Care Home: Trevi House

Similar services:

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

What the care home does well One woman on a treatment programme at Trevi House told us "I wasn`t sure what was expected of me, I was fighting the programme, but now, working the programme I feel much better and am seeing the benefits. There are huge differences in the mother daughter relationship I have since getting help with parenting and my emotions". Trevi House is an open, inclusive place that supports and enables women and their children as individuals to work towards a substance free future. The ethos at Trevi House enables women who come here often in a fragile emotional state to feel safe and protected. The employment of male staff has provided some women with a new and different perception that men are nurturing and caring, treat women as their equals and have no recourse to violence, threats and/or intimidation. What has improved since the last inspection? Since our last key inspection in January 2009 there has been a vast improvement at Trevi House. One noticeable change is the "common sense" approach to daily living. For example, the lunch time period has been extended during the winter months. This means the women can enjoy the daylight hours with their children, take their children out to the park or for a walk, all prohibitive after four o`clock when the group ends because it`s getting dark. In the evenings there is flexibility around meal times and settling children down to sleep, recognition that children do not go to sleep promptly and some may need time to adjust to new routines and environments. Evenings are more informal. Different rooms are used for groups to differentiate between living space and work space. Admission assessments are thorough. Every prospective client is expected to visit the project before making a decision about coming here. It is an extensive visit that includes an assessment of needs, a tour of the premises, time spent in the nursery with the nursery staff, an opportunity to meet staff, and an opportunity to spend time with the women to find out first hand about the treatment programme at Trevi House. The resettlement assessment and the resettlement support plan are put in place at the beginning of the treatment programme and reviewed regularly with each client. There is a rolling resettlement programme with a comprehensive book, "Skills For Life" that the women keep for reference after they leave Trevi House. Links have been built up with a local children`s centre giving the women and staff access to a much wider range of support. All children are registered here when they arrive at Trevi House. There is encouragement and support for the women to join or become involved with community groups and events locally. Staff conscientiously seek out social opportunities for the women that are cost free or affordable within a limited budget. The treatment programmes are more structured. Reduction programmes have been reviewed and modified giving improved outcomes for the women. The staff work together as a dedicated team. They are confident that Trevi House offers individualised support and openness that can help women to change their lives. Staff training has been reviewed and a training programme including a training needs analysis is in place. The new manager has established an air of calm and rationale to the running of Trevi House. Working with the staff team, they are creating an inclusive and comprehensive place where women can learn how to manage their lives without the use of drugs and/or alcohol, learn how to enjoy their children, learn life skills they can take away and make use of caring for their children and themselves after the treatment programme. Staff told us "Feels like we are a ship with a captain now". "The new boss has taken Trevi into the 21st century, and we have dedicated staff here at the moment." "Great new programmes" "Not insular any more." What the care home could do better: All staff would benefit from childcare training in order to provide a consistent approach with the women as they learn to care for their child/ren. Staff need to have up to date moving and handling training. The training needs analysis needs to include a structured induction and foundation programme for new staff. This would include some of the basic principles of care and safe working practices. The women would benefit from more information about health and safety around the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Trevi House 2/6 Endsleigh Gardens Mutley Plymouth Devon PL4 6DR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Megan Walker     Date: 0 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Trevi House 2/6 Endsleigh Gardens Mutley Plymouth Devon PL4 6DR 01752255758 01752255758 office@trevihouse.org www.treviproject.org Trevi House Limited care home 13 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: Age18 to 60 years Female Only Date of last inspection Brief description of the care home Trevi House is registered with the Care Quality Commission (CQC) as a care home for the first stage treatment of alcohol and drug dependence for up to thirteen women, between the ages of 18 and 60. A reduction programme, managed by staff at Trevi House and under the supervision of a local GP, can be provided. The home is not registered to provide nursing care and does not provide a detoxification service. Trevi House provides counsellors and support staff to maintain the programmes of care designed for the people who use the service. Abstain from taking drugs and/or alcohol except for any medication prescribed by a doctor for health care reasons is expected from anyone residing at Trevi House. The length of each treatment programme Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 