Latest Inspection
This is the latest available inspection report for this service, carried out on 6th October 2009. CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.
The inspector found there to be outstanding requirements from the previous inspection
report. These are things the inspector asked to be changed, but found they had not done.
The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for The Salvation Army (Bristol) Bridge Programme Detox.
What the care home does well Members of staff said that allowing people to make decisions even if they are the wrong decisions is part of the ‘Cycle of Change’ and is what the service does well. It allows for relapse without reprisals and for people to return and try again. This was evident during the inspection, it was recognised by both parties that the individuals were not ready for treatment and their placements was terminated, these individuals can re-refer themselves for treatment without prejudice of previous relapse. What has improved since the last inspection? The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 A member of staff giving feedback said that a more structured approach had been adopted at the dettox unit since the last inspection. There is now an expectation that people attend group work and that they establish a routine to reduce the potential of ‘isolation’ and returning to previous addictive behaviours. What the care home could do better: There is one requirement and one recommendation arising from this inspection and relate to reviewing the Statement of Purpose and the WhistleBlowing policy. Information about dual diagnosis, the model of treatment and restrictions on choice and freedom must be added to the Statement of Purpose, this will ensure that information is transparent. Enabling people to make decisions about using the service. The Whistle blowing policy should say to staff that if they witness poor practice and do not report it, they may be subject to disciplinary procedure Key inspection report CARE HOME ADULTS 18-65
The Salvation Army (Bristol) Bridge Programme Detox Social Services Centre, Logos House 2 Little George Street St Judes Bristol BS2 9EL Lead Inspector
Sandra Jones Key Unannounced Inspection 6 & 7th October 2009 10:00
th
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DS0000020366.V377884.R01.S.doc Version 5.3 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. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION
Name of service The Salvation Army (Bristol) Bridge Programme Detox Social Services Centre, Logos House 2 Little George Street St Judes Bristol BS2 9EL 0117 9552821 Address 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) justine.lewis@salvationarmy.org Salvation Army Miss Justine Lewis Care Home 4 Category(ies) of Past or present alcohol dependence (4), Past or registration, with number present drug dependence (4) of places The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Past or present drug dependence (Code D) 2. Past or present alcohol dependence (Code A) The maximum number of service users who can be accommodated is 4. Date of last inspection 9th September 2008 Brief Description of the Service: The Salvation Army Bridge Programme is an addiction treatment service for homeless people in Bristol. The treatment is described as being in four parts and the Detoxification (Detox) part of the programme takes place in a unit registered with us. The programme also offers Outreach support, PrePreparation, Preparation, and Rehabilitation, none of which are registered with us. As a Christian Organisation, The Salvation Army believes in an approach that covers every aspect of a persons life including physical, social, emotional and spiritual needs. The Detox unit provides temporary accommodation for ten to fourteen days and is located in The Salvation Army Hostel, which is situated close to the City Centre and major transport routes. The unit has designated qualified nurses and a Doctor attached to the unit. The people who use the service are expected to go off the registered premises and participate in therapeutic groups as well as activities groups and life skills groups. Fees for detox programme range from £193.55- £752.00 per week. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience GOOD quality outcomes.
This key inspection was conducted unannounced over two days in October 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. This information was used to plan the inspection visit. Two individuals were accommodated on the first day of the inspection and were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. A mutual decision to terminate the placement was taken by these individuals and the manager and by the second day of the visit these individuals had left the dettox unit. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings. What the service does well: What has improved since the last inspection?
