Care Home: Caleb Detoxification Centre

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What the care home does well The service provides an excellent structured and therapeutic treatment programme where people can safely withdraw from drugs and alcohol. The people who use the service spoke very highly of it. We asked them to tell us what the service does well and they said: "It does what it`s meant to do to help my addiction" "It`s a comfortable place to be" "They gave me the tools to help me remain clean and have a chance to give myself a life" "I had a good detox experience and would recommend Caleb" "If people really want to detox, this is the place to come" "Good service, good teaching, caring clinical staff. The staff are well trained, highly motivated and committed to their role. People using the service spoke highly of the staff and of the support they received from them. "Wonderful staff, warm welcome, always someone to talk to (confide in)" "All the staff are fantastic" "I am so grateful to have met such fantastic people" "I am grateful to have been here" The catering staff and the meals provided also received praise: "Fantastic food" "The catering is great" "Excellent catering and nutrition" The Expert by experience said: My overall findings of Caleb were excellent. Every person I spoke to was saying just what a lovely place this is. I found staff to be very nice and helpful to assist with anything you need, I do not have any concerns regarding Caleb detox unit I found everything to be great here and people were clearly happy and making progress with their stay here at Caleb and I wish them every success in the future. What has improved since the last inspection? This is the first inspection of the service. What the care home could do better: We have not made any requirements or recommendations in this report. Key inspection report Care homes for adults (18-65 years) Name: Address: Caleb Detoxification Centre 21 Bolling Road Bradford W Yorkshire BD4 7BG     The quality rating for this care home is:   two star good 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: Lynda Jones     Date: 0 8 1 2 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 32 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 32 Information about the care home Name of care home: Address: Caleb Detoxification Centre 21 Bolling Road Bradford W Yorkshire BD4 7BG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Daniel Luke Birrane Type of registration: Number of places registered: care home 12 Caleb Community Interest Company Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Service users with past or present Alcohol dependency - Code A Service users with past or present Drug dependency - Code D 2. The maximum number of service users who can be accommodated is 12 Date of last inspection Brief description of the care home Caleb Detox Centre is for people over the age of 18 who wish to participate in a full physical withdrawal from alcohol and /or drugs or who have a medical need to be stabilised in their drug/alcohol use. The centre provides a safe, supportive environment where this can take place with medical support and within a specialist treatment Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 6 6 Brief description of the care home setting. It is situated in the heart of Bradford, 10 minutes walk away from the main train and bus station, and 5 minutes drive from the motorway. The service is provided in a 12 bedded detox unit that was purpose built and opened in 2009. The bedrooms are single en suites with 1 room designed for service users with a disability. Communal space is provided in the form of 2 lounge areas and a large meeting room. The service has a main kitchen where main meals are provided and 2 small kitchenettes for drinks and snacks. There is a pleasant, secure seating area outside. The fees are between 255 and 328 pounds per night. Care Homes for Adults (18-65 years) Page 5 of 32 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: two star good 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 is a new service that has only been operational since July 2009 and this is the first key inspection of the service. A brand new service cannot be excellent at the first key inspection following registration, as it would lack a track record of performance over time. Those services can only achieve a 2 star, good, rating. More information on the way we award quality ratings is available on our website, www.cqc.org.uk This is what we used to write this report: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and people with an interest in the service. We received 15 surveys in total, these were from people who are using or Care Homes for Adults (18-65 years) Page 6 of 32 have recently used the service, from staff and from health care professionals who have contact with the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Relevant information from other organisations. A site visit carried out by one inspector between the hours of 10:20 am and 3:15 pm and what we call an Expert by Experience. This is a person that has experience of services similar to the one Caleb provides. The expert talked to people using the service and helped us get a picture of what it is like. We have included extracts from the report that the expert sent to us. The visit was unannounced. During that time we spoke to people using the service and to staff and management. We looked at various records, looked around the building and observed staff as they carried out their duties. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? This is the first inspection of the service. Care Homes for Adults (18-65 years) Page 8 of 32 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. 