CARE HOME ADULTS 18-65
Weymouth Aftercare Centre Carlton House 9 Carlton Road North Weymouth Dorset DT4 7PX Lead Inspector
Sally Wernick Unannounced Inspection 3 November 2005 09:30
rd DS0000026891.V283003.R01.S.doc Version 5.1 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 DS0000026891.V283003.R01.S.doc Version 5.1 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. DS0000026891.V283003.R01.S.doc Version 5.1 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 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) Mr Trevor George Felgate Mrs Joy Marie Felgate Care Home 15 Category(ies) of Past or present alcohol dependence (15), Past or registration, with number present drug dependence (15) of places DS0000026891.V283003.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th April 2005 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. DS0000026891.V283003.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 9.30 am on 3 November 2005. It was conducted as part of the normal routine of inspecting twice during a twelve month period. Senior staff and service users 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 documentation submitted during the course of the 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:
Carlton House is a welcoming, comfortable house with good accommodation, an array of reading material and confident, committed staff. Service users at the home described their treatment in very positive terms and enjoy very good links with their local college and community. Care plans contain some detailed information and service users are involved in their formulation and review. There is a clear complaints form and service users are confident that any concerns will be dealt with quickly and appropriately. A spirit of openness exists at Carlton House and service users stated that they are treated individually and with respect and dignity. Lifestyle, social interests and activities of service users encourage independence, are wide-ranging and entirely appropriate. They contribute towards the goal of achieving a healthy lifestyle and promote confidence and self-esteem. Staff are qualified in the treatment of addictions and have a good skill mix. Regular training is provided and some staff are affiliated to relevant professional bodies. Staff spoken to were very committed to the work undertaken at Carlton House and this was reflected in the very positive comments received by service users and in the good relationships between residents and staff. DS0000026891.V283003.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. DS0000026891.V283003.R01.S.doc Version 5.1 Page 7 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 DS0000026891.V283003.R01.S.doc Version 5.1 Page 8 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 the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000026891.V283003.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6&9 There is a good level of service user participation in discussing and formulating care plan needs and goals. These are not always recorded fully in care plans. There is no clear timetable for developing care plans. Risk assessments contain insufficient information and do not detail action needed to minimise risk of harm. Risk management strategies are not recorded in individual plans EVIDENCE: Three-service user files were case tracked during the course of the inspection two contained a care plan only one of which was signed by a key worker. The care plan included identified treatment needs, goals and action required to achieve those goals, spiritual and health needs as well contact with family and friends. In addition a focus assessment was in place, which asks service users to identify their aspirations and expectations of treatment following their arrival at Carlton House. Service users to chart their recovery and to identify any obstacles to treatment also complete weekly event sheets. DS0000026891.V283003.R01.S.doc Version 5.1 Page 10 Service users spoken to thought that their needs had been well assessed and that the small staff team were aware of their treatment goals. The absence of a key-worker system means that information is shared within morning staff meetings and a daily log is kept. There is no clear timetable for care plans however, which meant that after six weeks one resident was still without a formal plan. Weymouth Aftercare has an individual approach to treatment in that service users weekly self-assessment documents are shared with their peers in, group discussions. Similarly monthly progress reviews include both staff and peers and each service user is required to identify a new weekly “goal” which is written on a “goals board”. There is a high level of service user participation in all aspects of treatment the emphasis is on self-determination and retaining responsibility for individual progress. Risk assessments were in place for each resident however, information was limited and it was unclear what aspect of risk the assessment was referring to. Plans did not detail what action needed to be taken to minimize risk of harm either to self or others and where one service user had relapsed and left the home this was not recorded. DS0000026891.V283003.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12 & 14 Service users are able to take part in many local activities and this is actively facilitated by the staff at Carlton House. EVIDENCE: Carlton House has very good links with the local community and service users are very involved both in voluntary work and in attendance at the local college. In addition there is a mini-bus, which is used to take all residents out weekly to local places of interest. One member of staff recently arranged a treasure hunt, which was a great success. Examples of voluntary work which current service users are involved in include: charity work with Oxfam, assistance at the local rugby club, Help the Aged, Save The Children practical help at charity car boot sales as well as helping at a fun day at a local school. Residents play football, golf and Rugby and there is a good balance between therapeutic input and learning the necessary skills which will enable service users to integrate fully within the local community. The emphasis at Carlton House is on service users taking the initiative to develop their own interests and resources. Staff, encourage service users to pursue their leisure time constructively and their response to this challenge is
