Care Home: Clouds House

Similar services:

• Closereach

What the care home does well Clouds House has extensive experience of working within the substance abuse speciality. Reviews of records and discussions with staff indicate that the service continually seeks to improve service provision. Staff spoken with at all levels showed a detailed understanding of services provided and their roles in service provision. They talked about peers in a positive, non-judgemental way and this was reflected in their record-keeping. Very clear information is provided to peers prior to and after admission to Clouds House. Full records of all interventions are maintained and it was clear that staff took appropriate action in the event of a change in a peer`s condition. Peers reported that their confidentiality was respected. Peers spoke favourably about the service provided by Clouds House. One person reported "Clouds is an exceptionally good resource for people who have virtually reached the end of their road in their self abuse with the drug of their choice", another reported that Clouds House "have a great model for treatment & is cost effective", another "The combination of care from the counsellors and nursing team is excellent" and another described Clouds House as a "great place" and that "I would recommend it to any addict". Social workers also commented favourably on the service. One reported "because of the nature of addictions, clients have a poor image of themselves and their self esteem is low. The facility is created to raise clients self esteem and dignity and the clients I have placed there have benefited from this", another "The service works collaboratively with the client in an empowering way", another stated that the best factor about Clouds House was that it does what it says" and another summed their response up, stating "Clouds provide and excellent detox, therapeutic programme for substance dependant individuals." What has improved since the last inspection? Clouds House has not been inspected under its current registration of Action on Addiction. However it was inspected on 24th April 2007 under its previous registration. At that inspection, it was judged to be excellent. No requirements were set and five good practice recommendations were made. All have been addressed. A Standard Operating Procedure for the ordering, storage, recording and administration of controlled drugs has been developed. All staff now sign and date their job descriptions. All parts of the staff induction programme are completed and a procedure has been developed to state by when different parts of the induction should be completed. Inductions of agency staff are completed in writing. What the care home could do better: No requirements or good practice recommendations were made as a result of this inspection. Clouds House has a system for regularly reviewing quality of service provision and there was evidence that where matters were identified that managers took action to address them, so the inspection process did not identify any areas for change or development. CARE HOME ADULTS 18-65 Clouds House East Knoyle Salisbury Wiltshire SP3 6BE Lead Inspector Susie Stratton Key Unannounced Inspection 14th December 2007 10:30 Clouds House DS0000070367.V349305.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 Clouds House DS0000070367.V349305.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. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clouds House Address East Knoyle Salisbury Wiltshire SP3 6BE 01747 830733 01747 830783 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) www.actiononaddiction.org.uk Action on Addiction Alan Mead Care Home with nursing 38 Category(ies) of Past or present alcohol dependence (38), Past or registration, with number present drug dependence (38) of places Clouds House DS0000070367.V349305.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 - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Past or present alcohol dependence (Code A) Past or present drug dependence (Code D) The maximum number of service users who can be accommodated is 38. 24/4/07 in previous registration as “Clouds”. 2. Date of last inspection Brief Description of the Service: Clouds House is registered for 38 persons, all of whom are undertaking a structured therapeutic programme from withdrawal on dependence on drugs and/or alcohol. All persons are admitted for 4 or 6 weeks only, during which time the aim is that they will complete detoxification and, through Clouds established protocols, be supported in strategies of managing their lives without dependence on addictive substances. Service users at Clouds House are referred to as “Peers”, so this is how they will be referred to throughout this report. Many of the persons admitted have become dependant on several substances. Clouds House has nursing and medical as well as counselling staff to assist peers through complex drug and alcohol withdrawal regimes. Peers have a wide range of backgrounds and age ranges. They will be admitted from all over the country and some persons come from abroad. Generally peers do not have significant additional care needs other than their drugs and/or alcohol dependence and are able to self-advocate, although some, as would be anticipated in this speciality, do have some additional medical or mental health needs. Clouds House is a Grade II listed building, situated on an elevated position above the village of East Knoyle. The house provides accommodation over ground, first and second floors, as well as a basement. Some support and administrative services are provided in separate accommodation. Clouds House is situated in a rural setting and has extensive grounds. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 5 East Knoyle is on the A350 between Warminster and Shaftsbury. The closest railway stations are Tisbury or Gillingham, both about a 15-20 minute car journey away. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of this inspection, 40 questionnaires were sent to peers and 16 were returned, 20 questionnaires were sent to social workers and seven were returned. Comments made by peers during the site visit and members of staff have been included when drawing up this report. Clouds House is considered to be a new service as it has re-registered, however the statement of purpose has not changed apart from this, and none of the senior staff ,including the Responsible Individual or Registered Manager have changed, so a review of the file of the previous registration was included in the inspection process. The providers submitted a very detailed annual quality audit to inform the inspection. The site visit took place Friday 14th December 2007. The registered manager, Mr Mead was on duty for the site visit. During the site visits, we met with three peers who were currently in treatment and five peers who had recently been in treatment and had come back to attend day support. We reviewed documentation in detail for three peers. As well as meeting with peers, we met with two registered nurses, a care assistant and other ancillary and administrative staff. We toured some of the building, including the medical centre. Our pharmacist inspector has recently reviewed systems for administration of medicines. A range of records were reviewed and evidence from the past inspection, including staff training records, staff employment records, maintenance records and financial records were taken into account. What the service does well: Clouds House has extensive experience of working within the substance abuse speciality. Reviews of records and discussions with staff indicate that the service continually seeks to improve service provision. Staff spoken with at all levels showed a detailed understanding of services provided and their roles in service provision. They talked about peers in a positive, non-judgemental way and this was reflected in their record-keeping. Very clear information is provided to peers prior to and after admission to Clouds House. Full records of all interventions are maintained and it was clear that staff took appropriate action in the event of a change in a peer’s condition. Peers reported that their confidentiality was respected. Peers spoke favourably about the service provided by Clouds House. One person reported “Clouds is an exceptionally good resource for people who have virtually reached the end of their road in their self abuse with the drug of Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 7 their choice”, another reported that Clouds House “have a great model for treatment & is cost effective”, another “The combination of care from the counsellors and nursing team is excellent” and another described Clouds House as a “great place” and that “I would recommend it to any addict”. Social workers also commented favourably on the service. One reported “because of the nature of addictions, clients have a poor image of themselves and their self esteem is low. The facility is created to raise clients self esteem and dignity and the clients I have placed there have benefited from this”, another “The service works collaboratively with the client in an empowering way”, another stated that the best factor about Clouds House was that it does what it says” and another summed their response up, stating “Clouds provide and excellent detox, therapeutic programme for substance dependant individuals.” What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 8 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 Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 9 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): 1, 2 & 5 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Prospective peers are given detailed information about the therapeutic approach at Clouds House prior to admission, this together with the detailed assessment process means that Clouds House can meet the diverse needs of people admitted for the six or four weeks programme. EVIDENCE: All persons who seek admission to Clouds House are given very detailed information about the therapies offered. Referrals may be made by the peer, a supporter, social worker, criminal justice worker, GP or other involved person. When a referral has been made, the admission department ensures full information of services provided at Clouds House are sent to the prospective peer themselves, as well as any referring agency. The information is in the form of a range of booklets relating to different topics. The language used is clear and any prospective peer would be in no doubt about the therapeutic approach offered, services provided, conduct expected by peers and range(s) of fees. All nine peers met with reported on how useful the information provided to them had been and that it enabled them to make a decision about if they wished to be admitted to Clouds House. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 10 One person reported “Because of the reputation of the place, I decided to come here”, another “I did all the research myself but the information received beforehand was excellent” and another “There is information on Google and they sent more detailed literature when I applied for a place here.” All prospective peers are asked to complete an application form. As well as including details of addictive substance(s) taken, the form includes sections relating to medical, psychiatric and other needs. Completed application forms reviewed had been individually completed and were from the peer’s point of view. Once the application form is received, the admissions department contacts relevant persons, such as the prospective peer’s doctor to gain further information. Once this information is received, each prospective peer is discussed during the weekly multi-disciplinary admissions meeting. At this time, decisions are made as to whether more information is needed and who will do this. For example, one prospective peer was noted to have difficulty in mobilising and as no bedrooms are provided on the ground floor at Clouds House, this was followed up, to assess if the prospective peer would be able to manage a flight of stairs. All prospective peers have a written assessment by a member of the team prior to admission. The person who will do this assessment is decided at the weekly admissions meeting and will depend on the prospective peer’s needs. As peers come from all over the country and even aboard, some assessments are telephone assessments. However there are criteria for when a peer must have their assessment at Clouds House, for example if the prospective peer has a medical need and has to be seen by Clouds House’s Medical Consultant, or has a psychiatric diagnosis, to be seen by the Consultant Psychiatrist. If peers ask to come to Clouds House for their assessment, they are never discouraged. Following receipt of all relevant information the multidisciplinary admissions team makes a decision about whether Clouds House can meet the prospective peer’s needs and the individual will be contacted. For example one recently admitted peer had additional needs relating to medical care and Mr Mead was able to describe how he had assessed this person’s needs prior to recommending that Clouds House could meet their needs. This process was clearly documented. This detailed admissions process means that prospective peers are correctly assessed and that only persons who will benefit from the therapies offered by Clouds House will be admitted. Peers spoken with reported on how supportive they had found the whole admissions process. One social worker described the assessment process as “thorough”. All peers are given a folder on admission. This folder includes a copy of their contract relating to their admission and period of residence in the home. The contract details a series of short points relating to the person’s conduct in therapy. For example they are advised that they will be discharged if they consume alcohol or take drugs or show violence towards others. Peers sign a copy of this contract, which they retain. A copy is also placed in their records. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Peers are supported by Clouds House’s procedures, which support diversity and confidentiality and so help people to make decisions about their own lives without a reliance on addictive substances. EVIDENCE: Peers complete a detailed admission process on the day of their admission, supported by a member of the nursing staff. They are introduced to their assigned counsellor and have a medical examination. Any significant factors observed, such as bruising, is documented. Peers are tested for addictive substances on arrival. They are also assisted to unpack individually and issues such as the storage of valuables and destruction of addictive substances, discussed. All peers are admitted to Clouds House to undertake a structured programme for withdrawal from drugs and/or alcohol. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 12 Clouds House has considerable experience in this field and a series of pathways are used, depending on what substance(s) the peer was using. Peers are supported through the detoxification process, which can be uncomfortable for some people, and detailed records are maintained of their progress at this stage. Following detoxification, all peers are supported in a process of commencing a life without dependence on addictive substances. As part of this process, the peer’s individual counsellor draws up individual records, starting with their first meeting, identifying individual aims and barriers to progress. Records maintained by counsellors and clinical staff are completed in detail. Where a peer has needs which are not related to their substance abuse, individual care plans are drawn up. For example one peer had an additional complex medical condition and a clear care plan had been drawn up with the peer and clinical staff, to direct on how their needs were to be met. The care planning process is supported by twice daily multidisciplinary meetings, one first thing in the morning, so that progress on the previous day and night can been assessed and one late morning, where progress in the morning’s therapeutic groups and plans for future work can be discussed. A smaller meeting is also held at the end of the day so that the on-call counsellor is aware of all relevant factors. Peers have all chosen to come to Clouds House to support them through a process of withdrawing from addictive substances. This means that they are very involved with staff at all levels in reviewing their progress. Two peers in the home and five peers who had retuned for follow-up care reported that they had been able to discuss with their counsellor and nursing staff, appropriate placements for themselves after discharge from Clouds House. All people reported how positive they had found this process and that they had felt fully