Care Home: T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit

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What the care home does well Good information is provided to prospective service users and professionals involved in drug and alcohol services. This includes a DVD created with the involvement of service users, with copies being made available to prisons and other agencies. Following the pre admission assessment the manager keeps in contact with the individual whilst they are in detoxification, either by telephone or by visiting them. This support helps to keep people focussed on the treatment programme. There are arrangements in place whereby individuals can be collected straight from prison or from the place of detoxification. This seamless transition is a strength of the service. The service users spoken to said that they were happy with the mix of group sessions and individual sessions, free time and planned leisure activities. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 The diverse staff team have a balance of all the skills, knowledge and experience to meet people’s needs. Qualification training for staff is given a high priority. The number of qualified staff exceeds national targets and is to be commended. Service users spoke highly of the staff team, their qualities and their availability for one to one support when required. There are good management systems in place and the management team provide strong leadership for the staff team. Quality monitoring and quality assurance are given a high priority and systems have been maintained and built upon since the last key inspection. The treatment programme supports individuals to share experiences and the regular group sessions encourage an open dialogue. Staff are available 24 hours a day and an open and trusting ethos is promoted, meaning that service users can raise any issue or concern as part of day to day life at Witton Bank. Residents meetings take place and surveys are regularly distributed to service users, inviting feedback about their experiences at the home. What has improved since the last inspection? Since the last key inspection the management team have sustained and built upon existing strengths and have responded to the areas highlighted for improvement. Medication procedures have greatly improved. There is now a dedicated room for the safe storage of medication. The clinical coordinator, who is a qualified nurse, now takes the lead responsibility for medication at the home, ordering stock, liaising with the dispensing pharmacist and carrying out checks. All staff who deal with medication have undertaken accredited training. These improvements all help to ensure that people receive medication as prescribed and that clear records are maintained. Any potential health care need or indication of risk is identified at the assessment stage and plans are put in place to address this. Robust recruitment procedures are now in place, which help to ensure that only suitable staff are employed at the home. Training for staff is well organised, with health and safety topics being addressed and all project workers have achieved level 3 NVQ. (National Vocational Qualification.) What the care home could do better: The management team should continue to maintain the high standards achieved during the last year, with the robust quality assurance measures playing a key role in this. Although medication practices have much improved and are generally good, it is recommended that medication packaging is dated when it is first used. This would help to ensure that medication is not used past its use by date andT.H.O.M.A.S Drug & Alcohol Rehabilitation UnitDS0000071249.V377146.R01.S.doc Version 5.2 would also help to provide an audit trail of medication administered. Where handwritten entries need to be made on medication administration records, these should be checked and signed by two people, to help to avoid any errors being made. Some medications, prescribed to be taken when required, were not on the printed medication administration records supplied by the dispensing pharmacist and this should be addressed with the pharmacist. The medication administration record should give details of all prescribed medication. Key inspection report CARE HOME ADULTS 18-65 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit Witton Bank Witton Spring Lane Blackburn BB2 2PW Lead Inspector Lesley Plant Key Unannounced Inspection 11th and 16 September 2009 09:30 th T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit Address Witton Bank Witton Spring Lane Blackburn BB2 2PW 01254 59240 01254 56884 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) T.H.O.M.A.S (Those on the Margins of a Society) Mrs Catherine Victoria Woolham Care Home 21 Category(ies) of Past or present alcohol dependence (21), Past or registration, with number present drug dependence (21) of places T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.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 only - code PC, 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: 21 Date of last inspection 9th September 2008 Brief Description of the Service: T.H.O.M.A.S Witton Bank is a care home offering rehabilitation for adults with a history of drug and/or alcohol dependency. The service can offer 24-hour personal care and accommodation for up to 21 people. The rehabilitation programme runs for 26 weeks and is based on the 12-step philosophy, combined with cognitive and psychotherapy techniques. The organisation also provides stage 2, supported housing in the Blackburn area, which people may move onto following their stay at Witton Bank. The home is situated in a residential area approximately two miles from the centre of Blackburn, which has a full range of community facilities and access to transport networks. The house has a mix of single and shared bedrooms. Most of the bedrooms do not have en-suite facilities but there are sufficient toilets and bathrooms situated around the home. Communal rooms include three large lounges, a dining room, a group room and kitchen. Details of the fees can be obtained by contacting the manager of the home. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.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 3 star. This means the people who use this service experience excellent quality outcomes. This key inspection focused on the outcomes for people who use the service and involved gathering information about Witton Bank from a wide range of sources over a period of time. The initial site visit for this inspection was unannounced, with a further planned visit taking place At the time of this visit there were 15 people resident at the home. All of the key national minimum standards, plus the standards relating to information provided to prospective service users and staff supervision, were assessed. Time was spent talking to service users, staff, the manager and the chief executive of THOMAS, the provider organisation. Records were viewed and a tour of the building took place. The Annual Quality Assurance Assessment completed by the manager of the home, also provided some useful information. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. Care Quality Commission surveys were received from 5 members of staff and information from these is included within this report. The last full key inspection was conducted in September 2008. What the service does well: Good information is provided to prospective service users and professionals involved in drug and alcohol services. This includes a DVD created with the involvement of service users, with copies being made available to prisons and other agencies. Following the pre admission assessment the manager keeps in contact with the individual whilst they are in detoxification, either by telephone or by visiting them. This support helps to keep people focussed on the treatment programme. There are arrangements in place whereby individuals can be collected straight from prison or from the place of detoxification. This seamless transition is a strength of the service. The service users spoken to said that they were happy with the mix of group sessions and individual sessions, free time and planned leisure activities. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 6 The diverse staff team have a balance of all the skills, knowledge and experience to meet people’s needs. Qualification training for staff is given a high priority. The number of qualified staff exceeds national targets and is to be commended. Service users spoke highly of the staff team, their qualities and their availability for one to one support when required. There are good management systems in place and the management team provide strong leadership for the staff team. Quality monitoring and quality assurance are given a high priority and systems have been maintained and built upon since the last key inspection. The treatment programme supports individuals to share experiences and the regular group sessions encourage an open dialogue. Staff are available 24 hours a day and an open and trusting ethos is promoted, meaning that service users can raise any issue or concern as part of day to day life at Witton Bank. Residents meetings take place and surveys are regularly distributed to service users, inviting feedback about their experiences at the home. What has improved since the last inspection? What they could do better: The management team should continue to maintain the high standards achieved during the last year, with the robust quality assurance measures playing a key role in this. Although medication practices have much improved and are generally good, it is recommended that medication packaging is dated when it is first used. This would help to ensure that medication is not used past its use by date and T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 7 would also help to provide an audit trail of medication administered. Where handwritten entries need to be made on medication administration records, these should be checked and signed by two people, to help to avoid any errors being made. Some medications, prescribed to be taken when required, were not on the printed medication administration records supplied by the dispensing pharmacist and this should be addressed with the pharmacist. The medication administration record should give details of all prescribed medication. 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. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.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 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People using the service experience excellent quality outcomes in this area. Good pre admission assessments take place, which help to ensure that the service can meet the needs of the person and that any associated risks are identified at an early stage. Contact is maintained with service users during their detoxification programme, with the aim of providing a seamless transition into the rehabilitation programme at Witton Bank. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Good information is provided to prospective service users and health/social care professionals who may make referrals to Witton Bank. A Statement of Purpose, Service User Guide and promotional DVD are all made available. The DVD was created with the involvement of service users and copies have been made available to prisons and other agencies involved in drug and alcohol services. Three people were spoken to regarding their admission to Witton Bank. All confirmed that they were provided with good information about the T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 10 rehabilitation programme and the associated restrictions which apply to all service users at Witton Bank. Two of the service users had visited the home, where the assessment had taken place. The third person had their assessment, supplemented with information from the referrer, over the telephone. All three had completed a detoxification programme at another location prior to admission to Witton Bank. One person explained how changes had been proposed regarding the length of time his detoxification would take and that he had been very concerned about how this could potentially change his agreed admission date to Witton Bank. The manager provided assurances that his admission date could remain flexible and would ‘fit in’ with the detoxification programme. The individual concerned spoke of the support this gave him, knowing that his place at Witton Bank would be held for him. The manager explained that people are invited to visit the home, share a meal and talk to staff and service users about the nature of the rehabilitation programme. This is not always possible, due to distance or because some people come to Witton Bank from prison. The manager will keep in contact with the individual whilst they are in detoxification, either by telephone or by visiting them. This pre admission support helps to keep people focussed on the treatment programme. There are arrangements in place whereby individuals can be collected straight from prison or from the place of detoxification. This seamless transition is a strength of the admission process. Records show that good information is gathered prior to admission to the home. Information includes drug/alcohol history, criminal record, employment history and any health issues. There is also a psychological self assessment and a self assessment of support needs. Risk assessments also take place, such as regarding coping skills and self harm. Following the assessment, admission to Witton Bank is confirmed in writing to the individual with, signed agreements regarding drug testing and house rules being obtained. Assessments from the referring drug and alcohol team were also viewed on individual files. Discussion took place regarding people who are admitted to Witton Bank and then leave, early on in the programme. The manager explained that people referred directly through the criminal justice system may not be fully committed to the programme of change but that the organisation strongly believes that this opportunity to change should be given to all. Anyone leaving the programme early is offered outreach support and the referrer is informed. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 People using the service experience good quality outcomes in this area. Support plans and risk assessments are in place and are regularly reviewed to reflect the changing needs of each person as they progress through the treatment programme. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person is fully involved in the development of their care plan and the reviews which take place. Each person is allocated a service user mentor, who has been engaged in the programme for some time and is in a good position to provide peer support. A key worker is allocated who meets each week with the individual concerned and conducts the monthly reviews of the care plan. The weekly key worker reports give a good account of how each person is progressing within the programme. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 12 The monthly reviews seen were all signed by the service user and contained an action plan for the following month. These regular reviews are an essential element of the service, as individual needs will change as they progress through the programme. Each person has their own file, containing the work they are doing in relation to the 12 steps and they have a copy of their care plan in this file. The monthly reviews also allow for any restrictions to be reviewed at regular intervals. Project workers complete daily records and each service user writes a daily ‘feelings log’, with any issues raised being addressed. One service user spoken with explained how the first steps from the 12 step programme would be worked through at Witton Bank and that further steps would then be addressed. This individual explained how project staff offer support with this process and that the steps would continue to be worked on after discharge. Each person has complete ownership of their own steps file. Review reports are sent to the person funding the service after three months and just prior to discharge. Funders also carry out their own reviews and are invited to the formal three monthly review. The clinical coordinator, a qualified mental health nurse has started compiling psychosocial reports for each service user after discussion with the key worker and the psychotherapist. This is an overview of progress, which pulls together the different strands of the treatment programme. The nature of the programme means that restrictions are in place, such as no visitors until the individual is fully settled in and there are restrictions and conditions regarding going out alone. There is structure to each day, with people attending group and one to one sessions, having time to work on their ‘steps’ files, time to carry out domestic household tasks and set periods of leisure time. Within this framework decision making is supported and this often involves group decisions regarding who is group leader, choice of menu and choosing who will be the kitchen manager. Risk assessments and risk management plans are in place and are regularly reviewed, showing how certain risks are reduced as an individual works through the programme. An individual spoken to explained the process of risk assessing prior to any home visit, whereby the key worker helps in drawing up a risk management plan for the time spent away. Risk assessments also take place regarding any visitors to the home, including children. Peers are also involved in risk management during discussions within the group sessions which form part of the treatment programme. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. The service supports people to address previous lifestyle issues, learn new skills and provides a good balance between choice, restrictions, structured programme sessions and free time. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the beginning of the treatment programme individuals are not encouraged to look too far ahead as people need to focus on each day of their recovery and their emotional and mental well being. Lifeskills such as cooking and budgeting form part of the programme as appropriate to each individual. A volunteer worker provides literacy support for people who find the written aspect of completing their ‘steps’ files difficult and there is also a dictaphone T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 14 and other equipment available for people to use. As people come near to the end of the programme, there is more focus on activities such as college and voluntary work, with many people choosing to stay in the local area and move into the second stage supported housing service provided by THOMAS. THOMAS also run an ‘Academy’ programme that offers recovering users opportunities to engage in accredited schemes for education and personal development, including peer support, recovery coaching and Drug & Alcohol National Occupational Standards based training. Discussions with service users confirmed that there is time for social and recreational activities, both group and individual. The written weekly programme clearly identifies periods of free time. Those spoken to said that there was a good balance between structured time and free time. People go out regularly into the local community with staff or peer escorts. Several people go to the gym regularly. A weekend trip away is being planned and several people said that they had enjoyed a country hike recently. Other activities include swimming and visiting the library. The home has a mini bus, which is used for group trips out. Positive relationships with and understanding by the local community is promoted and fostered. The current service users are planning an open day and a local community group use a room in the building for their regular meetings. Peer support is an important element of recovery, which was evident during the inspection visit. Attendance at alcoholics anonymous and/or narcotics anonymous groups also take