Care Home: Stabilisation Services Passmores House

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What the care home does well The home is managed in an open and flexible way and people who use the service are involved in making decisions about their daily lives. People who are undergoing rehabilitation have detailed care plans, which reflect their needs and individual goals. These plans are reviewed regularly with each individual and progress is monitored and recorded. Residents receive treatment according to their assessed clinical and heath care needs. Residents have access to a doctor and their medication is reviewed as needed. Residents are happy with the care and treatment they receive in the home and feel that they get the support they need. Residents enjoy the food provided by the home and receive appetising, nutritionally balanced meals. People who use the service know how to complain and feel that complaints and concerns will be taken seriously and investigated. Complaints received since the last inspection were dealt with appropriately. The home`s environment is suited to residents needs and they have their own single accommodation and access to large, comfortably furnished communal areas, rooms for group therapy and private counselling sessions and a treatment room for complimentary therapies. Staff are recruited robustly and all the relevant checks as to their fitness are carried out before they commence work at the home. Residents feel that staff listen to them and treat them well during their stay at the home. What has improved since the last inspection? There have been a number of improvements made since the last inspection. The home is managed in a more open and inclusive way, where people who use the service can make comments and suggestions about the service without the fear or recriminations. Complaints are received and handled more appropriately and residents feel that their concerns are taken seriously and they are listened to. The home is more relaxed and some of the house rules and restrictions have been reviewed so as to offer residents more choice and flexibility. Residents have more opportunity to go out, keep in contact with their families. Residents can receive telephone calls in private and can keep their personal toiletries in their bedrooms. Staff are recruited more robustly and all of the checks around their suitability to work in the home, including references from previous employers, Criminal Records Bureau disclosures and Independent Safeguarding Authority checks are carried out before a person commences work in the home. These checks help to safeguard residents from harm and abuse. Some staff are undertaking training specifically around drug and alcohol awareness as part of their National Vocational Qualifications. What the care home could do better: Care plans for people who are undergoing alcohol or substance withdrawal should be more individualised so that they reflect each person`s treatment and their personal goals. Residents should be given written information around their treatment and any associated risks. Where risks are identified these must be assessed, monitored and managed in accordance with relevant policies and procedures for supporting people with alcohol and substance misuse needs. Staff must receive training specifically around types of drugs, their affects and the treatment of people for alcohol and substance misuse. Policies, procedures and information around current best practice and National Treatment Agency and National Institute for Clinical Excellence guidance must be available to ensure that treatment offered is appropriate and evidence based. Key inspection report Care homes for adults (18-65 years) Name: Address: Stabilisation Services Passmores House Third Avenue Harlow Essex CM18 6YL     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: Carolyn Delaney     Date: 1 1 0 6 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 34 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Stabilisation Services Passmores House Third Avenue Harlow Essex CM18 6YL 01992553173 01992509729 enquiries@valehouse.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Vale House Stabilisation Services Name of registered manager (if applicable) Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following categories of service: care home with nursing - Code N to service users of the following gender: either. Whos primary care needs on admission to the home are within the following categories: Past or present Alcohol dependence - Code A. Past or present drug dependence Code D Date of last inspection Brief description of the care home Stabilisation Services Passmores House is a care home, which provides accommodation and nursing support for detoxification and rehabilitation treatment for up to a maximum of fourteen adults who have or have had alcohol or substance and drug misues problems. The home is situated on the outskirts of Harlow town. Each person is provided with Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 14 14 0 2 0 6 2 0 0 9 Brief description of the care home single accommodation and residents have access to communal areas dining room, lounge, treatment room for alternative therapies and a garden. Care Homes for Adults (18-65 years) Page 5 of 34 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 healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a planned key inspection of the service in line with our methodology for monitoring and improving services, which have a 0 star poor quality rating. We last carried out a key inspection of the service on 17th December 2009. We visited the home on 11th May 2010 to check on progress with the issues we identified around safeguarding vulnerable people through the homes recruitment processes. Where we refer to the last inspection throughout the report this relates to the last key inspection. We sent surveys to ten people who live in the home. We asked people to tell us about the service and to highlight any areas where the home did well and any areas where they felt improvements could be made. We received five completed surveys at the time of writing the draft report. Comments made