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 6 A member of staff giving feedback said that a more structured approach had been adopted at the dettox unit since the last inspection. There is now an expectation that people attend group work and that they establish a routine to reduce the potential of ‘isolation’ and returning to previous addictive behaviours. What they could do better: 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. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 7 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 The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 8 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) & (2) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided to people wishing to use the service must be more transparent so that people can make decisions about going into the dettox unit. The admission process ensures that the needs of people wishing to use the service can be met and there are procedures in place for when they relapse. EVIDENCE: The Statement of Purpose was reviewed in April 2009 and described are the aims, objectives and facilities of the detox unit. It explains that the unit is part of the Salvation Army, a Christian organisation and the unit supports the ethos of the organisations. The detox unit is an in-patient facility for medical-based detoxification for drug and alcohol misuse. It provides a reducing medication regime and therapeutic intervention to enable individuals to become free from substances in order to move into rehabilitation.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 9 The staff on duty were consulted about the way individuals with a range of needs known as dual diagnosis are assessed for admission at the home. A member of staff on duty said that during the assessment period individuals mental health needs are assessed as it is usual for people with an addiction to have associated mental health needs, for example depression and anxiety and as result of drug taking to have paranoia and psychosis. We were reassured that there is a robust admission process to ensure that the mental health needs can be met and where the individuals needs cannot be met, the person will be referred to more appropriate agency. The admission procedure described, places the emphasis on the person to complete referrals forms and to provide accurate information to ensure safe treatment. The Admission/Referral procedure supplements the process detailed in the Statement of Purpose. The target group, eligibility criteria and range of needs that cannot be met at the unit are specified within the procedure. It says that an after care plan and a goal of no more that 30 mls. of methadone or equivalent are pre-requites for admission at the detox unit. From the initial referrals a case conference with health and social care professionals will take place. The potential referrals from admission are discussed to determine the person’s suitability for the programmes offered by the Bridge Programme. The drug treatment doctor will then assess the person for suitability for detox at the unit, which is generally for 12 days. Feedback was sought from staff about the philosophy that the unit follows. It was stated that the unit adheres to the Cycle of Change, which entails precontemplation, contemplation, reaction and fall out of treatment. It was further stated that this philosophy allows for relapse and the advantages are that staff are then able to assess where in the cycle the person is and when discussed with the individual, they can identify where in the cycle they are in. The 12 steps principles are also used whereby there is a daily readings relevant to recovery, which is discussed with the people in the unit. We sought comments from staff about the restrictions in place on choice and freedom. People are escorted off the unit during their 12-day stay, no mobile phones, smoking in designated areas only and no drugs or alcohol on the premises. Drug screening consents must be signed during admission to confirm agreements with the values, rules and expectations of the detox programme. The Statement of Purpose would benefit from additional information to ensure full transparency so that people wishing to use the service can make decisions about the programme. Information about dual diagnosis, model of treatment and restrictions on choice and freedom must be added. The care files of the two people in the detox unit were examined to establish that the admission process ensured the person’s suitability for admission.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 10 Completed Entry referral forms, which seek personal details, social and criminal history, with additional information about programme preference and substance misuse, are held in their care file. Treatment Dr. and nurses assessments were completed about the person’s health, their medical needs and history of addiction. Triage assessments and recommendations show that the admission procedure was followed to ensure the suitability of the person for treatment at the unit. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 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) & (9) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are pivotal for the safe medication- reduction regime and are consistent with the aims and objectives of the dettox unit. People are supported to make decisions that will empower them to move into rehabilitation. EVIDENCE: Two people were admitted into the dettox unit the day before the inspection visit and their placement was terminated by the second day. The care plans for these individuals therefore contained brief and general information. Dettox care plans are mainly to support people with the safe medical reduction regime. They are sectioned into needs, goals and actions, with an outcome