place. Group and individual sessions address relationship issues, with individuals being supported to maintain positive and healthy personal relationships. There are restrictions on home leave and receiving visitors, which are necessary for risk reduction and for individuals to focus on their recovery. Whilst in the programme intimate personal relationships are discouraged, to enable individuals to concentrate on their personal development and treatment. Each person signs to agree to the restrictions at the home and those spoken to said that they fully understood the reasoning behind these restrictions. The structured treatment programme dictates the daily routines at Witton Bank. There are set times for group sessions, individual key worker meetings, leisure activities, domestic duties and meals. Individuals are also required to attend at least three alcohol anonymous or narcotics anonymous meetings each week. Those spoken to said that there was a good mix of structured activities and free time and that the arrangements for kitchen and domestic tasks were fair and worked well. A meeting is held every week to discuss the menus for the following week and there is a rota for kitchen duties, with a kitchen manager being elected who T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 15 goes food shopping. The manager oversees the menu choices and food shopping to ensure that meals are healthy and balanced. Many service users will previously have led a chaotic lifestyle which did not include healthy or regular meals and therefore healthy eating and regular meal times are given a strong focus. Several people spoken to talked of their general health improvement since coming to Witton Bank. People are also supported to learn cooking skills needed for healthy independent living. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. People are supported to access community health care services. Medication practices are generally good, however further improvement in this area will provide extra safeguards and strengthen current arrangements. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The people currently staying at Witton Bank do not require any support with their personal care, although staff support would be available if required. If any issues regarding personal hygiene arose, then this would be addressed on an individual basis, in one to one key worker sessions. The assessment process identifies any health care needs and risk assessments address issues such as self harm. All risk management plans are regularly reviewed. The records viewed showed that any health issues identified are addressed, with written guidance provided for staff regarding one person who T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 17 has a history of epilepsy. People register with a local GP and are supported to take responsibility for making their health care appointments. Staff support is available if needed. During the first day of the inspection an individual became distressed regarding certain results of health care testing in relation to his particular health condition. The manager provided sympathetic support and practical advice and later it was observed that a fellow service user was also providing support to this person. Peer support forms an important and natural part of the rehabilitation programme as seen during the inspection. Drug and alcohol testing is carried out, such as when people return from home leave. Staff have all been trained to carry out these tests and have had their competency checked by the manager of the home. People are supported to eat a healthy diet, with the menu planning being overseen by the manager of the home. Healthy regular meals, set times for going to bed and the structured rehabilitation programme all have a positive impact upon the health of those at the home. One person spoken to talked of his past chaotic lifestyle and how he felt that his physical and emotional wellbeing had vastly improved whilst at Witton Bank. Since the last key inspection, improvements have been made to the way medication is managed at Witton Bank. There is now a dedicated room for the safe storage of medication, with a fridge available for any medication requiring cold storage. The clinical coordinator, who is a qualified nurse, takes the lead responsibility for medication at the home, ordering stock, liaising with the dispensing pharmacist and carrying out checks. All staff who deal with medication have undertaken accredited training. Service users administer their own medication, with staff providing oversight and completing the medication administration record. Service users may retain certain medications such as creams or inhalers. Records are kept of any non prescribed medication such as homely remedies, taken by service users. Specific storage and recording systems are available for controlled drugs. It is recommended that medication packaging is dated when it is first used. This would help to ensure that medication is not used past its use by date and would also help to provide an audit trail of medication administered. Where handwritten entries need to be made on medication administration records, these should be checked and signed by two people, to help to avoid any errors being made. Some medications, prescribed to be taken when required, were not on the printed medication administration records supplied by the dispensing T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 18 pharmacist and this should be addressed with the pharmacist. The medication administration record should give details of all prescribed medication. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. People are encouraged to give feedback about the service provided and are given information regarding how to raise a formal complaint. Policies, good practice and staff training help to promote the protection of those staying at Witton Bank. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Details of the complaints procedure are included within the Statement of Purpose and the Service User Guide, which is given to all service users. The Service User Guide also contains a complaints form, along with details of the complaints procedure. Information in the surveys completed by staff confirms that staff know what to do should anyone raise a concern. The organisation promotes service user involvement and encourages people to raise ideas and suggestions via the residents meetings, feedback questionnaires and more informally through the day to day interaction with staff. A suggestion box is also provided. New staff complete the ‘Skills for Care’ (national training organisation) common induction standards which include, recognising and responding to abuse and neglect. These issues are also addressed within NVQ (National T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 20 Vocational Qualification) programmes undertaken by staff. Information within the AQAA completed by the manager confirms that policies, such as whistle blowing and safeguarding adults are in place and that there are systems in place for reporting any form of suspected abuse. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. The accommodation is maintained and decorated to a good standard, and provides a good range of communal rooms for both programme activities and relaxation. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is situated just outside Blackburn, in reach of local facilities. There is a good range of communal rooms suitable for both programme group sessions and relaxation. The conservatory is designated as a ‘quiet’ room, with no television or music. All areas seen were maintained and decorated to a good standard. There are seven single bedrooms and seven double bedrooms. The manager explained that new people, where possible are placed in a double room to help them settle in and prevent isolation during the first few weeks T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 22 when individuals may feel particularly vulnerable. People then move to a single bedroom as they progress through the programme. Some bedrooms have a wash basin and one bedroom has a shower. There are ample toilets and showers on the corridors near bedrooms. There is a ground floor room used for counselling sessions which could be used, and has been used in the past, for someone with mobility problems. Outside there is a parking area, a smoking shelter and another lower concreted area accessed by steps. Senior staff within THOMAS are currently considering how this space could be best used/adapted for service users to enjoy. A separate stairway leads to offices used for the administration and running of services provided by THOMAS. A maintenance worker is employed to carry out small jobs at the home, with specialist contractors called upon for more complex works. The laundry facilities are sited in the basement, with service users taking responsibility for the laundry and care of their own clothing. The weekly programme includes specified times for cleaning duties, which are carried out by service users. The home appeared clean. Infection prevention and control is included in the Skills for Care (national training organisation) common induction standards undertaken by all new staff and written policies are also in place and available for all staff and service users. The clinical coordinator is developing more robust guidance in this area. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience excellent quality outcomes in this area. Service users are supported by qualified, competent and well supported staff and good recruitment procedures are in place. This means that people are protected and have their needs understood and met. Staff have excellent opportunities to gain qualifications and therefore gain skills and knowledge which benefit those using the service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A psychotherapist and a counsellor are employed on a sessional basis and are qualified in their particular field of work. Project workers are on duty during the day with full working night cover also in place. The two full time project workers act as key workers to individuals and have additional responsibilities, which include reviewing care plans. This diverse staff team have a balance of all the skills, knowledge and experience to meet people’s needs. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 24 There are eight project workers, including those who work through the night. All the project workers have achieved NVQ (National Vocational Qualification) level 3. For one project worker this is level 3 DANOS (Drug and Alcohol National Occupational Standards) and for another, NVQ 3 in health and nutrition. There are plans for these two project workers to still complete NVQ level 3 in Care. Two project workers are undertaking NVQ level 4 in Health and Social Care, which will include units relating to drug and alcohol work, mapped against DANOS. The local college provides assessment and verification for these awards, with an assessor present on the day of the first inspection visit, carrying out observations and assessments. The care coordinator, who is a qualified mental health nurse, is going to commence the level 4 Leadership and Management for Care Services, which is replacing the Registered Manager Award. Qualification training for staff is given a high priority and is a real strength of the service. The number of qualified staff exceeds national targets and is to be commended. The service users spoken to all spoke highly of the staff team and confirmed that individual one to one support is available at any time, as seen during the inspection. Regular staff meetings take place with project meetings planned for every six to eight weeks. Minutes of recent meetings were viewed. The recruitment files for two recently appointed members of staff were viewed. Documentation includes an application form, references, copies of past training certificates, a record of the interview and a criminal records bureau disclosure including evidence of a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable people. These checks help to ensure that only suitable staff are employed. THOMAS has an ‘Academy’ in Blackpool which, aims to nurture and coach individuals to achieve their full potential in the workplace through personal, educational and skills development. The ‘Academy’ offers recovering users opportunities to engage in accredited schemes for education and personal development including peer support, recovery coaching and DANOS based training. A pre work training course is provided for recovering users who want to work in this field. It is acknowledged that some staff may have past criminal records which are given full consideration prior to making an appointment. The chief executive explained how consideration is given to factors such as the length of time an applicant has been substance free as well as the nature and history of any past offence. New staff complete the Skills for Care (national training organisation) induction standards, which include health and safety related topics and an understanding of safeguarding issues. The care coordinator, who is nurse qualified, confirmed that he had still worked through these induction standards, following his appointment three months ago. The manager has plans for all staff, including T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 25 those in post for some