Care Home: Haven Residential Rehabilitation Alcohol Dependency Unit The

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What the care home does well People have the opportunity to visit the home before deciding to move in. The home assesses individual needs prior to admission. People are supported to make everyday decisions during their stay and they told us, "I go the gym", "other people do courses, basic computers", "we have regular discussions". People also said that the staff treated them with respect and were caring and supportive towards them. They commented, "staff are very supportive and approachable", "we are on an equal footing", "I feel safe here". From speaking to several people living in the home and staff it was clear that the main activity is undertaking the rehabilitation programme and that this takes up quite a lot of time. People said, "we attend group sessions on a daily basis and we have at least one 1-1 session with the counsellor weekly. This has been a very positive experience for me". People who live in the home are encouraged to maintain and develop outside links, they can have contact with family and friends and the menu offered is of a good standard. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. People are protected from possible harm or abuse. What has improved since the last inspection? The manager and staff have worked hard in implementing new procedures, developed new documentation that includes care plans, risk management, the medication procedure. The recruitment and training for staff has improved. Following the inspection visit the home forwarded updated copies of risk management plans to the commission, these described the risk of a blackout/seizure for people and how these would be managed. People who use the service have their personal and health care needs met. The medication system has been improved and people receive their medication in a safe way. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Staff have undertaken training in order to safeguard people, therefore they are protected from possible harm or abuse. People receive support from a staff group that are appropriately trained and supervised. What the care home could do better: The home does not always receive an assessment of need from the placing authority, therefore may not be fully aware of all needs. There is no specific training in relation to alcohol misuse, mental health or other more diverse needs. Given that the home is registered for alcohol dependency rehabilitation, it is essential for staff to have a good understanding and knowledge about these areas and be up to date with current good practice and legislation. Further development is required to the care plans and risk management plans in order to ensure that they are individual, are centred around the person, their views and preferences. People living in the home help prepare some meals and have not undertaken food hygiene training. This would ensure that the food offered has been prepared safely and hygienically. The home is maintained to an adequate standard and the environment is clean, hygienic, comfortable, homely. However, the building would benefit from refurbishment and redecoration, as it is old and run down. The recruitment procedure could do with being more robust, including application form, details of previous employment and any criminal activity. To ensure that the home has taken appropriate action and are satisfied that staff employed are suitable to be employed. The views of people receiving are sought, however the shortfalls are not currently recorded and the manager is not currently registered with CQC. Key inspection report Care homes for adults (18-65 years) Name: Address: Haven Residential Rehabilitation Alcohol Dependency Unit The The Haven 5-7 Marshall Avenue Bridlington East Yorkshire YO15 2DT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Angela Tew     Date: 1 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Haven Residential Rehabilitation Alcohol Dependency Unit The The Haven 5-7 Marshall Avenue Bridlington East Yorkshire YO15 2DT 01262400329 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: havenalcoholinfo@yahoo.co.uk Mr Cyril Herbert Dennis Marsburg care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence Additional conditions: Date of last inspection Brief description of the care home The Haven is a residential facility for up to ten people who have alcohol dependency problems. It is situated in the centre of Bridlington close to all main community facilities and the public transport network. The staff team currently consists of the registered provider, the manager (not registered with CQC), a qualified counsellor and one care worker. The double fronted property has two floors. There are ten single bedrooms. None have en suite facilities. The property does not have a passenger lift and is consequently not suitable for people who have mobility problems. There are no gardens to the property. Permit car parking is available outside. Otherwise there is a car park near by. The home provides a programme of recovery and rehabilitation for people who have Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 10 3 0 0 4 2 0 0 9 Brief description of the care home made a positive decision to stop drinking alcohol. Nursing care or medical detoxification is not provided. People are given a copy of the service users guide when they contact the serivice. The inspection report is also available for anyone who wishes to see it. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This site visit took place over one day and took a total of 7 hours. Two regulation inspectors visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home, staff members and health and social care professionals. The Annual Quality Assurance Assessment was returned to the CQC prior to the visit taking place. It had been completed to an adequate standard. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be Care Homes for Adults (18-65 years) Page 6 of 33 taken. All of the people currently living in the home were spoken to about the support they receive and what it is like to live in the home, some of their comments have been included in this report. Three files of people living in the home and four staff personnel files were looked at during the site visit. A tour of the building was undertaken and a number of records were looked at to ensure that the home is well maintained. The medication procedure and the way that incidents are reported was looked at and the manager was given feedback at the end of the visit. The manager told us that the current fees charged is £450.00. We also checked how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. We would like to thank the people that stay at the Haven, staff and management for their hospitality during the visit, and also thank the people who had discussions with us. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home does not always receive an assessment of need from the placing authority, Care Homes for Adults (18-65 years) Page 8 of 33 therefore may not be fully aware of all needs. There is no specific training in relation to alcohol misuse, mental health or other more diverse needs. Given that the home is registered for alcohol dependency rehabilitation, it is essential for staff to have a good understanding and knowledge about these areas and be up to date with current good practice and legislation. Further development is required to the care plans and risk management plans in order to ensure that they are individual, are centred around the person, their views and preferences. People living in the home help prepare some meals and have not undertaken food hygiene training. This would ensure that the food offered has been prepared safely and hygienically. The home is maintained to an adequate standard and the environment is clean, hygienic, comfortable, homely. However, the building would benefit from refurbishment and redecoration, as it is old and run down. The recruitment procedure could do with being more robust, including application form, details of previous employment and any criminal activity. To ensure that the home has taken appropriate action and are satisfied that staff employed are suitable to be employed. The views of people receiving are sought, however the shortfalls are not currently recorded and the manager is not currently registered with CQC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to visit the home before deciding to move in, individual needs are assessed prior to admission. However, the home does not always receive an assessment of need from the placing authority, therefore may not be fully aware of all needs. Evidence: The manager told us that people have their needs assessed prior to and following admission. However, the home does not always receive a full assessment of need from the placing local authority and she said, we dont always receive the full community care assessment, but we do ask for this. When someone visits, the manager gathers as much information as she can to help understand what support the person will need. This information is based mainly around the persons alcohol addiction, and how it is affecting their life, this has been developed since the previous inspection and the assessment includes other areas within the persons life such as mental health history, mobility, education, work, family and relationships and interests. We received an annual quality assurance assessment (AQAA) that the home had completed and this gave information about the support and care offered to people. Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: We looked at three files of people staying at the home confirming that people have the opportunity to visit the home before they decide to move in and from speaking to people during the visit it was clear that this is their choice. People said, yes I visited and had a look around, met other people staying here, I knew as soon as I came that I wanted to move in, it had a homely atmosphere and was not threatening at all. The manager told us that currently there is no specific training in relation to alcohol misuse, mental health or other more diverse needs. Given that the home is registered for alcohol dependency rehabilitation, it would be essential for staff to have a good understanding and knowledge about these areas and be up to date with current good practice and legislation. The home employs a counsellor who has undertaken appropriate training in offering emotional support to people. The manager and counsellor for the service told us that the home offers short term support to people who are wanting to stop misusing alcohol. The home offers support for up to 6 months. The counsellor explained what was involved in the rehabilitation programme, people take part in group therapy and towards the twelve step AA of recovery, this deals with their past, family issues and daily life. It is a complete change of lifestyle and we expect people to commit to the programme. People using the service spoke very highly of the staff and the programme and felt that they would not have stopped drinking alcohol without it. One person said, I was dubious at first that it would work, but I am ready to leave and I feel like a different person. the home prepares you mentally and practically, I wont be as isolated as I was before. The counsellor showed us various written evidence about what the programme would entail. People are given terms and conditions and house rules upon going to live in the home and although these are quite structured and restrictive, they appear to be positive in the rehabilitation process. People told us, I needed the structure and rules, it helped me settle in and accept that I needed support, the routines have been good for me, giving me discipline in my everyday life. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further development is required to the care plans and risk management plans in order to ensure that they are individual, are centred around the person, their views and preferences. Evidence: The manager told us that people usually undertaken a detoxification programme before they are admitted. This means that the person will have abstained from drinking alcohol for a period of time. A pre printed care plan and risk management plan is used, which is the similar for everyone. This means that the care plan does not focus on the specific needs of and risks to the person concerned. Further development is required to the care plans and risk management plans in order to ensure that they are individual, are centred around the person, their views and preferences. For example, two of the files looked at did not contain a risk management plan for blackouts and seizures, however these had been described in the assessment undertaken by the placing local authority. The manager said, the blackouts had occurred when the person was drinking. However, there is still a potential risk of it Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: happening again and there should be a plan describing what the risk is, signs and symptoms to look for and how this can be managed or reduced. This would give clear guidance to all staff. Following the inspection visit the home forwarded updated copies of risk management plans to the commission, these described the risk of a blackout/seizure for people and how these would be managed. The home now needs to maintain this practice and demonstrate sustainability until the next inspection visit. People are supported to make everyday decisions during their stay and they told us, I go the gym, other people do courses, basic computers, we have regular discussions, overall its a nice place, it has a warm feeling, there are restrictions, but there has to be for it to work. People also said that the staff treated them with respect and were caring and supportive towards them. They commented, staff are very supportive and approachable, we are on an equal footing, I feel safe here. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are enabled to take part in some activities and education, they are encouraged to maintain outside links with family and friends and the menu offered is of a good standard. However, people living in the home help prepare some meals and have not undertaken food hygiene training. This would ensure that the food offered has been prepared safely and hygienically. Evidence: People told us that they are encouraged to attend day centres or community groups. Written evidence in case files confirmed that people attending local groups in Bridlington. People staying in the home said, we are supported to go out independently is possible, I am going to do a computer course and the staff helped me to find out about it, we attend the local AA group. People using the service also told us that the home assists with keeping contact with Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: family and friends. From speaking to several people living in the home and staff it was clear that the main activity is undertaking the rehabilitation programme and that this takes up quite a lot of time. People said, we attend group sessions on a daily basis and we have at least one 1-1 session with the counsellor weekly. This has been a very positive experience for me. The service has developed close links with the local college. There are specific training groups which people have attended which help them back into society, such as a stress buster course. People also attend social activities as a group. There is gym equipment for people to use in the home. People accept that they will not always be able to make decisions about what they do each day. As this is a crucial part to the programmes success and in order for them to achieve sobriety their programme must take priority. The home does not employ domestic or cooking staff, so it is also part of the programme that those who live there are responsible for keeping all communal areas of the premises clean and tidy, as well as looking after their own laundry, cleaning their own room, and helping with kitchen tasks. However, people living in the home do not currently receive food hygiene training. Once people have completed the early stages of their programme, they have more freedom to go out alone. The manager said, this helps them return to everyday normal life. The owner of the home or one of the staff cooks the main meal, which is served at lunch time. People using the service prepare the tea time meal. People can also make drinks whenever they wish. People told us that the food offered was of a good standard and some comments were, its good, generally it is ok, we do get a lot, we do our own tea, but the staff help if we need it. People also told us that there is always enough food in the home, if anything is running low we tell the staff and it is replaced. The manager told us that there is a set menu and a copy of the menu was seen. She said, we do have a printed menu, but the home is flexible and food preferences are discussed at the daily meeting. If someone wants a particular thing then we would get it. We have incorporated nutritional needs in our assessment and any specific issues Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: would be recorded. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their personal and health care needs met. The medication system has been improved and people receive their medication in a safe way. Evidence: People who stay in the home are usually independent and can manage their personal care. The manager told us that staff do offer emotional support and encouragement and that people are often unmotivated when they first arrive, but as time goes by their confidence and independence increases. People staying in the home told us, the staff are very supportive and approachable, staff always around if you need them, we are on an equal footing. It was clear that staff had developed very positive relationships with people. People told us that they were treated with respect and that they felt at home in the Haven. People also told us that the routines of the home aid their rehabilitation and this is an essential part of the programme. The manager showed us that the personal care needs of people are assessed before or Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: following admission. It was evident that if people required health support then this is accessed and people confirmed that this was the case. Everyone who stays at The Haven