13 13 Brief description of the care home depends on individual assessment of needs. Generally this is between three to six months. Children under the age of 8years can be accommodated with their mother at the project. Trevi House has a nursery for the children, regulated by Ofsted, and children of school age attend local schools. Trevi House is run by Trevi House Ltd., a not for profit organisation. Fees are £785.38 per week per client, and £477.58 per week per child. These charges are due to be revised on 1st April 2010. There are other charges that include matters relating to courts, drug tests, transport and escort to appointments, and overnight stays for visiting siblings. Fees do not include toiletries, nappies, and other personal purchases. The financial assessment by the referring agency may result in some women on treatment programmes at Trevi House having to make a contribution to their residential fee. Trevi House policy requires this must be agreed before start of the placement. Information about charges was provided to the CQC in December 2009. Detailed information about fees and the project, as well as copies of inspection reports, can be obtained from Trevi House, or on their website at www.treviproject.org Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. The last key inspection took place on 7th January 2009. This unannounced inspection visit took place on Wednesday 2nd December 2009 between 09:15 and 16:15 with two Regulation Inspectors and an Expert by Experience; and one Regulation Inspector on Friday 4th December 2009 between 14:00 until 19:20, and Monday 7th December 2009 from 14:00 until 19:10. The Care Quality Commission considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. Care Homes for Adults (18-65 years) Page 6 of 33 A tour of the premises took place and records relating to care, staff and the home were inspected. We met people who live at the home. We looked at how medication is administered, recorded and stored. The Expert by Experience sat in on a group session, spoke to four women as a group and one woman in a 1:1 conversation. The General Manager whom we met at our last key inspection left Trevi House at the end of March 2009. A new person has been appointed to take day to day responsibility for the home, and has been in post since June 2009. In the report this person is referred to as the General Manager. This person was available throughout the visit for consultation and information. The Responsible Individual also gave us an update on things that have happened at Trevi House over the past twelve months. We received an Annual Quality Assurance Assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are met for the people who live in the home. We sent surveys for completion by people who use this service or their relatives/advocates, staff, and health and social care professionals. We received two from people staying at Trevi House, three from staff and one from a health care professional. All this information helps us to develop a picture of how the service is managed and what it is like to live at Trevi House. This report is written on behalf of the Care Quality Commission (CQC). Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Since our last key inspection in January 2009 there has been a vast improvement at Trevi House. One noticeable change is the common sense approach to daily living. For example, the lunch time period has been extended during the winter months. This means the women can enjoy the daylight hours with their children, take their children out to the park or for a walk, all prohibitive after four oclock when the group ends because its getting dark. In the evenings there is flexibility around meal times and settling children down to sleep, recognition that children do not go to sleep promptly and some may need time to adjust to new routines and environments. Evenings are more informal. Different rooms are used for groups to differentiate between living space and work space. Admission assessments are thorough. Every prospective client is expected to visit the project before making a decision about coming here. It is an extensive visit that includes an assessment of needs, a tour of the premises, time spent in the nursery with the nursery staff, an opportunity to meet staff, and an opportunity to spend time with the women to find out first hand about the treatment programme at Trevi House. The resettlement assessment and the resettlement support plan are put in place at the beginning of the treatment programme and reviewed regularly with each client. There is a rolling resettlement programme with a comprehensive book, Skills For Life that the women keep for reference after they leave Trevi House. Links have been built up with a local childrens centre giving the women and staff access to a much wider range of support. All children are registered here when they arrive at Trevi House. There is encouragement and support for the women to join or become involved with community groups and events locally. Staff conscientiously seek out social opportunities for the women that are cost free or affordable within a limited budget. The treatment programmes are more structured. Reduction programmes have been reviewed and modified giving improved outcomes for the women. Care Homes for Adults (18-65 years) Page 8 of 33 The staff work together as a dedicated team. They are confident that Trevi House offers individualised support and openness that can help women to change their lives. Staff training has been reviewed and a training programme including a training needs analysis is in place. The new manager has established an air of calm and rationale to the running of Trevi House. Working with the staff team, they are creating an inclusive and comprehensive place where women can learn how to manage their lives without the use of drugs and/or alcohol, learn how to enjoy their children, learn life skills they can take away and make use of caring for their children and themselves after the treatment programme. Staff told us Feels like we are a ship with a captain now. The new boss has taken Trevi into the 21st century, and we have dedicated staff here at the moment. Great new programmes Not insular any more. 