Inspection on 19/04/05 for Weymouth AfterCare Centre

This inspection was carried out on 19th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Weymouth AfterCare Centre 26/06/08

Weymouth AfterCare Centre 18/07/07

Weymouth AfterCare Centre 25/05/06

Weymouth AfterCare Centre 03/11/05

Weymouth AfterCare Centre 14/09/04

Weymouth AfterCare Centre 21/04/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Weymouth Aftercare Centre Carlton House 9 Carlton Road North Weymouth DT4 7PX Lead Inspector Julia Mooney Unannounced 19 April 2005 11:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Weymouth Aftercare Centre Address Carlton House 9 Carlton Road North Weymouth Dorset DT4 7PX 01305 779084 01305 750879 carltonhouse@line1.net Mr Trevor George Felgate Mrs Joy Marie Felgate Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CRH - Care Home Only 15 Category(ies) of registration, with number A - Alcohol depend past/present (15) of places D - Drug dependence past/present (15) Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14 September 2004 Brief Description of the Service: Weymouth Aftercare Centre is a private care home that provides a residential rehabilitation programme for up to 15 men suffering from alcohol or drug dependency problems. The Centre is a large house situated in a quiet residential area of Weymouth within easy walking distance of the seafront and local amenities. There is a small garden area at the back of the house and parking for a few cars at the front of the building. It has been established as a care home for approximately 15 years and retains strong links with the local community. The Centre accepts service users from any part of the country. Ordinarily, service users are admitted from a primary care unit, where treatment has already commenced. In a minority of cases service users may come directly from prison or may be subject to a probation order. Placements are of a short-term nature, ordinarily approximately of three months duration. Service users either then return to their own area or move on to a “half-way” house in Weymouth. Service users are encouraged to take responsibility for their own recovery. The emphasis is on participation in daily activities, household chores and group meetings. Staff provide support through individual and group counselling sessions. Service users are expected to comply with the structured programme. In pursuance of the goals that service users are seeking to achieve, certain rules and restrictions are in place which limit individual freedom. Service users formally agree to these arrangements prior to admission. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 11:00am on 19th April 2005. It was conducted as part of the normal routine of inspecting twice during a twelve month period. The senior counsellor – Dominic Castle, the service users and staff all assisted the Inspector in the work. Methodology used included a tour of the premises, review of records and discussions with service users and staff. The inspector also reviewed the contact sheet for Weymouth Aftercare Centre held at the Commission for Social Care Inspection office and various documentation submitted by the registered provider in response to requirements made at the last inspection. Not all of the National Minimum Standards were assessed on this visit. Please note where a National Minimum Standard was not assessed the score is shown as x. What the service does well: The home has an excellent comprehensive Statement of Purpose providing the reader with sufficient details to make an informed choice about whether to live at the home. A formal contract of residence ensures security of placement. Care plans at the home primarily focus on the addictive disorder of each service user and personal daily accounts of progress so far are unique to Weymouth Aftercare Centre. Records indicated that service users were involved in the formulation of care plans and reviews and service users spoken with confirmed this. The lifestyle, social interests and activities of service users accommodated at Weymouth Aftercare Centre promote independence and are wide ranging and entirely appropriate. Use is made of the local College with many attending vocational courses. The home has strong and long-standing links with the local community. Service users spoken with stated that they have participated in a wide range of community projects throughout the year. Many were Charitable Events and all benefited the community. Several said they had recently received a “Community Award Certificate” for work in the community. Service users’ personal and healthcare support is comprehensively met at Weymouth Aftercare Centre and there are satisfactory systems in place to protect them from significant harm or abuse. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 6 The home supports service users’ with disabilities particularly well and even though no specialist equipment has been purchased, existing equipment has aided independence for these individuals. The home is clean and bedrooms were personalised to varying degrees. Service users are supported by a sufficient number of counsellors/support workers who are suitably trained and qualified. Staff spoken with impressed as friendly and caring and from speaking with service users, they are well respected. The home promotes good practice in relation to safeguarding the health, safety and welfare of service users. What has improved since the last inspection? What they could do better: In relation to complaints made, the home must be able to evidence that a record is kept at the home and this must be available for inspection. The bathroom on the first floor would benefit from refurbishment. Written evidence suggests that the home’s recruitment policy and procedure is slowly improving with each inspection. However, further work is required in order to fully meet this standard. A new member of staff had recently been recruited and key documentation was found to be missing from his personal file indicating that procedures were not followed by the registered providers on this occasion. Mr. Felgate was unable to evidence that formal staff supervision was regularly taking place for all staff. The registered providers have been particularly slow in their attempts to meet this standard which was first brought to their attention in December 2002. In order to prevent enforcement action being taken, the registered providers must ensure that staff supervision takes place at least 6 times a year. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 7 The registered providers must decide who will be the registered manager of Weymouth Aftercare Centre and ensure that person undertakes NVQ 4 training this year. In addition, the registered providers must ensure that 50 of care staff are trained to NVQ level 2 this year. The home would benefit from a more formal Quality Assurance system to evidence that it regular seeks service users views and the opinions of relatives and other professionals. Five recommendations were made in relation to signing care plan reviews, producing a realistic timetable for completing the building work at the home, fitting privacy screens in bedrooms, ensuring that 6 staff team meetings take place each year and fitting temperature control valves to hot water taps in bathrooms. 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. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. The home has a comprehensive Statement of Purpose/Service Users’ Guide which allows prospective service users to make an informed choice about staying at Weymouth Aftercare Centre. The particular needs, aspirations and restrictions of service users’ are assessed by professional people, discussed with all parties involved and agreed prior to admission to the home. Having received information about the nature of recovery/therapeutic programmes prior to admission, the prospective service user arrives at the home with the knowledge that their needs will be met. A trial period at the home allows the service user to ascertain whether the placement would be right for them. A written costed contract outlines the terms and conditions between the home and the service user. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 10 EVIDENCE: Since the last inspection Mr Felgate has produced an updated Statement of Purpose/Service Users’ Guide which was examined by the inspector on this occasion. It contained relevant information about the home, including the aims, objectives, facilities and services. Prospective service users are normally assessed by a relevant professional prior to admission (e.g. Care Manager from Social Services or Probation Officer). Assessment details were examined on this occasion and are received either by telephone or by a report/letter from the referring agency or from the primary care centre where the service user is living. Any special needs or restrictions are discussed and agreed by all relevant parties, prior to commencement of placement. The homes’ referral form clearly states the outcome of this assessment. Service users spoken with confirmed that they were thoroughly assessed prior to admission to the home. The home only admits those people for whom it can offer an effective service. This is achieved through the assessment process. Service users spoken with confirmed that they were provided with written information about the nature of the recovery/rehabilitation programme prior to admission. Placement agreements are confirmed in writing with the referring agency. Wherever possible prospective service users visit the home to meet other service users, staff and view the accommodation etc. If the service user wishes they can be accompanied by family, friends, Social Worker etc. A trial period is offered if, after discussion, it is felt that Weymouth Aftercare Centre would benefit the prospective service user. A trial period of 2 – 3 weeks is continually assessed by staff and the service user is fully involved. Service users are funded by an external agency and therefore there is a written contract between the home and the placing agency. Since the last inspection Mr. Felgate has produced a more suitable costed contract between the home and the service user. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10. There is a high level of service user participation in formulating care plan needs and goals, however, reviews were not always signed by the service user and key worker. Service users take responsibility for their own progress during the therapeutic programme at Weymouth Aftercare Centre. Opportunity for service users to participate in the day-to-day running of the home is limited due to short nature of the programme. Staff enable service users’ to take responsible risks whilst accommodated at the home. The home places emphasis on respecting service users’ confidentiality. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 12 EVIDENCE: Each service user has a care plan. There is a section for identified needs, goals, and tasks to achieve those goals. The plan reminds the person(s) completing it to take into consideration the religious and cultural needs of the individual. The inspector examined four care plans and found reference to attendance at college, voluntary work and family/social support for that individual. The care plans were signed and dated by the staff member and the service user. The plans evidenced frequent reviews by the service user and staff member although Mr Castle explained that it was not always possible to engage Care Managers in reviewing the plan. However, written summaries are provided by the home on the service user’s departure or at other significant intervals. The care plan review document was considered by the inspector to be a good example of progress and achievement by service users during their treatment programme at Weymouth Aftercare Centre. It also highlighted any new goals and related to the original care plan. Risk assessments form part of the care plan. However, of the four examined on this occasion, two were not signed by the service user or support worker. The home works with service users in a particular way. Service users complete a weekly self assessment document. These assessments are shared with their peers in group discussions. A personal review takes place once a month, this involves the service user completing part of the review, the peer group also review progress and there is feedback from staff. The group may identify an area of concern for a particular individual. This