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Care Home: City Roads Crisis Intervention

  • 352-358 City Road London EC1V 2PY
  • Tel: 02078431640
  • Fax: 02072780807

The service is operated by Cranstoun Drug services has assumed responsibility for the unit. This organisation is a non-profit, independent registered charity, which provides a range of specialist treatment and support services in the community and in residential settings. City Roads Crisis Intervention provides a specialist residential service for people in crisis related to their drug use. Adults, whose lives are out of control because of their escalating drug and alcohol use may self refer themselves to the service, The maximum stay is 21 days. During this time people will undergo an individually assessed detoxification or stabilisation programme. It is a care home with nursing. The unit provides support for up to 21 service users at any given time. It is housed within four Georgian Houses. The premises are not signposted and blends in with its` surroundings. The aim of the unit is to offer a place of safety to drug and alcohol users while they undergo medically supervised detoxification treatment. The staff team composes of trained nurses and social care workers. A Doctor holds a surgery on the premises every week day from 10.30 to 15.30. Treatment is determined by the outcome of a comprehensiveCity Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 5assessment. There is a range of counselling and support services, psychiatric assessment, complimentary therapies and access to ongoing treatment. The service users have a range of complex needs and care plans are individualised following a detailed needs assessment. During their stay further needs are assessed with each service user to ensure follow up treatment is clearly defined. The cost of the service ranges from £247 to £279.98 for an occupied bed night dependent upon the type of contract and the level of usage by a Borough in an annual period. Cost is reflective of the either the spot contract or the block contract. The range also reflects that this service accepts referrals from all London Boroughs.

  • Latitude: 51.53099822998
    Longitude: -0.10300000011921
  • Manager: Eileen A Doyle
  • Price p/w: £263
  • UK
  • Total Capacity: 21
  • Type: Care home with nursing
  • Provider: Cranstoun Drug Services
  • Ownership: Voluntary
  • Care Home ID: 4600
Residents Needs:
Past or present alcohol dependence, Past or present drug dependence

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for City Roads Crisis Intervention.

CARE HOME ADULTS 18-65 City Roads Crisis Intervention 352-358 City Road London EC1V 2PY Lead Inspector Pippa Canter Unannounced Inspection 17th July 2008 10:00 City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service City Roads Crisis Intervention Address 352-358 City Road London EC1V 2PY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7843 1640 020 7278 0807 www.cranstoun.org. Cranstoun Drug Services Ms Katharine H. Porter Care Home with Nursing 21 Category(ies) of Past or present alcohol dependence (21), Past or registration, with number present drug dependence (21) of places City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with nursing to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D 2. Past or present alcohol dependence - Code A The maximum number of service users who can be accommodated is: 21 21st September 2008 Date of last inspection Brief Description of the Service: The service is operated by Cranstoun Drug services has assumed responsibility for the unit. This organisation is a non-profit, independent registered charity, which provides a range of specialist treatment and support services in the community and in residential settings. City Roads Crisis Intervention provides a specialist residential service for people in crisis related to their drug use. Adults, whose lives are out of control because of their escalating drug and alcohol use may self refer themselves to the service, The maximum stay is 21 days. During this time people will undergo an individually assessed detoxification or stabilisation programme. It is a care home with nursing. The unit provides support for up to 21 service users at any given time. It is housed within four Georgian Houses. The premises are not signposted and blends in with its’ surroundings. The aim of the unit is to offer a place of safety to drug and alcohol users while they undergo medically supervised detoxification treatment. The staff team composes of trained nurses and social care workers. A Doctor holds a surgery on the premises every week day from 10.30 to 15.30. Treatment is determined by the outcome of a comprehensive City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 5 assessment. There is a range of counselling and support services, psychiatric assessment, complimentary therapies and access to ongoing treatment. The service users have a range of complex needs and care plans are individualised following a detailed needs assessment. During their stay further needs are assessed with each service user to ensure follow up treatment is clearly defined. The cost of the service ranges from £247 to £279.98 for an occupied bed night dependent upon the type of contract and the level of usage by a Borough in an annual period. Cost is reflective of the either the spot contract or the block contract. The range also reflects that this service accepts referrals from all London Boroughs. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people using this service experience excellent quality outcomes. This unannounced key inspection was completed over two days 15th May 2008 and 17th July 2008. A total of 11.00 hours were spent in the care home altogether. The first visit focused on the arrangements for safeguarding people who use the service and the second visit looked at the remaining key minimum standards. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included registration information relating to the new providers who have successfully applied and received registration since the last inspection. We looked at the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. We reviewed and summarised any incident reports supplied by the home. Postal questionnaires were circulated for people living in the home, staff as well as health and social care professionals. Three surveys were received from people who had used the service. Six surveys were received from staff. We have looked at the information collected from the previous inspection. During the second visit we looked at the premises and spoke to people as they became available. There were discussions with both the manager and staff. Staff were observed interacting with service users. We followed the care for two (2) people who are currently living in the care home. The care plans were compared with the service being given. The choice of care plans reflected people’s gender, specific health care conditions and cultural needs. The inspection focused on the ethos of the service, the structured programme activities, staffing levels, supervision and development, complaints and adult protection. Staff recruitment and training records were looked at as well. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. What the service does well: City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 7 The following are quotes received from people using the service, ‘provide excellent care’, ‘they helped me get out of a real mess” “ they greatly improved the quality of my life”, “without them I would not have survived People using the service felt supported and knew they could go to staff when they needed them, knew they were committed to a structured programme and clearly understood the ethos of the service. They described the home as ‘the best’, ‘I needed help and City Roads were willing to give me that help. I was told the rules and that I would get some help here and that was all I needed to know”, “clean & tidy within reason’ and ‘food is great”. The evidence found during our visit substantiated the above views. The home was clear whose needs they could meet. The assessment and admission process is robust. Care plans are specific to peoples’ needs. Key working was focused on the needs of individual service users and getting them to address their crisis situation. Principles of dignity, choice, privacy, rights, and fulfilment, underpinned all aspects of the service. The arrangements for safeguarding people who use the service are robust. Health care needs were identified and addressed to support a healthier lifestyle. People using the service were seen as individuals, whom needed staff support at this time and in some areas of their life. Staff were competent and knowledgeable about the needs of the service users. Recruitment, training, and supervision were to a high standard. On balance staff receive appropriate support. There was a focus on the work of the staff member as well as personal support. . The home is well managed. Record keeping was efficient, with important documents being easily located. Internal audit and monitoring was to a good standard. Service users’ views were sought and acted upon. The service always keeps up-to-date with good practice guidance. What has improved since the last inspection? There have been improvements to the environment. Bedrooms have been redecorated and furniture replaced. Communal areas have been improved. Refurbishment will be extended to the bathrooms and shower rooms. A wider range of social activities has been developed. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People actively choose to access the service. They know the service will be responsive and the admission process supportive taking account of the equality and diversity of referrals. Admissions are based on a holistic assessment of need and aspirations. EVIDENCE: Two case files were looked at in detail. We got feedback from people using the service through surveys and face-to-face contact. The manager and staff also gave feedback during the visit and through the AQAA and surveys. Case files showed clearly the referral and admissions process. The information within also confirmed that City Roads is a responsive service. Each case record contained comprehensive assessments. There are three stages to the assessment process starting with the initial telephone contact. People in crisis are able to self refer themselves to the service. This may mean the person has to contact the service on a repeated basis until a bed becomes available. This is an indicator of their motivation. Feedback from people that had or are still accommodated at City Roads stated that they had chosen to access the service. Comments received were: City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 11 “No one asked me to come here. I asked to come here. I didn’t really get any information about the house, as I didn’t ask for any. I was in **** street and I needed help and City Roads were willing to give me that help. I was told the rules and that I would get some help here and that was all I needed to know.” “I called City Roads asking for help and within 36 hours and two more phone calls they asked me to come. Information about the home was not important at the time. I had been told about it from my drug worker and I really wouldn’t have wanted to wait for info to be posted to me or for applications or forms.” The service understands the importance of passing on information at appropriate times. It has developed a clear strategy for ensuring that people moving into City Roads understand the specialist services provided as well as any rules and restrictions. People using the service said that they had received information on the service and care they would be receiving during the referral and admission process. This information is provided both verbally and in writing. Each service user receives a “Residents Handbook”. The “Handbook” outlines all aspects of the care provided, how the day will be structured, the residential environment and any restrictions and practical information. The Residents Handbook has been written in direct