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 12 section to record the progress. The baseline status, safe dettox and the reduction of re-using drugs and alcohol form part of the care plans. Drug and alcohol use, physical and psychological, social and criminal justice needs form the Bridge Programme care plan for those individuals that will be going through other stages of the Bridge Treatment Programme. The named nurse reviews Dettox care plans weekly and the person and the outcomes are recorded on the appropriate section of the care plan. It is the responsibility of the keyworker to review the Bridge Programme care plans six weekly with the person. The manager explained that the Bridge Programme offers three treatment stages, which include the Preparation Unit, Dettox and Rehabilitation, with a potential stay of 32 weeks in total. A keyworker that overarches all the stages is appointed, who will coordinate stays over the 12-day dettox period and develop care plans that run alongside the dettox care plans. The keyworkers for the individuals accommodated were consulted about their role with people on dettox. We were told that the purpose of their role was to give support while they are going through dettox; continuity of care for people going through various stages of the treatment programme and the approach used is gently, gently. Keyworkers are a point of contact; provide assistance with practical issues, for example probation and someone to talk to when their head are in ‘chaos.’ We were also told that keyworkers meet with individuals regularly for short periods initially and as they progress with their treatment less frequently but for longer periods. It was further explained that 1:1 time to discuss issues, support with practical help, accompany people outside the dettox unit; drug testing, care planning and reviews are included in the role of the keyworkers. In terms of supporting people with decision-making, the keyworkers said they offer advice with what is available, remind people with where they were and where they have been, to assist them to make the right decision. If people choose to leave, information is provided about where to go and the risk of ‘using’ after being on dettox is conveyed. Keyworker 1:1’s are recorded, the topic of discussion with any actions to be taken are included. Outcomes of visits, observations and appointments are reported by the keyworker on the daily report sheets. Initial risk assessments based on the individual’s current and past history of violence, aggression, self-harm, history of misuse, social, relationships risk factors are completed and reviewed. Early discharge plans are devised on admission to establish where the person will stay, how they will get to the place of safety and advocacy agencies that can be contacted in the event of that their placement is terminated.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 13 People are tested on admission then randomly throughout their treatment and because some drugs remain in their body for longer, it can be difficult to establish how recent the misuse was. The manager told us that behaviours i.e. mood changes are the platforms used to further explore with the person if misuse has occurred during their stay. Once the timescale for all drugs has passed a test is carried out, if this test is then positive, the person’s placement will be terminated. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 14 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) & (17) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make decisions about their future and are supported to develop life skills. EVIDENCE: The primary function of the unit is to provide a 12-day residential detoxification of substances. The manager said that the in the early stages of treatment is on structure and the emphasis of the dettox unit is on group work and 1:1 because the stay in the unit is short. It is part of the agreement that people engage in the programme; they must attend group work within the Bridge Treatment Programme, which includes relapse, prevention, recovery, and AA and NA meetings. Assistance in obtaining employment or skills associated with the activity is more relevant to second stage treatment
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 15 . The Statement of Purpose and Service User Guide says that visits and phone calls from family and friends are not usually permitted while people are in the dettox unit. Professional visits and phone calls are permitted under the supervisions of keyworkers of dettox staff. Separate arrangements will be made for meeting children, as they are not allowed into the Bridge Programme. Logos House is a Salvation Army Centre providing accommodation support and treatment for homeless people. The dettox unit sits within Logos House and the hostel handbook specifies the rules and expectation, the Service User Guide is unique to the dettox unit. The daily routine of the unit is detailed in the Service User Guide and says that there is an expectation that people rise between 8:15- 8:45 for breakfast, attend group during the day, and undertake household chores, they can also expect to have support from the unit staff. There is a policy in place about room searches, which the manager said people are informed about during their induction into the dettox unit. The purpose of the room searches, the people who will be involved and generally rooms are searched when there is suspicion of misuse or that there is drug and/or alcohol on the premises. The arrangements for privacy against the risk of ‘isolation’ and development of trust and honesty