Care Home: Broadreach

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• Clouds House
• Closereach
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• Longreach
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What the care home does well People staying at Broadreach receive an excellent standard of care that meets their diverse needs. Everyone is treated as an individual and their beliefs, culture and background are respected. The care plans are up to date and have relevant information about people`s assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. People staying at Broadreach benefit from a staff team that is dedicated and has a commitment to provide care and support to anyone who chooses to undertake a treatment programme there. The staff team has a professional and positive attitude towards their clients that contributes hugely to the provision of continuous and consistent care. The staff are friendly and work together to deliver care to the people staying there. Staffing levels are designed to meet people`s needs throughout the day and night. The managers are approachable and manage the home in a style that is open, positive, and inclusive for everyone living there and staff working there. Every potential new client is told about the restrictions that must be agreed to as part of the treatment programme. These are agreed and signed for on admission in a contract of terms and conditions. This includes the grounds on which the treatment programme could be ended. What has improved since the last inspection? All the building work has been completed since the last inspection. One of the biggest benefits has been moving all the staff offices to the ground floor and setting up the multi disciplinary staff teams. This means that counsellors and nurses benefit from being able to consult more easily with each other and having a holistic understanding of their clients` health and well-being. Changes to staff roles and duties across Broadreach House were being reorganised prior to this inspection. Personnel matters were being centralised to ensure a uniform approach to this area, particularly to put in place robust recruitment procedures and practice. The person taking on this responsibility had consequently started an audit of all the Broadreach House staff files. She had identified that two most recently appointed staff members had not had police checks prior to starting work at Broadreach. She had therefore started making appropriate checks to verify they were suitable to work here. What the care home could do better: Training for all staff needs to be put in place to ensure that the staff team continues to be skilled and qualified to provide quality outcomes for the people using this service. Key inspection report Care homes for adults (18-65 years) Name: Address: Broadreach 465 Tavistock Road Roborough Plymouth Devon PL6 7HE     The quality rating for this care home is:   three star excellent 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: Megan Walker     Date: 2 1 1 0 2 0 0 9 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 34 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 34 Information about the care home Name of care home: Address: Broadreach 465 Tavistock Road Roborough Plymouth Devon PL6 7HE 01752790000 01752785750 lesley@broadreach-house.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broadreach House Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 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 maximum number of service users who can be accommodated is 36. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Past or present alcohol dependence (Code A) Past of present drug dependence (Code D) Date of last inspection Brief description of the care home Broadreach is registered to provide 24hr nursing care for detoxification and/or `first stage treatment for drug and alcohol dependence, for up to thirty-six people over the age of 18yrs and up to the age of 65yrs. The length of stay is up to 6 weeks. Broadreach provides counsellors and other support staff to maintain the programmes of care designed for the people who use the service. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 36 36 Brief description of the care home Broadreach is situated on the outskirts of Plymouth. It is a large house, arranged over two floors with access to most parts of the building for people who use the service. There is a mix of single and shared bedrooms, some with en-suite shower and toilet facilities. There are additional separate bathrooms and toilets. Most of the bedrooms are located on the first floor. There is a chair lift to the first floor. Also on the first floor is an atrium, used for large group meetings. On the ground floor is a dining room, a lounge, another meeting room, offices and the nurses station. Additionally there are two observation bedrooms, both with en-suite facilities, and one suitable for wheelchair access. Broadreach benefits from well laid out gardens to the front and side of the house for residents use. Broadreach is one of five services provided by Broadreach House, a registered charity providing a range of services in Plymouth for the treatment of alcohol and drug dependence. Broadreach House also offers residential programmes for continued treatment (post first stage detoxification) at Longreach (women only) and Closereach (men only); day services at Ocean Quay; Supported Housing can also provided. The current scale of charges for Broadeach range from £990.00 to £1174.00 per week according to the assessment of care needs, and funding agreements with local authorities. These fees do not include