DS0000026891.V283003.R01.S.doc Version 5.1 Page 12 an indication of their therapeutic progress. The owners do have a range of contacts in the local community, which has assisted in the above. The home arranges access, to sporting and health club facilities all of which contributes towards the goal of sustaining a healthy lifestyle. DS0000026891.V283003.R01.S.doc Version 5.1 Page 13 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 the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000026891.V283003.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 22 The home has a clear and effective complaints procedure, which is properly maintained. EVIDENCE: The inspector examined the homes complaints log. A requirement of the last inspection was that the home maintains there current system to ensure recording is up to date. This is now in place. All service users spoken to were aware of the procedure and confirmed that they received a copy during the induction process. There have been no complaints during this inspection period. Service users and staff confirmed that if there are any concerns they are voiced in the community group meetings and staff act appropriately. A spirit of openness prevails within the home and the informality in the relationships between staff and service users suggests this is not an environment in which abuse is likely to prosper. DS0000026891.V283003.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24, 25 & 27 Service users at Weymouth Aftercare live in a warm, comfortable, homely environment. The property would be enhanced if the registered provider arranged for the building work to be completed on the ground floor extension. Bedrooms are comfortable with adequate screening suiting the needs and lifestyles of service user’s. Bathrooms at the home are clean and generally well maintained. EVIDENCE: Carlton House is an attractive well-maintained property with spacious rooms, comfortable furnishings and an array of reading material. It is clean, and welcoming and there is an attractive outdoor area. It is close to local amenities, the beach and Weymouth town centre and the style and ambience of Carlton House reflects the lifestyle needs of service users as well as the homes purpose. A ground floor rear extension has been in the early stages of construction for a number of years. In 2004 the decision was made to continue with the original plan of a single storey extension to provide an extended office, a quiet room, and an extended dining room to offer a larger communal space with access to
DS0000026891.V283003.R01.S.doc Version 5.1 Page 16 the garden area. As a result a recommendation was received for the registered provider to produce a realistic timetable for completing the building work at the home. This has now been received and there is a provisional start date of March 06. In line with the treatment philosophy at Carlton House there are a number of shared bedrooms. Service users spoken to stated they were more than happy with the arrangement and were aware of this prior to admission. All shared rooms are however, fitted with suitable screening to ensure a degree of privacy. This is in accordance with a recommendation made at the last inspection. There are no en-suite facilities at Carlton House. Bathrooms and toilets however, were clean, well maintained and allowed for privacy. In line with a requirement made at the last inspection there has been a programme of repair and redecoration, which was evident. However, there were no soap dispensers in upstairs bathrooms, which means that standards of hygiene could be compromised. Staff at the house agreed to install these immediately and this will be followed up at the next inspection. DS0000026891.V283003.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 36 Service users are supported by competent and qualified staff with a range of skills and experience. A stable staff team delivers an effective therapeutic programme, which meets the individual and collective needs of service users. Regular staff meetings are held but contain limited information. Some progress has been made in improving the home’s recruitment policies and procedures. Staff at Carlton House do receive some support and supervision. Some appraisals are in place however, the home has been slow in producing these for all staff on a regular basis. EVIDENCE: Staff at Carlton house have a range of relevant experience and a good skill mix. Both the registered providers are qualified in NVQ 4 and the project coordinator is hoping his qualification will be completed in the early part of next year. Three of the four counselling staff is working towards completing NVQ 2 and there is a strong commitment from staff and management towards training. Some staff, are allied to professional organisations in the field of addictions and service users spoken felt that staff were skilled in the