were reflected in the report and used to help us make judgements about the quality rating and the experiences of people using the service. Care Homes for Adults (18-65 years) Page 6 of 34 We reviewed other information available to us such as notifications of any illness, incidents or issues at the home which impact on the health, safety and wellbeing of people living in the home. We reviewed any information, complaints, concerns or allegations of poor practice or abuse we may have received about the service. When we carried this recent inspection we employed a nurse consultant who works with services that provide treatment for people with drug and alcohol misuse issues. This person accompanied us on our inspection visit and they carried out an audit of care plans, policies, procedures and staff training against current National Treatment Agency and National Institute for Clinical Excellence guidelines for good practice. They also spoke with residents undergoing detoxification treatment and the staff who support them. We used their detailed findings as evidence in making our judgements and overall quality rating for the service We spoke with nine residents, two members of staff, the homes manager, who had taken over the management of the home since the registered manager took retirement earlier this year, and the responsible individual. We looked at care plans and other written information that staff record about the needs of people living in the home and how they support them. We looked at the arrangements for ensuring that residents receive the care and medical attention they need, including medicines. We looked at how residents were supported in living their lives as independently as possible and the arrangements in place for providing opportunities for activities, socialising and occupation. We looked at how complaints and concerns were dealt with and how the views of residents were obtained and acted upon. We looked at the arrangements for recruiting and training staff and for safeguarding people who live in the home from harm and abuse. We looked at how the home was managed and maintained. Information obtained was triangulated and reviewed against the Commissions Key Lines for Regulatory Activity. This helps us to use the information to make judgements about outcomes for people who use social care services in a consistent and fair way. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care plans for people who are undergoing alcohol or substance withdrawal should be more individualised so that they reflect each persons treatment and their personal Care Homes for Adults (18-65 years) Page 8 of 34 goals. Residents should be given written information around their treatment and any associated risks. Where risks are identified these must be assessed, monitored and managed in accordance with relevant policies and procedures for supporting people with alcohol and substance misuse needs. Staff must receive training specifically around types of drugs, their affects and the treatment of people for alcohol and substance misuse. Policies, procedures and information around current best practice and National Treatment Agency and National Institute for Clinical Excellence guidance must be available to ensure that treatment offered is appropriate and evidence based. 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 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into Passmores House for detoxification or rehabilitation treatment can be assured that they will receive the support they need because their needs are assessed in detail. Evidence: Prior to visiting the home we sent surveys to ten people who use the service to complete and tell us about their experiences, what the service did well and any areas they felt could be improved upon. At the time of completing this report we had received completed surveys from five people. Each of the five told us that they had received enough information about the home so that they could decide if it was the right place for them. Four of the five told us that they had been asked if they wanted to move into the home. When we visited the home we looked at the arrangements for assessing the needs of people before they were offered a place for treatment. We looked at the assessments, which had been carried out for two people who were using the service for drug or alcohol rehabilitation. We saw that assessments had been completed for both people. Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: The assessments were detailed and covered information around each persons current and previous alcohol or drug use, frequency and level of use. There was information recorded about how this impacted on their typical day, general health, work and family life. People were asked about their early family life so as to identify potential triggers for substance misuse so that these could be addressed as part of the rehabilitation treatment programme. There was information recorded about any health issues a person may have and any medication they were currently taking. There was also information recorded around each persons current housing situation so as to identify what assistance may be needed upon the persons discharge from the home. An assessment was made into each persons insight into their addiction and their expectations and goals were recorded. Upon assessment of all of the information available a decision was made as to whether a place a Passmores House was appropriate and the decision to offer a place was made and recorded. We saw that one persons assessment had been completed in November 2009 and they did not commence rehabilitation treatment until February 2010. We discussed this with the manager and they told us that they person was initially admitted to Passmores House for detoxification treatment. We advised them that records and information around assessments for admission to the home must be kept so that there was clear evidence as to the procedure and timescales from assessment to admission so that we can see that people are admitted for treatment as soon as possible after the assessment has been carried out. We spoke with each of the four people who were