person is then expected to think about the concern and if he feels it would be of benefit to him, requests a “mini – group” where he can discuss the concern thoroughly with his peers and new goals are set. The home has a “goals board” on which goals are written to remind individuals of their own. Consequently, there is a high level of service user participation in the review process. Service users spoken with felt their “own work” and being able to share this with the group was one of the most important aspect of their treatment programme. The principle of self-determination is intrinsic to the recovery programme. Service users retain responsibility for their own progress. Constraints may be in force if the service user is subject to a specific court/parole conditions. The home is currently accommodating several people on such orders and records relating to them were complete. Service users retain responsibility for Social Security benefits; the home does not act as appointee or agent. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 13 There are limitations to which service users can usefully have an input into long-term management decisions given the short-term nature of placements. Monthly household meetings of service users take place to discuss issues relating to the running of the home. The daily group meetings are primarily therapeutic in nature, but may give rise to discussions about the structure of the recovery programme. Service users confirmed that they are able to access the home’s policies and procedures if they request to do so. Risk assessments form part of the care plan. The inspector examined three risk assessments and noted that staff and service users sign the document and that they fully referenced any restrictions imposed by the Court under the Criminal Justice Act. The home has a policy on the issue of confidentiality and access to service users’ personal records. There is also a statement on confidentiality that includes relevant information on the subject and references the Data Protection Act 1998. This statement lists persons who can access service users files for instance, Social Workers, Inspectors from the Commission for Social Care Inspection, Care Managers, Police Officers etc. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17. Service users have opportunities to develop independent living skills. The service users at Weymouth Aftercare Centre are particularly public spirited and many have been rewarded for their efforts. Service users have a varied social life and are involved in many leisure activities during the course of a week. Service users maintain links with their families and friends and are encouraged to seek support and friendship in the wider community. The lifestyle at the home is conducive to independence and freedom of choice. Meals offer choice and variety and special diets are catered for. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 15 EVIDENCE: Service users are encouraged to take responsibility for their own recovery and development. Records evidenced that staff provide the therapeutic input through group or individual 1-1 counselling. More specialist input is also provided, according to assessed need. Service users are referred to relevant agencies on completion of the recovery programme at the home. Outside of the counselling programme there are structured activities designed to enable service users to obtain/re-learn the necessary skills to successfully integrate with the community. Use is made of Weymouth College to assist in the running of relevant courses. Mr Castle stated that a few service users attend Literacy courses. The inspector found reference to service users being involved in education and voluntary work placements in individual plans. The inspector spoke with several service users who stated that they attended college courses in Stone Masonary, Information Technology and Site Managers course. The home has strong and long-standing links with the local community. Service users have immediate access to Narcotics Anonymous and Alcoholic Anonymous meetings which take place in different settings in the town. The home maintains contact with ex service users who remain in the locality and offers a regular weekly aftercare follow-up group meeting. Service users have access to and are encouraged to use the local amenities and public transport. The registered providers purchased a new minibus last November and places visited recently include Lulworth Cove and Portland. Staff are on duty at all times to assist service users, where needed. The inspector was particularly impressed with evidence (a comprehensive file) that service users have participated in a wide range of community projects throughout the year. Many were Charitable Events and all benefited the community. From speaking with service users, several had recently received a “Community Award Certificate” for work in the community and Mr Castle stated that a Police Inspector was formally visiting the home later in the week to say thank you to service users for taking part in a door to door leaflet drop organised by the Police. The emphasis is on service users taking the initiative to develop their own interests and resources. Staff encourage service users to pursue their leisure time constructively; service users’ response to this challenge is an indication of their therapeutic progress. The management has a range of contacts in the community which can assist in this respect, e.g. in the past fishing trips have been arranged for service users with a relevant interest. The home arranges access to sporting and health club facilities. Mr Castle stated that walks around Weymouth Swannery and West Bay, and Ten Pin Bowling have been enjoyed by service users in recent months. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 16 Service users’ contact with family/friends is encouraged and maintained either by phone or by visits. This is achieved through a planned process and varies according to individual circumstances. The home’s communal areas can be used for visits as bedrooms cannot be used for this purpose. The development of intimate personal relationships is not encouraged during service users’ stay at the home as this is considered to be an unhelpful distraction in the therapeutic process, this is stated in the homes Statement of Purpose/Service Users’ Guide. The inspector found reference to maintaining family links and friendships in service users individual plans. The home’s rules and routines are geared towards the achievement of the service users’ goals i.e. sustaining a lifestyle which is free of chemical dependency. This includes the building up of trust amongst peers and developing self-confidence. It also includes carrying out domestic and household tasks. Service users are discouraged from “isolating” themselves by spending prolonged periods in their bedroom. Locks are not fitted to bedroom doors, as would ordinarily be expected in a care home and there is no lockable space in each bedroom. Previous inspections have highlighted the need for the rationale for this to be referenced in the homes’ Statement of Purpose/Service Users’ Guide and this has been achieved since the last inspection. The home takes care to provide a nutritious and varied diet; full account is taken of specific dietary requirements. The menu was examined by the inspector. The menu rota is changed approximately every 3 weeks. Service users are not directly involved in meal planning and preparation, this being the preferred policy of the management. Choice of main meal items is limited but account is taken of individual likes and dislikes. A vegetarian option is always provided when vegetarian service users are resident. Food and meals are supplied at appropriate intervals and in suitable quantities. The inspector viewed the cold lunch available on the day of inspection. It was buffet style, it looked appetising and nothing remained at the end of the meal. Service users spoken with said there are opportunities to discuss the menu content at meetings but that the food at the home was “excellent” and “too much at times”. Hot and cold drinks are freely available throughout the 24 hour period. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21. Personal support is offered in a way that promotes service users’ privacy, dignity and independence. Policies and procedures relating to the health care needs of service users promote good practice and ensure physical and emotional needs are met. Medication held at the home is well managed to ensure that service users medication needs are met and they are protected through the policies, procedures and practices of the home. The home has an appropriate illness and death policy and procedure which respects service users’ wishes. EVIDENCE: The service users are able-bodied and are not in need of “hands-on” personal care. Support and guidance is provided by staff in accordance with therapeutic principles. The inspector perceived the general atmosphere and social environment to be an inclusive one; throughout the day service users were treated as responsible adults. All staff are readily accessible to respond to requests for assistance from service users. A key-worker system does not operate as this is not considered to be a helpful arrangement by the management. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 18 All service users are registered with one local GP surgery where the doctors have a specific interest in the relevant client group. In view of the short-term nature of placements such an arrangement is acceptable. The home ensures that service users have access to all relevant healthcare facilities, including specialist outpatients’ appointments and visits to dentists. Service users are accompanied to appointments where necessary. The home’s accident book was examined on this occasion and found to be satisfactorily maintained. The inspector examined the homes’ medication storage and recording. Medication is kept in a small room off the kitchen and keys are kept nearby in private staff quarters which can be accessed by all staff administering medication. The home is currently retaining medication for 5 service users and records pertaining to these individuals were well recorded. Other records examined included medicines received and disposed of. They were sufficiently detailed and adequately maintained. The home obtains the Pharmacist’s stamp to agree what medication was returned to them for disposal. Four staff are attending a course on Medicines Administration. The home’s policy and procedure relating to medication is satisfactory. In view of the relative youth of the service users at the home, death of a service user is an unlikely event. However, the home has a policy and procedure for staff to follow in the event of a death occurring at Weymouth Aftercare Centre. The admission documentation takes into account the service user’s religious beliefs. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The home has a clear and effective complaints procedure, however, a full account of a recent investigation conducted by Social Services should have been available for inspection so that service users know that their views have been listened to and acted on. Written policies are in place at the home to safeguard service users against abuse, neglect and self harm. EVIDENCE: The inspector examined the homes’ complaints log, although the record was checked and signed by Mr Felgate every 3 months, there was no reference to a complaint that was investigated by Social Services in November last year. Mr Castle was not able to say why Mr Felgate had not written this up. The home’s complaint procedure had been updated to include the recommendation to keep a verbal complaint record sheet, which was made as a result of the recent complaint investigation. Mr Castle stated that if service users have any concerns they are voiced in the community group meetings and staff act appropriately. With the spirit of “openness” which prevails in the home and the informality in the relationships between staff and service users this is not an environment in which abuse is likely to prosper. Mr. Felgate has produced an Adult Protection policy and procedure. A Whistle Blowing policy and a policy on handling aggression is in place at the home and staff have had in – house training from Mr. Felgate on the issue of restraint. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30. Service users live in a comfortable, homely way at Weymouth Aftercare Centre. The property would be enhanced if the registered provider arranged for the building work to be completed on the ground floor extension. Bedrooms at the home suit the service users but with a large number of shared rooms screens should be provided to ensure a degree of privacy. Furniture and fittings in bedrooms promote independence. Bathrooms at the home are not of a particularly high standard and although this does not pose a risk to service users, improved décor would be more pleasant for anyone accommodated at the home. Communal space at the home provides comfortable areas in which to relax in addition to services users’ own bedrooms. The home offers much support to enable service users with disabilities to be independent. The home offers a clean and safe environment in which to live. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 21 EVIDENCE: The home is located within walking distance of Weymouth town centre where there are a range of amenities and facilities. The property has a pleasant garden and casual sitting area (partially enclosed) to the rear of the building. A ground floor rear extension has been in the early stages of construction for several years. Last year Mr Felgate informed the inspector that he made the decision to continue with the original plan of a single storey extension to provide an extended office, a quiet room, and an extended dinning room to offer a larger communal space with access to the garden area. As a result, a recommendation was made for the registered provider to produce a realistic timetable for completing the building work at the home. Mr Felgate failed to produce this so the recommendation is therefore repeated for the third time. The home benefits from a planned programme of re-decoration, renewals and repairs and maintenance records were available for inspection. There are a number of shared bedrooms. The registered providers’ view is that such an arrangement accords with the home’s philosophy and aims and objectives. In accordance with a recommendation first made in 2002, shared bedrooms are currently being fitted with suitable screening to ensure a degree of privacy for the occupants. Service users spoken with stated that did not mind sharing rooms and that they knew they would be sharing a room before admission to the home. The home’s statement of purpose states the number and size of bedrooms at the home. Service users’ bedrooms were personalised to varying degrees. The registered providers’ attempts at upgrading Weymouth Aftercare Centre over the past year are commendable. Each bedroom now has had new bedding and curtains, one bedroom has new furniture and three bedrooms have been redecorated. One bedroom has new carpet and the second floor bathroom has new flooring. The lounge and dining room have been decorated and the hallway is currently in the process of being decorated. All bedrooms had radiators which have been fitted with thermostatic control valves to allow the occupant to control the temperature in the room. Each bedroom now has at least 2 double sockets. As windows in rooms on the first and second floors are not fitted with restrictors, a risk assessment is completed to ensure the safety of the occupant(s) and others. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 22 The home has 5 toilets and 2 bathrooms. The facilities were found to be clean but the first floor bathroom would benefit from refurbishment as it was looking shabby. The number of toilets, baths/showers, wash hand basins and en suite facilities at the home are included in the statement of purpose/service users’ guide in accordance with a requirement made as a result of the last inspection. There are a total of three communal rooms, including a dining room where there is a computer for service users, a library area which is designated as the smoking area and a lounge. One room can be set aside for service users to receive visitors in private, although it is not specifically for this purpose. Two of the rooms are suitable for group meetings. There is a payphone in the hallway for general use. The office telephone is used for private calls to such people as Social Workers and Probation Officers. The home is currently accommodating service users with disabilities. The inspector spoke with them and received very positive comments about the efforts of staff to fully include them in all aspects of day to day living at the home. One described his delight at being able to manage his “personal work” by using the computer at the home. Service users spoken with said it was not necessary for the home to have special environmental adaptations or equipment for them to be accommodated at Weymouth Aftercare Centre. The home was found to be clean. The service users clean their bedrooms and most communal areas, under the overall supervision of the staff. There are no laundry facilities on the premises. Information on laundry arrangements should feature in the home’s statement of purpose. Service users confirmed that they are provided with money to do their personal laundry in a nearby laundrette, whilst bed linen is cleaned via an external laundry service. This arrangement is in accordance with the home’s philosophy of assisting the recovery process and encouraging service users to make use of community resources. The home has a comprehensive infection control policy/procedure which describes in general terms appropriate preventative and reactive measures. In view of the medical history of some service users, the home adopts precautionary infection control measures as part of the daily routine and all staff have undergone in – house training. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36. Staff have clearly defined job descriptions to ensure that they have an understanding of their own role and responsibilities. The home has a well-qualified stable staff team to ensure that an effective, detailed therapeutic programme is delivered to service users, meeting their individual and collective needs. Only limited progress has been made in addressing the home’s recruitment policy and procedure potentially leaving service users at risk. There is no clear or consistent supervision system at the home to support staff and ensure that service users receive consistency of care. EVIDENCE: Staff spoken with demonstrated that they had a clear understanding of their role and of the aims of the home. During the inspection process the inspector noted suitable therapeutic relationships between staff and service users and there was a good level of empathy and understanding of issues relating to substance abuse. All job descriptions examined were appropriate. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 24 Staff have relevant experience and those involved in counselling either have a qualification or are working towards achieving this. Staff have other qualifications relating to health and safety and to running a care home. One member of staff has NVQ 2 qualification and is working towards NVQ 3. Mr Castle stated that a further member of staff has almost completed NVQ 2 and one other is likely to commence NVQ level 2 training in September 2005. Mr Castle said that staff keep abreast of changes in the counselling field by periodic training and updating information through professional organisations. The registered provider is reminded of the need for 50 of care staff to be trained at NVQ Level 2 by 2005. In addition to the registered providers (who work part time hours) the home has a senior counsellor, 2 counsellors, 2 support workers one of whom assists with cooking when the main cook is away. The staff group are effective with the majority having been in post for several years. A weekly record of staffing arrangements is maintained. Staffing arrangements are made according to the assessed needs of the service users and dependency levels are calculated in accordance with Department of Health guidance. Records indicate that staff meet on a daily basis and that some months a full staff meeting took place on the last Thursday of the month. The registered provider is reminded that staff meetings must take place at least 6 times a year and that these meetings are recorded and actioned. Written evidence suggests that the home’s recruitment policy and procedure is slowly improved with each inspection. The registered providers must have a robust recruitment procedure to include volunteers. The procedure for future staff (and volunteers) should involve a written application form, formal interview, two written references and a satisfactory check from the criminal record bureau. Each member of staff must have in their personal file, a recent photograph and documentary evidence of their qualifications. They should also have a formal contract stating the terms and conditions of their employment and be given a copy of the homes’ disciplinary and grievance procedures and the General Social Care Council code of practice. At the last inspection, Mr Felgate acknowledged that further work was required in order to fully meet this standard. During this inspection the inspector examined the personal file of a newly appointed staff member. There was evidence of a job description and some personal details were available for inspection. However, there was no contract of employment and no application form. As on the last occasion, new contracts and terms and conditions of employment are still to be introduced. The inspector advised that a minimum of 3 months probationary period and at least 5 days training (pro-rata) be added. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 25 As the majority of staff members have been in post for several years, their application form and record of references may not have been retained. The registered provider is reminded that records should be retained in full during the period of employment and that it is not acceptable to not retain these records. Disclosures via the Criminal Records Bureau exist on all staff members. Staff spoken with confirmed that they were given copies of the General Social Care Council code of practice which relates to standards of conduct in the caring profession. All staff are expected to adhere to these standards. Given the short-term nature of service user placements at the home it would not be appropriate to involve them formally in the staff recruitment procedure. Mr. Felgate in conjunction with Weymouth College Assessment Team has conducted a training needs analysis for the team. Staff have personal training files that were very well maintained with certificates in place. As on the last occasion, the home was unable to evidence that regular formal staff supervision was taking place for all staff. Supervision records exist but sessions are not consistent and records not particularly informative. Mr Felgate has been particularly slow in his attempts to meet this standard which was first brought to his attention in December 2002. He stated that until now supervision has been with external counsellors to assist staff with their professional practice and development. The registered providers have been paying for this facility. The registered providers are advised to retain this record of supervision in staff files. In order to prevent enforcement action being taken, the registered providers must ensure that staff supervision takes place at least 6 times a year and that all staff receive a supervision session within the time scale specified in this report. A record must be maintained and the supervisee must be given a copy. The sessions should address the individual’s training needs and personal development plan. The registered providers should refer to the National Minimum Standards – Care Homes for Adults, for guidance. Staff annual appraisals were not asked for on this occasion. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40,41,42,43. The home does not benefit from having a registered manager to ensure that the home is run effectively and in the best interests of the service users. Only limited progress has been made in implementing a formal quality assurance system at the home which gives the impression that service users views are not sought or perceived as important. A spirit of openness exists within the home with service users able to access policies and procedures that safeguard their rights and best interests. Appropriate Health and Safety measures are in place to promote and protect service users, including their welfare. There is a development plan to ensure the effectiveness, financial viability and accountability of the home which indicates how improvement was going to be resourced and managed. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 27 EVIDENCE: The registered providers, Mr and Mrs Felgate, have several years experience of managing a care home. Neither has obtained NVQ level 4 in management and care but the inspector was informed that Mrs Felgate and the senior counsellor Mr Castle will commence NVQ 4 training in July 2005. In addition to a counselling qualification, Mr Felgate has a certificate in education. The registered providers must nominate one of the partners or Mr Castle to be the registered manager of the home. The last two inspections have highlighted the need for the home to have a quality assurance system. At the last inspection Mr Felgate evidenced that he had started to address this matter with the issuing of a feedback form to service users once a month. However, they have not been used regularly and neither has a similar form specifically designed for others e.g. Relatives and Care Managers etc. The findings on this occasion were similar to previous findings. The registered providers must introduce a formalised system to monitor quality assurance at the home within the time scale specified in this report. Failure to do so may result in enforcement action being taken. The inspector spoke with four service users. They made positive comments about the care, facilities and services at Weymouth After Care Centre and stated that the treatment on offer at the home was “excellent” and that staff were very caring and knowledgable. The process of monitoring, reviewing and amending all policies, procedures, codes of practice and records in a formalised way to include signature and date is ongoing at the home. Staff and service users have access to this documentation. Service users are able to access their records at any time and are fully aware of what is written in their file. Individual records are secure in the office. Measures and systems are in place to cover most aspects of health and safety, including the regular servicing of most of the installations and equipment and staff training. The home’s electrical and gas certificates were valid but there was no evidence that a portable appliance test had been conducted for smaller items. A current certificate should be forwarded to the Commission for Social Care Inspection office as soon as it has been located. The inspector examined fire records and found them to be satisfactory. There have been no reportable accidents, injuries, illness or communicable disease or the death of a service user at Weymouth After Care since the last inspection. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 28 Water temperatures at the home are now being recorded in accordance with a recommendation first made in 2003. The record evidenced a temperature of around 43 degrees Celsius at the hot water outlets. The registered provider should give consideration to fitting regulator valves to hot water taps when refurbishing the first floor bathroom. “Caution Hot Water” stickers have been fixed near wash hand basins. At the last inspection, the registered provider reported that records of all business transactions were held and that an accountant conducted an annual audit of the accounts. Mr Felgate held business meetings with senior staff in August and September 2004. The inspector received copies of the minutes one referred to repairs, refurbishment and renewals and the other was a business planning meeting to meet a requirement that was first made in December 2002. Suitable insurance and public liability arrangements are in place and were seen on this occasion. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 4 3 Standard No 11 12 13 14 15 16 17 3 3 4 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 1 3 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Weymouth Aftercare Centre Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 2 x 1 3 3 2 3 D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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 22 Regulation 17(2) Schedule 4.11 Requirement The registered providers must keep a record of all complaints made by service users about the operation of the care home and the action taken by the registered provider in respect of any such complaint. Bathrooms at the home must be of sound construction and kept in a good state of repair. The homes recruitment policy and procedure must be in line with National Minimum Standards and adhered to when recruiting new members of staff.Original date for compliance was 31/03/04 The registered person must ensure that persons working at the care home have regular supervision meetings at least six times a year.Original date for compliance was 31/03/04 The registered providers must implement the homes’ quality assurance system. (Use of surveys). The outcome from all surveys should indicate success in achieving the homes aims and objectives and inform future planning.Original date for Timescale for action 31/08/05 2. 3. 27 34 23(2)(b) 19 31/08/05 31/08/05 4. 36 18(2) 31/08/05 5. 39 24 31/08/05 Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 31 compliance was 30/08/04 6. 32 19(5)(b) The registered providers must ensure that 50 care staff have NVQ level 2 qualification this year. The registered providers must appoint a manager for the home. 31/12/05 7. 37 8 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard 6 24 25 33 42 Good Practice Recommendations It is recommended that care plan reviews are signed by the service user and support worker. It is recommended that the registered providers produce a realistic timetable for completing the building work at the home. It is recommended that the programme to provide screening to safeguard privacy in shared bedrooms is completed. It is recommended that staff meetings ( a minimum of 6 per year) be recorded and actioned. It is recommended that the home fits temperature control valves to hot water taps in bathrooms. Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Weymouth Aftercare Centre D55 S26891 Weymouth Aftercare Centre V220435 190405 Stage 4.doc Version 1.30 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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