relation to the statement of purpose of the home and is regularly updated. To support service users with poor literacy skills or where there is a significant language barrier, information is passed on verbally or where required with input from an interprer. The service has a dedicated admissions team employed to fully assess all clients making referrals to the service. Where it is relevant, the service has engaged the use of interpreters. The admissions team will complete a telephone assessment. At the point of admission, there is a further assessment completed on a face-to-face level. The “nursing assessment” is comprehensive and involves identifying drug and alcohol history, behaviour and physical health. The assessments are completed by fully trained staff that have the skills and experience to engage with individuals who complex needs and are in a state of chaos. A doctor on site will conduct a full medical and from the drug histories can develop a suitable detoxification programme. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 12 There is a 1:1 session between the client and keyworker within the first 4 days of admission. This enables all the information gathered during the assessment and admission process to be summarised. The key worker can support the service users to identify goal. The purpose is to focus the service user on their treatment and it is the beginning of breaking the cycle of drug use and changing lifestyles. A risk assessment is also completed taking into account information other professionals such as drug workers, social workers or GP who may be supporting the referral. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service are fully involved in the development of their care plan. They identify personal goals and these are reflected in their care plans. They are supported to make decisions about changing their lifestyle. Service users know that information about them is handled appropriately. EVIDENCE: We looked at two case records in detail. People living in the house were asked for their views and this information was compared to the comments recorded on surveys returned by people who had left the service. We spoke to both staff and the manager and looked at policies and procedures. All the information gathered during the assessment and admissions guide the care planning process. Care plans seen on the day of the inspection clearly identified individual needs looked at all areas of the persons’ life. Risk assessments are also completed taking into account information from other professionals such as drug workers, social workers or GP who may be City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 14 supporting the referral. As part of a comprehensive risk management strategy service users are restricted from leaving the building for the first 24 hours. Risk assessment must also take account of staff who are in a position of lone working off site with a service user. People in crisis make an active choice to access the service provided by City Roads. With input from experienced and skilled staff they are supported to make informed decisions in regard to their care and onward referral and treatment following their admission. Restrictions are in place to protect a service user group who are vulnerable and to assist them to engage in the treatement programme. There are restrictions on coming and going from the premises and visitors into the care home as well as the withdrawal of mobile telephones and Ipods. Service users are asked to sign a care contract, which stipulates any restrictions to their lifestyle. Feedback from people using the service was that these restrictions had been fully explained to them and they understood the rationale behind them. The manager recorded in the AQAA that “Service users rights are paramount to the care provided and, when working within restrictions it is essential that staff are respectful of clients ability to make decisions within the scope of the home and the policies, procedures, guidelines and boundaries” Comments received from people using the service confirmed this approach. These were: “Apart from groups I can do as I like and if I need help there is someone willing to give me the help I need or as much as they can.” “There are rules. I can do what I want except for going out on my own. During the day it is structured and at night you have a choice if you want to take part in anything.” “Apart from keeping to the rules. I can do what I like to a point.” There are procedures to make sure that information about people using the service is handled sensitively. The service ensures that people being accommodated are consulted regularly during their short stay to get information about their satisfaction with the home. Their feedback is used in the development and review of the service. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to develop alternative healthier lifestyles, which match their aspirations and wishes. Their rights and responsibilities are recognised within the context of their care contract. Residents are encouraged to eat healthily. EVIDENCE: Two care records were examined, along with the weekly programme. People using the service were asked their views and we also received feedback on the surveys from previous residents. Staff were observed debriefing following a group meeting. Staff were also asked about the programme, and approaches used within the home. People moving into City Roads are in crisis. Although they are making an active choice to improve or make changes to their lifestyles, they are City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 16 vulnerable, in poor condition both physically and psychologically and socially isolated. Staff use a variety of approaches to reduce the impact. There is a varied and full activity programme. One that is appropriate to the needs and abilities of the people accessing the service. Service users are involved in a daily planning meeting and through this can have a choice over the leisure activities in which they take part. The activity programme includes