DS0000026891.V283003.R01.S.doc Version 5.1 Page 18 management of addiction. Communication between staff and service users was particularly good and was commented on by all service users spoken to. Residents felt that there was a good balance between meeting the particular and fluctuating needs of individuals whilst maintaining good standards of care for all. Staffing arrangements at Carlton house are made according to the assessed needs of the service users and dependency levels are calculated in accordance with Department of Health guidance. Service users stated that there, was always members of staff to talk to and that this extended to the middle of the night if necessary. The staff team are stable and reflect the gender composition of those living at the home. Records indicate that staff meet on a daily basis and that weekly staff meetings are also held. However, there was no clear, formal agenda nor points which needed to be actioned. Notes were scant and referred only briefly to some residents. A requirement at the last inspection stated that the home must adhere to recruitment procedures as laid down in National Minimum Standards. As there have been no new appointments since the last inspection this requirement is not relevant on this occasion. The home must however, follow proper procedures for recruitment in the future if they are to fully safeguard and protect those in their care. For those staff appointed just prior to the last inspection contracts of employment and terms and conditions are now in place. Staff files demonstrated that criminal Records bureau disclosures exist on all staff. However, disclosure information should not be retained beyond a maximum of six months or until seen by an Inspector from the Commission for Social Care. In the case of a dispute, disclosure information may need to be retained for a longer period, but this should be for no longer than 6 months after resolution of the dispute. Three staff files were examined during the course of the inspection only two of which contained an appraisal. Records of supervision had been maintained but did not meet the minimum standard of 6 sessions within a 12 month period. In order for service users to benefit from well supported and supervised staff professional guidance and support must be given within a formal setting. Training and developmental needs should be identified and care must be taken that the homes philosophy is translated into work with service users. Similarly the annual appraisal must be completed for all staff. Performance must be reviewed against job descriptions and it would be beneficial for staff if career development plans were charted more fully. DS0000026891.V283003.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 43 Only limited progress has been made in implementing a formal quality assurance system at the home. Whilst the person responsible for the day to day running of the home remains unregistered service users do not benefit from competent and accountable management. EVIDENCE: The last three inspections have highlighted the need for the home to have an improved Quality Assurance System. The last inspection evidenced the registered provider has taken steps to address this matter with the issuing of a feedback form to service users once a month. However, they have not been used regularly neither has a similar form designed to obtain the views of families and other stakeholders. There is no formalised system for collating information nor for feeding back results to service users. The quality Assurance system should be more comprehensive and be able to demonstrate that service users views underpin all self-monitoring, review and development by the home.
DS0000026891.V283003.R01.S.doc Version 5.1 Page 20 Service users spoken to felt that their views were listened to and acted on and through a variety of forums they were able to express their opinions. Staff were described as “caring” “supportive” and “knowledgeable” and a spirit of openness exists. Good relationships were observed between staff and service users and where personal or practical issues needed to be addressed this occurred either in an individual or group work forum. However, the registered providers must introduce a formalised system to monitor quality assurance at the home, the system should be comprehensive and target all areas of the treatment programme. No application has yet been made for a registered manager. This requirement must be met by the previous timescale of 31/12/05. DS0000026891.V283003.R01.S.doc Version 5.1 Page 21 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 2 X 1 X X 2 x DS0000026891.V283003.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 Care plans should be completed within a specific, reasonable time-frame and should be signed by both service users and staff. Risk assessments must identify specific risks and detail what action needs to be taken to minimise harm. The registered person must ensure that persons working at the care home continue to receive supervision and appraisals are competed yearly charting professional development needs. The registered providers must ensure that 50 of care staff has NVQ level 2 qualification by the extended date of 2006. The registered providers must appoint a manager for the home within previously agreed timescales 31/12/05 The quality assurance system in place must be improved to reflect views of service users and stakeholders. It must be comprehensive and state how the home is meeting its aims and objectives. Timescale for action 01/02/06 1. YA6 15 2. YA9 13 01/02/06 3. YA36 18 01/02/06 4. YA32 19 01/02/06 5. YA37 8 01/02/06 6. YA39 24 01/02/06 DS0000026891.V283003.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000026891.V283003.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Poole Office 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
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