Care Home: Longreach

Similar services:

• Clouds House
• Closereach
• Westcliffe House
• Hilldales
• Chandos House
• Cherry Orchards Camphill Community Ltd

What the care home does well Assessments are comprehensive and ongoing after the women move into Longreach. Emotional wellbeing is considered as an integral part of the assessment process. The care plans are up to date and have relevant information about the women`s assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. Staff try to gauge a "good leaving outcome" for clients. They acknowledge that it may be better to help someone move on after two or three months to another, different style treatment programme because it is more suitable to the person`s presenting needs. Unplanned discharge is rare. The main trigger and cause of women being asked to leave is the individual`s management of their anger and temper. The examples of records we saw showed that unplanned discharges were nonetheless "managed" discharges. The staff are friendly and work together to deliver a comprehensive treatment programme to the women living in the home. The registered manager and the staff manage issues competently, and in a timely manner. What the care home could do better: The House Timetable was not explicit in its description of events. The mornings show either "Workshop" or "Group" (with the exception of one day), and the afternoons show a Therapeutic Activity. The evenings do not show any planned activity except karate and tai chi on Tuesday and Thursday. Friday afternoon is a leisure activity organised with the Women`s Education Association (W.E.A.). We were told the support staff organise activities for the evening and weekends however this is not regular. Saturday afternoon and all day Sunday is "Free Time." This has to be planned in advance with the support staff. If anyone chooses to go out during the weekend, they must be back at the house by 16:30. New clients generally do not leave the house for the first couple of weeks and when they do go out, it is either with a member of staff or someone who has been at Longreach for several weeks. We were concerned that the timetable shows "Free time" Friday evening, and from Saturday afternoon until Sunday evening. The manager described some of the informal activities organised by the support staff and we discussed that it would provide a better structure and benefit the women if these were formalised. The manager agreed that to have planned events such as film nights (film agreed a few days before) and beautysessions, would enable the women to recognise this as a wind down and "end of week" time. She agreed to discuss this with the support staff and gather ideas from the women about things they may like to do in a formalised way. Staffing levels are designed to meet people`s needs throughout the day and night, and there is a low turnover of staff and this helps care to be consistent. We were concerned that long periods of sickness on top of organisational changes has put a strain on staff levels. This means that over recent weeks the staff team, particularly the counsellors has been "too lean" with no slack for holidays, other planned leave or any unplanned leave or sickness. The majority of the women have continued to have one to one sessions and support from the same counsellor. For a few women they have found this a difficult period of time where they have felt unsupported. Measures are in place however to address this over forthcoming weeks following this inspection. This is to include considerations of options that can "enhance and increase responsibilities for the current staff at Longreach" thereby giving them recognition of their current achievements of positive outcomes for the women at Longreach. Random inspection report Care homes for adults (18-65 years) Name: Address: Longreach 7 Hartley Road Hartley Plymouth Devon PL3 5LW three star excellent service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Megan Walker Date: 1 2 0 5 2 0 1 0 Information about the care home Name of care home: Address: Longreach 7 Hartley Road Hartley Plymouth Devon PL3 5LW 01752788699 F/P01752789980 longreach@broadreach-house.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Wendy Van Der Niet Type of registration: Number of places registered: Conditions of registration: Category(ies) : Broadreach House care home 20 Number of places (if applicable): Under 65 Over 65 0 0 past or present alcohol dependence past or present drug dependence Conditions of registration: Female only Age 16-64yrs Date of last inspection Brief description of the care home 20 20 Longreach is one of three residential centres owned by Broadreach House (*). The organisation is a registered charity, overseen by a board of trustees, and provides a range of services in Plymouth for the treatment of alcohol and drug dependence. Longreach provides second stage residential and rehabilitation treatment for women between the ages of 16 and 64 years of age who are substance free. Longreach does not provide a detoxification service. It is not registered to provide nursing care. Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home Longreach is housed in a large detached house and a separate cottage within the grounds of the house. Up to fifteen women can be accommodated in the house that is made up of six double bedrooms and one single bedroom. The cottage is completely separate living space including a kitchen and lounge, and can accommodate up to five women in two double bedrooms and one single bedroom. The cottage is usually reserved for residents moving towards the end of their treatment programme at Longreach. There is a large garden to the rear of the building with a vegetable plot and a small area reserved for the homes pets. Longreach is located in the Hartley area of Plymouth with easy access to the city centre and other parts of Plymouth by bus. Longreach is staffed twenty-four hours by a team of trained counsellors, support staff, catering staff, and administration staff, all supported by a manager to ensure the home runs effectively on a day-to-day basis. Broadreach House has a website with downloads for all the services it offers and relevant forms at www.broadreach-house.org.uk. [(*) Broadreach House comprises of five services: Broadreach, Longreach and Closereach all offer residential treatment programmes and Ocean Quay offers day services. Supported housing can also be arranged as part of the Aftercare Plan. Broadreach House owns a 5-bedroom house and also has contracts with two housing associations for this purpose.] Care Homes for Adults (18-65 years) Page 3 of 13 What we found: This was a random inspection undertaken by one regulation inspector to check compliance with regulation. Longreach was lasted inspected on 25th April 2007 when it was rated Excellent. The fieldwork part of this inspection was unannounced and took place on Tuesday 20th April 2010 between 10:00 and 16:00. An Expert by Experience joined this part of our visit. The Care Quality Commission (CQC) considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. We made a further two visits to Longreach on 5th May 2010 from 10:30 until 18:00, and 12th May 2010 from 10:00 until 13:00. We met with the Responsible Individual during the same week to provide an opportunity for her to talk to us about the service, the organisational changes of Broadreach House and how these affect Longreach. Two surveys were returned from women staying at Longreach. Seven surveys were received from staff. We also spoke to the women, the staff on duty, students on placements and the registered manager. In addition we used the last Key Inspection report and all other information relating to Longreach received by the CQC since the last inspection to inform this inspection. We found that Longreach provides comprehensive information for prospective clients as well as commissioners and care managers. It describes itself as a therapeutic community, offering a person-centred approach and individual treatment plans, within a structured evidenced-based programme. Two women we asked told us that they had been given information about Longreach by their care managers. One woman said that she knew she needed help and from the information she was given about different places, Longreach had looked the most suitable. The two women who returned surveys told us that they had been asked if they wished to go to Longreach for treatment. They also told us in their surveys that they had received enough information about the service so they could make an informed decision about if it was the right place for them. Two social and health care professionals returned surveys to us. One told us that the assessment arrangements ensured accurate information is always gathered to plan the right service for people. The other social and health care professional told us this usually happens. One social and health care professional wrote: Good assessment and communication. The other wrote: Whenever possible Longreach will be flexible in meeting our clients needs. One social and health care professional told us that Clarity over what services are included in the price and what is extra, could improve. We were told by the registered manager that the fees have been modified to include all the services and treatments. Commissioners therefore pay a flat rate and clients do not have to negotiate for extras. We found that the process of assessment is completed by the Broadreach House Care Homes for Adults (18-65 years) Page 4 of 13 Assessment and Admission Team, based at Ocean Quay. This team is responsible for all referrals to Broadreach House. The assessment may include assessment by telephone as well as consultation with the care manager and if possible, a meeting with the prospective client. During our visit one of the counsellors completed a telephone assessment. We were told that prospective clients are invited to visit Longreach and meet other women on treatment programmes as well as the staff team if is practicable to do so. The AQAA told us that there is a need to improve systems for ensuring that contingency plans paperwork is completed and returned by referrers prior to admission. We found that there are plans to upgrade the current IT system and network facilities. This should enhance communications between all the Broadreach House projects and particularly assist in the transfer of pre-assessment information from the Assessment Team to the staff team at Longreach. We looked at four care files. They all had an assessment of need. The application form included the type of treatment programme being requested, for example, detoxification at Broadreach and longer term rehabilitation at Longreach or longer term rehabilitation at Longreach only. Each care file also had a copy of a letter confirming a place that was sent to both the care manager arranging the placement as well as the prospective client. This included the proposed date of admission. We also saw a Discharge