receiving rehabilitation treatment. One person told us I moved over here from the detox unit and the transition was easy for me. They told us I chose this place because of the holistic treatments but I am disappointed as we dont get the complimentary therapies we should because the therapist is off sick. Each of the four people we spoke with told us that they were happy with the service and the treatment they received. One person said I am have been here for six months and am still here... I wont really know how good it is until I leave and face life on the outside. This person told us When I leave I know I can come back and sit in groups and get help if I need it. That helps me prepare for leaving. We looked at the assessments carried out for three people who had moved into Passmores House for detoxification treatment. There were three stages to the assessment. The initial assessment was completed by the administrator with information obtained from the referring agency. The other two assessments were completed by the doctor and nursing staff. We saw that detailed medical assessments had been carried out by the doctor, which included diagnosis and an assessment of Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: each persons health and any medical conditions. The nursing assessments were not completed in detail for one person and did not include information around current medication, baseline observations (Blood pressure, heart rate and respirations) so as to give an indication of current state of health. There was no information recorded about this persons drug or alcohol usage. Nursing assessments were basic and did not include information around harm minimisation, loss of tolerance to drugs or safeguarding issues. We discussed these issues with the manager and responsible individual and suggested ways in which the assessment process could be improved. We spoke with three residents who had been admitted to the home for detoxification treatment. Each of the three told us that they were happy with the treatment they were receiving. They did comment that they couldnt really remember what was going on for the first two or three days when I moved in so could not really comment on the assessment process. One person told us that they were due to move into the rehabilitation unit once their detoxification was completed. They told us that they would have a rather lengthy assessment on the day their detox was finished in order to assess my suitability for the rehab. They suggested that the assessment should be ongoing during the 4 weeks in the detox and issues should be addressed as they arise on an ongoing basis, then I would know whether or not I was ready for the rehab and could then work on any issues that came up during detox in order to be prepared for rehab. We discussed this with the manager who agreed to consider this. When a person moves into Passmores House they sign a license to occupy, which includes rules about their stay in the home. We looked at a copy of the rules and these included residents agreeing to staff opening official post and visitors to the home would agree to urine testing when they visited the home. Residents also had to agree that if they broke any of the homes rules that they would be asked to leave. We discussed these issues with the homes management team. We advised them that it is an inappropriate for staff to open residents mail and to test visitors to the home. We suggested also that the license agreement should be changed to reflect that if a person broke the house rules that they may be asked to leave and that this would be a decision made with the other people using the service. Care Homes for Adults (18-65 years) Page 13 of 34 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. People using the services at Passmores House can make more decisions about their daily lives and treatment. Evidence: One of the five people who completed a surveys told us that they always made decisions about what they do each day, two said that they usually did and two said that they never did. The home has a very structured programme for how residents spend each day including counselling sessions and group work. Residents who completed surveys very complimentary about the home and how they were treated. One person told us Passmores is good at listening to your issues and always have time for you and staff are very respectful and polite. Another person said I was very happy with the way I was dealt with and it has given me a stepping stone for the outside world. When we visited Passmores we looked at how staff supported residents to achieve their personal goals, make decisions about their care and treatment and to take Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: appropriate risks. When a person moves into Passmores House they give their consent and agreement about who they wish to have information about them and their treatment shared with and this helps to protect residents confidentiality and ensure that only those who the person agrees to is given information. We looked at the care plans for two people who had moved into Passmores House for drug or alcohol rehabilitation. We saw that care plans were developed with input from residents. There were set goals, which reflected what residents indicated they wanted to achieve during their treatment such as improving literacy and numeracy skills, finding employment and managing finances. We saw that care plans for both these people were reviewed on a regular basis with each individual and updated with information around the progress made with the goals set. We looked at the care plans for five people who were receiving detoxification treatment for alcohol or substance misuse. We saw that each person had a care plan developed for them and that residents had signed their care plan. However care plans were very prescriptive and written from a clinicians rather than the individuals viewpoint. There were up to fourteen goals recorded for some residents. Goals did not reflect residents perspective on what they wished to achieve and there were too may goals for a person to achieve at this stage of treatment. Care plans did not include