toiletries, clothes and other personal purchases. All charges information was provided to the CQC in November 2009. Care Homes for Adults (18-65 years) Page 5 of 34 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: three star excellent 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: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was a Key Inspection undertaken by one regulation inspector accompanied on the first day by a pharmacist inspector. The fieldwork part of this inspection was unannounced. It took place on Thursday 8th October 2009 between 10:00 and 19:45, Monday 12th October 2009 between 11:00 and 19:00, and Thursday 15th October 2009 between 09:30 and 13:00. There was an additional meeting by appointment with the Chief Executive Officer at Ocean Quay on Wednesday 21st October 2009. Throughout this report the term we will be used as the report is written on behalf of the Care Quality Commission (CQC). An Annual Quality Assurance Assessment (AQAA) was completed by the acting manager prior to the inspection. The AQAA is a selfassessment that focuses on how well outcomes are met for the people who live in the home. Care Homes for Adults (18-65 years) Page 6 of 34 This inspection included talking to people who live at the home and care staff working at the time of this visit , observation of interactions between staff and people using this service, a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The senior managers were available throughout the inspection visit to provide relevant information such as the day-to-day routines as well as the management of the home. Five surveys were returned from people living in the home. Thirteen staff members were spoken with and five surveys were received from staff. Eight surveys were received from health and social care professionals. In addition we used the last Key Inspection report and all other information relating to Broadreach received by the CQC since the last inspection to inform this inspection. One requirement and four good practice recommendations were made as a consequence of this inspection. Care Homes for Adults (18-65 years) Page 7 of 34 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. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 34 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 34 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 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided to prospective clients enables them to make an informed decision about admission to the service. The service has a safe admission procedure to ensure that clients make the best of the treatment available at Broadeach. Evidence: The process of assessment is completed by the Broadreach House Assessment and Admission Team, based at Ocean Quay. This team is responsible for all referrals to Broadreach House(*). The assessment may include assessment by telephone as well as consultation with the care manager and if possible, a meeting with the prospective client. At the time of our visit web cams and Skype were being introduced as an alternative face-to-face way of carrying out assessments. Broadreach House has a website with downloads for all the services it offers and relevant forms at www.broadreach-house.org.uk. The people we spoke to told us that their care managers had given them information about different services from which they had chosen Broadreach. From the surveys Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: returned to us, four people out of five told us that they had been asked if they wished to go to Broadreach for treatment. Four out of five people also told us in their surveys that they had received enough information about the service so they could make an informed decision about if it was the right place for them. Before arrival the client is sent a copy of their client contract, their client care plan, and a booklet about Broadreach. Broadreach employs an Admissions Clerk, a clerical role with extra because this staff member is able to engage clients quickly as she is responsible for meet and greet. The Admissions Clerk works full time, Monday to Friday. The Assessment Team at Ocean Quay send all the paperwork for admissions through to Broadreach prior to the client arriving, usually about two weeks before the treatment programme is due to start. The Admissions Clerk organises all admissions including checking bedrooms to ensure they are ready and suitable for the client (based on the information provided on the pre-assessment form. Priority is given to anyone who has a medical need, mental health issues and/or a physical disability). One of the nurses told us that a large proportion of the admission process is completed by the Admission Clerk, therefore the nurses are able to prepare for the medical side of admission. Blood pressure and weight are checked on admission. Anyone who is malnourished and underweight is prescribed build up supplements, and body weights are checked weekly. The staff try to encourage people to eat, starting with breakfast, so that they do not become reliant and dependent on build-up drinks only. The Admissions Form also includes the funding authority and if there is a drug testing order, the type of test and how many times per week. Usually Probation officers are responsible for these tests although this is variable according to funding. Also recorded on the form are prescribed medicines, how long its been used, how much, when last used, and any recent abstinence. New clients are admitted on Mondays, Tuesdays and Wednesdays. Additionally Thursday mornings, people coming to Broadreach from the Plymouth area can be admitted. On arrival generally the Admissions Clerk will show newcomers around the building and helps with unpacking. This includes checking there are no drugs or sharp implements, including needles. The Admissions Clerk told us that people tend to be very anxious on arrival and need reassuring and made to feel welcome. A buddy is appointed to show the person around and introduce them to other people. The Admissions Clerk in discussion with the counselling/nurse teams, will decide who is fit to be assigned as a buddy. The first day of this inspection there were twenty- three clients with ten new admissions, four of whom were coming for a six-week treatment programme. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: Admissions tend to average ten to twelve per week with an average stay of two to three weeks. It was noted that a significant percentage of people stay less than six weeks. At the time of this inspection there was evidence that choice about treatment programmes and aftercare services for clients at Broadreach is restricted by the commissioning teams. For example, clients who are local to Plymouth have no choice about where they attend for day services and they cannot continue treatment with Broadreach House at Ocean Quay. Clients who come to Broadreach from London usually have their care plan set out before they arrive in Plymouth. One person we spoke to told us that he would like to stay in Plymouth for the second stage of his treatment however the system is too rigid and it cannot be changed. Most of the people who come to Broadreach from Cornwall are only there for a detoxification programme of three weeks. They then return to Cornwall for day services as part of their treatment plan. Another person we spoke to told us that, in his opinion, the people who only came in for three weeks would be likely to relapse. He talked to us about the emotional impact of giving up drugs and alcohol. He also talked to us about the need for emotional support to get through and so prevent relapse. Someone else we spoke to also expressed concern about the number of people who only came to Broadreach for a detoxification programme of three weeks. He was also at Broadreach for six weeks before moving on to a second stage treatment programme. One social and health care professional wrote on their survey: Encourage purchasing agencies to visit so they have a better understanding of the programme and hence the ability to make more appropriate referrals. [(*) Broadreach House comprises of five services: Broadreach, Longreach and Closereach all offer residential treatment programmes and Ocean Quay offers day services. Supported housing can also be arranged as part of the Aftercare Plan. Broadreach House owns a 5-bedroom house and also has contracts with two housing associations for this purpose.] Care Homes for Adults (18-65 years) Page 13 of 34 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. Clients know their assessed needs and personal goals, including after care plans, are reflected in their individual care plan. Clients are encouraged to make decisions about their lives with assistance as needed and within any restrictions of their treatment programme. The clients quality of life, whilst in the home, is improved by having as much freedom and choice as possible, within the restrictions of the treatment programme. Evidence: Everyone we spoke to at Broadreach was positive about their treatment programme and the support they received from the counsellors. One person told us that he had an assigned counselling team and he felt that all the counsellors helped him. He expressed some uncertainty about having to re-tell everything each time. Another person told us that the the groups were very mixed with new people coming in nearly every day. We spoke to the counsellors about this. They confirmed that clients repeated a lot of information because they saw anyone in the counselling team. One counsellor told us that people could choose to see one counsellor and often this did Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: happen. We were told by counsellors that because the counsellors work a seven day shift system, and because there is a high turnover of clients, counsellors can find that they do not know clients names. They suggested that an ideal arrangement could be to have a group for those people on a programme of stabilisation or detoxification. This could focus more on relapse prevention and social workshops. The people on six-week treatment programmes would thereby have more stable main group sessions, one to one counselling sessions, and open group sessions. Comments we received from social and health care professionals include: Broadreach has supported many of my clients over the years....Clients are always supported from referral to rehab. Broadreach is a very professional organisation that provides a holistic service to drug users. Tailor made packages Good therapeutic approach with clients. manage diversity waiting client group. More flexible approach in treatment programme. [Broadreach]Provides detox and initial rehab to a diverse range of clients with substance dependencies. The levels of care provided are outstanding. All the care files we looked at had a full assessment and care plan. The assessment includes questions such as What I need to do in treatment Activities Id be interested in eg literacy, money management, gardening, yoga, acupuncture, gym, music. Anything else we should know about you? The average stay at Broadeach is three weeks. The funding is variable according to each local authority as to how it was paid, however a review report is written mid term for those