Inspection on 04/06/07 for Westcliffe House

This inspection was carried out on 4th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Westcliffe House 16/03/06

Westcliffe House 26/07/05

Westcliffe House 24/02/05

Westcliffe House 07/10/04

Westcliffe House 24/02/04

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Richards House

Hamer Cottage

Turning Point (Hoole Road)

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

CARE HOME ADULTS 18-65 Westcliffe House Westcliffe House 3 - 4 Braddocks Close Hurstead Rochdale Lancashire OL12 9UZ Lead Inspector J Andrew Unannounced Inspection 4 June 2007 09:00 Westcliffe House DS0000025533.V338564.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 Westcliffe House DS0000025533.V338564.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. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Westcliffe House Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Westcliffe House 3 - 4 Braddocks Close Hurstead Rochdale Lancashire OL12 9UZ 01706 377197 01706 372910 Turning Point Deborah Bithell Care Home 8 Category(ies) of Past or present alcohol dependence (8), Past or registration, with number present drug dependence (8) of places Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 8 service users to include up to: 8 service users in the category of A (Adults with past or present alcohol dependence); 8 service users in the category of AD (Adults with past or present drug dependence). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16th March 2006 2. Date of last inspection Brief Description of the Service: Westcliffe House is a residential service for eight individuals who need support in achieving a drug and alcohol free lifestyle and have been unable to achieve this whilst living in their own home or community. The project, operated by Turning Point, a national charity, enables individuals aged 18 to 65 years to develop skills so that they may eventually live independently. Single person accommodation is provided, along with shared communal facilities of lounges, kitchens and bathrooms. The property is situated on the outskirts of Rochdale town centre and is conveniently close to local shops and post office. As the accommodation is on first floor level, the service would not be able to be accessed by people with a physical disability, as there is no lift provided. The home is staffed during the week between 09:00 and 12:00 midnight and at weekends 09:00 until 16:30. Referrals are accepted from all areas of the United Kingdom and residents’ lengths of stay vary dependent upon their agreed care package. The current weekly fee is £390.00 per week. The provider makes information about the service available in the form of a resident handbook that is given to new residents upon admission. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed on the notice board in the office, which residents may have access to. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced key inspection site visit on 4th June 2007. This means the staff in the home did not know that an inspection was to take place. The inspection lasted seven hours. In order to find out about the service, seven residents, one support worker, a student, the administrator and the manager were spoken to. In addition, a brief tour of the building was done, although individual bedrooms were not inspected on this occasion. Records such as care plans, risk assessments, medication and maintenance were also seen. The house is staffed up until midnight during the week and up until about 16:30 at weekends. An on-call system operates out of these hours. What the service does well: The assessment process is thorough and before anyone is admitted to the home, a project worker undertakes a detailed assessment of need. In addition, a care management assessment is also requested. This thorough process ensures that people who are not ready for a rehabilitation unit are not accepted by the service. Dependent upon people’s circumstances, they are not always able to visit the project before admission but two people spoken to had been able to do so. They said, “I was shown around the project and spent a lot of time being assessed by a project worker” and, “I was made welcome and was able to meet the other residents living at the house”. The group of people currently living at Westcliffe House had been there for varying periods of time and those spoken to were committed to their rehab programme. They all felt really well supported, said they could talk to their key worker and request more key worker sessions if they felt they needed them. Without exception, they felt they were living in a safe environment. The care planning process was done with full involvement of the resident and areas where risks were identified were looked at in depth. Actions to address the risk areas were then written into the care plans. The care plans focused on each person’s individual needs, wishes and preferences. People were encouraged to access community facilities and to use their time productively by getting voluntary jobs, attending college courses or visiting other voluntary projects around the Greater Manchester area. One person said “I’m really enjoying the skills course I’m doing”, another said, “I’m beginning to feel more confident now” and other comments included, “I’m keeping myself occupied which is good”, “I’ve had a lot of support off my key worker” and, “I’ve come on in leaps and bounds since moving here”. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 6 Residents appreciated that some restrictions had to be in place due to the nature of the project. They all said these had been made clear to them, both at their assessment visit and upon admission. These were also written in to their licence agreement or attached separately to it. The team had a number of ways of checking out with people what they thought about the service, such as house meetings, one to one key worker sessions, resident representation at staff meetings and completion of satisfaction questionnaires when someone left the project Good systems were in place to make sure that residents and staff were not treated unfairly (equal opportunities). The licence agreement, which residents signed when coming into the project, set out what kind of behaviour would not be tolerated and staff made sure that if problems did occur, the right action was taken to address them. The recruitment of new staff was thorough and staff were not able to start work until all the right checks had been received. Training records seen, showed that Turning Point offered the staff a wide