Care Home: International Eating Disorders Centre

Annual service review Name of Service: International Eating Disorders Centre The quality rating for this care home is: The rating was made on: three star excellent service 0 2 1 0 2 0 0 8 A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection We do an annual service review when there has been no key inspection of the service in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review.   Has this annual service review changed our opinion of the service?   No You should read the last key inspection report for this service to get a full picture of how well outcomes for the people using the service are being met. The date by which we will do a key inspection: Name of inspector: Maureen Richards Date of this annual service review: 3 0 0 9 2 0 0 9 Annual Service Review Page 1 of 9 Information about the service Address of service: 119/121 Wendover Road Aylesbury Buckinghamshire HP21 9LW 01296330557 01296339209 enquiries@eatingdisorderscentre.co.uk Telephone number: Fax number: Email address: Provider web address:   Name of registered provider(s): Conditions of registration: Category(ies) : mental disorder, excluding learning disability or dementia Conditions of registration: Dr Clarke Number of places (if applicable): Under 65 Over 65 9 0 The maximum number of service users to be accommodated is 9 The registered person may provide the following category of service: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia (DE) Have there been any changes in the ownership, management or the No service’s registration details in the last 12 months? If yes, what have they been: Date of last key inspection: Date of last annual service review (if applicable): Brief description of the service The International Eating Disorders Centre (IEDC) is a registered care home providing care, a programme of treatment and accommodation for nine service users with an eating disorder. It is located about a half mile from Aylesbury town centre. There is parking to the side and rear of the home. The home is conveniently situated for the amenities of Aylesbury. The home describes its treatment programme as having four phases: pre-admission Annual Service Review Page 2 of 9 0 2 1 0 2 0 0 8 assessment, in-patient care, partial care and aftercare. On admission service users enter a highly structured five-level treatment and rehabilitation programme to which they and their families consent before admission. The home is staffed by a multidisciplinary team, which includes medical staff (including a consultant psychiatrist), nursing staff, a consultant psychologist, counsellors, a dietician, cook, and healthcare assistants. The home can also admit young people from aged 16 years of age and is subject to the supplementaty standards for care home accommodating young people of those ages. Annual Service Review Page 3 of 9 Service update since the last key inspection or annual service review: What did we do for this annual service review? We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: 1. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. 2 Surveys returned to us by people using the service and from other people with an interest in the service. 3. Information we have about how the service has managed any complaints. 4. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. 5. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. 6. Relevant information from other organisations. 7. What other people have told us about the service. What has this told us about the service? The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It was informative and outlined what progress and improvements have been made within the home and what it aims to achieve over the next year. Surveys were sent to 9 service users, 24 staff and 6 Social and health care professionals. 7 service users, 7 staff, 5 Social and health care professionals surveys were returned. The AQAA confirms that the all service users are assessed prior to admission and the service has established webcam conferencing facilities for assessments and discharge follow up for service users who live out of the area. All prospective service users are given detailed information about the service before they are admitted and service users are given the opportunity to test drive the in patient service if they so wish. Under this arrangement they can be admitted for two weeks, and experience what it means to be an inpatient at the IEDC. This is called an assessment admission. Feedback from some staff indicate that admissions to the home are managed by the unit coordinator and not the registered manager and that on occasions service users are admitted to the home without consultation with him. The registered manager confirmed in his response to this feedback that he has the capacity to stop inappropriate admissions even in situations where the unit coordinator might have tried to approve an admission and no service user has been admitted without the registered managers approval. Annual Service Review Page 4 of 9 The AQAA tells us that care plans and risk assessments are in place with service users participating in risk assessments, so that they become part of the subsequent risk management plans. Service users are given the opportunity to participate in discharge planning through the Care Programme Approach (CPA), the benchmark of person centred health and social care provision. The AQAA outlines that the centres treatment model fully supports service users in their personal development, education, career choices and occupation, linking their community reintegration programme with the service users future aspirations and post treatment. Service users are given the opportunity to plan for their leisure activities as individuals and as groups with the leisure opportunities in and out of the home being expanded on over the previous twelve months. Service users have a well balanced nutritional intake compatible with recovery from an eating disorder as recommended by the Dietician involved with the centre. The AQAA tells us that service users have access to a range of health professionals as part of their admission and treatment programme with specialist services being accessed for service users with dual diagnosis which has minimised relapse for those individuals. Service users are supported with their personal care as required in line with the level of the treatment programme. The AQAA confirms that service users administer their own medication independently with staff supervision only for those whose risk assessment requires this. The AQAA indicates that the home has had one complaint in the previous 12 months with this complaint responded to within 28 days. The Commission has received one complaint in respect of this service which was investigated and responded to appropriately by the provider. Written feedback received from service users confirm that all 7 service users who responded know how to make a complaint. The AQAA tells us that a summary of the complaints procedure is included in the service users handbook with the full procedure available on the notice board. The service has a suggestion box accessible to all service who may want to raise a complaint or concern anonymously. The AQAA confirms that the home has had one safeguarding of vulnerable adults referral and investigation in the previous 12 months. It tells us that all staff has received training in Safeguarding Adults and Child Protection and staff sign to confirm they have read and understood key policies, which include the whistle blowing policy. The plans for improvement over the next 12 months are to run in house bi - annual refresher courses to ensure that all staff remain up to date with their responsibilities and duties, as far as safeguarding issues are concerned. They also intend to ensure that all key working staff are