time, to complete this induction programme as a general refresher/update. Each member of the team has an individual training record. Both internal and external training is available to staff, which address work related topics such as harm reduction and counselling. The manager regularly meets with the project workers for formal supervision and records of these meetings are kept. The records viewed indicated that project workers, including night staff have had four supervision meetings this year. There are also plans for staff to receive clinical supervision from the clinical coordinator. Annual appraisals also take place and these include a self assessment carried out by the individual member of staff. Regular staff meetings take place and the manager is available to staff as part of her day to day role at the home. The CQC surveys completed by staff confirmed that staff receive enough management support and that the manager meets with them to discuss how they are working. To the question ‘What does the home do well?’ responses included; “support available to clients and staff whenever needed.” And “Line management.” Staff surveys also gave positive feedback about the training provided, with one staff member stating; “The home is very supportive. Gives me the right education that I need to support my role.” T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience excellent quality outcomes in this area. The home is run in the best interests of service users and in a way that protects the health and safety of everyone living and working there. Excellent quality assurance measures are in place, which means that service users can influence how the service is delivered. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has worked for THOMAS for seven years, has gained the Registered Managers Award, which is the recommended qualification for people managing a care service and is registered with the Commission. The manager T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 27 focuses on operational issues, with the care coordinator having a lead role in clinical aspects and the chief executive having a more strategic role. This structure appears to work well, providing clear lines of accountability and good direction for staff. Regular management meetings take place and a management seminar day is planned for the near future. Quality monitoring and quality assurance are given a high priority and systems have been maintained and built upon since the last key inspection. Residents meetings take place and an example was given of action being taken in response to a request made by service users at a recent meeting. Staff meetings take place at different levels within the organisation, giving good opportunity for staff to influence service development. The chief executive conducts a monthly quality audit and produces a report for the manager. Service users are regularly given feedback surveys to complete and some of the returned surveys were viewed. These surveys are anonymous and showed a high level of satisfaction with the service provided and that the minority view that activities were not enjoyed by all had been given some attention by the manager. These surveys ask for feedback regarding different aspects of the service, including the programme, meals and activities. Responses are collated and a summary report written by the manager. Another survey is given to each person as they leave the programme, allowing people to reflect upon their experience at Witton Bank. A suggestion box is also provided, for staff or service users to use. The treatment programme supports individuals to share experiences and the regular group sessions encourage an open dialogue. Staff are available 24 hours a day and an open and trusting ethos is promoted, meaning that service users can raise any issues or concern as part of day to day life at Witton Bank. The chief executive is looking at ways to involve service users at a more strategic level and so have even more influence on the development of the service. A magazine ‘Edges’ is published and distributed to interested parties, giving updates of service developments and containing articles written by service users. This helps to promote the work of THOMAS in the wider community. Some of the current service users suggested having an open day, which is now being planned. This will involve inviting people from the local community to find out more about the service and the programme provided at the home. Two service users who come from the local area have said that they do not want to be involved on this day, which has been respected and alternative arrangements have been made for these individuals. Feedback from staff included the comments; “I believe the home is continually improving since opening.” And “We deliver a good quality, structured programme of care.” T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 28 Risk assessments are in place including a fire risk assessment for the building. Records of fire equipment being serviced and fire alarms being checked were available, along with records of other checks including the electrical installation in the home. A poster on the notice board in the dining room advises service users how to access written policies and procedures, including health and safety procedures. People staying at Witton Bank are given guidance regarding safety in the kitchen and wear gloves when preparing food. Staff have received training in health and safety topics, including first aid and a first aid kit is kept in the kitchen. T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 29 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 3 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 4 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000071249.V377146.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit Score 3 3 2 X 3 X 4 X X 3 X Version 5.2 Page 30 NO Are there any outstanding requirements from the last inspection? 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 YA20 Good Practice Recommendations It is recommended that medication packaging is dated when it is first used. This would help to ensure that medication is not used past its use by date and would also help to provide an audit trail of medication administered. Where handwritten entries need to be made on medication administration records, these should be checked and signed by two people, to help to avoid any errors being made. The medication administration record should give details of all prescribed medication. 2. YA20 3. YA20 T.H.O.M.A.S Drug & Alcohol Rehabilitation Unit DS0000071249.V377146.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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