supported throughout. Where peers are not progressing as anticipated, this is discussed by the therapeutic team and the peers may be given a written therapeutic contract of treatment. One such letter reviewed was written in a very supportive style, emphasising the peer’s strengths and supports available to them, as well as advising them of actions which could be taken if they found compliance with the regime too difficult to conform to. Some of the peers spoken with reported that they had been admitted to similar facilities in the past and they all reported that they had found Clouds House one of the most supportive. One person reported “After 20 years of treatment, victim of detox procedures elsewhere, care on general psychiatric wards etc, I came to Clouds, completed and am doing well.” As part of the therapeutic approach, peers are supported via groups, individually with their counsellors, by writing a life history and with other staff in reviewing their past lives. This can put peers at risk as they consider factors in their past lives which have caused them trauma and perhaps how they may have caused trauma to others. Clouds House ensures that peers feel supported throughout this process. Two peers reported on how helpful night staff had been to them when they had not been able to sleep, as they had felt the need to discuss something which troubled them about their past life. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 13 One person reported “The carers are always on hand with good advice” and another “Counsellors are readily available – as are the nursing staff and other fellow peers/patients.” Clouds House cares for a wide range of peers from a variety of different social backgrounds, ethnic groups and ages. One social worker commented on Cloud’s House’s ability to meet the diverse needs of peers “Clients I have referred to this be they women, straight or gay, middle or working class.” Peers and staff were very aware of the need for confidentiality as some matters spoken about in group could be intensely personal and they need to be able to discuss these matters in the full knowledge that they remained confidential. During the inspection, one peer was observed to attend the medical centre, as other persons, including us, were in the medical centre, the registered nurse checked first if the peer would like to go somewhere else rather than raising matters relating to themselves, in front of other persons. Clouds House has also admitted persons who are well known to the press, at various times. Staff reported that it was important that such persons were able to continue in therapy without being disturbed. All staff sign a clear confidentiality agreement relating to their role and conduct at Clouds House and staff who answer the phone have been given standard responses to use when enquiries from external persons are made. Staff spoken with during the inspection were fully aware of how they needed to deal with such enquiries in line with Clouds’ House’s policy. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 14 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. The ethos of Clouds House is to support peers in returning towards the way that they wish to live, encouraging them in a participative and healthy lifestyle. EVIDENCE: Peers are admitted to Clouds House for a structured programme to withdraw from addictive substances. As such they work according to a normal working day and are required to attend group therapy, counselling and lectures, as well as completing written work. Peers are informed about this prior to admission and all peers spoken with reported that they were fully aware of Clouds House’s approach. Outside the required programmes, a range of other activities are available for peers to engage in if they wish. Many of the peers commented in particular on the wide range of complimentary therapies offered. All such activities are run by persons who are trained in the therapy. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 15 One peer reported, “Apart from the compulsory things I make decisions about complimentary treatments, walks etc.” another commented on “Yoga, Shiatsu, acupuncture” which were available. In their annual quality audit, the manager reported that art therapy, drama therapy, creative writing and drumming workshops were also available. Peers also reported that they were able to go out to a local sports centre and to use the gym and swimming pool, which they enjoyed. Peers are only admitted to Clouds House for a period of four or six weeks and will then go on to secondary care or return to their own homes. It is therefore not part of Clouds House’s programme to involve peers in the local community as it does not relate to their future lives. Peers can go out to some local amenities to participate in sport and do shopping. On Sundays, peers who wish to may attend the local churches. Most of the emphasis is on supporting peers in their future lives, whether in the community where they come from, or a community which will more meet their needs. Some peers commented particularly on how much they appreciated Clouds House’s location as it was so far away from their own locality, so that they were able to get away from the pressures of their own community, to really consider their future lives. One person reported “I escaped (….) and headed for the peace and tranquillity of the West Country” another previous peer commented “Location was idyllic – long way from London.” As part of Clouds House’s approach, peers can only meet with relatives and other persons important to them at set times on Sundays and only by invitation. However