agreement from DCHA to have the kitchen-dining area completely refurbished and building work is expected to start in November. Stainless steel units, domestic ovens, a single gas hob and five rings will be fitted. The current domestic refrigerators will be replaced with industrial refrigerators to provide more robust equipment. The plans include a central island for food preparation and the new design will mean that a child-gate can be fitted between the kitchen area and the dining area. The new arrangement is planned to suit three families preparing meals at the same time. There is also a plan for the provision of wipe-clean walls and more up to date dining furniture to make the dining area look less institutional (at the time of this visit there was only one long a refectory style table for everyone to sit around). Pest control had been attending the house, but without full success, as mice had been seen outside the previous week, confirmed by staff and residents. A local authority care manager told us about her concerns for the confidentiality of her client, particularly 1:1 counselling sessions. The key workers told us that there was not a separate room for 1:1 counselling. These sessions therefore took place in the ‘Out of Hours’ staff bedroom, the staff room or the kitchen-dining area. They told us that there was nowhere offering privacy or a comfortable room that was aesthetically pleasing. The group work sessions were held in the lounge. We noted that these sessions were respected and took place uninterrupted. The sofas in the lounge were old and one of the women felt they were too dusty for young children. In the fire risk assessment carried out in July 2007, the sofas had been identified as not meeting fire regulations. There are four offices for administration purposes. The General Manager has an office near the main reception, and the key workers and support staff share a small office in one of the houses. There is also a staff meeting room, suitable for client case reviews. The key workers’ office is available to the residents to make telephone calls to other agencies, for example, care managers, probation officers and the Benefits Agency. The key workers told us that because the women are in and out between group sessions, there was no confidentiality. The care plans were seen kept in this office. They were in a lockable filing cupboard however it was not locked on any of our visits. The room however was locked when there was no staff member using it. The General Manager 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. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 25 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 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment system is robust, and training is being provided, but although steps are being taken to recruit qualified and experienced staff, residents had not been assured of sufficient staff to meet their needs. EVIDENCE: On the first day of our visit there were nine women on treatment programmes at Trevi House. Each had diverse and complex psychological and emotional care needs. There were two full time key workers who provide 1:1 sessions and facilitate the group sessions. They are also ‘on call’ evenings and every other weekend. The group of five women we spoke to said that there had been periods earlier in the year when there had only been one key worker at one time due to holidays and latterly, sickness. The key workers confirmed this had happened. One staff survey stated: “ There has not been a full team for at least 2 1/2 years. Over the past year there have been times when there has only been 1 key worker on duty for a week or a fortnight at a time.” Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 26 At the time of this visit there was an agency worker and a support worker providing relief cover for key worker posts. Both key workers independently told us that for the project to succeed it required 4.5 key workers on duty. In addition to the key workers there are nine Out Of Hours Support Workers who work in pairs providing support for the women and their children in the evenings, over-night and weekends. The women are encouraged to ask their peers to help with childminding however the Support Workers will assist if needed. The feedback we received from the staff was that they felt they worked hard however staff shortages meant that care plan reviews, keeping external care managers up to date fell behind, and daily hand-overs were brief. The recent resignation of the resettlement worker had a serious effect on the well being of the residents. Keyworkers said they had to use 1:1 time for practical issues to facilitate re-settlement. Training to provide safe methods of working is being provided, including Fire Safety training and First Aid. All the Out of Hours (OOH) team completed an induction programme under the new management, followed by the offer of National Vocational Qualification (NVQ). The General Manager said that there are 9 staff qualified at or above NVQ2, and six working towards this. We were told that there were regular weekly staff meetings with the General Manager who also provided regular general supervision for all the staff except those employed to work in the nursery. Staff completing surveys confirmed that they meet regularly with their manager. The qualified counsellors were not receiving clinical supervision. The Manager said she would arrange for independent professional supervision for the keyworkers, but this was not in place at the time of this inspection. The keyworker who had been the clinical lead had left the project in April ’08. A staff survey said that ‘this was badly missed, as work with clients had been challenging.’ Further, if inexperienced workers are involved with this client group, difficult situations can be exacerbated. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 27 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 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The combination of issues to be dealt with is very challenging, and the service cannot at this time be seen as being run in the best interests of the residents. EVIDENCE: The last registered manager resigned their post as manager at Trevi House in June 2007. Then there was a period with no manager, followed by interim management consultants before the current General Manager was appointed in December 2007 and started working at Trevi House in January 2008. She has achieved the National Vocational Qualification level 5 in Management and level 4 in Care, and has completed the work for the Registered Managers’ Award and is awaiting verification. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 28 The General Manager is introducing improvements in the service in order to meet the regulations of the Care Homes Regulations. She has brought in an independent bookkeeper to ensure accuracy in residents’ and establishment finances. She organised an external 5-day “Change Management” course for all the senior staff working at Trevi House to attend earlier this year. The Responsible Individual for the company is Mrs Gwen McPherson. We were concerned that the overall management of the home is not transparent and actual. Its style is causing low staff morale and tension. The General Manager told us that she meets fortnightly with the Board of Trustees (BOT) for a three hourly meeting. Other staff told us that the Board has fully backed the changes that the General Manager has introduced to the service. We found the General Manager was confident about the actions she has taken since she been post. We were concerned however that because all the staff had been given high expectations of “the new manager”, she was struggling to take the whole staff team with her. It was unclear what the Board of Trustees had set as its own agenda and its expectations for the “new manager”. The main underlying tension for both the residents and the staff group were about the increase in fees and additional costs, without accompanying visible improvements either to staffing levels or the environment. Members of the committee had visited the home to monitor the quality of the service, but not recently. We had been given copies of their reports for February and March 2008. They had highlighted the poor state of the environment, but this had not changed by the time of this inspection. The General Manager told us that it was hoped that more trustees would be appointed to strengthen the contribution of the Board. The home has not yet introduced a quality assurance system that focuses on residents’ views and obtains feedback from staff and health and social care professionals who have worked with residents at the home. The General Manager has introduced health and safety measures including Fire and First aid training. The fire precaution system had been professionally tested. Fire risk assessments had been carried out by the previous management consultant, and were due for review. An electrician was called to inspect the circuit. Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 1 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 X X 3 X Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 30 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 YA2 Regulation 14(a) Requirement Pre-admission assessment must be thorough and robust to include consideration of dual diagnosis, medical assessment, and discharge arrangements, in conjunction with the purchasers of services, in order to safeguard residents. Residents must not be given notice to leave without consulting their Care Manager/funder, as this might put them at risk of harm. The management of the risk of relapse and early discharge must be robust in the early stages of treatment. This must be reviewed as the treatment programme progresses so that risk assessments reflect the aftercare plan and ultimately independent living. Suitable arrangements must be put in place to ensure that the project is conducted in such a manner that respects the confidentiality of residents. Timescale for action 30/09/08 2. YA7 12(1) a 30/09/08 3. YA9 12(1)(2) 30/09/08 4. YA10 12(4) a 30/09/08 Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 31 5. YA30 23(2)b 6. YA33 12(1) b 18(1) a 7. YA37 Ch.14, Part II 11(1) 26 The planned refurbishment of the kitchen and dining room must be carried out in order to provide a hygienic and attractive environment for the women and children. Residents must not be admitted if suitably qualified staff is not available to meet their needs, and carry out the treatment programme. As the care home is owned by a company, a manager must be registered with the CSCI. The Responsible Individual or a representative must visit the home at least once a month to monitor the standard of care and the state of the premises, and send a report to the CSCI. The Registered Person must introduce a system for reviewing and improving the quality of care provided at Trevi House, that seeks the views of residents, staff and all other stakeholders. This is the third inspection where this requirement has been made. Previous timescales of 01/05/07 and 08/12/07 not met. 31/10/08 30/09/08 31/10/08 8. YA39 31/10/08 9. YA39 24 08/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The Manager should continue the phasing out of the holding account for residents money. DS0000003558.V365617.R01.S.doc Version 5.2 Page 32 Trevi House 2. YA13 Women on treatment programmes at Trevi House should be enabled to work towards independent living through the provision of suitable links with the community. Specific plans should be in place to ensure that children’s needs for family re-integration can be fully met. Redecoration and refurbishment should be carried out where required to make the environment more comfortable, bright and cheerful. All bedroom doors should be fitted with appropriate locks that can be accessed from the outside in an emergency. Risk assessments should be carried out and service users consulted about whether or not they would like a key to their bedroom doors to enhance privacy and security of belongings. 3. 4. YA15 YA24 5. YA26 Trevi House DS0000003558.V365617.R01.S.doc Version 5.2 Page 33 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. 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