any information around education, training or employment and residents did not have a copy of their individual care plans in accordance with National Treatment Agency 2007 guidelines and National Institute for Clinical Excellence (NICE). We spoke with each of the residents present on the day of the inspection. Residents told us that there had been improvements in the service especially within the previous few months. Residents told us that they could now receive telephone calls without staff being present and that they could go out more. One person commented that They could let you have more time out when you reach further in your recovery. We looked at how risks were assessed and managed when determining restrictions to the choices and decisions residents could make. At the time of this inspection there was no evidence that restrictions were based upon risks to individuals and the manager accepted this and told us that they would work on achieving this. Care Homes for Adults (18-65 years) Page 15 of 34 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. Residents make beneficial changes to their lifestyle as part of the structured treatment programme so as to assist them with their recovery and prepare them for moving out of the home. Evidence: One of the five people who completed surveys told us they could do what they want during the day, in the evening and at weekend. Four people told us that they could not and one person commented We have to attend groups. Group therapy sessions are an integral part of the treatment programme offered at Passmores. Most residents we spoke with during the inspection visit commented positively about the structured programme. One person said There is good discipline, routine and structure to the day. Two people commented that these sessions could be improved upon. One person told us that some of the sessions are too long and it is hard to keep concentration. Another person said that some of the sessions were repetitive. One resident told us Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: that they were going to speak with the manager about the group sessions and to make suggestions as to how they could be improved so as to be more beneficial. Residents told us that there had been improvements made in the way that they were able to make lifestyle choices. Residents told us that they could keep their toiletries in their bedrooms. When we last visited residents had not been permitted to do this. Residents told us that they could also take calls from family or case workers without the need for staff to be present. Residents felt that this improved their experience of using the service. They also told us that the home had a relaxed atmosphere. Residents told us that they could have family visits each Sunday now. One person who was undergoing detoxification told us that they would like the opportunity to see family, as this is not permitted for the first twenty- eight days of treatment. They told us that they did have the opportunity to speak with family on the telephone and suggested that a family day where relatives could come for lunch and participate in group work may be useful. We passed these comments on to the manager who said that they consider these options. We saw from care plans for people who were undergoing rehabilitation that goals and wishes around the individuals lifestyle were well recorded. We saw that one person had been supported in improving their literacy skills and had secured part time employment. We spoke with this person and they said I now have a job and my reading is much better and this has helped my self confidence so much. Overall we saw that there had been improvements made in supporting residents in their lifestyle choices within their treatment programme. However some limitations were still in place without evidence as to the reasons for these. One person told us I made a request that we could go to the cinema as a group as a treat but this was refused because there is a bar at the cinema. We discussed this with the manager who told us that the decision had been made as some members of the group were at the stage of their recovery where they would be a t increased risk of relapse and there for the decision had been made to decline the request. We discussed with the manager how this could be managed so as to give residents greater freedom of choice, while managing any assessed risks. On the day of the inspection a graduation ceremony was held for one resident who was nearing completion of their rehabilitation programme and was due to move out of the home the following week. This event was held to celebrate this individuals achievement and family and friends were invited to have a celebratory meal at the home. We spoke with the resident and they told us that they were very happy with the support they had received around preparing for their discharge. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Residents we spoke with were very complimentary about the meals provided by the home. We were invited to join residents for lunch and the celebratory meal and the food was well presented, nutritionally balanced and appetising. Residents in the rehabilitation unit told us that on occasions when the cook was not on duty such as weekends, holidays and when absent due to illness that they were responsible for cooking meals for all residents. They told us that this was very stressful as they had to attend group and cook meals and this left little free time during the day. One resident told us that when they had to cook that often there were not enough ingredients to prepare the meal, and we saw that this had been brought up in residents meetings. We discussed the issues raised with the manager and suggested that cooking could be managed so as to be incorporated into the residents programme as part of preparing them for moving out of the home. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well cared for and receive treatment as planned. Residents would benefit from information about their treatment and associated risks. Evidence: People using the services at Passmores House were independent for their personal care needs. Each of the five residents who completed surveys told us that staff and managers always treated them well. When we spoke with residents during the inspection visit they were very complimentary about their treatment and the support they received from staff and managers. Three of the residents we spoke with in the detoxification unit told us that they were extremely happy with staff. Each of the three told us that they felt that the treatment programme was too prescriptive and felt that their care plans should be more tailored to their individual needs rather than a one size fits all approach. Two residents said that they would like information about their treatment and the medicines they were taking. One person said I dont have a clue what I am on. We looked at the arrangements in place for supporting people during their withdrawal from alcohol and substances misuse. We saw that the none of the residents were Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: given written information around their detox and any associated risks. There were no policies and procedures in place for alcohol, opiate or stimulant withdrawal. There was no policy around overdose and the use of naxalone in opiate overdose management. These policies must be made available so as to support staff in caring for people who use the service. We saw that the programme for assisting people to withdraw from alcohol and substances using a substitute prescribing reduction regime were in line with current clinical guidance and good practice guidelines. The home is supported by a doctor who visits the home three days each week to coincide with admissions. We looked at how risks to the health and safety of people using the service were managed. We saw that the home had a system for assessing risks using the Worthing Weighted Risk indicator. This tool was predominately designed for assessing risks in an older population and while staff categorised risk and levels of risk there was no scoring tool to evidence how these decisions had been made. We saw that risks around self harm and suicide had been identified for two residents. However there was no plan in place as to how these risks were to be monitored or managed. The home had a policy for dealing with risks of blood borne infections and diseases. This policy only referred to Human Immunodeficiency Virus (HIV) and did not include information around other infections and diseases such as Hepatitis etc. Residents were not given information around the risks associated with discharge from the unit during their treatment, loss of opiate tolerance and risks of overdose. Residents told us that they found the complimentary therapies such as massage and Reiko very beneficial. However they told us that many of these treatments were not provided as the therapist was often off sick. One person told us I feel let down as I chose this home especially for the holistic therapies. Another person said Nobody tells you they are cancelled until they dont happen and this is frustrating. Care Homes for Adults (18-65 years) Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the services at Passmores House feel confident that their complaints will be taken seriously. Evidence: At the previous two key inspections carried out in 2009 people who use the service told us that they did not feel that they could make complaints or raise concerns without fear of recriminations. From the surveys we received before we carried out this inspection each of the five people told us that they knew who to speak to informally if they were unhappy and that they knew how to make a complaint. When we visited the home we spoke with three residents in the detoxification unit and four residents in the rehabilitation unit. In a stark contrast to previous visits residents on this occasion were happy to speak with us freely about their experiences in the home. Residents told us that they felt listened to. We asked residents if they felt they could make complaints or raise concerns and whether they felt these would be dealt with properly. Residents told us that staff and managers were more approachable and two people told us They listen to us more now. Each of the residents we spoke with told us that they were happy with the home and staff. Residents said that there was always someone to speak with if they had any issues. They told us that they felt confident to be able to raise concerns or make suggestions without any fear of recrimination. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: Residents we spoke with told us that they had no complaints about the treatment they received and that overall they were extremely happy at the home. Three people told us that they had previous experience of using the services at Passmores. They told us that they felt that things had improved greatly. They told us that while they could not pinpoint exactly the changes they felt that the home was more relaxed and they were listened to more. We looked at records for any complaints made since the last key inspection. We saw that one complaint was recorded where a residents clothing had been damaged in the washing machine. We saw that this had been investigated and the resident had been compensated with money towards the cost of replacing the items of clothing damaged. We spoke with the complainant and they told us that they were satisfied with the outcome of the complaint. We had received one anonymous complaint about the service since the last key inspection and we looked at this when we carried out a random inspection of the service in May 2010. We looked at the arrangements in place for safeguarding residents from harm or abuse. We saw that there was a policy in place around safeguarding vulnerable people and a whistle blowing policy, which assured people that they could raise concerns about poor practices etc without fear of recrimination. The safeguarding policy required updating as it did not include details of recent changes to guidelines and did not identify when and how safeguarding alerts should be referred to local safeguarding teams. We looked at how staff were recruited to work in the home. We looked at the recruitment file for one person who had