structured groups, which service users know they must attend. As a result of feedback from previous service users, a range of leisure activities are also available. Activities are available both within and outside the home. The programme is designed to give service users opportunities for personal development. There are opportunities to be involved in drama workshops with the Almeida, outings to the Tate and art workshops. Relationships with family and friends are looked as part of the ongoing assessment process. Contact is restricted to telephone calls bearing in mind that such relationships may have contributed to the service users current lifetsyle. Service users with children may have arranged child visits but these are governed by any custody issues or social services involvement. People using the service need to be focused therefore intimate relationships between service users are also restricted. A comment from a person using the service was: “City Roads do their best so when you leave here for secondary rehabiliation all your outside issues are dealt with giving you time to focus on yourself.” Emphasis is put on making meal times an informal and social occasion. Staff are encouraged to eat with the people using the service. This practice has a number of benefits in terms of interaction with people and promotes a good atmosphere within the community. People using the service are involved in planning the menu for the week togther with the chef. They may also assist in preparing meals under supervision. Discussions with people using the service and staff confirmed that the menu plan is varied, takes account of individual preferences, and dietary requirements for cultural, religious or medical reasons. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that their health care needs will be assessed and where specific health care needs are identified arrangements are made for these to be met. EVIDENCE: People using the service were asked for their views. There was discussion with staff and the manager. Two case files were examined. Staff were observed interacting with service users. We looked at the storage arrangements and records relating to controlled drugs and discussed these with the staff concerned. This was compared to the information in the AQAA, which demonstrated the service is meeting outcomes for people in this area. People using the service at City Roads do not require personal care input from staff as they can manage their own needs. To prevent further social isolation some service users made need to be encouraged to improve their personal hygiene standards. Feedback from people who use the service confirmed that they are treated with respect and that they are treated well by the staff. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 18 The service employs both general and psychiatric trained nurses therefore the assessment process is thorough on admission. Each service users receives a full medical assessment by a doctor and a nurse. These assessments will identify any physical as well as mental health problems. These are can be specific to drug use as well as alcohol use. Clients receive a full medical assessment by a doctor and a nurse on admission. Case records show that care plans and treatment regimes are established accordingly. A Doctor holds a surgery every week day from 10.30 to 15.30 in the home therefore people using the service have continuity of medical care. The rota for the service ensures that there are trained staff member on duty over a 24 hour period therefore there are ongoing reviews of service users’ conditions. A review can also be conducted by the doctor during the service users’ stay. Where necessary onward referrals for specialist treatment can also be organised. In liaision with their pharmacy, required medication will be dispensed and administered. Service users can also access emergency dental treatment during their stay. All medication is administered by nursing staff. By necessity controlled drugs are kept in the home. The arrangements for storage were looked at and found to be secure. The room is alarmed and nursing staff are fully aware of their role and responsibilities in relation to th esafe ordering, stoarge, adminstration and disposal of controlled subtances. The arrangements for storing and recording controlled medications is inspected by the Metropolitan police on an annual basis, under the safekeeping of medication regulations. In the controlled drugs register all entries were doubly signed for and balances were being checked. Care staff are trained in supporting the nursing staff in this role. Full records of ordered, received and disposal of medication are kept within the home. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted upon. They are protected, as far as possible, from abuse, self-harm and neglect. EVIDENCE: The record of complaints was looked at along with two case records. People using the service were asked for their comments. There was feedback from both staff and previous service users. Past complaints have been responded to appropriately. Concerns raised on a day-today basis are listened to and acted upon. All the service users said that they knew what to do if they were unhappy with any aspect of their care. They had all received a copy of the complaints procedure but felt that as staff listened to and responded to what they told them, that there was no need to implement the complaints procedure. Feedback from staff confirmed that they are trained to support service users in raising concerns. They clearly demonstrated that they knew what action to take if they received a complaint. The service takes the view that all feedback is valuable as it can contribute to the development and improvement of the service. People who use drugs and alcohol can often place themselves in very vulnerable situations but may not see themselves as a vulnerable adult. There are clear procedures and systems in place to safeguard service users’ property, valuables and benefit entitlements; restrictions are in place regarding family and