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. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women considering a treatment programme at Trevi House are provided with sufficient information to enable them to make an informed decision about the project. The admissions procedure is robust and ensures that women considering a treatment programme at Trevi House know that it will meet their needs and aspirations. Evidence: Since the last inspection the Trevi House pre- assessment policy has radically changed. Now, except in the most exceptional circumstances, the women considering coming to Trevi House have to visit before they move in. When feasible they are also expected to bring their child/ren with them. The pre-assessment includes Domains of assessment based on Models of care with specific questions about the womans child/ren (health, needs, likes, dislikes etc). It also identifies any particular needs that the mother may have during her stay at Trevi House. Opportunity is made for the prospective client to talk to other women already on treatment programmes as well as staff. Time is also given to spend time in the nursery with the nursery staff. Occasionally women come alone although an invitation is offered to the referring social Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: worker/funder to visit with client. One woman staying at Trevi House told us I was told by Social Services at the beginning I had to go to rehab.I got [information] off the internet but I was given information on some things at my assessment. At the time of our visit only the General Manager or the Resettlement Officer was undertaking pre-assessments. The key workers told us they feel confident they have sufficient information about prospective clients from a report and brief background produced by the person doing the pre-assessment. They also received the information in advance of the woman moving into Trevi House. We looked at three care plans. Each one had a full assessment of need prior to admission. The detail of information was also sufficient to ensure admission would be safe and in the best interests of the woman and her child(ren), and the other residents and their child(ren). Arrangements for what was to happen on discharge was seen recorded, including arrangements for the child(ren), to cover the possibility of (1) a woman deciding to leave; (2) of the service finding that she had broken the terms of her residency; and (3) at the completion of her programme. Each prospective resident is sent a letter confirming acceptance of her application, offering her a place at Trevi House with a date and time to arrive. A contingency plan is also sent with this admission letter. We were told that funders are now expecting their clients to make a contribution to their fees. Trevi House therefore requires that contributions be agreed beforehand, so that they can be included in the detailed budget planning. The staff have found some have been imposed retrospectively, or after the admission was arranged, resulting in debts and anxiety for the client. Care and funding arrangements for children are agreed independently and separately from their mother. Trevi Houses Statement of Purpose and Service Users Guide were being updated at the time of this visit. Once these are complete they will be available on the homes web site. The last key inspection report was on display in the home and we were told is available on the Trevi House website. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women on a treatment programme at Trevi House are confident that they are enabled and supported to make choices and decisions about their lives through active participation in the rehabilitation programme. Evidence: We received two surveys from women staying at Trevi House. They told us At Trevi there is always support when needed and we are all treated as individuals. Got a lot of structure and planning. There is always someone to talk to. Very good nursery for children. We observed a non therapeutic group that focused on weekend planning, called Prac group. Although this group can be difficult to manage to suit all clients needs for weekend activities, the staff handled the group well, responded well to queries and showed a positive attitude to the task in hand and the varying needs and wants of the women in the group. This included responding to wishes to regain faith whilst in treatment, encouraging the women to consider their peers financial restrictions, and Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: ensuring quality one on one time was spent by the women with their children. We looked at a Resettlement Assessment put together by the Resettlement Officer with a client soon after her admission. We were told this was done very early on so the women are encouraged to think clearly about their concerns. A Resettlement Support Plan is then drawn up, in which the client specifies the support they need. We were told that each client is helped to draw up a budget sheet, including utility bills, and to negotiate with any creditors in order to reduce debts during their stay, and ensure feasible payments are acceptable after leaving Trevi House. Trevi House has various in-house therapeutic and practical groups and workshops that cover wrap around elements of substance misuse. They work towards enabling women to lead substance free