adequately trained and supervised to ensure they are not only effective advocates for the vulnerable adults, but also to educate and empower service users in dealing with abuse. The AQAA tells us that the home is clean, hygienic, safe and comfortable and promotes service users independence. It indicates that areas of the home internally and externally have been have been redecorated and refurnished to provide a homely environment for service users. They have recently been awarded a 5 star excellent rating for environmental hygiene by Aylesbury Vale District Council. This mainly focuses on environmental cleanliness, policies and management as well as food Annual Service Review Page 5 of 9 hygiene for the Unit. The AQAA outlines that staff are suitably recruited, inducted, supervised and trained in their roles with the home having access to a range of specialist training to support staff in their roles. The home has a had a low turnover of staff over the previous 12 months which has reduced the use of agency staff which provides continuity of care for service users. Written feedback received from staff confirm that they are suitably recruited, inducted and supervised. Two staff commented that what the home could do better is to enable all staff to undertake training relevant to their professions in order to keep up to date with current practices and foster cohesive working relationships with service users. One staff member commented that the home could benefit from more appropriate supervision for staff which would benefit staff and service users with clearer and specific job descriptions so that individuals did not cross over into others remits. Another staff member commented that there in not sufficient time on a shift to do supervision of staff and therefore staff are having to stay late in order to receive or provide supervisions. The AQAA confirms that the majority of the care staff already hold a National Vocational Qualification level 2 or above with the aim being for new staff to be registered for this training once they have completed the IEDC induction and Common Foundation Standards. The home has an experienced registered manager who attends periodic training and development meetings to update his knowledge, skills and competence while managing the Unit. He is also regularly funded to attend training and workshops over and above the bare mandatory requirement to enhance his clinical and leadership skills and to keep abreast with relevant research, guidelines and changing legislative issues where applicable. The home has developed an auditing tool to ensure effective monitoring of key systems in the running of the home. The manager has been proactive in eliciting service user views through house meetings, admission questionnaires, discharge questionnaires, in patient anonymous questionnaires and the suggestion box.This ensures that service users views are considered in the day to day running of the home and has lead to changes in the treatment programme, visiting and weekend leave arrangements and the activities provided The dataset section of the AQAA indicates that policies were updated and reviewed in April and May 2009 and that the servicing of equipment is up to date. Written feedback from service users confirmed they were happy with the care provided with responses indicating they do not always make decisions about what they do each day and cannot do what they want during the day, in the evening and at weekends due to the constraints of the treatment programme which they agree to on admission. Feedback received from service users include comments such as friendly, caring staff who believe in what they are doing. Comprehensive individualised programme and excellent therapists. A manager who Annual Service Review Page 6 of 9 always sorts things out and is willing to talk things through. Staff listen to our ideas and concerns and acts on them. Totally supportive, happy selfless friendly staff at all times. Care is tailored on an individual basis and individual needs and input always included. Super place for intense care and treatment. Staff care for us and respect our needs. Staff are easy to talk and take our needs and worries into account. They listen. Staff communicate well with each other. The home is clean and fresh. The home feels welcoming and comfortable at all times. The timetables are fulfilled and the arts and crafts and Pilates are very relaxing. I would recommend this unit to anyone because of the level of care which is provided. It is a home from home not a hospital. The IEDC has saved my life, it is an amazing place. It has helped me to grow and develop self respect and belief. Service users feedback that what the home could do better is inform service users if groups are not going to take place and provide alternatives. Have better staffing as sometimes they are short of people. The food should be served fresh, less use of canned foods and more simple and plain foods. There could be more activities to fill the time, especially at weekends as no treatment sessions makes it little lonely and tedious at times. More things to do especially for service users on level 1 and 2 of the programme. Sometimes there can be a lack of and or delayed communication between staff and service users which can lead to frustration. Written feedback from social and health care professional was positive with individuals confirming they were happy with the care provided. This included comments such as the service offers individualised patient care and aftercare. They offer a personal touch and psychology input which is not offered in similar services elsewhere. They provide a good service to their clients offering a broad range of interventions. They place the individual at the centre of their approach enabling a holistic treatment. In terms of the service provided it is as good as it can get. One professional commented that it is very challenging service and I would like to see a stronger multidisciplinary team approach. Another professional commented that the service could do better by caring for their staff. Staff at times do not feel valued. One staff member commented that the team can be quite split at times between staff and management which can lead the staff to feel undervalued. One staff member commented that the nursing team work well within the unit and is supported by the manager but what the home could do better is to allow nurses to be accountable for their shift and position within the company. They should accept judgements and decisions made by nurses and for nurses to feel valued and a professional within his her rights and remit. Another staff member commented that what the home could do better is inter departmental communication. One staff member confirmed that team meetings do not take place frequently and that decisions made at team meetings are over turned by the owner. They commented that the owner listens to concerns and feedback from staff but is not proactive in dealing with the concerns raised. This feedback should be considered by the home and the provider as part of their continuous development to ensure that the issues raised are addressed. Annual Service Review Page 7 of 9 We looked at the information in the AQAA and our judgement is that the home is still providing an excellent service and that they know what further improvements they need to make. What are we going to do as a result of this annual service review? We are not going to change our inspection plan, and will do a key inspection by the 2nd October 2011. However we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Annual Service Review Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Annual service review CQC General Public 0870 240 7535 (national contact centre) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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