friends; as well as intimate relationships between service City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 20 users. The service has a thorough and robust recruitment process. Staff have an in-depth induction and are supported through training and supervision to be competent to work with the service user group. When staff were spoken to they clearly understood what safeguarding meant and could relate it to the very vulnerability of the client group because of the nature of their dependence. The training records show that two staff have attended safeguarding training and the minutes of staff meetings show that this has been cascaded down to other members of the team. Allied to this the provider has a rolling programme of staff training which includes protection of vulnerable adults. The service has a whistle blowing policy and safeguarding policy and procedure. People are also protected by the services’ policies and procedures relating to bullying, clients’ rights, equal opportunities and diversity. The policy and procedure manual is to be revised and updated. The current procedure is not clearly linked into the host authority’s procedure. However discussions with the manager and staff showed that they are competent to recognise abuse and respond appropriately. The service ensures that there is learning from safeguarding incidents through critical incident analysis, staff meetings and supervision sessions. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in an environment that they find to be comfortable. EVIDENCE: The building was toured with the manager. Planned repair, redecoration and improvements were discussed. In May of this year the manager reported a possible infestation of “bed bugs” in the building. The service has been taking guidance from the Environmental Health Officer. Money had already been allocated for environmental improvement. All bedrooms have been re-decorated within the last 12 months, and hallways and the majority of communal areas. In addition, in the staff areas, the care team office and staff room have been re-decorated. The whole of the external building has been re-decorated and any structural repairs completed in cluding a full assessment and any required repairs to the roof. Plans are available to remodel the bathrooms, showers and toilet areas. As these improvements City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 22 have already been identified and are being adressed by the provider then no requirement has been set. City Roads is spread across 4 Georgian Houses. People using the service are accommodated for no longer than 3 weeks. Following the ethos of the service, shared bedrooms predominate but there is the option for single occupancy if that is the assessed need. The rooms are spacious but because of the style and age of the properties floors are uneven and there are a lot of steps and narrow staircases. This is not a service that would be suitable for people with mobility needs. Overall the properties provide sufficient personal and communal space both inside and outside in the courtyard garden. Service users are expected to participate in keeping the premises clean and tidy in particular their own personal space. This is complimented by dedicated ancillary staff. Over all the premises were found to be clean and tidy bearing in mind that the service user group is transitory and in crisis on admission. Feedback from people living in the home is that the premises are usually fresh and clean. Comments received were, “The house can get a bit upside down but that is down to the people who are there.” “The house is always fresh and clean.” From observation and feedback from staff it is clear that all necessary precautions are taken to prevent cross infection. Catering staff are clear on the requirements and actions for the safe storage, handling and preparation of food. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service benefit from a staff team who are clear about their roles and responsibilities, and the ethos of the home. Staff are very competent, follow training appropriate to their jobs, and receive regular supervision. EVIDENCE: The rota was looked at and staff who were on the rota were mapped in the building. Staff training, recruitment and supervision records were examined. Service users were asked their views by a sample survey and during a group meeting. Staff were also asked for their views, were observed interacting with service users, and indirectly during the inspection. Policies and procedures were examined. The provider has robust policies and strategies in place regarding recruitment and staff support, training and development. Feedback from staff confirmed that all relevant safety checks are in place. The recruitment records of three members of staff were examined. These had records of the recruitment and selection process including application forms, proof of identity, references and CRB checks were seen on file. All staff including volunteers and session City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 24 workers are required to have an enhanced CRB. Copies of CRB checks are available. We drew the managers’ attention to the recent Commission for Social Care Inspections’ guidance regarding the retention of CRB checks. These can be destroyed following each key inspection as long as details are recorded including the date it was received and the reference number. The service has an induction process for all new starters. Although staff reported differing experience of the induction process, on balance it was positive and effective. Comments received were, “I was inducted during a very busy shifts, I was not briefed on every aspect of the job.” “My induction only partly met my needs. Time not allowed, previous job experience overcame induction difficulties.” “My induction mostly covered what I needed to know about the job.” “I had a very thorough induction.” “My induction covered all relevant areas very well.” “My induction was excellent. At the end of it, I had been shown every task that I would use in my work.” On