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 32 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 32 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 pre admission assessments and planning for admission are of an excellent quality. This makes sure the service can fully meet peoples needs. Information about the service is clear and easily accessible. This helps people to decide if it is the right service for them. Evidence: Prospective users of the service are given plenty of information about the service so they can make an informed choice about using it. Caleb staff have produced an excellent handbook which contains good, detailed information about the facilities and what people can expect from the service provided. Arrangements can also be made for people to visit prior to admission. A Statement of Purpose is available which gives clear, comprehensive information about the scope of the service. Caleb also has a good web site which gives lots of useful information about the facilities provided. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: In the surveys people confirmed that they received enough information to help them decide if Caleb was the right place for them. When we visited there were four people using the service. One person had completed their treatment plan and was leaving that day and another person was being admitted. Admissions usually take place on Mondays, Thursdays and Fridays when there is a specialist doctor available on site. People are greeted by the admissions manager or another member of staff; a full medical assessment takes place and a suitable detox regime is agreed. All admissions to the unit are planned, even emergency admissions are rigorously assessed. Staff told us the assessment procedure is very important in determining whether people are ready to use the service. In the AQAA the manager said Our assessment procedure is comprehensive, multi professional, person centred and of excellent quality throughout. It forms the basis of our care planning and is completed prior to admission. We looked at a sample of assessments and saw evidence to support this. The assessment procedure is designed to highlight special needs, including disabilities. This ensures that additional or specialist staff can be available if required. People who use the service are fully involved in the assessment process. Everyone signs a contract to show they are in agreement with any restrictions. on their freedom. Care Homes for Adults (18-65 years) Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about their lives, and play an active role in planning the care and suppport they receive. Evidence: People who use the service have a care plan developed by the home and based on their pre-admission assessment. The care plans are comprehensive and tailored to the needs of the individual person. We looked at a sample of care plans and found the information clear and comprehensive. Staff told us they explain the plan to people in detail and talk to them about their needs and treatment goals. They also agree an aftercare package with each person which is usually arranged by the referring agency. In the Patients Handbook it says the most important aspect is the patients committment to whatever aftercare is agreed upon. The Centre maintains close communication with the referring agency to ensure a smooth journey and to help avoid relapse. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: In the AQAA, the manager said All through their treatment the service user is presented with the choices available and helped to make informed decisions about their treatment. This is done in group sessions, goal setting assignments and one to one keyworking sessions. We asked one person if they knew what was detailed in their care plan and they told us that key workers sit and spend lots of time with them and they work together with staff. On risk management the manager said our risk management process is comprehensive and includes the patient throughout. In the early stages of detox risk taking is limited as it is important to complete the process involving reducing dosages of medication taken to a very closely managed schedule. In a staged process we enable our patients to think about how they will risk manage when they leave the detox and encourage them to put strategies in place. People have the opportunity to have a say about the service in the house meetings. These meetings are minuted and plans are in place to ensure that the service responds to suggestions in a timely way. There are also plans to develop the role of service user representative so that people have additional opportunities to express their views. The Expert by Experience said Each person I spoke to said they have one to one work with their key worker but if their key worker isnt available then any member of staff usually always tries and helps in any way they can. Group work takes place every day. One person said the process group they deliver saved her life, its all centred around getting emotions out and for this particular person thats something she thought she could never do but now shes leaving Caleb after successfully completing her detox she said she will miss the process group the most. She then went on to say I will miss Caleb altogether as the last 5 weeks Ive spent in there has been the best 5 weeks of my life, staff are so nice I will miss each and every one of them. The Expert went on to say It was clear to me after talking to people, the structure and motivation provided by Caleb is at a fantastic standard. People are asked to comment about their experience of using the service in the discharge questionnaires. All the comments we looked at were very positive. These are some of the comments we read: All staff and recovery coaches were absolutely brilliant Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: A big thank you to all staff - all amazing - every single one of them I respect what these guys at Caleb do The service has policies and procedures in place in relation to patients privacy, confidentiality, access to data and information sharing which all staff are made aware of during their