lives. The women we spoke to during our visit and those who returned surveys told us that they were happy with the overall treatment programme. They felt the various therapeutic tools used within the programme were effective. We were told that the group work gave the women an opportunity to explore issues that may be a barrier to abstinence after they leave Trevi House. They felt it was of a good standard because it explores both practical and emotional issues. In the AQAA we were told Moving toward an environment, which encourages independence, offers trust and is prepared to let people make mistakes, is a slow process. Staff will require further training, in approaches including motivational interviewing as well as longer to adjust to a new regime that does not endorse frequent and ill judged imposition of rules. The rules themselves are in a state of regular adjustment at present and will have a complete rewrite, with assistance from residents By the time of our visit the House Rules had been rewritten. This was done in consultation with the women staying at Trevi House. Staff told us they had found the women to be more directive and punitive than staff would have been! One woman told us I have got a lot out of my treatment at Trevi. It took me a while to get into it and get my head around what was expected of myself and what to expect to get from Trevi. I feel like I am getting from treatment what Im putting in. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women on a treatment programme at Trevi House feel confident that they have opportunities for personal development, various activities available, and independence and choice is promoted. Evidence: The routines at Trevi House have improved since our last inspection. The daily programme runs from 10:00 until 15:45 with the nursery starting at 09:15. This allows 45 minutes before the first group to do housework. There is a common sense approach to daily living. For example, due to winter nights drawing in early, the lunchtime break is extended so the women can take their children to the park and out for walks. Previously the women only had time at the end of the afternoon programme, by which time it is already dark. In the evenings there is a more relaxed approach to cook slots which are now between 16:30 and 19:30. This means the women have more quality time with their children rather than rushing through feeding Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: and getting them ready for bed. The evenings are more informal and the women can choose to be in the lounge or in their bedrooms. Weekends are focused more on activities with little or no financial cost and are suitable for children. This approach aims to teach the women about considering whats better for their child/ren and a self awareness about how easy it is to spend money. For example, part of the budgeting programme considers a trip into town with children. The women are asked to keep account of everything they buy including refreshments for their child/ren and themselves. We were told that very quickly the women recognise how easy it is to spend a lot of money on cups of coffee, juice, sweets and snacks. They also appreciate that pushing a child in a buggy around a shopping mall for an afternoon quickly turns into a costly activity and generally results in a cranky child. The resettlement programme run by the Resettlement Officer is now called Skills for life. This is run in fortnightly workshops. The women also have a handbook complied from these workshops that they can take with them for future reference after they leave Trevi House. Social inclusion has improved since our last inspection. There are links with a local childrens centre and every child is registered here on arrival at Trevi House. The women attend weekly child play sessions and healthy cooking courses. A Family Support Worker visits regularly and is also available to staff for advice. Also a Link worker visits regularly to give advice and support about childrens mental health (bonding and attachment). A Health Visitor is teaching baby massage. At weekends there is a local mothers and toddlers group that the women can attend. A fourteen week rolling programme on domestic violence called Freedom To Change has recently started at Trevi House. This is run by an external contractor. The programme includes Why is it so hard to leave; effects on children; early warning signs; Saying goodbye to old patterns; and moving forward. If needed, there is the possibility to liaise with the police domestic violence unit. Women who stay in the Plymouth area after leaving Trevi House are given information about local support groups such as Seeds (Survivors Empowering and Educating Domestic Abuse Services). The key workers can also refer their clients to another local agency for 1:1 counselling for domestic abuse, if they and the client feel more support than group sessions and/or 1:1 with the key worker is needed. The programme also includes two gym sessions each week, and a local training company offers computer based learning to gain national tests (graded as equivalent Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: GCSE) acceptable to employers and training providers. Numeracy and literacy courses as well as 1-day courses such as First Aid & First Aid for Children are also available. After the treatment programme, there is the possibility to link into apprenticeships and NVQ at work schemes. One of the women on a treatment programme at Trevi House grew up in the Hindu tradition. She has since chosen to follow Islam, however still wishes to celebrate Hindu festivals. Accompanied by staff with her baby, the woman had attended a Hindu celebration held at the University. The other women had joined in to learn and celebrate with her at Trevi House. She