balance staff are well supported through regular supervision and opportunities for further training. Assessments, including risk assessments, care plan, and key work session records demonstrated that staff were very competent. All evidence showed that they had knowledge and understanding of the needs of this group of service users. Staff demonstrated a high level of knowledge of drug and alcohol use, and appropriate interventions. Case records showed that they apply this knowledge to their work, without stereotyping residents. They have the ability to use theoretical knowledge to the best advantage of each individual service user. This includes acknowledging diversity. The service is staffed over 24 hours. It is a multi-disciplinary team. There is nursing cover and social care team members on duty at all times. Staff are deployed so that the work of structured programme can take place and that that of the admissions team. The staff team is complemented by volunteers and session-based workers. There is also administration and reception support. Therapeutic work is the main focus of this service rather than personal care as in many homes covered by the Care Standards Area 2000. People using the service felt that staff were always helpful. Comments received were, “Staff always treat me well.” “Staff listen and act on what I say.” “City Roads do the best so when you leave here for secondary rehabilitation all your outside issues are dealt with giving you time to focus on yourself.” “If I need help there is someone willing to give me that help.” City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 25 Although people using the service found that staffing levels met their needs, there was a mixed response from staff. Six staff returned surveys. Two staff commented that there is “always enough staff”; two said that there were “usually enough staff” and two recorded that “sometimes there are enough staff.” Comments recorded were, “There is always enough staff on duty. Regular staff team, volunteers and a management team on hand all day.” “Sometimes there are enough staff but we need more volunteers.” City Roads is described as “a crisis intervention centre for people whose lives are spiralling out of control and are at personal risk and in danger of harm.” Therefore it can be a demanding and hectic environment as well as unpredictable. This inspection did not identify that staffing levels are insufficient however we would recommend that staffing is discussed as part of supervision and staff meetings. The manager has supplied information that the service has recently interviewed and appointed six (6) volunteers. They will be inducted once their CRB checks are returned. The AQAA contained information that the role of the nurses within the service will be extended to include the role of non-medical prescriber. In addition the manager confirmed that she has been asked to look at accessing training in prescribing. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using the service benefit from a well managed home. There is a clear ethos. Peoples’ views underpin developments. The health, safety and welfare of staff and residents are generally protected. EVIDENCE: Since the last inspection a new provider has been registered in respect of the care home. The previous registered manager has a new role within the organisation but still oversees the service. The day-to-day management of the service is the responsibility of an interim manager who will be applying for registration. There has been a stable management structure in place and the service has a good history of staff retention. Management cover now extends to 20:00 hours. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 27 There is a clear management structure. Lines of communication are clearly drawn and usually staff find these to be good. However two out of six staff felt that communication needs to be improved. The current systems in place include handovers, staff meetings, management and clinical supervision. This is an area that can be explored as part of the current management systems. There is a strong ethos of being open and transparent in all areas of running the home. The staff team has been recruited and trained to a good standard. As previously stated, the service is looking to extend the role of the nurses within the service to be nurse prescribers. This is intended to improve the service on offer. The AQAA contains clear, relevant information that is supported by clear pieces of evidence. It reflects the ongoing developments in order to improve the quality of the service. The service has a commitment to equal opportunities and has a focus on meeting the diversity issues. People using the service are able to make a contribution to its’ ongoing development. Safeguarding is given a high priority given the nature of the service. There are clear policies and procedures that support systems to safeguard clients property and valuables from the point of admission to discharge. This includes supporting clients with their benefits and ensuring they apply and receive the appropriate payments. Currently the policies and procedures are under review. The team works to a clear health and safety policy. Notifications to the Commission for Social Care Inspection are minimal. Records are of a good standard and are being routinely completed. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 4 4 X X 3 X City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA33 YA35 Good Practice Recommendations It is recommended that people’s views on the staffing levels and staff deployment are discussed as part of the supervision process. It is recommended that peoples’ experience of induction is discussed as part of the supervisory and support process. City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI City Roads Crisis Intervention DS0000071348.V364187.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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City Roads Crisis Intervention 17/07/08

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