has to register with the local General Practitioner (GP). People are accompanied on all visits to health professionals by a member of staff from the service. The home no longer offers a detoxification service and the service user guide has been amended accordingly. Since the previous inspection the home has improved the medication procedures and have had input from the local PCT in formulating the procedures. All of the people currently using the service self-medicate and there had been an assessment as to their ability to do this. This included areas around understanding of the medication, understanding the implication of not taking their medication, if they could read. The procedure was detailed and instructed staff about how to record medication that comes into the building and how to maintain the records to a good standard. There was a detailed procedure about people self-medicating. The medication administration record (MAR) sheets were completed by the staff only to record medication coming into the building. On a weekly basis one staff member checks the medication stock and charts. Currently only one member of staff sign the MAR sheet when the medication is booked into the building. It is recommended that two staff sign, to ensure good practice. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. People are protected from possible harm or abuse. Evidence: The home has a complaints procedure and it was confirmed from speaking to people using the service that complaints are listened to and acted upon. People told us that, we have a meeting daily where we can express our concerns, you can see the staff on a 1-1 basis, issues are sorted quickly. There had been no complaints since the previous inspection visit. The manager told us that she had further developed the complaints procedure and she showed us the new form to be used in the event of a complaint been received. People get a copy of the service users guide before they are admitted. This guide gives information about how people can complain, who to, and how long they can expect to wait before they will get a response following any investigation. The procedure is also displayed in a public area of the service. The home has a policy and procedure for the prevention of abuse. Staff have undertaken training in this area. Since the last inspection there has been no safeguarding referrals made to the Local Authority Safeguarding team. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: The manager told us that currently all of the people using the service take care of their own finances. Each person has a locked facility in their room, to ensure their personal possessions and money are safe. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained to an adequate standard and the environment is clean, hygienic, comfortable, homely. However, the building would benefit from refurbishment and redecoration, as it is old and run down. Evidence: During the visit a tour of the building was undertaken and the standard of accommodation and cleanliness was adequate. The home is now looking shabby and, while clean, some areas are now in need of redecoration and some of the bedroom furniture needs replacing. We were shown new furniture that will be put in place once refurbishment had taken place. It is recommended that the manager submits a written copy of any refurbishment plan, detailing timescales and prioritising areas of greatest need. One of the bathrooms had been refurbished and the lounges homely and comfortable. The rooms which were occupied were warm. On the ground floor there is a sitting area where group meetings take place. There is also office accommodation, a dining room and kitchen and laundry. There is a separate smoking lounge, behind which there is a quiet room and a fitness area. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: The communal areas are provided with comfortable seating for people, and there is sufficient space for them to meet as a group, or privately with their counsellor. People using the service told us, it is homely and comfortable, nice and spacious, it could do with a lick of paint thats all, needs updating, but it is homely. The home had been recently visited by the Environment Health Officer and no areas of concern were identified. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from a staff group that are appropriately trained and supervised. However, the recruitment procedure could do with being more robust, including application form, details of previous employment and any criminal activity. To ensure that the home has taken appropriate action and are satisfied that staff employed are suitable to be employed. Evidence: During the inspection visit all four staff files were looked at confirming that three people have a criminal records bureau check and references. However, there was no application form or any detail of past working history in place. The manager said, I have had a CRB check done in the past and I have had my new one countersigned at CQC. However, there was no written evidence to confirm that a previous employment CRB had been received. Supervision is offered to all staff and from looking at written evidence it was confirmed that this is offered on a regular basis. We looked at staff files and found essential training was up to date. Staff undertake induction training that meets the common induction standards and 75 of staff have achieved NVQ level 2. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Some staff had undertaken training in relation to meeting more diverse needs and these included mental capacity act, deprivation of liberty, person centred awareness and aromatherapy. The manager told us that new staff undertake the skills for care induction standards. From speaking to two of the staff it was clear that they had developed an understanding of the needs of the people who use the service. However, staff need to complete specific training that would include alcohol dependency and meet the Drug and Alcohol National Occupational (DANOS) standards. This would give staff specific knowledge and ensure they are competent when tackling alcohol misuse. The staffing levels were looked at for this week and taking into account the level of need and number of people it would appear that they are currently sufficient to meet the basic needs of individuals. People confirmed that the staff are very helpful, professional and polite when offering support. It would appear that the staffing levels do not vary as the number of people receiving a service changes. The service should review the staffing levels when the numbers of people increases. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run to an adequate standard, the views of people receiving are sought, however the shortfalls are not currently recorded and the manager is not currently registered with CQC. Evidence: The manager has completed the Registered Manager Award and NVQ level 4 in Care. She told us that she has not yet submitted her application to become registered with the commission. However, she has had her CRB countersigned at a CQC office and has an appointment two days after this site visit with the GP. She said, as soon as I have been to the doctors I will be posting the application, it is completed in full and ready to go. The manager has developed an understanding about people with an alcohol problem need. However, she has not attended any formal training in order to underpin the knowledge she has. As stated earlier in the report it is recommended that she source some training, from which she and other staff could update their skills about current good practice. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: People using the service spoke highly of the manager and commented, the manager is approachable, all of the staff including the manager are very good, I feel on an equal level. The home does seek the views of people using the service and surveys are given to them at the end of their stay. Weekly meetings are held with people using the service and these are recorded. Surveys are sent out to health and social care professionals and the manager told us, we do sent the surveys, but do always receive them back. Daily meetings are held with people and these are to discuss any issues they may have, make suggestions for changes. The manager said, people tell us what they feel and if there is anything that needs changing. We do listen and try to meet all requests. The home also receives thank you cards from people who have used the service. These were seen and were very complimentary about the home. Although the home listens to the views of people involved in the service, the information is not currently formulated into a report that would identify any shortfalls and action require. The manager told us that she does this on a day to day basis and although action may be taken, it is not always recorded. The building is well-maintained by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. Care Homes for Adults (18-65 years) Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The home must ensure they 14/04/2010 receive essential information and a full assessment of need that has been undertaken by the placing local authority. This would ensure that the home can meet the persons needs and is aware of any difficulties before a place is offered. 2 3 18 Staff must receive training 14/04/2010 in relation to alcohol misuse, mental health issues and other specialised courses that would help them to support the people in the home and fully understand their needs. To ensure that the staff have the necessary skills, knowledge and expertise that would help them support people and be up to Care Homes for Adults (18-65 years) Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action date with current good practice. 3 6 15 Care plans should be written 15/04/2010 with the person, include their views, feelings and preferences and include more detail making for them to be individualised. This would make them individual and person centred. 4 9 13 The home now needs to make sure that the risk management plans are updated, reviewed and maintained. This would make sure that people are safe whilst staying in the home. 5 34 19 All staff must have a CRB, application form and details of past working history and details of any decision to employ staff who have criminal convictions. To ensure that people staying in the home are supported from staff who have been checked and are suitable. 14/03/2010 15/04/2010 Care Homes for Adults (18-65 years) Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 35 18 Staff must receive induction training to the Drug and Alcohol National Occupational Standards (DANOS). So that they have a common understanding about the needs of people who have an alcohol dependency. 14/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 17 People staying at the home should receive basic food hygiene training, as they are involved in the preparation and cooking of food for others. This would ensure that the food preparation is carried out safely. Two staff should sign the MAR charge when booking in medication, to ensure that errors do not occur and the correct medication is received. The home is looking run down, it is recommend that a refurbishment plan is submitted to CQC, prioritising work to be carried out with timescales for action. The refurbishment and redecoration plan to be implemented as soon as possible, to ensure that people stay in a home that is nicely decorated and furnished. When occupancy levels increase the staffing levels should be reviewed. To ensure that there are sufficient staff on duty at all times. The manager should submit an application to be registered. This would ensure that the service is run by a registered manager approved by CQC. The quality assurance system should include the views of all people, including GPs, social and health care professionals, family and staff, the shortfalls identified and Page 31 of 33 2 20 3 24 4 33 5 37 6 39 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations a written report prepared at the end of the yearly cycle. To ensure that the views of all stakeholders are sought and acted upon that would mean the quality of the service is monitored. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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