form (reason for discharge ie planned end to treatment; does not wish to complete treatment; asked to leave treatment; referred on to ...) on each care file. All the information about treatment and outcomes is collated for the National Treatment Agency (NTA) purposes. Each care file also had a signed contract confirming the funding authoritys agreement for the placement. We found that because funders expect their clients to make a contribution to their fees, this is agreed before arrival at Longreach. The client is sent this information and it is discussed with new clients on arrival at Longreach to ensure they are aware and understand about these contributions. If for any reason the contributions are not paid, individual funding bodies have different arrangements for collection of non-payments. Contributions are based on a financial assessment and vary between funding bodies. We found that written information is given to clients and referrers prior to admission, and this makes clear any restrictions or rules in place that are designed to ensure clients safety and wellbeing. This is also discussed with new clients on arrival at Longreach to ensure they are aware and understand about restrictions and rules. The AQAA told us: We continue to offer a structured treatment programme designed in response to identified needs. Written individual treatment plans cover all aspects of care, including psychological, social and medical care. Some activities and educational sessions are optional. Contingency plans are in place in case of placement breakdown and care is taken to ensure that clients are supported in making transitions between treatment stages or options. The women who returned surveys told us that Longreach Help me with recovery; Keep me focused; Teaches me how to be aware, assertive and helps me with boundaries; Structure, support and understanding. Keeps you safe. A social and health care professional told us [Longreach]Cater for women with issues Care Homes for Adults (18-65 years) Page 5 of 13 around abuse and self-harm including eating disorders. They provide a safe place for women where these issues can be explored. We found that the daily programme runs from 08:00 until 16:00. This includes an hour and a half for administration of medication and therapeutic duties - TDs. There are also three check in sessions, one in the morning, another after lunch and the third one at the end of the day at 16:30.when the counsellors meet with the women to find how they are, if there are any issues, and to ensure everyone knows the days programme. Anyone not attending a group has to report to a counsellor beforehand to explain why they are not attending. There is an expectation that everyone will attend unless they are sick, have a medical appointment or a significant reason to be absent. Whole house groups (Monday and Friday) have a facilitator and a co-facilitator. Groups with less than six women have one facilitator. Students sit in on groups and observe until they are confident with opening and closing groups. The programme consists of a group session each morning Monday to Saturday and a therapeutic activity each afternoon. The whole programme is a focus on honesty and respect for each other, and preserving confidentiality. We found the Womens Education Association (W.E.A.) runs educational activities including a healthy eating programme that combines growing vegetables from seed to menu planning, preparing and cooking meals. The WEA runs a digital photography group. This gives the women an opportunity to take photographs of different topics. They learn how to download their pictures and edit them into albums. We saw photographs of a recent project linked in with the Eden Project about recycling. There were also plans to make cards using photographs. We found that a fourteen week rolling programme on domestic violence called Freedom To Change is run by an external contractor. The programme includes Why is it so hard to leave; effects on children; early warning signs; Saying goodbye to old patterns; and moving forward. If needed, there is the possibility to liaise with the police domestic violence unit. Women who stay in the Plymouth area after leaving Longreach are given information about local support groups such as Seeds (Survivors Empowering and Educating Domestic Abuse Services). We found that the counsellors are planning to re-introduce a Newcomers Group now more new people are arriving together. Over the past few months the turn around has been fairly slow (one new person approximately every three months). Now there are a number of newcomers it is possible to refocus on this group. It is also anticipated that a student will sit in on this group as they are now far enough into their placements to be able to take a more active role within the programme. We found that emotional wellbeing is integral to the treament plan. Eye Movement Desensitisation and reprocessing (EMDR) therapy, for example, is provided if appropriate, however this is subject to assessment. For some women this may be later in their treatment programme when they are better prepared for it by earlier work in other parts of the treatment programme. It is not suitable for everyone who comes to Longreach and is not a given part of the treatment programme. We found that the counsellors were concerned about funding and felt it is a major and restrictive issue. Most authorities now only fund for a maximum of twelve weeks. The Care Homes for Adults (18-65 