one peer did comment that if specific individual needs were identified meaning that visits were needed outside specified times, that Clouds House’s rules were not inflexible. Family meetings are also arranged by the peer’s focal counsellor. Access to telephones is limited, so that peers’ therapeutic programmes are not affected. Peers are all advised of this prior to admission. Several peers spoken with saw this as an advantage, so that they could concentrate on themselves and their own needs while under therapy. As part of their contract, peers agree not to form exclusive relationships, as this could also distract them from the benefits of therapy. Peers reported on how they appreciated the wide diversity of the peer group at Clouds House and how they saw this as an advantage. Peers reported that the atmosphere at Clouds House was that an individual’s sexual orientation, financial background, ethnicity or religion were accepted. Peers said they could be the person they were, without concern that they might receive comment or feel “different”. Much of the ethos at Clouds House is in supporting peers in respecting other persons’ rights and developing senses of responsibility towards others. All newly admitted peers are allocated to a peer who is towards the end of this programme. This has a mutual benefit of supporting new peers, but also in developing responsibility in supporting others for peers who are about to be discharged. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 16 Peers are also expected to support each other and a review of notes showed that peers were often documented as reporting to nursing staff when they felt that someone was unwell or needed additional supports. Peers are also expected to help the community, for example by being allocated to empty the bins in the peers’ kitchen or make the toast for breakfast. One peer reported that they had been in other communities where they had been expected to do so much more, such as washing floors and scrubbing bathrooms and that this had not benefited them, while Clouds House’s approach was much more beneficial. Several peers who had been in other facilities reported on how much they appreciated the cleaning staff and cleanliness of Clouds House. They reported that by providing such a clean environment, they felt more respected and were more likely to respect the environment themselves. Peers all eat their meals at refectory-style tables in a large, pleasant dining room. They also have a separate kitchen available to them where they can make snacks and drinks. A drinks dispenser, which only stocks healthy drinks and water has been provided in the basement, in place of a fizzy drinks machine. All peers spoken with said that they liked the meals. Peers are given three full meals a day, as well as snacks if they need them. One person described the catering as “kitchen staff food A”. The chefs reported that peers are often admitted to Clouds House in a thin state, with a history of a poor diet and that one of their aims is to improve both this and peers’ attitude to food while in Clouds House. The menu is based round health living principals, with a low fat, low salt, and low sugar diet. All foods, including bread and sauces are cooked up from raw ingredients and no pre-prepared ingredients are used. The chef was very aware of some individual peer’s requirements and had met with them, to try and meet their needs. The home is able to offer a full range of ethnic and medical diets when needed. Two former peers reported that they had really enjoyed their meals, had put on weight, which they needed to, and had had been able to start eat properly, after a long period of not doing so. Clouds House DS0000070367.V349305.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 excellent This judgement has been made using available evidence, including a visit to this service. Peers’ physical, emotional and health needs are met. Medication is handled in line with procedures designed to protect the peers, and protocols which allow the safe use of individual medication regimes. EVIDENCE: Very few peers at Clouds House need the provision of personal care. However many peers may be unwell for varying periods while undergoing detoxification. Peers will need additional emotional support during therapy and all peers spoken with reported that staff at Clouds House were very good at doing this. A review of records showed that peers’ conditions are closely monitored. For example, one peer developed additional symptoms relating to a pre-existing psychiatric condition during and after detoxification. Their records showed that their condition was closely monitored and medical advice sought promptly. Another peer had an additional medical condition, records showed that relevant equipment needed by this person was provided and that their pulse and blood pressure were regularly monitored. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 18 Where staff or other peers consider that a peer may have relapsed, peers are requested to provide urine or oral samples to the nursing staff, who then test them and advise the multidisciplinary team accordingly. One peer reported that they saw this as a strength of the service, as they felt that if they were tempted to use addictive substances while under treatment they would be detected, and that knowing that staff could to test them was a deterrent. One person reported “Clouds House has been a life saver to me. I would put this place for treatment as five star.” A social worker reported on how Clouds House was an “Excellent service for identifying outside of the therapeutic needs” and another “Clouds are able to maintain a high level of support/advice when needed for health issues outside the detox programme.” As some peers may not have attended their GPs or other healthcare professionals for a considerable period of time, Clouds House supports them in having clinical needs assessed if indicated while they are in treatment. For example one service user’s social worker reported on how Clouds House had supported the peer in attending a dentist. Where peers have additional medical needs, full information on the management of such needs was available in their records. One peer had recently returned from hospital, following a destabilisation of an underlying condition. Their records showed that prompt action had been taken by staff to stabilise their condition in an emergency and that relevant medical support had been requested as soon as it was observed that their condition was no longer stable. All peers are tested for relevant underlying conditions which can be associated with taking addictive substances, such as sexually transmitted diseases and appropriate treatments introduced to address the condition if indicated. One registered nurse reported on how staff at Clouds House work closely with the local midwifery team when pregnant peers are admitted. Our pharmacist inspector has looked at arrangements for the handling of medicines, observed some administrations and had discussions with staff. A refit of the treatment room had been completed during the past year and medicines were all stored securely, with separate storage for stock and non stock items. All medicines received, administered and sent for disposal were recorded. Copies of stock orders were seen, signed by the doctor. Medication administration records are kept together in a file with protocols and nursing notes for ease of reference. All medicine administration is witnessed by two staff and peers are given time and privacy for health checks and medication. Medicines brought in at the time of admission are recorded and their eventual return or disposal. Records of all medicines given on discharge or for day visits are kept. Controlled drugs are kept as stock and stored and recorded accurately. Clouds House has a very comprehensive set of procedures and protocols to enable the safe handling of all medicines by trained staff. One social worker highlighted the importance of supporting people in correct management of their own medication, reporting “This is especially pertinent with this client group. Clients sometimes have a history of abusing moodaltering medications. Detox medication falls into this category. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 19 Our clients who have poor self care and managing their medication and respecting its benefits are important lessons to learn.” Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 20 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. Peers have their views listened to and their interests safeguarded. Action is taken when issues are raised. EVIDENCE: All of the peers met with reported that they felt that staff at all levels would listen to their views and act upon them. One peer reported that they would raise a matter “Direct to the counsellors or nurses in the given way.” A review of individual records showed that peers felt able to raise matters and that these were documented. Clouds House has an established complaints procedure, which all peers are fully informed of. Fourteen out of the fifteen peers who responded to this section of the questionnaire reported that they knew how to make a complaint. All complaints are promptly acknowledged in writing. Complaints are analysed centrally. A review of records showed that all complaints made had been fully investigated by an appropriate person. None of the complaints received since the previous inspection had been upheld. As some peers may have a history of self harm, all prospective peers are reviewed for such matters before admission. Where relevant, risk assessments are drawn up and made available to persons who need to know, prior to admission. All peers are encouraged to inform staff if they become aware of another peer who may be at risk of self-harming or if they feel they may themselves be at risk of self-harming. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 21 Records and discussions with staff showed that this had taken place recently for one peer and that staff had taken prompt and appropriate action. The managers of Clouds House are used to working with a range of people relating to vulnerable adults including local agencies and have taken action in the past when indicated. No referrals have needed to be made recently under the local procedure. One peer reported “The carers of Clouds House always listen and act in our best wishes.” Clouds House operates a very clear accounting system for peers who hand in valuables and moneys for safekeeping. The administrative officer who manages this area meets with all peers soon after admission and supports them if needed, in re-developing strategies for handling money. Where indicated, she also supports them in applying for all benefits to which they are entitled. As part of her role, she observes for when individual peers may need additional supports and advises the therapeutic team accordingly. The officer also observes general issues relating to moneys, which could present risk and passes such information on. For example, if the balance of change given out to peers and change received in the shop and drinks machines does not tally, this could indicate that some peers may be engaging in gambling, which is a risk to themselves, particularly while undergoing treatment. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 22 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, 25, 28 & 30 Quality in this outcome area is good This judgement has been made using available evidence, including a visit to this service. Clouds House presents an environment which has been developed with the peers’ needs in mind. The owners have a continuous programme for improvement and development of the environment. Peers are protected by effective systems for the prevention of spread of infection. EVIDENCE: As part of Clouds House’s treatment programmes, all peers sleep in multioccupancy bedrooms. Peers are fully informed of this prior to admission. Two of the peers spoken with reported that they had previously had experience of treatments in facilities which had single rooms but felt that multi-occupancy rooms were preferable, as they stopped isolation, encouraged responsibility towards others and the presence of other peers who were going through or had gone through similar experiences, gave them support. All bedrooms have at least one wash hand basin and some have baths/showers and WCs. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 23 Separate bathrooms and WCs are provided. These provide privacy and are maintained at high standards of cleanliness. Peers spend most of their days in treatment programmes. Meeting rooms are provided for this. There is also a large sitting room, with a protected smoking area immediately outside, as well as the dining room. The seating in the large sitting room is domestic in tone and comfortable. Smaller meeting rooms are provided for 1:1 meetings. New garden rooms have recently been provided, away from the building, where individual meetings can take place in increased privacy. Peers also have the benefit of extensive grounds round the house itself. At the time of the site visits, there was scaffolding up over the front entrance. This was because works were being completed to the roof. The central atrium has been fully redecorated since the last inspection with care being taken to restore it to its original appearance. Throughout the improvement works process, all areas have been made safe. The medical centre has been fully refurbished during the past year, providing improved facilities for medical examination and storage of day-to-day records. As part of the refurbishment, a separate relaxation room has been provided. It was reported to be well used. All staff have been trained in infection control and staff are aware of the potential risks presented by some peers whose past lives involved a dependence on addictive substances. Information regarding a peer’s history of infectious diseases associated with addictive behaviours, such as tuberculosis, is obtained pre-admission, and checked on admission. Where staff perform clinical dressings, full aseptic procedure is used and there are systems for correct disposal of potentially infected articles. All bed linen is sent to external contractors and peers have access to a laundrette in the basement for their personal items. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 24 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 & 36 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Peers are supported by an experienced team of staff, who have a range of skills to meet their diverse needs. EVIDENCE: Clouds House employs a range of differently qualified staff to meet peers’ needs. A full team of counselling staff are available during the working week, counsellors also work at weekends and an on-call system is in operation in the evenings, at weekends and on bank holidays. At least one registered nurse is on duty throughout the 24-hour period and an on-call system is in place to further support staff. Mr Mead actively supports and recruits registered nurses who have a range of qualifications, to ensure that the varied and complex nursing needs of different service users can be met. Registered nurses are supported by care assistants. Clerical, administrative, managerial, catering and domestic staff are also employed. Mr Mead reported that staff turnover is low and that there is only occasional use of agency staff. If an agency registered nurse does work a shift, they are always on duty with a permanent member of staff. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 25 Where a peer needs additional 1:1 support due to their condition, this is arranged. Records showed that this had happened recently for a peer whose condition had become unstable. Clouds House has a separate human resources department, which supervises the management of the recruitment process. All employees complete an application form and/or submit a CV. Two references are obtained, all staff are checked by the occupational health department and police checks are made. All staff are interviewed by two people, using an interview assessment tool. All staff are given a contract, which they sign. Staff also have a job description, which they also sign. One social worker reported “From feedback from the clients referred to Clouds and information received from the staff, the staff are chosen for their excellent skills.” All staff have an induction prior to formally taking up their duties. There is a standard induction and more detailed inductions are in place for certain roles, such as registered nurses. At three months, on completion of the induction programme, all staff have an appraisal and their appointment is confirmed in writing. Mr Mead reported that all agency staff are also given a brief induction before they commence working. The