variety of courses so they would be better able to meet the needs of the residents who used the service. What has improved since the last inspection? When a child is visiting or staying at the home, new documents have been put into place. These included looking at the risks that may be involved and getting permission from the care manager and notifying the Commission for Social Care Inspection. The arrangements for out of hours support to residents had been improved, with only staff from Westcliffe House and Richards House being used. Residents said, “I’ve been in twice when someone rang the on-call and they came straight away” and “I’ve only experienced this once but the response was good and they sorted things out”. All the staff had done protection of vulnerable adult training and were aware of what to do if they suspected abuse was taking place. Since the last inspection, a new bath had been fitted in one of the bathrooms, the bathrooms had been painted and had new flooring laid, the bedrooms had been painted, new blinds had been fitted in bathrooms and bedrooms and the lounges had also been decorated. The kitchen units had been replaced in both flats. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 7 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. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The thorough assessment process in place ensured that the service could meet the needs of the people admitted. EVIDENCE: Westcliffe House offered a specialist service for people who have been dependent upon drugs and/or alcohol. Due to the nature of the project, it would not be appropriate for residents to live at the home for a trial basis but they are invited to attend to look around before deciding whether or not the home was right for them. The manager said that residents were always referred to them via the care management process and detailed assessments were undertaken, a copy of which was usually sent to the home. These were seen on the files inspected. However, Turning Point also had their own assessment form, which was detailed and completed for all new potential residents. This was confirmed from checking the care plan files for three of the residents. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 10 Dependent upon each person’s circumstances, the assessment may be done at Westcliffe House during a pre-admission visit, at an external venue or by telephone if the person lives a long distance away. All the residents spoken to said they had received either a personal or telephone assessment before moving in and that the rules and restrictions were clearly explained to them during this process. Some people said that because of their state of mind at this stage, what was said was very hazy but it was explained again when they were admitted. As part of this initial assessment process, a clinical risk assessment was also undertaken which looked at all potential risk areas. This will be addressed in more detail in Standard 9 below. The manager said they tried to avoid admissions on a Thursday or Friday so that staff would have more time to spend with new people when they were first admitted, taking them through the induction process. This was usually done on the day of admission or the following day. Those interviewed said they were again told very clearly about the rules and restrictions they would have to comply with, had the licence agreement explained to them which they signed and were given a copy of the resident handbook (service user guide). They also confirmed they were given a key to their bedrooms, signed a confidentiality agreement and that arrangements were made to be registered with a doctor. An induction sheet confirming this was seen on each of the three files inspected. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents’ individual needs and choices were respected and promoted within the confines of risk assessments and project rules, resulting in people becoming more independent and increasing their self-worth. EVIDENCE: The people spoken to during the inspection had been at Westcliffe House for differing periods of time, ranging from four weeks to six months. They were therefore at varying stages of their rehabilitation programme. Key workers were allocated upon admission and would spend as much time as was needed during the first weeks of each person’s stay, dependent upon individual need. After the initial period, key worker one to one sessions would be arranged on a weekly basis. Two residents said they had initially needed more than one session a week and more meetings had been arranged for them. One resident said “there’s always a member of staff to talk to if Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 12 needed” and another said, “I needed more support in my early stages of recovery and the extra sessions really helped me”. When asked about being able to change key worker, one resident said this had been possible. Another person said that whilst they had initially not got on with their key worker, over a period of time things had been satisfactorily resolved. During the visit, three care plans were checked. Each contained an initial basic care plan, which was done in partnership with the resident within the first day or two of admission. Over the next three or four weeks a detailed care plan was formulated with the new resident. All seven residents spoken to said they were fully involved in the care planning process and care plans had been signed to show they were in agreement with them. The plans addressed areas around physical and mental health, emotional needs, finances, leisure/courses, resettlement and cultural/religious needs. The care plans were working documents, which were reviewed monthly involving the resident and the key worker. Each care plan included a comprehensive risk assessment, which was regularly reviewed. The risk assessment document was initially completed as part of the admission process. It could include risk areas such as self-harm, suicide, drug prescription misuse, alcohol, etc. Dependent upon the outcome of the assessment, e.g., whether the risk was identified as low/medium/high, then a risk management plan was written, showing what needed to be done to lessen the risk. Where limitations were in place, the decisions had been made with the person and they had signed their agreement. Procedures were in place to ensure that people using the service were informed of their rights to confidentiality and, as part of the induction process, confidentiality statements were signed. The staff spoken with were fully committed to supporting people to have as much control over their lives as possible within the risk assessment framework. Residents spoken to all felt they were able to make informed decisions and comments included, “As long as I attend the meetings and follow the project rules I can do my own thing”; “I’ve found the scheme good for allowing flexibility in routines”; “It’s the right environment for me as I’m not being pushed too quickly” and, “I get the right support from people who know their jobs”. Whilst a key worker system was in place, the staff had a good system in place for sharing their knowledge about each resident with each other. This was done on both an informal and formal basis, the formal being within a team meeting where each resident’s progress was discussed. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 13 Discussion with residents identified they were supported and empowered to remain as independent as possible during their stays, with group meetings arranged to discuss cleaning rotas, menu planning (as needed), visits to families, etc. Dependent upon the recovery stage, staff supported residents to visit external voluntary organisations where they could access specialised counselling and courses. These provided local peer support networks that could be continued when they had completed their rehab programme. Finance and budgeting was addressed as part of their rehabilitation programme. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to acquire new skills and participate in community activities in order to pursue a meaningful and healthier lifestyle. EVIDENCE: The success of each person’s recovery was dependent upon people being committed to their rehab programme and to taking responsibility for their actions. Due to funding arrangements, residents were not able to seek paid employment and, at this stage of their recovery, it would be inappropriate for them to do so. Residents were, however, expected to attend compulsory groups and had the option of attending others. The compulsory groups and one to one meetings with key workers formed an important part of each person’s recovery programme. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 15 Feedback was mixed about the group meetings. Comments included, “It depends who is taking the group because sometimes they take too long”; “For those of us who’ve been here for sometime they are repetitive”; “The meetings could be more interesting”; “New topics need to be introduced”; “I find the morning meetings very helpful”; “The meetings are really useful” and “The meetings are generally informative”. In view of the mixed feedback, the manager should spend time with the staff team and the resident group, looking at the content and format for future meetings. Everyone was encouraged to join in community activities and key workers were good at finding out things that may interest their individual residents. The student on placement at the home was a key worker for one person. She had identified a previous hobby they had really enjoyed and supported the resident to join a voluntary project where he could utilise his skills. Other examples of community based activities which people were involved in included voluntary work, college courses, attending voluntary organisations where access to arts/crafts, educational and computer skills could be learnt. One resident had an interview with a local college to enrol on a health and social care course. In-house social activities took place, which were arranged by the residents with some staff support. A barbecue at a local beauty spot had been arranged the previous weekend, which had been enjoyed by the residents who had not been away from the project. Regular quizzes, communal meals and other social activities, such as walking, swimming and trips to the gym, were also enjoyed. Staff encouraged people to take up healthy outdoor pursuits and two of the residents said they regularly walked up to the local reservoir and spent a lot of time walking over the hills. Residents’ spiritual needs were addressed as part of the admission process. The resident handbook contained a very informative list of all the local places of worship, which included those of all different faiths. As part of each person’s rehab programme, key workers specifically addressed how relationships with family and friends could be maintained, as part of the care planning process. One of the project rules was that there was minimal contact during the early stages to avoid distraction and before any overnight stays, risk assessments were undertaken. As there could be a significant risk of re-establishing previous unhelpful networks that were associated with addictive behaviour, visits from family and friends to the project would generally be agreed and specified in the person’s care plan. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 16 Following a requirement made at the last inspection, the manager had drawn up a visiting policy and risk assessment document for when a child visited the project or stayed on an overnight basis. The policy included getting permission from all relevant parties. As the wishes and feelings and recovery programmes of other residents were also taken into account, there were times when it was felt inappropriate to allow such visits. Daily routines were planned around group meetings and other commitments, such as key worker sessions. Residents were encouraged to assist in daily routines, such as cleaning, and weekly meetings took place when the cleaning rota for each flat was agreed. Upon admission, each person is given a key to his or her bedrooms. There was, however, a clause in the licence agreement which clearly recorded the policy on room searches and testing for drugs or alcohol. In order to encourage independence, each person was expected to make their own meals, for which a weekly allowance was given. Food receipts had to be handed in on a weekly basis so that purchases could be monitored. One resident said that whilst he had been given dietary advice from his key worker, he had really benefited from other residents who had given him really good support. He said “I’ve learnt so much that I made chicken chasseur after one of our house meetings”. Everyone spoken to felt the amount given for food was sufficient and that they could afford to eat well. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were supported to manage their own healthcare and to access National Health Service community facilities, thus ensuring their health care needs were fully met. EVIDENCE: In order to promote an independent lifestyle, residents retained maximum control over their lives, with support where needed, from the staff team, especially key workers. The staff team was small and consisted mainly of female support workers. There was however, one male support worker who worked during the evenings and another male worker who worked with the clients on the supported living project. This enabled people to have some choice in the gender of their key worker, although key workers were initially designated as part of the admission process. One resident had in fact got two key workers, with whom he discussed different issues. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 18 At the last inspection, some residents had expressed concerns about the arrangements for “out of hours” contact. Since then, the arrangements for oncall had changed with only staff from Westcliffe House and Richards House in Middleton, being on the on-call list. The current resident group said they had not experienced any problems when they had occasion to activate the on-call system. One person said they had been on the premises on two occasions when the on-call system had been used and that someone had responded quickly. Another person said this had also been their experience. On-call arrangements were clearly set out on the wipe board outside the office. The residents contact the on call by pager with a further contact number using a mobile phone. Discussion with residents and staff and inspection of care plan files, provided evidence that residents’ health care needs were being well met. As part of the care planning process, the individual’s whole health care needs were addressed, e.g., physical, mental and emotional. Risk assessments were then undertaken and action plans to address high or medium risks were recorded and agreed with the person. In order to ensure that all staff are aware of any changes in a residents’ mental health needs, a “current” risk notification is held in the communication book. Upon admission, the resident was registered with a local doctor who had some specialist knowledge in substance misuse. All residents spoken with were happy with the GP they had been registered with. Staff support to access health care services was given as appropriate. This was assessed as part of the care planning process. Where risk assessments showed high risk of residents picking up their own prescriptions, support was given. Whilst some people felt able to attend appointments unsupported, others needed some support and this was arranged. One resident said he had needed to attend for dental treatment. Initially, he had received support from a worker but, at his last care plan review, it had been agreed he would attend his next appointment without support. He said that to lessen his anxieties, his key worker had obtained bus timetables for him so that he would feel more confident in doing this alone. One worker said she would support one of her residents on health care appointments but stay in the waiting room so that their consultation could take place privately. Arrangements in place for the recording, handling, safe storage and administration of medication was satisfactory, except that there was no controlled drug book in place. The manager said that, whenever possible, two staff signed upon dispensing any controlled drugs but this was not always possible if only one staff was on site. In such circumstances, she said the drugs were counted again at the end of shift and re-signed for. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 19 Medication was discussed and agreed with each new resident, as part of the admission procedure. Dependent upon assessment some people were responsible for ordering their own medication, collecting the prescription and obtaining their medication from the pharmacist. Where it was felt this would not be a safe option, appropriate help and support were given to residents, until they reached the stage where they were assessed as able to undertake this for themselves. All the staff had received medication training so they could dispense drugs safely and certificates were held on file, confirming the training had taken place. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 20 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 excellent. This judgement has been made using available evidence, including a visit to this service. Satisfactory policies, procedures and practices were in place for investigation of complaints and protection of residents, which meant people felt safe living at the home. EVIDENCE: The Commission for Social Care Inspection had not had cause to investigate any complaints at the home since the last inspection. Neither had any protection investigations been undertaken. The manager was knowledgeable about protection issues and Turning Point had their own Code of Contact. This was linked to the General Social Care Council Code of Practice. Residents were familiar with the complaints procedure, a copy of which was contained in the resident handbook that they were given upon admission. Without exception, all the people spoken with said they would feel able to raise concerns or complaints with any members of the staff team. They also said they were well supported and felt that Westcliffe House was a safe environment for them to live in. The complaints file was checked and monthly complaint returns sheets were completed and sent to the head office so that complaints could be monitored. The complaints received since the last inspection had been thoroughly investigated with relevant action having been taken to address them. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 21 The home had a copy of the Local Authority’s Adult Protection procedure as well as their own protection policy. A requirement was made at the last inspection for all staff to receive protection training. This had been done. Other training courses undertaken by some staff included brief focused intervention work, managing challenging behaviour and lone working. There was a behavioural policy in place, which was issued to residents as part of the admission process. They were asked to sign the policy to evidence they had read and understood the document and a copy was held on file. Other policies in place for the protection of the residents were incident reporting, violence and aggression, missing persons and risk management. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence, including a visit to this service. Recent investment had significantly improved the appearance of the home creating a comfortable and safe environment for those living there. EVIDENCE: Residents spoken to were satisfied with their rooms, which they were responsible for cleaning themselves. They were able to bring in small items so they could make their rooms more personal. Those spoken with all confirmed they had been issued with bedroom door keys as part of the admission process and that they also had keys for their individual lockable space. Whilst the rooms did not have en-suite toilets, the bathrooms and toilets were close to all the bedrooms. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 23 The communal areas of the home had recently been improved. Both the flats had benefited from new kitchen units being fitted, bathrooms had new flooring, a new bath had been provided, a new three-piece suite had been purchased for one lounge, the lounges and bedrooms had been painted and all bedrooms and bathrooms had new window blinds. At the time of the visit, there was discussion taking place between the staff and the residents about the Government’s new no smoking rules. At the present time, there were two lounges, one of which was used for people who wished to smoke. Due to the nature of the project, it was not uncommon for all residents to be smokers. The majority of the residents spoken to said they had recently been advised that the current smoking lounge would become a no smoking area and that people would only be able to smoke in their bedrooms. This had made many people quite anxious, as they did not want to become socially isolated from their peers by having to remain in their bedrooms. One resident said that if this came into force, she felt this would set her progress back, which she did not want to happen. The residents’ views were fed back to the manager at the end of the inspection and she said she would consider the options further. Turning Point also had a supported living project in flats above and below the rehabilitation unit. Anyone who wanted to continue their programme and was assessed as suitable could move into one of these flats as a “next stage” option. One of the residents from these flats was spoken to during the visit. He spoke highly of the help, advice and support he had received from the worker. He could not praise either of the projects highly enough. He said, “They’ve really sorted me out” and “I can’t tell you how much this place has helped me get back on track”. The communal areas were clean and hygienic and it was the residents who were responsible for keeping the home clean and/or doing their own washing. A house meeting was held each week when agreement was reached about who would be responsible for specific tasks within the communal areas. This was working extremely well in one flat. In the other flat, one resident said they did more than their share due to one particular resident not adhering to the rota. Staff monitored that the home was kept clean. Hand washing facilities, including liquid soap and paper towels, were provided in the bathrooms/toilets. Disposable gloves and aprons were also available should they be needed. Regular health and safety checks were done and a recent fire evacuation of the home had taken place. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence, including a visit to this service. The staff team had the skills and expertise to ensure residents were well supported and their needs were met. EVIDENCE: The project was not staffed on a 24-hour basis but cover was provided up until midnight during the week and 16:30 on a Saturday and Sunday. The residents were happy with these arrangements and knew how to use the on-call system that operated out of hours. The details of the on-call system were displayed within the home. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 25 Feedback about the staff team and support given to them was positive. Residents’ comments were as follows: “I like the mixed ages of the staff because there is always someone you can relate to”; “I got more support in the early stages of my programme which really helped me”; “There’s someone to talk to if needed”; “I think the team have the right skills for their jobs”; “Since I’ve been here (six months), the same team have supported me”; “The staff have really helped me get back on my feet”; “I’ve come on in leaps and bounds since coming here” and, “My health has improved no end, even though I’ve only been here for a few weeks”. As the team was small, communication systems worked well and regular team meetings took place. There was one male support worker on the team who worked on the evening shift and a full-time male project worker who worked with the supported housing clients. This meant that if male residents wanted to discuss personal issues with someone of the same sex, it would not be a problem. At the time of the visit a student was undertaking her placement at Westcliffe House. She said she was receiving regular supervision and that she was really enjoying her time at the project. She felt she was well supported by the other team members. As part of her placement she had been allocated one resident for whom she was the key worker. From speaking to the resident, it was clear that he had benefited from the input she had given. Three staff personnel files were seen and these contained evidence that robust recruitment procedures were followed. Evidence of Criminal Record Bureau (CRB) checks, references, application forms, contracts and supervision were on file. One file was checked for a staff member who had previously been a voluntary worker. As a volunteer, this person had been thoroughly checked out in just the same way as if he was a paid member of the team. The staff team had done varying training courses. One full-time day project worker had recently completed her NVQ level 2 qualification and was registering for her NVQ level 3 which she hoped to start in September 2007. The other team members had done other courses such as Level 3 counselling diploma, Advanced Certificate in Young People & Substance Misuse. Turning Point provided mandatory training in health and safety, food hygiene, moving/handling, first aid, administration of medication and protection training. From checking the files for three of the staff, it was identified they had attended such courses. In addition, other training, such as managing challenging behaviour, focused intervention work, stimulant workshop, had been done by different staff. One person had done training in alternative therapies. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 26 Staff discussed their training needs during supervision or at six monthly performance reviews. Evidence of training undertaken was on their files, as were supervision notes. At the time of the inspection, the administrator showed the inspector a new system whereby the training done by each staff member would be inputted onto the computer so that it could be more easily identified when refresher training was due. No new staff had commenced working at Westcliffe House since the organisation had introduced a new induction training programme approximately 12 months ago. The inspector was therefore unable to see a completed package but did have sight of the content of the training. It was modular training linked to the Skills for Care and Drug and Alcohol National Occupational Standards. Westcliffe House DS0000025533.V338564.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 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The home was well managed with good quality assurance and monitoring systems in place that helped to improve the service to residents. EVIDENCE: The registered manager of the home had been in post for approximately three years and had worked for the Turning Point Organisation for the past 11 years. She was therefore very experienced with this client group. She had a BA (Hons) in Community Studies and the HNC in Business Studies. She had also recently applied to do a Masters degree in substance misuse and addiction and was hopeful this would start in September 2007. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 28 Other training courses attended over the past two years had included fire, first aid, managing staff absence and medication. She had also completed her practice teachers award in January 2007. The organisation’s equal opportunity policy was being adhered to and the manager was knowledgeable about the importance of equality and diversity within the service. She was committed to providing a quality service and was person centred in her management approach. She was aware of current developments both nationally and by the Commission for Social Care Inspection and planned the service accordingly. Over the past 12 months she had been acting service manager for another of the Turning Point projects until an appointment to this post had been made, which had involved half a day a week of her time. She confirmed her commitment to this programme would be finished by the end of June 2007. She was also committed to attending meetings and other Turning Point initiatives but said she spent the majority of her time within the project. Since the last inspection, she had moved out of the main office into a smaller office on the ground floor. This meant that supervision and any other confidential meetings could be held in private and that the lounges used by the residents were no longer being used for such purposes. Feedback about the manager was positive from the staff and residents spoken to. Residents did however say that they did not see a lot of her and that they felt it would be good if she spent more time with them. The manager was open to this suggestion and said she would discuss it with the team and look at ways of doing this, such as holding a regular meeting with them. Regular staff team meetings were held with two resident representatives invited to the meetings, one from the rehab project and one from supported living. This enabled them to bring issues from their respective peers to the meeting and to take information away to share. Those spoken with who had attended team meetings felt their views and opinions were listened to and taken on board. The minutes of the meetings were seen and confirmed this was usual practice. At each meeting, the team took this opportunity to discuss progress of the residents and at this stage in the meeting, the representatives left so that confidentiality was upheld. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 29 The manager had different ways of monitoring the quality of the service they provided. The residents spoken to confirmed their involvement in the running of the home. They held regular house meetings, attended staff meetings and had weekly one to one key worker sessions. Another way of obtaining feedback about the service was by giving out questionnaires to the residents when they were ready to leave the project. These were held on file and any comments made were shared with the team and acted upon, where possible. Care manager feedback is also obtained. Other qualitative initiatives were regular staff supervision, opportunities to attend training courses and adherence to the Turning Point’s Health and Safety policies and procedures. Turning Point had a comprehensive health and safety manual in place, which was held in the office and easily accessible to all the staff working there. A named health and safety representative ensured that regular safety checks were undertaken throughout the building. During the visit, a random sample of maintenance checks was done. The electrical appliance checks had been done very recently, accident recordings were satisfactory and the fire logbook was up to date. Residents were clear about what to do in the event of a fire and said that only very recently they had evacuated the building when the fire alarm had been activated. Risk assessments for the home were in place. As previously stated, the staff had undertaken all mandatory health and safety training and a system was being put into place so that refresher training dates would, in future, be able to be more easily identified. Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 30 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 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 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 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 X 4 X X 3 x Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA12 Good Practice Recommendations The manager should review the content and format of group meetings in order to ensure they meet the needs of new residents and those at a later stage in their programmes. A controlled drug book should be used to show more clearly that medication has been counted and countersigned. Further discussion with residents should take place in order to try and reach a satisfactory way forward in respect of allocation of a designated smoking area. 2 3 YA20 YA30 Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Greater Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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 Westcliffe House DS0000025533.V338564.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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