people who come into Broadreach for six weeks by the counsellors on behalf of their clients. This report gives the funder an update on the progress of their clients treatment programme. It is also an opportunity for Broadreach to request further funding if this had not already been agreed at the start of the programme. Care Homes for Adults (18-65 years) Page 15 of 34 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. Clients have access to opportunities for personal development that will help during and after the treatment programme. Clients are able to take part in appropriate activities to ensure a good quality of life while staying at Broadreach. Clients understand and have agreed to limited access to the local community as part of their treatment programme. Clients rights are respected within the agreed constraints of the treatment programme. Dietary needs of the clients are well catered for with a balanced and varied selection of food available that meets the clients tastes and choices. Evidence: One day of our inspection visit the days programme consisted of morning groups on either budgeting or housing resettlement, and acupuncture or gardening. This was Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: followed by Letters of Introduction, a brief biography written by new clients and presented to the whole group. The afternoon group was a health workshop about blood-borne viruses and sexually transmitted diseases, and the effects of drugs on the liver. People also had assignments to write or one-to-one sessions with a counsellor. There are also two groups daily, morning when the days activities are planned, and late afternoon when staff can check who is vulnerable, who needs monitoring, ready for the evening and overnight handovers. Support workers organise activities for the evenings. Clients also have access to pool, table tennis and board games. Broadreach offers a wide range of alternative therapies including Indian head massage and auricular acupuncture. Two people spoke very positively to us about Mindfulness sessions. They told us these sessions were helpful because they relate to current situations. Some other people were waiting for a yoga session that they found beneficial. Outside activities are very limited mainly because people are too unwell and also reluctant to go out. Very few attend Alcoholics Anonymous(AA) and Narcotics Anonymous(NA)groups. Saturday and Sunday afternoons there are trips out to a local place of interest, however anyone going out on these trips must be medically stable. Anyone on a stabilisation programme does not go out at all. Support workers will also accompany people on short walks around the local area. Two afternoons a week gym sessions are available although this also varies in how many attend. Again, clients must be medically stable. The counsellors and nurses have to work to existing care plans especially with local clients. We were told relapse seems to be a feature of the recovery journey. A stabilisation programme is offered for people who live in the Plymouth area. These clients return at a later stage for detoxification and the management team felt this was working very well. They told us there are occasional difficulties with those clients on abstinence courses although clients are generally tolerant of each others needs. A member of staff who returned a survey wrote: All aspects of residents care is catered for well during their stay, thus ensuring that residents are accorded respect, dignity, and appropriate quality of care..... Many individuals with complex needs other than drug and alcohol misuse are being helped where this is possible in conjunction with their drug/alcohol issues. Another staff member wrote: We aim to offer a wide range of pharmaceutical and alternative therapies. We aim to accommodate all cultures and diversities from food choice to areas for prayer. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Broadreach employs a Head Chef and two chefs/kitchen assistants. There is open access to the dining room for clients to make tea or coffee and to chilled juice machines. A microwave and a toaster are also available at all times in the dining room for people to use. A separate fridge is provided, also in the dining room, for clients personal food that needs refrigeration. Clients are responsible for clearing up the dining room after meals. They are responsible for any washing-up that they create between meals although not after meal times. The main meal is served in the evenings and a light lunch midday. People are requested to state their preference, midmorning for lunch, and again during the afternoon for the evening meal. Soup and salad are always available at lunchtime and there is always an omelette or sandwich of the day. At the time of our visit no-one needed a diabetic diet however we were shown menu examples for when these were needed. The menu also included options for anyone who was dairy intolerant, and we were told that Halal meat could be provided if needed. There is usually a vegetarian option on the menu each day. Anyone who is absent at meal times, e.g. hospital appointment, has their meal put aside for them to reheat when they return. Once a week a cooking group is offered and anyone who is interested is able to join this group. Usually people help with preparing the vegetables and generally helping to prepare the meal. Care Homes for Adults (18-65 years) Page 18 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people on treatment programmes at Broadreach can be confident that their physical and psychological needs will be met. The homes policies and procedures for