were discussed with the manager. The accommodation in the unit is single en-suite bedrooms with keys provided. People are escorted to collect their mail from reception and are observed opening their post. While people have lockable bedrooms the manager said, if they do not open the door within a reasonable period or after 3 knocks, staff will override the locking system and enter. In terms of ‘isolation’ that may lead to return to addictive thinking and behaviour, the manager said that there is a structure in place and only outside this time people can spend in their rooms and the risk of isolation forms part of the care plan. Outside contractors are used for cleaning and catering. People have three meals per day provided in Logos House and there is a small catering area in the dettox unit for people to make refreshments and light snacks The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 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) & (20) People using the 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 health and personal care that people receive is based on their individual need. Medication systems are safe. EVIDENCE: People that seek accommodation at the dettox unit are generally independent with hygiene. A timetable of activities for re-establishing routines specifies the times to rise and mealtime. Three qualified mental health nurses and a unit doctor who overlooks the medical care staff the dettox unit. The medically qualified staff ensure that the unit is able to meet its aims of a medical reducing regime that supports people to move into rehabilitation services.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 17 The manager said that people are required to register locally with a GP and NHS facilities. A drug treatment doctor is attached to the dettox unit and visits twice weekly. Both individuals are registered with a local GP and have no current medical needs. As people in the dettox unit are on restrictions, their keyworkers would generally arrange appointments and escort people on dental and optician appointments. The manager told us that medical advice is generally passed from the GP to the drug treatment doctors at the unit, which is then cascaded to the qualified nurses. A counsellor is employed by the Bridge Programme and Drug and Alcohol workers (who act as keyworkers) and can also be trained counsellors. Referrals for counsellors can be made by the dettox staff and keyworkers and Brief Solutions focus on cognitive behaviour therapy, psychodynamics is used by staff when they engage with people; the counsellor covers posttraumatic stress and grief. All medications are administered by the staff at the unity and the people accommodated were not on regular prescribed medication. Comments about the drug reduction regime were sought from the manager. We were told that the drug treatment doctor will prescribe the regime and when required medications. Medication records specify the regime to be followed and staff sign the records after administering the medications. ‘When required’ medications for cramps, nausea, insomnia can be administered from a stock supply as needed by the persons. The purpose of the medications and the max dose that can be administered are listed in the medication records ensuring the safe administration of medications. Homely remedies for symptomatic pain relief and are also administered when required by the qualified nurses. A record of medications no longer required is maintained and pharmacist countersigns the records to indicate receipt of the medication for disposal. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 18 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) & (23) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home can express their concerns and have access to an effective complaint procedure. The Safeguarding Adults procedure shows a commitment to protecting people from abuse. EVIDENCE: The Complaints procedure is included in the Statement of Purpose, Service User Guide and on display in the dettox unit. One complaint about the equipment was received and resolved by replacing equipment since the last inspection. The process followed was confirmed by records completed for the complaint received, the nature of the complaint was recorded; the copy of the response letter to the complainant indicates that the complaint was acknowledgement, and the records of the investigation shows the complaint was satisfactorily resolved. The Safeguarding Adults procedure with a flowchart are available at the unit which are clear about the steps to be taken with telephone numbers of the agencies to be contacted for alleged abuse.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 19 Whistle blowing procedures that enable staff to raise concerns without reprisals are in place and should include the implications for staff that witness poor practice and do not report it. Risk assessments are completed during the admission process to establish past and current level of aggression and violence. The manager said that accommodation is only offered to people that have a past history of aggression and violence. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 20 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), (26), (28) & (30). People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Salvation Army Hostel, Logos House is situated close to the City Centre and major transport routes. The Salvation Army Bridge Programme is an addiction service for homeless people in Bristol and also offers Outreach support, Stage 1 Preparation, and Stage 3 Rehabilitation, none of which are registered services. The dettox unit sits inside the hostel and provides single accommodations to four people.