been recruited to work in the home. We saw that all of the appropriate checks including Independent Safeguarding checks and Criminal Records Bureau disclosures before they commenced work. These checks help to ensure that only people who are suitable are employed in the home. When we carried out our random inspection in May 2010 we saw that all staff working in the home had these checks carried out. We looked at information provided by the manager around staff training. We saw that all but newly employed staff had completed training around safeguarding vulnerable adults and children and that annual training updates were provided. Training was planned in August for the most recently employed member of staff. However none of the staff working in the home had undertaken training around identifying, managing and minimising risks and residents were not provided with information around risks associated with detoxification, loss of tolerance to opiates and other drugs and risks of overdose. We discussed these issues with the manager and responsible individual and Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: they assured us that these issues would be addressed. Care Homes for Adults (18-65 years) Page 23 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clean, safe and well maintained personal and communal spaces,which suits the needs of people who use the service. Evidence: Three of the five people who completed surveys told us that the home was usually fresh and clean and the other two told us that it always was. When we visited the home we made a brief tours of the premises communal areas. All areas of the home we looked at were clean and free from unpleasant odours. Residents have their own single personal accommodation and had access to communal dining room, lounge areas, which were nicely furnished and equipped with televisions and music systems. Residents also had access to rooms for group therapy and counselling sessions, a treatment room for complimentary therapies, a designated smoking area and attractive garden. During the inspection residents we spoke told us that they were happy with their accommodation. We looked at records for regular weekly residents meetings. At these meetings residents raised some issues about their accommodation such as issues with showers not working properly, smelly drains and bedroom doors slamming or not closing properly. We saw in the minutes of the most recent meeting that the manager Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: had arranged for a contractor to visit the home within the next few weeks to deal with the issues identified. Care Homes for Adults (18-65 years) Page 25 of 34 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. Residents are well cared for by staff who are recruited robustly. Residents would benefit from staff who are trained to meet their specific needs. Evidence: Each of the five residents who completed surveys told us that staff and managers treated them well. Residents told us that staff and managers were approachable and helpful. One person told us staff here are excellent, always available to speak to when I need them. When we visited the home we looked at how staff were recruited, trained and deployed to support people who use the service.We looked at staff rotas for both the detoxification unit and the rehabilitation units for a period of four weeks. Rotas did not clearly identify staff roles or designations and it was difficult to determine what hours staff worked. It was also not easy to identify where temporary agency worked in the home. Where agency staff were employed their full names were not recorded on the duty rota. We discussed these issues with the manager and advised them that the rota should show names and roles of staff working in the home. The manager told us what the staffing levels were for both units. They told us that a minimum of one nurse and one case manager was employed during the day and at night on the detoxification unit. The manager told us that there were staff shortages due to vacancies and that Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: once new staff were employed that staffing levels would be more flexible. The manager told us that where possible that two nurses were employed on the days where people were admitted to the unit for treatment. Residents told us that staff were available when they needed them and that there was always someone to speak to. We looked at how staff were recruited to work in the home. We looked at the application and other information for the one person who had been employed to work in the home since we last visited in May 2010. We saw that a full and detailed employment history and satisfactory references from previous employers had been obtained. In addition satisfactory Criminal Records Bureau disclosure and Independent Safeguarding Authority check (formally PoVA First) had been obtained before the person was employed. These checks helped ensure that only people who were suitable were employed in the home. We looked at records kept around interviewing candidates. The interview was very basic and did not cover areas such as relevant experience, skills and competence of individuals applying to work in the home. We looked at how staff were trained and supported to meet the assessed needs of people who use the service. We saw that staff Some staff were currently undertaking National Vocational Qualifications specific substance misuse modules, which are linked to the Drug and Alcohol National Occupational standards (DANOS) and we advised the manager that all staff should undertake this training. From the training file provided by the manager we saw that planned staff training included moving and handling training annually, training around child protection and safeguarding vulnerable adults, infection control, risk assessment, health and safety, fire safety, medication, food hygiene and first aid every two years. We saw that no staff had received infection control or risk assessment training. We looked at training provided specifically around understanding and managing drug and alcohol misuse. We saw that staff did not have basis training in