dealing with medicines is safe. Evidence: People come to Broadreach for up to six weeks. They sign an agreement to participate in a treatment programme of detoxification, stabilisation, rehabilitation and therapy. Each individual plan underpins support to overcome addictions and develop the necessary life skills needed to live independently without a dependency on drugs or alcohol. Emphasis is given to providing a structured environment in which people can learn to live their lives in a different way. As part of the treatment programme group sessions as well as individual 1:1 counselling sessions are part of the care plan for each client. We looked at four care files and these contained information relating to clients health care needs, as well as addressing physical and emotional well-being. There were also detailed records to monitor an individuals progress. These were maintained thoroughly and consistently by each of the counsellors for their clients. Contact Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: information was recorded for any agencies or medical services that counsellors may need to liaise with about their client. The care plans were focused on immediate issues arising from starting treatment. Broadreach benefits from a GP-lead clinic every day. There is also a consultant psychiatrist in addiction who visits weekly to see clients and will also visit outside hours. A multi disciplinary team meeting is held weekly that both GPs and the consultant attend along with the senior managers of Broadreach.The counsellors and nurses told us that one of the greatest improvements is the multi disciplinary team. Counsellors are now involved in the medical side of their clients care because they are able to get more information and a better insight into clients health and capabilities. Also, the psychiatrist is open to seeing clients with their counsellor. A health care professional told us: I have been surprised and impressed by the level of personalisation of the care provided. I am aware that they have kept clients in for several days without being funded because they havent felt that adequate community arrangements were in place, a huge amount of liaising when clients are discharged without completing to ensure that the best possible outcome is salvaged, they have been as flexible as possible in accommodating clients with specific needs (physical or psychological). Feedback we received from social care professionals included: The groups seem good. Counsellors keep me informed. I get positive feedback. Broadreach has supported many of my clients over the years. Clients are always supported from referral to rehab. Good therapeutic approach with clients. Manage diversity within the client group. Flexible approach in treatment programme. We found from talking to people using the service and listening to things staff told us about their work that most of the staff at Broadreach exceed their job description to enable people to succeed with their treatment. We found that a new nursing station / medicines room was now in use, within this room we found that new cupboards to store controlled drugs had been obtained. These cupboards now meet the current regulations. We found that the stock of all medicines is regularly audited and it was possible to track medicines from receipt to either administration or disposal. We found that people were supported to look after some of their own medicines within a clear risk assessed process. People looking after any of their own medicines had clearly defined agreements, and they were aware they would not be able to continue if they acted outside the agreement. We found that the home had reviewed their medicines policies and these now include clear directions on Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: how any illicit substances found would be handled and disposed of. We found that a dedicated medicines fridge is provided and that the current temperature of the fridge is recorded. The thermometer present records the maximum and minimum temperatures which were within the manufacturers defined range. However these temperature readings were not recorded. This means that people cannot be certain that the medicines have always been stored within the correct temperature range. All the nurses are being trained in the use of Lofexidine, a medication that can be used for detox-appropriate withdrawal. This is given based on clinical assessment. The nurses have had training to use this medication adjunct to other medicines. Training also included a clinical opiates withdrawal tool which provides an evidence base for refusal of prescribed medication and helping clients to look at ways of relaxing. The nurses consider it important that clients have an awareness about PRNs and know what they can ask for. Care Homes for Adults (18-65 years) Page 21 of 34 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. Clients are listened to and complaints are properly managed. Procedures need to be put in place to ensure that all staff know how to protect vulnerable adults. Evidence: Broadreach has received three complaints since the last inspection. These were all managed in accordance with the Broadreach Complaints procedure. CQC has not received any complaints since the last inspection. We were told that most clients were quick to raise issues . There are twice daily house groups where people can raise concerns and grumbles. People also have open access to the senior managers at Broadreach. We found that the Complaints Procedure in the Service User Guide needed to be updated with the most recent CQC contact details. Also we found that the Complaints