induction period. Care Homes for Adults (18-65 years) Page 15 of 32 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 rights of people who use the service are respected and people are treated with fairness equality and respect. The staff team supports people to identify their own goals, and work towards achieving them. Evidence: People use the detox service for a fairly short amount of time, on average this is about 10-20 days, therefore making the most of this time is seen as very important. Conversations with the manager and staff showed that there is a very good understanding of a holistic approach to health. The service caters for the physical, emotional, social and spritual well being of each person. The Patients Handbook says The Caleb programme addresses the whole person body, mind and spirit. You will experience a medically managed detoxification or stabilisation, but this will be alongside a wealth of sessions/groups,talks which will Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: help you make the most of your stay into the future. Various in house activities take place and taking part in them is compulsory and part of treatment. This is explained to people prior to admission and forms part of the contract. The programme is full time and varied to meet each persons needs. The list of activities includes groups to help people understand and overcome particular difficulties during withdrawal, regaining life skills, gentle exercise, family workshops and daily house meetings. The handbook contains a sample programme so that people can see how the week at Caleb is structured. The Expert by Experience said After speaking with people in Caleb it was clear just how well structured this service is, with motivation being high priority to the members of staff and to the people currently staying at Caleb. The work that is done with people is fantastic and well organised. Spiritual needs are seen as very important, a prayer room is available for all faiths and a Chaplain makes regular visits to the service. If people require any specialist counselling this can be arranged. Leisure activities are also provided and include Wii activities, art and craft, board games, gardening etc. People are allowed to take personal music systems in with them, for use in their own rooms. Mobile phones, computers and games consoles are not allowed. People are asked to set up a credit account when they move in to use to purchase snacks and any personal toiletries they need (some toiletries are provided). Bringing in large amounts of money and bank cards is discouraged. People are advised to bring enough items with them for the duration of their stay, including cigarettes. During the programme people may be subjected to certain restrictions to their independence and contact with friends and family. These have been agreed by the person using the service and are seen as important in their aim of achieving sobriety and preventing relapse. People are not allowed to use mobile phones nor to receive calls while in the centre. A payphone is available for use at suitable times. For private calls the office phone can be used but a member of staff will be present throughout the call. It is suggested that people do not need to receive post for the short time they are at the Centre. Any that is received will be opened by the recipient in the presence of a member of the staff team. People are asked to remain on site for the entire duration of detox. Visitors are welcome on Sunday afternoons when there are also family/carer support Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: groups where they also receive informative support. People using the service are able to nominate two people who will be allowed to visit during detox. They must be over 18 and not users of drugs or alcohol and be totally supportive of the detox programme. The only under 18s allowed to visit are the patients own children. Visitors can bring in any items that people specially request, either when they visit on Sundays or by leaving items at reception during the week. The Patients Handbook reminds people that these items will be searched. In the AQAA the manager said We are good at enabling service users to feel they have independence and freedom of movement, even though we need to be very security conscious. Patients have their own fob key for their room and staff knock before entering. Patients open their own mail in front of a staff member. patients are required to be involved in the programme of activities on offer, however, this is handled sensitively and patients struggling with this for whatever reason are supported. Smoking is allowed in the courtyard and this is explained in the handbook and induction. One person using the service said The structure is fantastic, its really scary when you first arrive, there is no way I thought I could stick to such a routine but I did and staff are always around to cheer you up and get you motivated it is just what I needed but I couldnt have done this without such wonderful caring staff. Food services are excellent. The catering manager recognises the importance of good nutrition and regular meals as part of the recovery process. There is a good choice of meals and plenty to eat. The Expert by Experience said During my visit at Caleb I was kindly invited to sit and have a meal with staff and people using the service. I really enjoyed the meal and the atmosphere in the dining area. I witnessed staff members sitting down together with everyone, happily chatting, eating meals which added to a friendly environment.The food was very nice with a good selection of choices; people told me that even if there is nothing on the menu you like then the kitchen staff are more than willing to prepare something else that you like to eat. Snacks are always available, fruit in bowls, tea/coffee facilities always available in the kitchen area or upstairs for when its night time. Every person I spoke to said