Inspection on 07/01/10 for Withnell House, Inward House Projects

This inspection was carried out on 7th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Withnell House, Inward House... 01/06/10

Withnell House, Inward House... 01/03/10

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Hamer Cottage

Turning Point (Hoole Road)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Withnell House, Inward House Projects Bury Lane Withnell Chorley Lancs PR6 8BH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Plant     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Withnell House, Inward House Projects Bury Lane Withnell Chorley Lancs PR6 8BH . Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Inward House Projects Name of registered manager (if applicable) Miss Jayne Naylor Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D, Past or present alcohol dependence - Code A. The maximum number of service users who can be accommodated is 29. Date of last inspection Brief description of the care home Withnell House is a care home offering rehabilitation for adults with a history of drug and/or alcohol dependency. The service provides 24 hour staff support and accommodation for up to 29 people. The home is situated in a rural area approximately eight miles from both Preston and Chorley. The home has a mix of single and shared bedrooms, with some having en suite facilities. The building has Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 29 29 Brief description of the care home separate accommodation areas for male and female service users. Withnell House is able to accommodate service users with a physical disability, having wheelchair access, a lift and specific shower and toilet facilities. The length of the programme varies according to the needs of the individual service user, but will normally be between six and nine months. A three month programme may also be offered if this is appropriate to the needs of the service user. The programme is designed to allow service users the time to reflect on how to overcome their addiction or dependency, and take responsibility for decisions. The service user is central to their own recovery. The programme is provided through a series of group and one to one sessions. Inward House Projects, the provider organisation also offers an aftercare programme. Details of the fees can be obtained by contacting the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for people who use the service and involved gathering information about Withnell House from a wide range of sources over a period of time. The inspection was unannounced and was carried out over two days. At the time of the inspection visits there were 15 service users staying at the home. All of the key national minimum standards, plus the standards relating to the personal development of service users and staff supervision, were assessed. Time was spent talking to service users, staff and the manager of the home. A staff meeting and a staff handover discussion were observed and with the agreement of service users, the inspector was able to sit in on part of a group work session. Records were viewed and a tour of the building took place. Care Quality Commission surveys were received from 6 service users and 6 members of staff and information from these is included within this report. Care Homes for Adults (18-65 years) Page 6 of 36 The Annual Quality Assurance Assessment completed by the manager of the home, also provided some useful information. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 8 of 36 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with information about Withnell House and assessments are carried out prior to admission. This helps to ensure that all parties are satisfied that needs can be met before any decision is made. Evidence: A comprehensive assessment process is in place. Inward House Projects has an admissions coordinator, based in Lancaster who oversees the process and conducts assessments. One of the Team Leaders at Withnell House, who is a mental health nurse, conducts assessments if the individual concerned has mental health issues and also conducts assessments if the admissions coordinator is busy or absent from work. There are three stages of assessment. Firstly there is a referral tool, gathering basic information from the referrer. Then a more detailed triage assessment tool is sent to the referrer to complete with the prospective service user and then the assessment takes place with the service user. This can be carried out at Withnell House, at Inward House Projects headquarters in Lancaster, at the place of detox or at the individuals location which may be in prison. Service users come from all over the country and Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: sometimes assessments have to be conducted over the phone. Wherever possible the individual is invited to visit Withnell House prior to admission, to find out about the rehabilitation programme and to meet other service users. One such visit was taking place on the first day of this inspection. An information pack is provided to all prospective service users. Following the assessment the individual is written to confirming if a place is to be offered. Copies of these letters were viewed on files. Records were also seen of any pre admission contact with the service user and the referrer. A group discussion took place with eight service users who all confirmed the assessment process as described above. One person had had a telephone assessment. Service users confirmed that they were made aware of the rules and restrictions prior to admission, but at that stage feel they may not have been in a position to absorb all of this information fully. Following admission there is a structured induction process which includes the individual being assigned a peer mentor who will help the person to settle in and go through the house rules and routines. All those spoken to said that this works well. Inward House Projects are aiming to encourage more women to enter rehabilitation, as this group are often resistant to seeking help due to child care commitments or fear of their children being taken away. The admissions coordinator sends literature to prisons and the organisation is currently looking at other ways to reach women and provide information about the service. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place and are regularly reviewed, allowing for changing needs to be identified and met. Decision making is limited by the agreed restrictions of the treatment programme. Risks are identified and action is taken to minimise harm. Evidence: The records for three service users were viewed. Each person has a written care plan which is regularly reviewed. The dates for reviews are prearranged and listed at the front of each file. Reviews take place after one month and then every three months, with a final client closure and aftercare summary meeting held at discharge. Care plans address a range of needs such as mental health issues, maintaining family contact and sleep problems, as well as needs relating to engaging with the treatment programme. Initial care plans all include the need to register with a GP. All the care plans and reviews seen were signed by the service user. Each service user has a nominated key worker who has one to one meetings with the Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: service user and is responsible for reviewing the care plan. Funders are kept informed of progress and receive copies of care plan reviews. The review documentation seen was very detailed and gave a good overview of the individuals progress within the treatment programme. Key workers also complete assessment sheets, which focus on different aspects of the treatment programme, such as relationships with peers and engagement with treatment. For some service users these are completed on a weekly basis. Individuals have to adhere to group decisions and the set routines of the programme, with individual decision making being given more focus toward the end of the programme as they prepare for discharge. Records show that service users sign documents agreeing to various rules and restrictions and that they understand the potential consequences, such as extra work duties if rules are breached. Following admission the service user goes through a period of induction, with specific group work to address initial needs. The length of the induction period can vary according to the individual. During this time the focus is on the rules and routines of the house. The treatment programme is extremely structured and there are clear expectations regarding engaging with the programme, attending group and individual sessions and adhering to house rules and routines. The timetable for each day is displayed on the noticeboard. There are periods of free time in the evening and at weekends, when service users decide how this leisure time is spent. This may be decided as a group or by nominated service users, with staff then approving these decisions. One service user spoken to explained that he had visited three rehabilitation services before deciding to come to Withnell House as it had a structured programme, which he felt he needed. During discussion with a group of service users, some individuals raised a query regarding visits from family members, saying that they used to be able to meet relatives in the nearby town but that this had been changed recently and now relatives had to first come to Withnell House and that due to time and transport issues this was causing problems for all parties. When discussed with the manager it was explained that this was risk assessed on an individual basis and that when an individual had been at the home for some time, this rule was relaxed. The manager is advised to clarify this with service users, who are under the impression that this is a blanket ruling which applies to all. Initial screening for potential risks takes place during the assessment process. Risk assessments and risk minimisation plans are in place and address areas such as; self Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: harm and neglect. A specific risk assessment tool is used and risk assessments are regularly reviewed, sometimes on a weekly basis. Withnell House is able to accommodate children overnight, to support service users to maintain family contact. The manager explained that this has only taken place on two occasions, that it is closely monitored and that the parent retains full responsibility for the child. The service user has to produce a written plan of how this time will be spent and this is approved by staff. Certain risks are addressed, such as the need to have the front door locked if a child is staying overnight and service users with convictions for offences such as arson and sex offences are not admitted to the home. Although children rarely stay at the home, it is recommended that more robust risk management plans are put in place and that each stay is risk assessed on an individual basis. Advice regarding the recruitment of staff has also been made in the section of this report relating to staffing. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal development of each service user is at the core of the treatment programme and results in positive outcomes for individuals. Service users are encouraged to take responsibility for their actions, positive relationships are promoted and the arrangements for meals and household tasks are seen as appropriate and fair. Evidence: The personal development of the individual underpins all of the work carried out at Withnell House and is at the core of the treatment programme. Some group sessions are facilitated by Withnell House staff and some by external tutors. A tutor from Lancashire College facilitates anger management group sessions, as seen during this inspection. A parenting group is held. Some groups are run separately for males and females and others are mixed groups. Key workers provide one to one sessions with service users and individuals are also able to have sessions with an external counsellor if they wish. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: From discussions with service users it is clear that individuals are able to achieve positive outcomes and make appropriate lifestyle changes. On a CQC survey, when asked what the home does well, one service user wrote Gets us off drugs, changes our behaviours, makes it better, stops the damage we have caused. During the inspection a group session was observed, where a service user was asked to account for and address negative behaviours which had been flagged up by other service users. Staff facilitated this session in a thoughtful and controlled manner, allowing the individual time to reflect on his actions, consider the consequences for his peers and look at ways of changing his future responses. The session was clearly emotional for the individual concerned and was handled sensitively by the two members of staff present. A member of staff explained that at the end of the treatment programme service users are able to have a graduation ceremony. A buffet is provided and relatives can attend to celebrate the personal achievements of the individual concerned. Service users can opt out of this if they wish. The member of staff explained that these events are extremely uplifting and are a chance to reflect on the positive changes and progress made by the service user. Education and employment are given a stronger focus as each person progresses through the treatment programme, with the initial focus being on the here and now and plans for discharge being discussed later. A preparation for work course is a compulsory part of the programme. This is facilitated by external trainers and looks at areas such as completing application forms and attending interviews. The trainers are also able to help individuals to get work placements. At present one service user is involved in voluntary work at a boys club. Staff also provide advice regarding benefits, housing and employment, as appropriate to the individual. The programme provides periods of leisure time in the evenings and at weekends. Each evening two nominated service users arrange that evenings activity, such as a quiz or a snooker competition. Some activities are treatment related, such as a service user taking about and answering questions about their life. External activities mainly take place at the weekend, with Inward House Projects providing a set amount of money for these activities. Service users are able to propose an activity, which then has to be approved by staff. Recent activities include walking, trips to the Lake District and ten pin bowling. Withnell House has two mini buses, which can be used for trips out. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: Twice a year there is a residential trip to the Lake District. Service users generally stay at Withnell House for six to nine months and are therefor able to take part in this trip at some point of their stay. The trip is for five days and includes two half day periods of voluntary work for the National Trust carrying out whatever work needs undertaking at the time, such as laying paths or clearing undergrowth. Individuals receive a volunteering award from the National Trust for the work that they do. The rest of the week is spent on other activities such as walking. A member of staff and a service user talked about how enjoyable these trips are and the positive benefits of having a period of time in a different environment. The rules of the programme state that service users will be advised against forming sexual/exclusive relationships with other service users. It is also made clear that service users are not permitted any contact, including telephone, letters or visits, with any person who uses substances unless they have successfully completed a rehabilitation programme or have been substance free for two years. This includes family members. Service users are also not permitted contact with anyone involved in the criminal justice system. Service users sign in agreement to these rules and understand the purpose of such restrictions. Written information is provided to families, giving details of visiting arrangements and telephone contact. There are set visiting times at the weekend and set times for service users to make or receive telephone calls. Service users complete a movement plan, which acts as a risk management plan, regarding how they will spend their time with visitors. Although there are restrictions regarding visiting and contact with people outside of the home, positive relationships are supported. Withnell House is able to accommodate children overnight, to support service users to maintain family contact. A parenting group is run and individuals are supported to address any relationship issues. Group sessions help individuals to acknowledge the consequences of their behaviour and how this may affect personal relationships. One service user explained how he had been enabled to visit a sick relative and was then supported by staff following the death of this relative. Daily routines are extremely structured. The programme for each day is displayed in the hallway. This includes set times for getting up, groups sessions, leisure, chores and meals. Household tasks, such as cleaning and cooking are shared within the group. All the service users spoken to felt that this worked well and that, as jobs were rotated regularly the system was fair. Extra household chores may be allocated if an individual acts in such as way as to split the group, cause concern or break the rules Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: of the house. Service users have responsibility for food ordering, food preparation and the making of meals. A kitchen manager is appointed very two weeks, who takes the lead responsibility for ensuring that these tasks are done. The inspector spoke to the current kitchen manager who explained how the system works. Staff check the food orders before the service user rings them through to the supplier. The menus are decided jointly by staff and service users and written menus were viewed. There is a choice of two meals for both lunch and tea, with one being a vegetarian option. The inspector enjoyed the lunch provided on both days of the inspection. Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although health care needs are generally met, the serious shortfalls in the way that medication is managed pose unacceptable risks to service users. Evidence: Service users do not require any practical support with personal care. Any issues identified would be addressed within one to one key worker sessions. All service users are registered with a local GP and staff generally sit in on the first appointment. After this the individual may be supported to go to the surgery and would then see the GP alone. The manager explained that some individuals request that staff join them for the actual consultation. Staff will initially telephone on behalf of the individual to make an appointment but there is an expectation that service users will then do this themselves. Service users sign to give consent for alcohol and drug testing, which is carried out by staff. Service users are able to keep their own inhalers and prescribed creams, with all other medication kept in a locked cabinet in the main office, with a separate container for each persons medication. There is a staff chart completed daily, which identifies the Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: staff member who is responsible for medication. Service users come to the office, are handed their medication container by staff and then select and take their medication, observed by staff. Staff sign medication administration records. Staff do not, in the strictest sense, actually administer medication. However by taking responsibility for storage, observing individuals and keeping medication administration records, there is clearly a staff responsibility for medication and an associated duty of care is required. The medication administration records and prescribed medication for five service users were checked, with four showing serious errors in either recording, administration or both. For one person a medication dosage change had been recently made by the GP, increasing the medication from 10mg once a day to 20mg twice a day, as seen on the packaging. The medication administration record stated 10mg to be taken twice a day and had only been signed as being given once the previous day. For another person the packaging stated 300mg and the medication administration record stated 330mg. Both the packaging and the medication administration record stated two tablets to be taken three times a day. However twice in the previous week the medication administration record had been signed as being given four times a day. Another medication record stated that the medication should be taken three times a day but the administration record showed that it had been given only twice a day for two days of the current week. In relation to another service user the medication container stated that it should be taken three times a day, the medication record stated four times a day and it was being signed as being taken twice a day. Handwritten/typed medication records should always be checked and signed by two members of staff, as this will help to avoid errors being made. No record is being kept of medication being received into the home, making it impossible to conduct proper audits or checks. A record is kept of all non prescribed medication, such as paracetamol, given to service users. However this is a joint record. Individual records should be kept of all medication administered or handed to service users by staff. Should a service user refuse their medication, then this should be recorded on the medication administration record and if this continues to happen the issue needs to be addressed within the care plan for that person. At present there is no system whereby individuals who are approaching discharge are supported to take responsibility for the Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: storage, administration and ordering of their own medication, which is what they will be doing when they leave Withnell House. Again individual care plans could support this move to independence. The medication policy for Inward House Projects was viewed and it is clear that this is not being adhered to at Withnell House. It is also necessary for specific written guidance to be available for staff to follow, which is relevant to the particular service provided at Withnell House. The provider organisations policy would then act as the overarching good practise guide, with the Withnell House guidance actually telling staff in a step by step basis how this is to be put into practise. Training regarding medication was discussed with a member of staff, who explained that she had indeed received training in this area of work. However there had been no assessment of competency or checking of knowledge. Appropriate training should be provided for all staff who handle medication and this should include an assessment of their competency for carrying out such tasks. The serious shortfalls in the management of medication were discussed with the manager, who arranged for staff to check all medication packaging against the written records. On the second day of the inspection the manager confirmed that this had been done. The manager was made aware of the need to address the issues raised as a matter of urgency and confirmed that action would be quickly taken and would not await the receipt of the inspection report. Following the inspection the manager was provided with guidance regarding suitable training for staff and was advised that a CQC pharmacist would be visiting the home to ensure that improvements were being made. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to raise concerns in the knowledge that they will be taken seriously. Staff training, policies and procedures help to protect those staying at the home. Evidence: A complaints procedure is in place. Forms are available for anyone who wishes to put forward a compliment, comment or complaint. No formal complaints have been received. However the manager is aware that a record of any compliant must be maintained and give details of the outcome and any action taken. There are formal and informal ways for service users to raise any suggestion or concerns. A weekly service user group meeting takes place, with an external facilitator. Minutes are taken at these meetings and should any issue be raised, one or two service user representatives would bring this to the next staff meeting. The manager gave examples of where changes had been made in response to issues raised by service users. This included providing a smoking shelter at the back of the home and providing gym membership for service users. Service users have regular one to one meetings with their key worker and this too provides opportunity for any problems or issues to be aired. A box is available in the hallway. This is used for service users to raise any issues regarding the behaviour of their peers, which they feel is not conducive to the Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: treatment programme. This box is emptied twice each day and any issues addressed. There is also a group twice each week, where individuals can raise any concerns about the behaviour of their peers. The inspector observed one such meeting, facilitated by two members of staff, where individuals were supported to address any issue regarding their behaviour. These meetings help to ensure that the treatment programme and the progress of individuals is not weakened in any way. The induction of new staff includes addressing issues of abuse, vulnerability and protection. This is also covered within the staff training programme and is a core element of National Vocational Qualification training undertaken by staff. The provider organisation Inward House Projects has an abuse policy in place. This has recently been reviewed and is awaiting ratification by the board. The manager is aware of agreed procedures to be followed in relation to any allegation of abuse. Care Homes for Adults (18-65 years) Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained, providing a pleasant environment for those staying there. Evidence: The building was re designed and refurbished to make it appropriate and suitable for its function as a registered care home providing a rehabilitation treatment programme. The building stands in its own grounds accessed by a private driveway. The home is well maintained with good quality furnishings and fittings. There are designated bedroom, shower, toilet, lounge and dining areas for males and females, with some shared lounges and a communal kitchen. The building is able to accommodate people with mobility difficulties. There are several large lounges which are also used for group sessions, plus a smaller interview room used for one to one sessions. This room is also used as a multi faith worship area. The main staff office and the administration office are on the ground floor. All service user accommodation is on the ground and first floors, with additional offices for staff on the second floor. There are a mixture of single and twin bedrooms, all of which have a wash basin, with some also having an en suite toilet. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: At the rear of the building there is a separate annex, which has been used as both a craft room and a music room, a garage with gym equipment and a smoking shelter. Extensive grounds surround the home, with level areas where games such as football and rounders can take place. There is a parking area for staff and visitors. The report from the CQC site visit, conducted as part of the registration for Withnell House raised concerns about the design of some of the shower and toilet rooms, in relation to the privacy and dignity of service users. New plans have been drawn up and there are plans for this remedial work to start very soon. It is understood that whilst this work is being carried out there may be some temporary restrictions regarding the use of certain toilet, shower and bathing areas. It may be necessary for female service users to use the facilities normally used by the men. The manager explained that any restrictions on new admissions during this period may have adverse outcomes for individuals as admission is closely tied in with the finishing of a period of detoxification. The manager is aware of her responsibilities in managing these changes and keeping any disruption to a minimum. The end result will be improved facilities, which meet service users need for privacy. Service users take responsibility for cleaning in the home and for carrying out their own laundry tasks. Rotas and time tables are in place for both cleaning and laundry. The home appeared clean, fresh and well maintained. Staff undertake training regarding infection control and blood born viruses and provide advice to service users. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are excellent opportunities for staff to gain appropriate qualifications, meaning that service users are supported by competent and knowledgeable staff. Staff feel that they receive training and support appropriate to their work. Evidence: All of the staff team are qualified at National Vocational Qualification level 2 or above. Some staff have achieved the level 3 award and a number have additional relevant qualifications such as in counselling. The promotion of qualification training for staff is excellent and means that service users are supported by competent and qualified staff. Staff have specialist skills relevant to their work in the field of addiction and recovery. Training programmes address areas such as motivation, harm minimisation, conflict management, mental health and case management. A weekly staff meeting takes place, as observed during the inspection. There is also a weekly meeting of support workers and project workers which looks at individual service users and their progress within the programme. Formal hand overs take place three times a day as new staff come on duty, ensuring that all staff have up to date information about the people they are supporting. Recording systems were discussed with the manager. Important information regarding Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: service users is recorded in the handover file, ready to be shared with new staff coming on duty. This is creating a joint record and the manager is advised to review this system as individual records should always be maintained wherever possible. Also there is some duplication of recording which may be unnecessary. Minutes are taken of community group meetings, with important issues then being written in the handover file and then again being written on the individuals file. Situations where the same information is being recorded more than once should be reviewed by the manager and the staff team, to see if this is necessary. Service users spoken to confirmed that staff are approachable and committed to supporting individuals during the treatment programme. Seven service users returned CQC feedback surveys. Comments about staff included; It has enough staff who are willing to help when needed, and The staff do great work and help us. The administration of the staff recruitment process is carried out at the organisations headquarters in Lancaster. At present there are no vacancies within the staff team. The recruitment records for a recently appointed support worker were viewed and show that appropriate checks are carried out before new staff are appointed. Records include an application form, a record of the interview questions and responses, a role definition statement, copies of training certificates, two references and a criminal records bureau disclosure. These checks help to ensure that only suitable people work at the home. Occasionally children stay overnight at the home and whilst they remain the responsibility of the parent, the staff recruitment procedure could be strengthened by ensuring that criminal records bureau disclosures for staff include a check against the nationally held list of people who have been deemed unsuitable to work with children. There is a structured induction programme for new staff, although staff would not be appointed unless they had some relevant knowledge and experience from past employment or volunteering. The induction programme includes five days of training addressing, health and safety, safeguarding, motivation, case management and anti discriminatory practise. A mentor from within the team is appointed and new staff then shadow experienced staff as they go about their duties. Inward House Projects has a rolling programme of staff training, which runs every three months. Experienced staff also access this programme in order to update their knowledge. The training programme addresses health and safety topics and topics relevant to the rehabilitation programme, such as harm minimisation. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: Two members of staff spoken to confirmed that although formal recorded supervision has not been regularly held of late, informal supervision does take place and this includes reflective practise sessions where groups of staff may get together to discuss how issues have been handled. The manager is aware of the need to provide formal recorded supervision sessions for all staff and is keen to address this. Six members of staff returned CQC surveys. Information within these surveys confirmed that staff are given up to date information about the needs of the people they support, that relevant training is provided and that the manager meets with staff and supports them in their role. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run with good quality assurance measures in place. Staff training and good practise help to promote the health and safety of all people at the home. Evidence: The manager has worked for Inward House Projects for over six years and is registered with the Commission. The manager has gained a National Vocational Qualification in Health and Social Care at level 4 and is currently undertaking the Registered Managers Award, which is seen as the appropriate qualification for anyone who is managing a social care service. There are good opportunities for the manager to undertake further training and refresher training is also provided. Previous short courses attended include; dealing with conflict and vulnerable adults training. Courses relating to addiction covering topics such as crack cocaine, have also been accessed. At present there is no responsible individual from the provider organisation registered with the Commission and this is being addressed. The responsible individual carries certain legal responsibilities for the quality of the service provided and it is important that this position is quickly filled. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Information within the annual quality assurance assessment completed by the manager, indicates that some of the operational policies have not been reviewed since 2004. The manager explained that the Inward House Projects Human Resources department has responsibility for such reviews. It is recommended that this takes place in order to ensure that all policies are up to date and relevant to the service at Withnell House. There are formal and informal systems in place for gaining feedback about the quality of the service provided at Withnell House. At the end of each block of group work service users complete an evaluation of the programme. Completed evaluations relating to the reality of addiction and relapse prevention programmes were viewed and showed a high level of satisfaction with these programmes. Treatment outcome questionnaires are regularly completed by service users at certain stages of the programme and are sent to the National Treatment Agency for monitoring and statistical purposes. Copies are retained at the home. Each service user is also invited to complete an exit questionnaire and a feedback form relating to their key worker, when they leave the home. Key worker feedback forms ask if the service user was involved in their care plan and if one to one sessions regularly took place. The responses viewed were generally very positive, however some service users requested more one to one sessions or longer one to one sessions and these responses should be given further consideration by the manager of the home. Inward House Projects has achieved the Navajo charter mark award in recognition of working toward a lesbian, gay and bisexual friendly service. There is a quality assessment framework in place which sets targets for the service to achieve certain outcomes within a set time frame. This helps to ensure that the development of the service and service improvements progress in a timely manner. Senior managers from Inward House Projects carry out audits and spot checks and there was an internal review of all service users file paperwork carried out in July 2009. The manager anticipates that this audit will be carried out each year to help to ensure that records of all care plans and care plan reviews are in place. Service user group meetings form part of the weekly programme and provide a good forum for any issues or suggestions to be raised. There are also natural daily opportunities for service users to approach staff with ideas or suggestions for improving the service provided. Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: Inward House Projects are aiming to encourage more women to enter rehabilitation, as this group are often resistant to seeking help due to child care commitments or fear of their children being taken away. The admissions coordinator sends literature to prisons and the organisation is currently looking at other ways to reach women and provide information about the service. Records show that certain health and safety related checks takes place. Records of fire alarm tests, emergency lighting tests and inspection of fire equipment were viewed. The testing of portable electrical equipment is due to take place in the near future as this had been cancelled due to the adverse weather and poor road conditions. The manager confirmed that the recommendations made by the fire and rescue service have all been attended to. These included the testing of fire equipment and the provision of a fire risk assessment for the home. Inward House Projects commission an external consultancy organisation to carry out health and safety audits and this is due to take place very soon. Service users carry out cooking and kitchen duties with a nominated kitchen manager taking the lead role. The kitchen manager monitors kitchen duties, which include cleaning and the checking and recording of fridge and freezer temperatures. Up to date records were viewed. The induction programme for new staff includes health and safety training as does the rolling programme of core training for staff. Health and safety topics such as first aid, blood born viruses, fire safety, risk management and infection control are addressed. The inspector met with one of the project workers who confirmed that refresher training in health and safety topics was regularly made available. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 There must be 01/03/2010 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. In order for service users health to be protected. 2 37 7 A responsible individual for the organisation must be registered with the CQC. In order that there is a nominated person from Inward House Projects who is responsible for supervising the management of the care home. 01/03/2010 Care Homes for Adults (18-65 years) Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 20 The risk management plans for children staying at the home should be strengthened. There should be written guidance for staff detailing the medication procedures to be followed. This will help to ensure consistency and good practise. Regular audits and checks should be carried out to ensure that medication is being handled and recorded appropriately. All staff who handle medication should be appropriately trained to ensure that they have the knowledge and ability to perform this task. Non compliance in taking medication and the self management of medication as service users near the end of the programme should be addressed within care plans. This will help to ensure that individual needs are being met. All handwritten and typed entries on medication administration records should be checked and signed by two staff. This will help to prevent errors being made. The recording of administering non prescribed medication should be done on an individual basis, in order that each service user has their own record of medication taken. The agreed remedial work to the toilet and shower rooms should be carried out as soon as possible. A training matrix for the team should be developed and maintained. All staff should receive formal recorded supervision at least six times a year. All written policies should be regularly reviewed. 3 20 4 20 5 20 6 20 7 20 8 9 10 11 24 35 36 37 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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