policy rather than the Complaints procedure was displayed on the house noticeboard. The senior managers agreed to replace this with a copy of the Complaints procedure as in the Service User Guide. We found from training documents and talking to staff that some staff have completed child protection training. However we found no evidence of adult protection and safeguarding training. We discussed other training relating to safeguarding vulnerable Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff (therapists as well as care staff)working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. The senior managers were confident that the counsellors could recognise, manage and protect people from harm.It was unclear however if the other staff members had attended any training about recognising and reporting behaviour that was inappropriate at Broadreach. A staff member told us about induction training for support workers. We were told that support workers are told about their role and how they should manage situations. They are also given a Guide to New Staff that provides them with an outline of what is expected of them. It was highlighted to us the essential need for induction training and guidance about the purpose of the job and its role within the staff team. This was because some people starting had either not worked in this type of job before or, increasingly, we were told that people were starting work for the first time so came to the job with no work experience at all. People on treatment programmes at Broadreach are given a leaflet telling them about the risks of overdosing (opiates). They attend workshops based on drink and drug refusal skills and dealing with risky situations (e.g. weddings, funerals and Christmas). As part of the treat met programme, people are given relapse prevention assignments that make them look at their own personal triggers in order to recognise what could cause a relapse and what they can do to stop this happening. At the time of this visit the senior management team was made aware of the local authority training about safeguarding vulnerable adults based on the Department of Health guidance No Secrets. This training includes whistle blowing. Details of local training courses about the MCA and the DOLS were sent to the registered provider before this visit. We were told that the senior manager now responsible for training was looking for training on the MCA and the DOLS. During the period of this inspection a situation arose that was managed smartly and effectively by the staff and managers ensuring the safety and protection of everyone potentially and actually involved. Care Homes for Adults (18-65 years) Page 23 of 34 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 people who stay at Broadreach have enough space and facilities to meet their needs with appropriate equipment that encourages and promotes their independence. Broadreach provides a safe and hygienically clean environment for people staying and working there. Evidence: All the building works both started and planned at the time of the last key inspection have been completed. There is nothing outstanding. All the bedrooms except two are on the first floor with a chair lift providing access for anyone who may have difficulties climbing stairs. There are ten single bedrooms that have an en-suite and two that have a toilet with wash hand basin but no shower. Additionally there are five double bedrooms with an en-suite. Five single bedrooms have wash hand basins only and these are generally allocated to people who come to Broadreach for a short stay programme. There are three baths, three shower rooms and three toilets on the first floor. We were told that one bath is much older, longer and deeper and a good resource for people who are detoxing. Further conversation about peoples physical needs prompted a suggestion that if funds were available, a spa bath would be an ideal resource to help people through the physical aches and Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: pains of the detoxification process. The nurses station/treatment room is now located on the ground floor of the house. There are two bedrooms - one double room with an en-suite and one single room with wheelchair accessible en-suite facilities, on either side of the treatment room. These each have an observation screen from the treatment room. These bedrooms are used for incoming clients who need medical monitoring. One of the benefits all the therapeutic staff remarked upon was that moving the nurses station downstairs has improved communications between the counselling and nursing teams because they are all working in close proximity of one another. There are no offices upstairs at all now. The previous nurses station is now a bedroom and the small room next to it is used for Indian Head Massages as it is not big enough for use as a bedroom. Since the last inspection the counsellors have moved into two teams and each team has its own office. The rooms previously used as offices by the counsellors are now used as counselling rooms, or by visiting care managers to see clients. The room we were shown did not look inviting or somewhere that would encourage anyone to relax. It was in need of redecoration, soft lighting and furnishings to make it more suitable for use as a counselling room. The therapeutic staff team confirmed that all the rooms need a face lift and have become a dumping ground for unwanted furniture. Since our visit the registered provider has informed us that these two rooms have been emptied and redecorated including new flooring: They now provide a much more suitable space