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 21 People accommodated in the dettox unit access the unit via the main reception to The Salvation Army Hostel ensuring that everybody signs in and out of the building at one point and any visitors can wait in a waiting room. The main reception is staffed 24 Hours of the day seven days a week. The dettox unit is arranged on one level with single lockable bedrooms, lounge, bathroom and garden with laundry facilities. The four single bedrooms have the furniture and fittings necessary for a comfortable stay, they are lockable and en-suite with a toilet and wash hand basin. The lounge/dining area has sufficient seating for people in the unit to sit together and watch television, eat at the table and make refreshments and snacks. The communal space has information about Drugs Advocacy Service, a phone to contact reception, suggestion box and complaints procedure. There is a separate laundry facility, which has industrial washing machine and tumble dryer available for people to do their laundry. . The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 22 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): (34), (35) & (36) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the unit receive a consistent service from staff that are suitable to work with vulnerable adults. The staff are skilled and well supervised. EVIDENCE: Two qualified nurses and a manager are employed to work in the detox unit. The nurses currently working at the home were employed in 2006 and 2008, before the last inspection and where the recruitment process followed for these individuals was determined. Completed application forms that seek employment history, the names of two referees and declaration of criminal history, confirm the organisation’s determination to employ staff that are suitable to work with vulnerable adults. Two validated written references; Criminal Records Bureau (CRB) checks obtained and risk assessments for people with convictions show that the recruitment process is robust. CRB’s are
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DS0000020366.V377884.R01.S.doc Version 5.3 Page 23 renewed every three years to affirm the person’s integrity and to determine that they continue to be suitable to work with vulnerable adults. The personnel files of the two staff in dettox unit show that an induction took place to ensure they were aware of their role and the expectations of the role. Certificates for Groups Work Skills, Skills Solutions Focus and Health & Safety demonstrate that staff attend courses that ensure they can support people with their recovery from addiction. The manager described the arrangements in place for training. It was stated that there is a Bridge Training Programme that all Salvation Army staff can attend. The detox staff will attend management, assertiveness, Loss and Bereavement training. As qualified nurses, the dettox staff have attended dual diagnosis, domestic abuse; child protection and wound care training to maintain their nurse registration. The qualified nurses are currently undertaking NVQ level 3 in Substance Misuse to ensure they have the skills to meet the needs of the people using the Bridge Programme. Personal Professional Programme Development meetings occur every Thursday where staff cascade information from the training attended. It was also stated by the manager that decisions about changes needed to implement the training are made at these forums. The manager was consulted about the arrangements in place for individual supervision. It was explained that individual supervision is conducted by the manager six weekly and is based on standards of care, clinical issues and staff can prepare an agenda for the sessions. Every two weeks there is group supervision and external clinical supervision is six weekly, which focuses on anything that may affect performance. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 24 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) & (42) People using the 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 aims and objectives and the needs of the people using the service are met. People can expect to stay in a safe environment and can be reassured that standards are subject to ongoing monitoring. EVIDENCE: Comments were sought from the manager about the way the standards of care are maintained. It was stated that the dettox team is small team there is close working interaction with good working communication that include handovers when shift changes occur and informal supervision. Standards are maintained
The Salvation Army (Bristol) Bridge Programme Detox
DS0000020366.V377884.R01.S.doc Version 5.3 Page 25 thought the organisations policies and procedures, feedback from the manager at meetings, monthly monitoring by external managers and supervision. The Quality Assessment Framework is used to assess the way the Bridge Programme is meeting standards which includes the involvement of the people using the service and staff through surveys, 1:1 and feedback reports. From the assessment an action plan for 2009-2010 is developed that focuses on increasing occupancy, joint working and developing training. There are three staff currently working in the dettox unit and the rota in place shows the way staffing levels are arranged. There is one member of staff between 7:00 am and 7:30 pm with an additional member of staff rostered during peak periods and at night the project staff oversee the dettox unit. During annual leave and sickness, two staff will cover the vacant hours to maintain staffing levels, we were reassured that where people needs change and 24 hour care is needed, agency staff is used. Fire risk assessments are undertaken for the Bridge Programme and the assessments for the dettox unit was examined. The potential for fire, preventative measures to reduce the level of risk are part of the fire risk assessments. Within the assessments the checks, practices and drills to be conducted to ensure the environment is safe is specified. The gas boiler and portable electrical equipment is checked by an outside contractor to ensure that people live and work in a safe environment. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 26 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 2 2 3 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 2 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43
DS0000020366.V377884.R01.S.doc 2 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 Score 3 3 3 x 3 x 3 x x 3 x
Version 5.3 Page 27 The Salvation Army (Bristol) Bridge Programme Detox YES 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. 1. Standard YA1 Regulation 6 Requirement Information about dual diagnosis, the model of treatment and restrictions on choice and freedom must be added to the Statement of Purpose Timescale for action 30/03/10 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 YA23 Good Practice Recommendations The Whistle blowing policy should say to staff that if they witness poor practice and do not report it, they may be subject to disciplinary procedure. The Salvation Army (Bristol) Bridge Programme Detox DS0000020366.V377884.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
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