years) Page 6 of 13 domestic violent programme, Freedom To Change, for example, runs over fourteen consecutive weeks. The counsellors feel it is important for women to repeat this programme in order they gain a better understanding as their treatment progresses. For some women this opportunity is not available as their funding is only twelve weeks. Funding can therefore impose restrictions on the benefits of the treatment programme overall for these women. We observed a therapeutic group about domestic violence, facilitated by an external contractor. We found that after this group lunch seemed to be a rushed affair as some of the women were keen to get on with the afternoon which they described as going into town and heading out to go tanning and get tattoos. Some of the women told us they get very bored with just one group a day and lots of free time. One of the counsellors explained that Tuesday afternoon is specifically described as Admin Time and is two hours. It is meant to be time to sort out collecting money, paying bills including financial contributions. The counsellors were aware of the tanning sessions and had spoken to the women concerned prior to our visit. We found that Broadreach House has one Resettlement Co-ordinator who works across all its projects. She visits Longreach two days each week although this can vary depending on how many women are nearing the end of their treatment programme. We found that the women we asked about external network/link groups that could be beneficial after leaving Longreach talked positively about a parenting class. They were unable to tell us about little else apart from SALT (Sexual Abuse Listening Therapy) and SEEDS (Survivors Empowering and Educating Domestic Abuse Services). Both groups link into the treatment programme. We were concerned about the possible lack of social inclusion especially for women coming towards the end of their treatment programme. The counsellors told us that any woman who wishes can attend external groups such as Alcoholics Anonymous and/or Narcotics Anonymous groups. These are options on Saturdays and Sundays only. We found that restrictive measures had been put in place at the time of our visit prohibiting any of the women from attending the groups run on two other nights during the week. This was because the women who were attending were found to be attending only for reasons of personal relationships that were inappropriate and harmful at their stages of recovery and treatment. We found that when women move into the cottage (latter stages of treatment), they can increase how often they go to external groups, and when. We were told by the counsellors as much as possible is retained in-house. The counsellors said that they are trying to encourage the women to stay at the house during the week in the evenings and not attend evening outside meetings. This approach seems to have reduced the risk of relapse. We found that yoga is offered periodically however it had stopped at the time of our visit because although the women express an interest, they do not turn up for the sessions. It is an external teacher and too costly. The manager confirmed that yoga will be reintroduced in a few months time when a different group of women are living here. We found that room checks are not done routinely. On arrival a new woman is assisted with her unpacking. Her belongings are not searched although things such as mouthwash Care Homes for Adults (18-65 years) Page 7 of 13 with alcohol listed as an ingredient will be removed. Rooms are not checked because they are regarded as personal space and because they are shared, generally there is sufficient peer pressure to keep the room tidy and clean. We found that the women are not routinely tested for drugs and/or alcohol unless the staff have sufficient suspicion to believe that someone has taken either or both. The manager told us that the house is run on an ethos of trust and respect. We found that one of the counsellors has primary responsibility for the medications. All the counsellors and senior support staff are trained and take responsibility for medication handling and administration. All the medication is kept in a lockable medication cupboard. No-one at the time of our visit had prescribed controlled drugs however these would be kept separately and securely. There was a medication refrigerator for medications requiring refrigeration. At the time of this visit self medication was restricted to the women prescribed ventolin inhalers. They each had a risk assessment that was reviewed weekly. Prescribed medication and any medication prescribed Take as required is kept in a separate medication box, labelled for each individual. Inspection of the medication records found that all had been given correctly and signed for accordingly. We suggested to the counsellor that photographs of the individuals on the medication administration sheets to identify them would provide a safety precaution and is good practice. We were concerned about the quantities of prescribed medications some women were taking. Although for some women there are complex medical reasons both physical and mental that benefit from treatment with medicines, we suggested that regular reviews of prescribed medicines may reduce for some women. This would enable them to move away from a risk of over dependency on prescribed medications. There were clear procedures for staff to follow regarding refused medication, spoilt medication and medication for