for one-to-one work. The front lounge has been redecorated and has new chairs since last key inspection. This room is used for group sessions. Also on the ground floor is a television lounge with a pool table. This is occasionally used for groups. An atrium has been built on the flat roof above dining room, on the first floor. This is a large, light room and is used for group sessions and house meetings twice daily. Since the last key inspection there have been no changes to the dining room so this still has an institutional look to it. Also on the ground floor are more offices and the kitchen. Additionally there is a pay phone and a cigarette machine for clients use. The Pavilion that was previously used by the Assessments and Admissions team is now used by the Finance Team. There is also a room in this building that is well insulated and is used for face to face preassessment interviews. At the side of the house there is a purpose built laundry with three domestic washing machines and three domestic dryers for clients to use, and a commercial washing machine and a commercial dryer for staff to use to wash and dry bed linen. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: There are smoke detectors in all bedrooms, corridors and offices. The fire bells are tested bi-weekly, emergency lighting tested three monthly and fire safety checks by an external contractor are completed annually. There is a fire drill bi-monthly that everybody in building at that time has to participate in. Broadreach has a large garden. At the time of our visit a polytunnel project was underway. This had been prompted by a counsellor, and clients were encouraged to be involved. Care Homes for Adults (18-65 years) Page 26 of 34 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. The staffing levels and skill mix are satisfactory meaning peoples needs are currently being met at all times. There are some poor staff recruitment practices showing evidence of proper checks not being made to ensure that suitable staff are employed. Evidence: It was evident from observation and listening to the people on treatment programmes at Broadreach that they felt supported by all the staff there. We found that Broadreach has a very loyal staff team that is undeterred by the changes and difficult financial circumstances that have affected them over recent months. We received comments such as Broadreach is an excellent place to work. As a team we have endeavoured to offer an outstanding service. Some dedicated members of staff. Broadreach is a very professional organisation...Broadreach has great staff and good policy around their programme. I think that they [the staff at Broadreach] display an extraordinary commitment to the care of clients... At the time of this inspection there were thirty people employed on the staff team at Broadreach. There was a recruitment process to recruit a new nurse-counsellor and interviews were arranged for the end of October. There were also interviews during the period of our inspection to recruit bank support workers. We were told that the Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: main impact during the recruitment process has been the increase use of agency nurses who are employed to cover night duties. During the day the nurse-counsellors cover the day shift in the nursing station. This capacity has been affected by the recent departures of two nurse-counsellors however one of the night duty nurses has moved from night duty to cover the nursing station five days a week. The nursecounsellors cover weekend day shifts and work as the nurse lead in the nursing station. This means they take responsibility for clients medication and medical welfare. The Clinical Nurse Manager has changed her shift so it spans across both day shifts. This mean that she can works cover admissions, triage for doctors clinics and the doctors clinics. She is also on call at all times for nursing queries. The Support workers work from 1600 to 2100 or 2030 to 0830. Saturdays and Sundays they work from 0800 to 2100 or 1600 to 2100. They all work one night duty per week on a rotation basis. The Admissions Clerk who oversees the support workers told us that she was currently seeking First Aid at Work training and Health and Safety at Work for all the support workers. There will be an Induction programme for all the new bank support staff who are successful at interview. Several staff members told us that training had slipped over the past two years including mandatory training. We discussed this with the Senior managers who agreed that training over the last couple of years has been ad hoc with more focus on service development. It was also acknowledged that the number of support workers with a minimum NVQ Level 2 in Health and Social Care was not achieved however this has been confirmed as a priority by the Chief Executive Officer. She has also requested a training needs analysis and agreed that the Clinical Nurse Manager should resume the responsibility for overseeing and arranging training for all the staff at Broadreach. It was evident that mandatory training was a high priority for everyone as soon as possible. It was acknowledged by the Senior managers that re-instating a robust training plan was essential to retain staff and boost their morale as well as ensuring everyone was up to date with best practice methodology. At the time of this visit all the staff files were being audited by the Human Resources (HR) Manager. We inspected three files for staff working at Broadreach. The HR Manager had already identified that two of the most recently appointed staff members had not had police