recognising commonly used substances,such as opiates, benzodiazepines and stimulants, their street names, properties and effects. Staff working in the detoxification unit did not have training around recognising opiate overdose and its management, relapse prevention, harm minimisation and substitute prescribing. This training is recommended as minimum training for staff supporting people through alcohol and substance withdrawal by National Treatment Agency and National Institute for Clinical Excellence. We discussed these issues with the manager and the importance of appropriate training for staff. We saw that there was a structured supervision programme and policy for supporting Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: staff and that staff had regular sessions with the manager to discuss ways of working and training issues. Care Homes for Adults (18-65 years) Page 28 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Passmores House is well managed and run in the interests of people who use the service. Evidence: When we visited the home we looked at how it was managed and run in the best interests of the people who used its services. We looked at how the views of people were obtained and used so as to improve the service and the experiences of residents. There is a management team in the home, which which consists of a Service Manager, Finance Manager, Bed Manager and Project and Property Manager. There is also administrative support for the home. Residents we spoke with said that the home was much better and more relaxed. They told us that they felt listened to and that they could speak freely about their feelings to staff and managers. The registered manager had retired since the last key inspection and a new manager had been appointed. They told us that they were working to address issues identified during the last inspections and to make Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: improvements to the service. We looked at how the views of people who use the service were obtained. We saw that residents held weekly house meetings and any issues , comments and suggestions were recorded as was the action planned to address these. We looked at records for these meetings and saw that residents made suggestions about outings, meals, and the homes environment. We saw that actions were then taken so as to facilitate residents wishes where this was appropriate and practical. Residents who are admitted for detoxification treatment are given a survey to complete at the end of their stay and residents who are receiving rehabilitation support receive surveys at three and six month interim stages of their stay. We looked at the results from surveys, which residents had completed. Residents were asked if the service performed well in the following areas; making people feel safe and welcome, how approachable and knowledgeable staff were, how supported residents felt during their stay at Passmores House. Responses were very complimentary and positive. One resident commented said that treatment was excellent. Another person said Overall I had a positive experience, staff were friendly and supportive, other residents were friendly. Food was good and plentiful. One resident commented This is the best detox I have done. I would advise anyone coming in like I did to do the same and all the staff were brilliant. Thank You. And one person said The staff and facilities are excellent and if anyone has to go through a detox there is no where better than passmores. We discussed the issues we found in terms of care planning, risk assessments and the lack of important policies, procedures and staff training and the managers assured us that they would take appropriate action to address these and to comply with regulatory requirements made as a result of our inspection visit. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13 Risks to each persons health 26/03/2010 and safety must be assessed and appropriate action taken where risks are identified. This must be done so as to ensure that people can take appropriate risks within their treatment programme. Care Homes for Adults (18-65 years) Page 31 of 34 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 18 12 Policies and procedures specific to treatments residents receive must be developed and be made available to staff and where appropriate people who use the service. This must be done so as to ensure that residents are treated in accordance with relevant clinical guidelines and that staff have the information they needs to support people properly. 27/08/2010 2 19 13 Risks to the health and safety of people using the service, particularly risks around their treatment, substance and alcohol misuse and suicide or self harm issues must be properly assessed and managed. 30/07/2010 Care Homes for Adults (18-65 years) Page 32 of 34 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 This must be done so as to minimise risks to the health and safety of people using the service. 3 34 18 Staff must undertake 30/09/2010 training specific to the needs and treatment of people who are using the service for alcohol and substance withdrawal. This must be done so that staff have the knowledge, skills and relevant information so as to treat residents in line with current guidance and good practice guidelines. 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 6 Care plans for people who undergoing detoxification treatment could be more user focused and residents goals and choices for how they wished to be supported and treated. Restrictions to residents choices and decision making should be determined through a system of assessing risks to each individual and allowing people to take acceptable risks as part of their ongoing programme for treatment. The homes policy and procedure around safeguarding vulnerable people should be amended to reflect current local safeguarding guidelines including reporting procedures and safeguarding children. 2 9 3 23 Care Homes for Adults (18-65 years) Page 33 of 34 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 non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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