has also taught them about preparing and cooking with halal foods. The day before our visit, all the women and their children were accompanied on a visit to a local garden centre, including Santas Grotto. A Team Support Worker was planning to spend an evening with the women making Christmas cards that would use the photographs taken with Santa. The General Manager is keen to promote healthy eating. He described the meals that used to served as hearty meals such as might be a large pub lunch. The focus now is five a day portions of fruit and vegetables. The chef told us that fruit, crisps and biscuits are always available. When he came to Trevi House he found these were provided weekly. The women would grab what they could and take them to their rooms where some would later be found mouldering in drawers. This no longer happens. The chef is responsible for all the food ordering, and is not restricted by the management. He likes to seek bargains, and to buy locally. He had made pickles for Christmas, and told us he will be making the Christmas puddings, as last year he found it impossible to find commercial ones without alcohol. Everyone has been invited to join in and stir the mix. The chef gives 1:1 basic cooking skills once a week. The women tell the chef what they want to learn to cook and he buys in the ingredients beforehand, to allow time for cooking. Pasties and crispy roast potatoes have been amongst the skills people wanted to learn. Menus, written by the chef, were pinned on the wall. He told us they are adhered to approximately. He said that clients often spoke to him about their preferences, and he had good feedback from them. The women have introduced a communal Sunday lunch. There is a Kitchen Book for comments and requests for food. Each day the menu said veggie option, but did not specify what it was. The General Manager said he intends to see further development in this area. The chef has discussed budgets and choices with the clients. Some wanted fresh fruit juice, but this had to be instead of a pudding. They agreed to have a pudding during the week when the chef is cooking, and fruit juice at the weekends. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women on treatment programmes at Trevi House are confident that personal support promotes and respects their dignity and independence. Evidence: The admission process to Trevi House is much more robust, with two designated staff undertaking the pre-assessments. Women will be accepted for detoxification from stabilisation however Trevi House will not accept chaotic drug users. (They would be referred to a nearby rehabilitation centre registered to provide 24hr nursing care for detoxification and/or first stage treatment for drug and alcohol dependence.) The GP or prescriber with the nominated key worker and the client draw up a detoxification plan. The key worker monitors the plan as part of 1:1 sessions with the client. The detoxification plan is also structured to ensure, as far as is practicable, that the withdrawal process will not impact on other significant events (e.g. a court hearing) in the clients life. Since our last inspection the National Treatment Agency Care Plan approach has been introduced at Trevi House. Reviews are held every 8 weeks (includes funding report), 16 weeks and 24wks (final report). Some funders request monthly reports. Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: A 13week rolling programme with emphasis on relapse prevention has been introduced since our last visit. It is a much more organised programme. The room previously used as a staff room is now used for group sessions instead of lounge. This is because the key workers felt that using the lounge was inappropriate because it is the womens only communal living space. The key workers now check in at the beginning and end of each group to see how everyone is. This is to identify any issues that may need addressing before a group starts or issues arising from the group that key workers may need to address in a 1:1 session, or include in the evening handover with the Team Support Workers. Three sessions in the 13 week rolling programme are led by a group of healthcare students on sexual health, harm reduction and the harms of drug and alcohol use. The group describes itself as providing interactive and informal sessions and aims to empower [the women] to make informed choices about their reproductive health. A Blood Borne Virus Nurse was visiting Trevi House whilst we were there. She offers screening for sexually transmitted diseases and can give vaccinations. Some women ask for tests for HIV and or AIDS. The Blood Borne Virus Nurse will offer precounselling for these tests. She also gives training and separate sessions on sexually transmitted diseases. The General Manager told he was hoping for an agreement with the local primary care trust to allow the current monthly clinic to be more frequent, and the nurse to be on call. (that is available for consultation between clinics). There is automatic access to the Hepatitis C service via the GP for an appointment at the local hospital. The Eddystone Trust is also used by Trevi House. Each child has a nominated key worker from the nursery staff. The women have 1:1 sessions in the nursery with the nominated key worker for their child as well as 1:1 sessions with their own key worker. The nursery staff, the key worker, the childs social worker and the mothers social worker all contribute to court reports. LAC reviews are attended by both the mothers and the childs key workers. A Parenting Evaluation group is held weekly. This is a goal based programme about Being a mum, and is run by a key worker and a nursery team member. It provides scope for the women to go into the nursery to spend time learning to be with their child. The