the meals were lovely and well prepared. The AQAA told us The meals at Caleb are absolutely brilliant. The kitchen has 5 stars (highest grade) from Environmental Health and the Catering Manager has taken advice in developing a wonderful menu of heathy meals, which are always presented in an appetising way. We talked to the Catering Manager who said information about Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: peoples likes and dislikes begins to be assembled during the pre admission stage. She said she also likes to talk to people about the sort of meals they like as soon as they move in. The catering staff were all very positive about their role in the detox process and their efforts are clearly valued by people using the service and the staff who work there. These are some of the comments we received: Fantastic food The catering is great The food was absolutely wonderful & I thoroughly enjoyed every meal. Care Homes for Adults (18-65 years) Page 19 of 32 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: In the AQAA the manager said Caleb Detox Centre is a small unit with a dedicated staff team who are good at providing very supportive personal care at all times. The staff we talked to said good communication amongst members of the team is very important to make sure that everyone is aware of the needs of people using the service and of any adjustments to their treatment plans. Multi-disciplinary staff conferences take place twice a day to assist in this process. One of the areas identified for improvement is to increase the number of recovery coaches and Asian staff/volunteers as these groups are under represented in the make up of the team. In the AQAA the manager said We are very thorough and strict about our preadmission assessments, including blood tests, and we will not proceed without them. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: This means we can be confident that we only admit those we can treat to our high standard. It also means that if we need extra or specialist staff on duty we can arrange that ahead of the admission. There is a doctor on site three times a week who is involved in the admission process. Caleb is linked to the local GP surgery which provides for general healthcare needs. The service has developed links with other healthcare specialists such consultant hepatologist, consultant psychiatrist and district clinical lead for substance misuse. There are also strong links with referring agencies in Calderdale. There are good systems and policies for the administration of medication. Medicines procedures are extremely strict and adhered to. All medication is explained to people using the service. They cannot administer their own medication. We looked medication storage and records and talked to the nurse on duty who was in charge of medication administration and found everything to be in good order. Care Homes for Adults (18-65 years) Page 21 of 32 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. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, and are protected from abuse. Evidence: There is a clear complaints procedure in place which is detailed in the Patient Handbook. Everyone who returned a survey said they knew about the procedure; they said the staff listenened to them and they were were treated well. In the AQAA the manager said We are good at being transparent in our dealing with comments and complaints. We train all our staff in how to deal with a concern or complaint from a service user and our aim is for it to be initially addressed immediately, with a full response given within 10 days. We asked staff about the method they used for recording complaints and there was some slight confusion. There appeared to be two complaints files/books in circulation and no one was clear why. No complaints have been recorded but we were aware that one had been made because we have been notified about it. Details of the complaint, investigation and outcome were made available to us during our visit. When we talked to the manager he said it was not recorded in the complaints log because it contained confidential information but he agreed there should only be one place for recording complaints. In future, if a complaint contains confidential information this will be stored elsewhere and reference will be made in the complaints record for tracking Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: purposes. In the AQAA the manager said Caleb has worked hard to foster a culture of openness and honesty, with staff, patients and carers being able to report any uneasiness they feel about the way thigs are done, without any fear of unpleasantnessor recrimination. All staff during induction are instructed to always report any suspisions they may have of maltreatment of patients, immediately, without fear. The manager and deputy manager have attended Safeguarding Training for Managers and the Responsible Individual is booked to do the training early in the new year. All staff receive training about their responsibility to safeguard people during their induction training. The manager recognises that management of complaints and safeguarding training are two areas where staff need regular ongoing training. In the surveys we were told If you have any concerns, you can voice them at ease with management Care Homes for Adults (18-65 years) Page 23 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The design and layout of the building provides people with a comfortable, safe and well maintained environment where they can complete their treatment programme. Evidence: Treatment is provided in a brand new, purpose built facility that opened in July 2009. The site manager carries out all of the required safety checks and makes sure that repairs are promptly dealt with. The building is suitable for wheelchair use with easy access to the outside, lift to first floor and disabled toilet downstairs. All of the bedrooms are single and each