Care Home: Smithfield Detoxification Unit

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What the care home does well Since we last visited significant improvements had been made to the quality of assessments undertaken with people before they moved into the home. The information recorded in the four assessments that we looked at demonstrated that staff recognised each person as an individual with a different set of needs. This is called `person-centred care` and indicates that staff value and respect the diverse needs of people using this service. The following comments were made to the expert by two people using the service, "I can`t fault the staff in any way at all they`ve been fantastic to me" and " Staff are so friendly you can talk to them about anything and they will always try to help whenever they can". We commended this person-centred approach as an example of best practice. We found similar best practice examples when we looked at the care records belonging to four people using the service. This demonstrated excellent outcomes for people receiving the right amount of support in the way they preferred. The pharmacy inspector found further good practice in relation to medication systems used in the home. Staff were competent and managed the administration of medication safely. This promoted and protected the health of people who use this service. People using the service told us that staff took their views seriously and would take action if they had concerns. They told the expert that they felt safe living in the home. Robust systems were in place to keep people safe from harm and to ensure that only suitable staff were employed to work in the home. This provides evidence that the home was being managed in the best interests of people using the service. What has improved since the last inspection? It was pleasing to find that one requirement and three recommendations for improvement made at the last inspection had been addressed. All areas of medication handling had improved and people who use this service were no longer at risk of harm due to poor medication practices. At our last visit we asked for monthly reports on the home`s progress to be completed and forwarded to the Commission by a senior manager from the organisation. Monthly progress reports had been received up to October 2008. The manager said that reports for November and December 2008 would be sent following this visit. Improvements had been made to the assessment process to include detail on how people accommodated in the home would like to spend their free time. Records had improved to include details of staff training events and the outcome of their learning. What the care home could do better: Four good practice recommendations were made during this visit. The expert spoke to people using the service and attended a group discussion on the afternoon of our visit. People using the service unanimously expressed concerns at there being no structured timetable of activities in addition to the morning and afternoon group therapy sessions. They spoke of feeling bored and the expert was concerned that this may be detrimental to a successful recovery. The manager and staff explained why this is and we recognised that there were valid reasons that determine the safety of people using the service is a priority. However, we recommend that people using this service be consulted to find out if improvements can be made in this area. The expert also found that there was no second choice of meal provided at the midday mealtime, although a vegetarian option was available. The chef said that if somebody ordered an alternative meal it would be made for them. However, we were not sure that every person using this service would beconfident enough to request this so we recommend that people be offered varied choices at all mealtimes. Staff rosters did not provide enough detail to inform us of the actual hours staff had worked as shifts were written as `L` (late), `E` (early) and `N` (night). We recommend that the roster provides and accurate record of the actual hours worked by staff on each shift. The home`s fire risk assessment was last reviewed in October 2007. Since that time major alterations have been made to the environment and to the way the people using the service are accommodated. The document needs to be accurate as it can affect the systems in place for evacuating people from the building in the event of a fire. We spoke to the manager about this and it was agreed that the fire risk assessment would be reviewed and updated. CARE HOME ADULTS 18-65 Smithfield Detoxification Unit Thompson Street Collyhurst Manchester M4 5FY Lead Inspector Val Bell Unannounced Inspection 15th January 2009 09:25 Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smithfield Detoxification Unit Address Thompson Street Collyhurst Manchester M4 5FY 0161 8278570 0161 827 8571 ruth.anson@turning-point.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Turning Point Gill Campbell Care Home 32 Category(ies) of Past or present alcohol dependence (32), Past or registration, with number present drug dependence (32) of places Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence- Code A The maximum number of people who can be accommodated is 32 Date of last inspection 21st April 2008 Brief Description of the Service: The Smithfield Project is a registered service providing a residential detoxification service. The home is registered to provide 32 places for detoxification from alcohol and/or drug dependence. At the time of this visit the home had voluntarily limited the number of places to 22. The project is situated very close to Manchester City Centre, with easy access to public transport routes. The building also contains administrative offices. Bedroom accommodation is situated on the first floor. All bedrooms are single with hand washbasins. Communal space is provided on both floors along with a range of kitchen, dining and laundry facilities and a lift is provided for clients with restricted mobility. Clients attend support groups and participate in the therapeutic programme. Registered nurses and support workers are on duty throughout the 24-hour period. The fees vary according to the service being provided and are usually paid by the relevant Primary Care Trust or, very occasionally, privately. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection, which means that the manager was not told that the lead inspector and pharmacy inspector were coming to visit. Our visit was just one part of the inspection. We also looked at other information we had about the home, including events that the home had told us about since our last visit. We spoke to health and social care professionals that knew the home to ask their views on the quality of the service being provided. We were accompanied on this visit by an ‘Expert by Experience’ who is a person that has experience of using care services. The expert helped us to get a picture of what it is like to live in the home by talking to people accommodated on the day of our visit. We also looked at the home’s policies, procedures and care records, the environment and had conversations with staff and managers. What the service does well: Since we last visited significant improvements had been made to the quality of assessments undertaken with people before they moved into the home. The information recorded in the four assessments that we looked at demonstrated that staff recognised each person as an individual with a different set of needs. This is called ‘person-centred care’ and indicates that staff value and respect the diverse needs of people using this service. The following comments were made to the expert by two people using the service, “I can’t fault the staff in any way at all they’ve been fantastic to me” and ” Staff are so friendly you can talk to them about anything and they will always try to help whenever they can”. We commended this person-centred approach as an example of best practice. We found similar best practice examples when we looked at the care records belonging to four people using the service. This demonstrated excellent outcomes for people receiving the right amount of support in the way they preferred. The pharmacy inspector found further good practice in relation to medication systems used in the home. Staff were competent and managed the administration of medication safely. This promoted and protected the health of people who use this service. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 6 People using the service told us that staff took their views seriously and would take action if they had concerns. They told the expert that they felt safe living in the home. Robust systems were in place to keep people safe from harm and to ensure that only suitable staff were employed to work in the home. This provides evidence that the home was being managed in the best interests of people using the service. What has improved since the last inspection? What they could do better: Four good practice recommendations were made during this visit. The expert spoke to people using the service and attended a group discussion on the afternoon of our visit. People using the service unanimously expressed concerns at there being no structured timetable of activities in addition to the morning and afternoon group therapy sessions. They spoke of feeling bored and the expert was concerned that this may be detrimental to a successful recovery. The manager and staff explained why this is and we recognised that there were valid reasons that determine the safety of people using the service is a priority. However, we recommend that people using this service be consulted to find out if improvements can be made in this area. The expert also found that there was no second choice of meal provided at the midday mealtime, although a vegetarian option was available. The chef said that if somebody ordered an alternative meal it would be made for them. However, we were not sure that every person using this service would be Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 7 confident enough to request this so we recommend that people be offered varied choices at all mealtimes. Staff rosters did not provide enough detail to inform us of the actual hours staff had worked as shifts were written as ‘L’ (late), ‘E’ (early) and ‘N’ (night). We recommend that the roster provides and accurate record of the actual hours worked by staff on each shift. The home’s fire risk assessment was last reviewed in October 2007. Since that time major alterations have been made to the environment and to the way the people using the service are accommodated. The document needs to be accurate as it can affect the systems in place for evacuating people from the building in the event of a fire. We spoke to the manager about this and it was agreed that the fire risk assessment would be reviewed and updated. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Robust assessment of needs ensures that the service provided is based on meeting the personal needs and preferences of people using this service. EVIDENCE: At the time of this visit ten people were accommodated in the home. We looked at how the needs of four people had been assessed before they moved in. The good standard achieved in assessing needs identified at our last visit had been maintained and further improved. Current assessments detailed the specific needs of each person, including identified religious and cultural preferences. A doctor had undertaken medical assessments within 24 hours of admission and it was pleasing to find that emphasis had been placed on the assessment of individual’s mental health and emotional needs. Careful attention had been paid to assessing risks and restrictions on freedom of movement and choice had been agreed with each person based on the level of risk assessed. This provided evidence of best practice in careful assessment that safeguards the welfare of people using the service and was commended. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People using this service receive the care and support they need in a way that meets their expectations and emotional needs. EVIDENCE: We looked at care records belonging to the four people whose needs assessments we had examined. Plans detailing how people would be supported had been drawn up using the information written in their needs assessments. The four people had signed their support plans and they told us that they had been consulted about their preferences in how their needs should be met. This provided evidence that people admitted to the home were treated as individuals and that they were empowered to take responsibility for their own personal and healthcare needs. The good standard of support planning identified during our last visit had been maintained and further improved by recording daily observations of individuals’ mood and coping Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 11 strategies. This enabled staff to provide additional support when it was needed. One person said, ‘‘Staff have been very supportive to me. They have particularly helped me with my personal problems and anxieties around my mother’s ill health.” This was commended as evidence of best practice in what is termed ‘person-centred care.’ As identified under ‘Choice of Home’ risks had been carefully assessed and clear written guidance had been provided to inform staff what action they must take to keep people safe. Staff spoke confidently about their assessment and management of risk and demonstrated competence and skill in keeping people safe. Since we last visited, the Commission had received regular notifications from the home to inform us about how they had managed incidents that affected the welfare of people using the service. Support plans detailed where limitations to choice and human rights had been made in the best interests of individuals’ safety and it was evident that people using the service had been fully consulted where decisions had been taken on their behalf. The four support plans had been reviewed by the person using the service and their keyworker at intervals prescribed by the organisations procedures. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service receive support to maintain their relationships during structured treatment programmes. EVIDENCE: At the last inspection we recommended that support plans detail individual’s preferences on how they would like to spend their free time and this had been addressed by recording choices and preferences in care records. This marked a significant improvement on the findings of the last inspection. Emphasis had been placed on assessing each person as an individual and recognising that they had very different needs. The expert spent time talking to people using this service about mealtimes and opportunities for taking part in activities. Group therapy sessions were held each morning and afternoon and the expert joined the afternoon session on Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 13 the day of our visit. She found that people were expressing concerns about not having sufficient opportunity to engage in meaningful occupation for significant amounts of time during the day, other than the planned group therapy sessions. We asked staff and management about this. The manager explained that the priority of the service was to safely support people through detoxification programmes and the funding received for the service was predominantly targeted at facilitating this treatment. Staff told us that people were often unwell on admission and in the early days of their treatment and staffing was deployed to prioritise their safety. The manager added that it was explained to people prior to their admission that they would experience periods where not much was going on and that resources would be made available for social activities as and when available. There was some evidence that people had occasional opportunities to undertake escorted trips out of the home. We recommend that management consult with people using the service to determine if a more structured timetable of activities can be provided. Care records detailed where consultation had taken place with relatives at the discretion of people using the service. The expert found that people could maintain contact with relatives and friends through set visiting times and telephone calls. It was pleasing to find that people using the service had been asked to name the people that they would accept visits from as these measures afforded protection to their rights to privacy and a secure environment. The expert joined people accommodated in the home for their lunchtime meal. She found that meals were provided every day at set times with lunch served at 12.30 and the evening meal at 16.45. Breakfast was provided for the residents but they were responsible for preparing this in the kitchen on their unit. The expert expressed concern that people were not offered a choice of meal at lunchtime, although there was a vegetarian and non-vegetarian choice on offer. We asked the chef about this. He said that people can request alternatives and he did say that people could order something else and it would be made for them. However, some people using the service may not have the confidence to assert their choices in this situation. It is therefore recommended that a second choice be included on the daily menus. The evening meals were on a rota based menu changing every three weeks and people could choose their meal for teatime the previous day. Other snacks and drinks were available in the canteen to buy and fruit, snacks or drinks were available at any time, day or night. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The healthcare needs of people using this service are managed well and this ensures that they receive safe treatment and support according to their preferences. EVIDENCE: The four care records that we looked at showed that the individual’s personal, physical and mental health needs had been carefully assessed prior to admission. Records showed that these needs were being constantly monitored following admission to ensure there were no risks to their health and welfare. Where concerns had been identified, prompt referrals had been made for healthcare advice from doctors and community healthcare services. It was pleasing to find that the people accommodated received support to take responsibility for their personal and healthcare needs and to express their views on how they would like the support to be provided. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 15 During this inspection the pharmacist inspector checked that medicines were being handled safely and that the requirements made during our last visit had been met. The pharmacists visit lasted three hours. Full feedback was given to the team leader during the inspection and a summary of findings to the manager at the end of the visit. We looked at medication records together with medication held for four people living in the home on the day of the visit. At previous inspections we had found that there were discrepancies in the volumes of Methadone in stock because of poor measuring techniques. The pharmacy now supplies each dose of Methadone in an individually labelled bottle showing who it is for, the volume in the bottle and the day on which it must be taken. All Methadone can now be accounted for accurately. The quantity of methadone was recorded on receipt and careful checking in procedures showed that the pharmacy had supplied an incorrect quantity. The procedures ensured that the correct quantity was later supplied ensuring the correct dose could be administered. We found that the systems, which had been working well at, the previous inspection continued to work well. These systems included having full details of exactly what medication people needed to be prescribed on admission to the home and ensuring that the medicines were available as soon as the person was admitted so treatment was continuous and doses of vital medicines were not missed. The arrangements for the security of medicines continued to show that all medicines could be accounted for. Records about all types of medicines were found to be accurate and they showed that all medicines could be accounted for. They also showed that all medicines were given as prescribed. We found that all medicines were stored safely and at the correct temperatures. At the last inspection it was identified that the safety of people who wished to look after some of their own medicines was not assessed. We found current risk assessments in place to make sure that people were safe to look after their own medicines. It was discussed that the risk assessments should be made more personal to show the risk could be managed safely on an individual basis. The manager told us that medicines were regularly and formally audited to ensure that they could all be accounted for and that staff showed the necessary competency in handling medication safely. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 16 Overall we found that the systems and procedures in place regarding medication were good and that staff were competent in handling medicines safely. The health of people in the home was protected and promoted by good safe medicines handling practices. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust procedures ensure that people using this service are safeguarded from harm and have their concerns taken seriously. EVIDENCE: We asked a number of people using this service if they knew how to express concerns and complaints. People told the expert that they found staff to be approachable, their concerns were listened to and action was taken to make improvements. In conversation with staff we found that they took the welfare of the people they supported seriously. Staff talked about actively listening to service users’ views and communicating this information to senior staff when action needed to be taken that they were not able to deal with. The manager showed us the recording system for concerns and complaints. This provided evidence of how complaints were investigated and responded to within the prescribed time limits stated in the complaints policy and procedures. There were no outstanding complaints at the time of our visit. The people we spoke to confirmed that they felt safe while staying in the home. Policies and procedures were in place to safeguard the welfare and safety of people using the service. Staff told us that they had received training in how to recognise the signs of abuse and what action they must take if abuse was alleged or suspected. Notifications of significant events received from this service since our last visit provided evidence that harmful situations were Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 18 being identified correctly and reported through the appropriate channels. This was a significant improvement since we last visited. Two safeguarding referrals made to the local authority since our last visit had been investigated. It was pleasing to learn from the investigation team that their recommendations for improvement had been addressed by the home. The investigating team also told us that they had identified significant improvements to systems and procedures implemented in the home in order to ensure the safety of people using the service. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service live in a clean, warm comfortable and safe environment. EVIDENCE: We walked round the home to assess health and safety, cleanliness, hygiene and the quality of the environment. The home had undergone major alterations in the previous year in order to provide a safe service that was more responsive to the needs of people being admitted. Additionally, the organisation had voluntarily reduced their number of beds from 32 to 22 in order to consolidate these changes in a safe way. The expert made the following comments about the home, “During my visit to Smithfield I found the home to be very well kept. It was clean comfortable and homely. It seemed to have adequate security and the people I spoke to said they felt very safe and well cared for.” The expert had further observations as follows, “Even Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 20 though Smithfield is a non smoking building there is a smoking area provided in the outside back garden with a shelter and seats and ashtrays provided.” Suitable laundry facilities were provided for the people accommodated and thorough procedures were being followed to control the spread of infection. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive treatment and support from staff that they like and who have the skills to meet their needs safely and effectively. EVIDENCE: We looked at staff rosters. These told us that sufficient staff had been consistently deployed to meet the assessed needs of people accommodated. The rosters detailed which staff had been deployed on late (L) and early (E) or night (N) shifts. We recommend that rosters detail the start and end times of shifts worked by each member of staff to give an accurate record of actual hours of work. It was pleasing to see that the use of agency staff had been kept to a minimum. Agency staff that had been employed were familiar with the home and understood the policies, procedures and systems in use. We talked to three support workers and a nurse about their roles and responsibilities. We found them to be professional in manner and confident in describing how they met the needs of people using the service. They had good levels of knowledge and understanding of the policies and procedures Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 22 that they must adhere to and were also confident in talking about managing risk. One of the support workers said, “Changes (in the environment and procedures) make it feel much safer and we get good support. We will be having group worker training soon. I have a NVQ (National Vocational Qualification) level 3 in Health and Social Care. I was absent from work for some time recently and received really good support when I was returned to work. I was supervised regularly and that supervision is still ongoing.” The four members of staff confirmed that they had received training in essential health and safety and safeguarding adults from harm. The following are comments made by two people using the service in conversation with the expert, “I can’t fault the staff in any way at all they’ve been fantastic to me” and ” Staff are so friendly you can talk to them about anything and they will always try to help whenever they can”. “The expert had these observations, “My overall view after observing the staff and with comments made by the people accommodated is that staff are very approachable, friendly and helpful working well together as a team. No resident complained in any way about the way staff treated them, all residents spoke very highly of the care provided by staff.” The Commission employs Partnership Relationship Managers (PRM) to liaise with larger organisations at a national level. The PRM for Turning Point had undertaken an audit of Smithfield’s recruitment records during late 2008 and found these to contain the required pre-employment checks. Obtaining these checks ensures that the right kind of staff will be employed to work with people using this service. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is managed in the best interests of the people using its service. EVIDENCE: During this visit we found the home to be well managed with clear lines of responsibility and accountability. The following is the expert’s summary of their findings during the visit, “I found Smithfield to be a well organised, clean, homely and safe environment to be in. I feel people using the service have their individual needs met and I believe they are well cared for during their stay. I was impressed to hear that people are set up with the appropriate ongoing care needed when they are ready to successfully leave Smithfield and go back into the community. For example, links made to key worker, mental Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 24 health, depending on the person’s needs. I do think a lot more needs to be available activity wise as the boredom and frustration of sitting around watching TV could create a form of depression for some people and even prevent a successful recovery. I feel a greater selection of activities in the building such as cooking, flower arranging and playing board games could be considered to keep people busy and focused. Involving people in their own activity choices would be a great benefit to them. My overall view is I am pleased with the care provided to the residents and it was a well kept very modern home.” The home had a system in place to monitor and review the quality of the service being provided through regular auditing of policies and procedures and by issuing satisfaction surveys to the people using its service. We looked at a sample of health and safety records and found these to be accurate and up to date. However, the home’s fire risk assessment needed to be reviewed and updated to reflect the environmental changes that have taken place in the previous twelve months. The manager told us that this would be addressed. At our last visit we asked for monthly reports on the home’s progress to be completed and forwarded to the Commission by a senior manager from the organisation. Monthly progress reports had been received up to October 2008. The manager said that reports for November and December 2008 would be sent following this visit. Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations Management should consult with people using the service to determine if a more structured programme of activities can be provided. It is recommended that a second choice of meal be included on the daily menus. Rosters should detail the start and end time of each shift to provide an accurate record of the actual hours worked by staff. The fire risk assessment should be reviewed and updated to incorporate the environmental alterations and changes to the way the service is now delivered. This will provide accurate information for planning the safe evacuation of people in the building in the event of a fire. 2. 3. YA17 YA33 4. YA42 Smithfield Detoxification Unit DS0000021657.V373786.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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