key workers also told us that a parenting programme would be starting in January 2010, run by the childrens centre for all the women to attend. The childrens centre also offers the Webster Stratton specialised child programme, Parent training, a 12 weeks course of 1:1 sessions, based on Incredible Years. A bid for a Children In Need grant was about to made for a baby sensory development area. Funding for treatment programmes usually ends on a Friday. The key workers told us they try to encourage women to leave on a Monday rather than a weekend so they go Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: straight into an aftercare programme. We were told that the local Housing department is very supportive and tries to give priority to women leaving Trevi House. Consideration is also given to private housing sector provided by the council when there are occasional house shares for single people. The Resettlement Officer attends a Supported Housing panel that cant accommodate children however is useful as some women leave Trevi House without their children. The Resettlement Officer also attends the Drug & Alcohol Accommodation Group (DRAG) monthly housing panels. One of the key workers has developed an Eating Diary. The local Mental Health Team will assess any women the key workers refer to them. There is also a support group that the key workers enable women with an eating disorder to join. A Buddy system is in place from the first day a woman arrives at Trevi House. This is to ensure she has a peer who takes responsibility to introduce her to the other women, to show her around, and to whom she can ask questions. The buddy also accompanies the woman the first time she goes off the premises without a staff member. Initially each client is restricted to remain within the premises of Trevi House. At a later stage in their programme they are able to go out for a short time if this had been agreed with their key worker and subject to any other restrictions that is part of the persons treatment programme. Restrictions on going out alone or accompanied are decided as part of each womans individuals care plan. The contract issued when a woman starts a treatment programme states the restrictions that would apply during the programme. Usually they do not go out for at least the first week to allow a settling in period. Personal telephone calls are no longer restricted during this period. This has been reduced since our last inspection to enable those women with children not at Trevi House to continue to have contact with them. Feedback we received from the women both verbally and in surveys was overall very positive about the structure and planning of the treatment programme at Trevi House. Two women suggested that they didnt feel their 1:1 sessions were regular enough or planned. They also said they would prefer to have them on a set day each week. One woman told us I think there should be more groups especially about using. We have an open group for everyone which isnt really drug related. We do one session a week on domestic violence, one session a week on parenting, one session for only an hour on relapse prevention. I do feel there should be a lot more in-depth groups and much more often. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women on a treatment programme at Trevi House are confident that any concerns or complaints will be listened to and addressed. Evidence: All the women we spoke to said that if they had a complaint they would feel able to approach their individual key workers or the General Manager. The senior key worker showed us the Complaints Form, which had recently been redesigned. We also saw another form showing who people should speak to if they are not happy. The Complaints policy has also been rewritten. It states that staff should be clear about What the complaint is about; Who you spoke to; Were you satisfied; What do you think the outcome should be. The senior key worker told us the staff encourage the women to speak directly to people if they need to come to an agreement, as they would need to relate to neighbours when they move on. There is now a paper trail for audit purposes. The General Manager and the Resettlement Officer were due to attend adult protection training shortly after this inspection. They will then cascade this to all the staff. By mid-January all staff will have attended a basic child protection course. The local council has made it mandatory for basic child protection training first before anyone is able to attend training called Hidden Harm. (Within the framework of Every Child Matters, Hidden Harm training is based on a report in June 2003 by the Advisory Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Council on the Misuse of Drugs (ACMD) on the needs of children of problem drug users and the serious negative affects such use has on children from conception to adulthood). The General Manager therefore was hopeful that all staff would be able to attend this training once they had done the child protection training. Two Team Support Workers have attended Child Protection and Substance Misuse, a course run specifically for workers in rehabilitation centres. Two weeks prior to our visit the General Manager had initiated a meeting with the local council Child Protection Officer with a view to establishing a clear protocol and procedure in the event of any child protection issues arising at Trevi House. We discussed other training relating to safeguarding vulnerable adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for all staff working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. The General Manager agreed to arrange training on these subjects. There is a House Meeting held once a week. The Resettlement Officer sits in as the minute taker. She also takes grumbles to the General Manager for him to address either with the group or individuals. There is a clear Whistleblowing policy for all staff and all staff have done in-house training. The Resettlement Officer and the Senior Team Support Worker meet weekly to ensure cohesion between the day time and evening teams. A Communications Book has been introduced for all staff including nursery staff. There is also a Handover Book for use by the day team and the nursery staff. A member of the nursery staff team now attends handover at start and end of every day. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trevi House is homely, comfortable and safe. Evidence: We found Trevi House was welcoming with a good sense of community between the staff and the women staying there. The shared living areas were bright, clean and in good order allowing the women to make use of all the home comforts such as lounge and kitchen areas. The laundry floor and walls were in good condition, and the laundry was tidy. The buildings were in a good state of repair following recent building works. During our visit other works were ongoing to fit shower attachments to existing baths, and the floors of bathrooms and kitchenettes were being recovered. There has been a lack of clarity about responsibility for maintenance and improvements to the fabric of the building, as Trevi House is leased from Devon and Cornwall Housing Association (DCHA). However we were told that a meeting was arranged between representatives of DCHA and the General Manager the week following our visit, to discuss priorities. During an outbreak of diarrhoea earlier this year, yellow bags and appropriate collection were arranged. Both staff and clients joined in a deep clean throughout whole of premises. Since then bedrooms are checked weekly with the aim of achieving a high standard of cleanliness all the time. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: The senior Team Support Worker told us they were hoping to provide robust and solid furniture that would withstand wear and tear. She had consulted the women about preference of furniture. She told us they unanimously asked for storage and as much as possible! There were several disguarded nappies around the rear of the property that were not in bins. We suggested to the staff that the women may need to be given more information about health and safety around the home. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Women on a treatment programme at Trevi House benefit from an experienced, enthusiastic and dedicated staff team who work positively with the women and their children to improve their quality of life. Recruitment practices have improved so women and their children are protected from risk of harm. Evidence: At the time of our visit eighteen members of staff were employed to work at Trevi House. A new post of Day Support Worker has recently been created and someone appointed. She works part time in the nursery and may accompany clients to appointments. This avoids disruption to groups, as key workers used to do this. Also a temporary appointment of senior key worker has been made. The Job Description is yet to be approved by the Board of Trustees, following which the post will be formally offered so that all staff interested may apply, in order to comply with their recruitment procedure and ensure fairness. There are now three key workers who work 09:00 to 17:00 Monday to Friday, and are on call. There are five Team Support Workers and a senior Team Support Worker. They work from 17:00 to 09:30am (sleeping in), and weekends. There are also three Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: bank workers to cover their absences. Their child care responsibility has been clarified as a baby-sitting role. They can be left in charge of no more than four children, and the mothers may only leave their children after they have settled. At the time of our visit there were no whole team meetings. The Team Support Workers all meet with the General Manager once a week. We were told this is a practical meeting with a supervisory quality to it. The key workers also have a weekly meeting on a different day which they use to discuss issues with the General Manager. It is hoped that in the future the senior key worker will be responsible for supervision of the key workers and the senior Team Support Worker may hold regular supervisions for the Team Support Workers. The key workers each have individual monthly clinical supervision with an external supervisor. The General Manager has completed staff appraisals for all the staff and was in the process of drawing up a training plan for the staff team. Training materials were available, but the General Manager felt these were not appropriate for practice based learning. He had identified that moving and handling was needed. A trainer for First Aid had been booked. The Resettlement Officer/Senior Key worker had attended a leadership and management course, NVQ level 4, and refresher courses with the Department of Work and Pensions with respect to Tax Credits and Incapacity Benefit. A key worker had been working throughout the year on an Addiction Diploma, level 3. Other key workers had requested group learning. The Day Support Worker had recently attended training on Health and Hygiene. The administrator had recently benefited from IT training and had also obtained ITQ, which is a NVQ in computers.We did not see any evidence of a structured induction programme and foundation training. This would cover some of the topics that need updating such as safe working practices and the principles of care. Equality and Diversity training is still needed. The General Manager told us he does not want to provide off the peg training, as it may be meaningless in this context. He has previously been