checks prior to starting work at Broadreach. She was therefore making appropriate checks to verify they were suitable to work there. All of the files we looked at had references and a photograph of the person. They had all received induction training that included Fire Safety, Health and Hygiene, Moving and Handling and Health and Safety in the Workplace.The HR Manager plans to visit Broadreach monthly to deal with all HR related issues including ensuring all new staff files are Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: complete and up to date. Care Homes for Adults (18-65 years) Page 29 of 34 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 people using this service benefit from a well run home. The people using this service benefit from the ethos, leadership and management approach of the home. Peoples rights and best interests are safeguarded by the homes policies and procedures, and their health, safety and welfare is promoted and protected. Evidence: The Registered Manager resigned from his position May 2009. Consequently because Broadreach House is undergoing an organisational restructure, the Board of Trustees agreed that the Chief Executive Officer (CEO)would assume the day to day managers duties at Broadreach. The Board of Trustees concluded that this would provide stability and consistency of management during a period of substantial change for the organisation. This is reviewed by the Board of Trustees on a quarterly basis. It is hoped that a decision about a permanent manager who can apply for registration with the CQC will be made in the early Spring of 2010. The CEO, as acting manager, is supported in the day to day management of Broadreach by two other senior managers. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: We observed that Broadreach is run in an open and transparent way with responsibilities delegated appropriately amongst all the staff. The clients were aware of boundaries and restrictions imposed upon them, and had these explained to them both at the beginning of their treatment programme as well when required during the treatment programme. New clients all sign an agreement to allow information to be shared appropriately between multi disciplinary agencies. All the staff and managers maintain a consistent approach towards all the clients in encouraging them in their recovery. There are twice daily house groups where people can raise concerns and grumbles. People also have open access to the senior managers at Broadreach. There was a Clients evaluation of the service in September 2009. The results were being collated at the time of this inspection. Referrals to Broadreach come from all over the United Kingdom. A wide network of social workers and probation officers as well as other referring authorities therefore use Broadreach as part of the plan of care to meet assessed needs of their clients. This network forms part of the quality monitoring of the service as it also acts as a national grapevine promoting good practice or occasionally raising concerns about possible poor practice. Such incidents are clarified and resolved because Broadreach House is an approachable organisation that communicates its responsibilities to achieve its aims and objectives in the treatment of people who are dependent on alcohol and/or drugs. A Health and Safety committee meets three monthly. The meetings are minuted and the minutes sent to the CEO. The Estates Manager is responsible for maintenance and health and safety and he acts as health and safety adviser for all the Broadreach House houses and Ocean Quay. Each House manager takes ultimate responsibility for health and safety, although the Estates Manager visits at least once a week and a report book is kept in each house that he can check on each visit. He oversees all tests and checks in each house. He told us that he tries to encourage a grass roots responsibility by both staff and clients towards health and safety. All the periodic inspections were found to be up to date. All the routine fire safety checks were found to be up to date. Fire drills are held bimonthly for everybody who is in the building at the time. The nurse in charge is responsible at Broadreach. Fire drill is also incorporated into staff training and all new staff have an induction in fire safety and what to do in the event of a fire. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 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 20 It is recommend that the temperature recording form for fridge temperatures is reviewed to include maximum and minimum temperatures. This will assure people that their medicines are stored within the correct temperature range. The registered provider should consider the local authority as well as in-house training for staff who are not qualified counsellors so that staff will be alert to any potential abuse, and know what action to take in the event of any allegation being made. This would also give them a better understanding and more insight into recognising and reporting inappropriate behaviour. The registered provider should consider training on the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS) for all trained staff to ensure they are up to date with current legislation and practice. Priority should continue to be given to implementing a robust training plan to ensure that people using this service continue to benefit from a quality staff team that is appropriately trained to meet their needs. 2 23 3 23 4 35 Care Homes for Adults (18-65 years) Page 33 of 34 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. 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