has a toilet, shower and hand basin. The rooms are pleasantly decorated and are spacious enough for short term occupancy. Each one is equipped with a bed, bedside drawers, light and clock, chest of drawers, desk and hanging space for clothes. One larger bedroom with wheelchair access is fully equipped with a level access shower room. The rooms are lockable with only the occupant and staff having access. The AQAA says we are brilliant at preparing the room for new occupants, by using a double-checked list for cleaning, free toiletries etc. On the ground floor there is a tastefully decorated lounge, with comfortable seating, large TV, Wii, books, games and an exercise bike. The dining room leads out onto the Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: courtyard with plants and seating outside. Also on this floor is the teaching room and family room for vistors to use. Upstairs there is a domestic kitchen with drinks and snack making facilities and a washing machine and drier. This is what the Expert by Experience said: Caleb is a new building which opened July 09 this year. I found it to be a lovely,, warm well decorated home and very high standards of cleanliness making it a nice welcoming feeling from the moment you enter the building. Everything seemed very well organised around the home and well set out. The home was secure and safe with recent on call system installed throughout the building. Care Homes for Adults (18-65 years) Page 25 of 32 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 sufficient staff on duty to ensure the smooth running of the service. Staff are skilled and well trained and the recruitment practice is robust. Evidence: The home is staffed by two clinical staff (one nurse, one health care assistant) seven days a week. There are also two recovery coaches on duty Monday to Friday and one over the weekend. Two clinical staff are always on duty at night. The registered manager, marketing and admissions manager, site manager and administrator are also available during the week. The deputy manager is the clinical lead for the service. The catering team provide a service seven days a week. The service is flexible and responsive to changes in the needs of people who want to use it. In the AQAA, the manager said, Our staffing ratios were set after much consultation with other homes and with professional in the field. We are confident our levels are more than adequate for normal shifts. However, if a special need is highlighted we are able to boost staff levels or access specialist advice as necessary. This is monitored on a daily basis. We looked at a selection of staff files and found the the recruitment procedures to be robust. References and CRB checks (Criminal Records Bureau)are always taken up Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: before new staff are confirmed in post. This is to make sure that people using the service are safe and cared for by suitable staff. All staff receive statements of their terms and conditions of employment and must successfully complete a six months probationary period before becoming a permenant member of the team. Staff meetings take place monthly. Records are kept of the training staff undertake and of their competencies. Regular supervisions and appraisals take place which highlight individual training needs. The AQAA said We are equally interested in the staff members personal characteristics as we want them to be part of a passionate team that relates really well to patients. In the surveys people made the following comments about the staff: Recovery coaches are great All the staff are fantastic Wonderful staff Care Homes for Adults (18-65 years) Page 27 of 32 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 excellent 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 managed. The views of the people who use the service are valued and respected and their interests are safeguarded. Evidence: The registered manager and deputy are suitably qualified to manage the service and together they ensure that it is run in the correct manner. One of the surveys we received said The home maintains high standards. The care and concern of patients is top priority. The home is well run, clean and is of a friendly atmosphere. In the surveys we received from health professionals who visit the service they said, great communication and liaison with other agencies and they rehabilitate clients extremely well and liaise well with other agencies involved in the clients care. The manager and staff value the views of people who use the service. The manager said patients play a vital role in advising us on the quality and scope of our services and helping us to improve them. Everyone completes an exit questionnaire when they leave. We saw some of the comments people had made and without exception Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: everyone was very positive about their experience at Caleb. There are plans to collate and analyse the comments and use the information to generate an action plan for improvement. In addition to the questionnaires there is an opportunity for people to air their views at the weekly house meetings, in one to one sessions and through the comments, compliments and complaints procedure. Families and carers are also encouraged to voice their opinions and make suggestions about improvements to the service. The manager, responsible individual and site manager all ensure that the health and safety of everyone on site is given high priority. They sent us full details about the servicing of equipment. The manager had completed the AQAA to an excellent standard. It gave us all the information we asked for and identified plans for improvements over the next twelve months. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 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 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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