involved with a Social Inclusion organisation that he hoped would construct an appropriate training course for the staff at Trevi House. We looked at the files of the two most recently recruited staff. We found that the checks needed to protect clients from potential harm had been carried out. The clients had been involved in the recruitment process. The staff we spoke to and received surveys from told us We are one team now; Enjoy my job; Not negative & restrictive now; Evenings much better now - informal women do their pracs for the next day and sigs then free to so do as they wish for the evening; We have dedicated staff here at the moment; getting better; Crisis management before; Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Much more organised. A visiting professional told us that the staff are friendly and open. We were also made aware of some frustrations about communications around times of meetings, and that this could be improved. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust systems are in place for the benefit of the women staying at Trevi House . The women staying at Trevi House benefit from an open and inclusive ethos. The management and staff team strive to provide a stimulating, safe environment where residents are respected and rights are upheld. Evidence: In January 2009 we found that the General Manager (the person with day to day responsibility) and a small percentage of the staff group were working hard to improve the outcomes offered by the project for women who take up treatment programmes here. They were struggling to manage the many changes that had already happened over the eighteen months previous despite a strong element amongst the staff team that was having a negative impact on the project by their resistant to change. The registered provider took appropriate measures to ensure that those staff reluctant to adopt different approaches and methods of working did not erode and jeopardise the project for the women and their children now and in the future. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: At the time of this visit a new General Manager (the person with day to day responsibility) had been appointed following the resignation of the previous one. The new General Manager has been in post since June 2009. At the time of our visit he was applying to be a registered manager with the CQC. The new General Manger has made significant changes at Trevi House including the introduction of the National Treatment Agency approach to care planning, revised treatment and resettlement programmes, the introduction of a Code of Ethics, and a complete revision of policies and procedures. These have all improved the outcomes for the women who come to Trevi House. There has also been a revision of the service agreement with Devon and Cornwall Housing Association (DCHA) resulting in a complete change of commitment to improve the fabric of Trevi House for the people living and working here. [NB: DCHA is the landlord and Trevi House Limited is the tenant] The General Manager has regular contact with the Chief Executive Officer (CEO) of Trevi House Limited as well as other Board members. The Board of Trustees continue to carry out monthly visits and send the CQC copies of their findings on these visits. A Fire Risk Assessment with an action plan about fire safety was completed in July 2009. A comprehensive Fire Safety inspection was carried out by an independent Fire Safety Officer in October 2009. Periodic fire devices tests are carried out when required and there are fire drills every six weeks. As part of the revised fire safety policy, the nursery and evening fire drills will be included in the future. Trevi House has two named fire officers, one of whom is also the Health and Safety Officer. Quality Assurance was in progress at the time of our visit. As part of the revision of the Quality Assurance policy, a client snapshot, that is, a client evaluation every four weeks has been introduced. Also a Feedback form is sent out to referrers. The recent Ofsted inspection report found that the nursery was good and outstanding. The Board of Trustees has agreed that all staff will receive training in childcare to ensure there continues to be a consistent approach given to the women about the care of their children. Feedback we received from staff working at Trevi House and other people involved with the project, included recognition of the past twelve months, the hard work that has gone into bringing about so much change. We were told Trevi House can offer something of excellence. There is a lot of work ahead still. So few facilities in the UK offer what Trevi can offer. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 CSA 2000,Ch.14 Part II 11(1) As the care home is owned by a company, a Manager must be registered with the CQC. 31/03/2010 Care Homes for Adults (18-65 years) Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 32 All the Team Support Workers should be working towards achieving a minimum NVQ Level 2 in Care by an agreed date, or the manager can demonstrate that through past work experience staff can meet this standard. The training needs analysis should include the provision of a structured induction and foundation training plan for any staff newly appointed to work at Trevi House. You should consider the provision of training for all staff in childcare to ensure there continues to be a consistent approach given to the women about the care of their children. You should ensure that everyone residing at Trevi House is given information about health and safety around the home. This refers to the disposal of used nappies. You should ensure that all staff are up to date with training about safe moving and handling. 2 35 3 35 4 42 5 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!