agency staff employed during the past year have all worked at Clouds House previously. Clouds House offers a wide range of training opportunities for staff. Much of the training is in-house from Clouds House’s own training department. Such training is focussed on developing skills in the speciality. External trainers can also be accessed where relevant, for example, during the past year, specific training courses have included diversity and awareness of self-harm. A training day on eating disorders is currently being planned. Records of training are retained on staff files. One social worker reported “We use this facility for our more complex clients because they are so highly skilled” and another “Clouds have a reputation for highly trained staff.” Supervision and appraisal documentation has been further developed during the last year. Supervision records were individualised and completed in detail. Training needs and actions to be taken to meet staff members’ training needs including timescales, were included on all staff supervision documentation. A clear system for delegation of supervision is in place. The human resources department has a tracking system, to ensure that staff are regularly supervised. Clouds House DS0000070367.V349305.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, 39 & 42 Quality in this outcome area is excellent This judgement has been made using available evidence, including a visit to this service. Peers benefit from Clouds House’s clear management systems, which include a continuous system of quality assessment and ensuring the principals of health and safety are upheld. EVIDENCE: Clouds House has a clear management structure, roles within the organisation are delegated by the chief executive to relevant persons within the organisation. The nursing and care team are managed by Mr Mead, the registered manager, who is an experienced and highly qualified registered nurse. He reports directly to the Head of Treatment services. Managers meet regularly, so that all relevant information is made available across the team. Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 27 Peers are approached to offer their opinions on service delivery and how the treatment programmes meet their needs. All peers are asked to complete a quality review form when they leave Clouds House. Feedback forms have recently been revised and a statistical analysis system developed, to identify trends and inform managers. There is a “suggestions” box in the house, which is emptied weekly. Verbal comments are documented during peers meetings, which are led by the senior peer and attended by one of the counsellors. One peer reported on the systems for review, stating “We are invited to complete daily a significant events sheet, we have weekly community meetings with the whole community attending – plus some councillors and members of the medical team. This is an opportunity for the whole community to address issues which have arisen.” Purchasers are regularly asked to comment on service provision. One social worker when asked to comment on how the service could improve, reported “Not sure, as I think the service is already doing very well.” Clouds House reported in their annual quality assessment that, following comments by peers, medical and nursing staff have amended detoxification protocols, aiming for a less uncomfortable detoxification. This was in 2004/5. Completion of opiate detoxification increased significantly during the first three months, enough for them to continue with these new protocols. Their current detoxification completion rate for the year to date was 86 . Service provision and treatment programmes at Clouds House have been audited by E. A. T. A. (European Association for the Treatment of Addiction) who in 2006, gave Clouds House a national award as a leading addiction centre. Action on Addiction (the parent company) has recently been assessed against the 10 Investors in People indicators and all qualify for the award, which is valid until 2010. As of 1st April 2008, Clouds House report they will be fully complainant with National Institute for Health and Clinical Excellence (N.I.C.E.) guidelines. The health and safety of people is protected by Clouds Houses’ established systems. Peers, as well as staff, are expected to be involved in ensuring the health and safety of others. There is a health and safety committee, which meets regularly and reviews systems. These meetings are minuted. Any accidents to staff or peers are reviewed and audited. A system for “near misses” has been set up during the past year, to ensure that all risks are considered. There is a clear system for reporting of any building defects, which the maintenance man reviews and actions every day. There are established systems for fire safety and all persons, including peers and visiting medical staff are involved in fire drills when they arise. An environmental health officer visited the kitchen during the past year. Two minor matters were identified, which were dealt with on the day of their visit. Clouds House DS0000070367.V349305.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 4 2 4 3 X 4 X 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 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 4 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 X 4 X X 4 X Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 29 N/A 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. Refer to Standard Good Practice Recommendations Clouds House DS0000070367.V349305.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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