return to the dispensing pharmacist. There was a clear audit for all drug disposals. We found that relationships between the staff at Longreach and local general practitioners is variable particularly if there are mental health issues. If a client is already known to a community psychiatric nurse prior to coming into Longreach, generally it is possible for the staff to request a new referral via the general practitioner. In other cases some general practitioners contact the Longreach staff to gauge if mental health support and input is necessary, whilst others refer directly to a psychiatrist and the mental health teams without talking to staff. This can have a negative impact especially where there is a non recognition or lack of understanding about addiction and symptoms relating to detoxification and rehabilitation. We found that all the staff have completed in-house training about Self Harming, Sexual Abuse, and Child Protection Level 1. Training for safeguarding vulnerable adults (SOVA) with the local authority was planned for the near future. This will mean that staff will know how to recognise the abuse of vulnerable people and how to report it. The training will also be about whistle blowing. There is also training about the Mental Capacity Act (MCA), and the Deprivation of Liberties Safeguards (DOLS) planned in the near future too. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. We found that all the staff completed a Basic First Aid At Work course in March 2010. The fire logs showed that fire drills are bi-monthly and, generally, evacuation is within two Care Homes for Adults (18-65 years) Page 8 of 13 minutes. Training is given at roll call to both clients and staff as well as annual fire training for all the staff. All other fire safety tests are routinely carried out and logged. The staff and student induction training log showed it is signed and dated by each person on completion of fire safety awareness. We found that accidents are recorded and stored correctly and safely. The CQC is notified of any serious incidents affecting the health, safety or well being of any of the women living at Longreach. Care plans inspected had risk assessments included in them that were relevant to the individual person. What the care home does well: What they could do better: The House Timetable was not explicit in its description of events. The mornings show either Workshop or Group (with the exception of one day), and the afternoons show a Therapeutic Activity. The evenings do not show any planned activity except karate and tai chi on Tuesday and Thursday. Friday afternoon is a leisure activity organised with the Womens Education Association (W.E.A.). We were told the support staff organise activities for the evening and weekends however this is not regular. Saturday afternoon and all day Sunday is Free Time. This has to be planned in advance with the support staff. If anyone chooses to go out during the weekend, they must be back at the house by 16:30. New clients generally do not leave the house for the first couple of weeks and when they do go out, it is either with a member of staff or someone who has been at Longreach for several weeks. We were concerned that the timetable shows Free time Friday evening, and from Saturday afternoon until Sunday evening. The manager described some of the informal activities organised by the support staff and we discussed that it would provide a better structure and benefit the women if these were formalised. The manager agreed that to have planned events such as film nights (film agreed a few days before) and beauty Care Homes for Adults (18-65 years) Page 9 of 13 sessions, would enable the women to recognise this as a wind down and end of week time. She agreed to discuss this with the support staff and gather ideas from the women about things they may like to do in a formalised way. Staffing levels are designed to meet peoples needs throughout the day and night, and there is a low turnover of staff and this helps care to be consistent. We were concerned that long periods of sickness on top of organisational changes has put a strain on staff levels. This means that over recent weeks the staff team, particularly the counsellors has been too lean with no slack for holidays, other planned leave or any unplanned leave or sickness. The majority of the women have continued to have one to one sessions and support from the same counsellor. For a few women they have found this a difficult period of time where they have felt unsupported. Measures are in place however to address this over forthcoming weeks following this inspection. This is to include considerations of options that can enhance and increase responsibilities for the current staff at Longreach thereby giving them recognition of their current achievements of positive outcomes for the women at Longreach. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 10 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 11 of 13 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 You should ensure that prescribed medications are reviewed regularly by a general practitioner to minimise the risk of over dependency by individuals on prescribed medications. You should ensure that you continue to give priority to implementing a robust training plan to ensure that people using this service continue to benefit from a quality staff team that is appropriately trained to meet their needs. 2 35 Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!