Care Home: Turning Point

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What the care home does well Through discussion with service users and staff it is evident that the Turning Point Canterbury Project provides effective, consistent and well managed support for up to 12 people with alcohol addiction problems. One service user said, "The project is excellent, it has really helped me deal with my problems." The staff develop clear and concise support plans and provide a structured treatment programme enabling service users to take responsibility for their own lives. The environment is suitable for the needs of the service users and provides a conducive atmosphere to promote rehabilitation. There is an experienced a committed staff group who work well as a team providing mutual support and a varied approach. An administrator is employed in the service who ensures that all records and documentation related to the running of the home including health and safety information is kept up to date. User involvement is a key aspect of the service including regular group meetings, feedback surveys and other quality assurance measures. What has improved since the last inspection? The service has continued to develop the range of therapeutic activities tailored to the individual and collective needs of the service users. Staff reported that the cohesiveness of the staff team has improved even further with the addition a new team member. On-going development throughout the service has been key, it was reported, to the continuing success of the project. What the care home could do better: Only 1 recommendation has been made as a result of this inspection surrounding training issues. The staff in the home do not handle or prepare food for service users, however to ensure that food safety issues are monitored it is advised that all staff update their food hygiene training. Similarly moving and handling training should also be provided even though this would only be in relation to inanimate objects. CARE HOME ADULTS 18-65 Turning Point Canterbury Alcohol Project 63 Whitstable Road Canterbury Kent CT2 8DG Lead Inspector Joe Harris Key Unannounced Inspection 29th November 2007 10:00 Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Turning Point Address Canterbury Alcohol Project 63 Whitstable Road Canterbury Kent CT2 8DG 01227 454374 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) eleanor.harris@turning-point.co.uk www.turning-point.co.uk Turning Point Limited Ms Eleanor Harris Care Home 12 Category(ies) of Past or present alcohol dependence (12) registration, with number of places Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2006 Brief Description of the Service: The Project operates a short term rehabilitative programme (the Programme). This is designed to provide a therapeutic milieu within and by means of which service users can identify and practice the skills necessary to enable them to move away from a reliance upon alcohol which is not helpful. The Programme involves service users undertaking both private work and group activities. Most service users do not stay for a period longer than six months. The premises are an older, three storey detached property, which has been adapted for its present use. There is provision for six service users to have their own bedroom and there are three shared occupancy bedrooms. The property is set back a little from one of the main roads into Canterbury. The city centre is within easy walking distance. To the rear of the property, there is a large enclosed garden. The current fees for the service at the time of the visit are £440.00 per week. Information on the Home services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection process culminated in a site visit to the service on 29th November 2007. The site visit commenced at approximately 10am and concluded at 3.30pm, lasting for around 5.5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? The service has continued to develop the range of therapeutic activities tailored to the individual and collective needs of the service users. Staff reported that the cohesiveness of the staff team has improved even further with the addition a new team member. On-going development throughout the service has been key, it was reported, to the continuing success of the project. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 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 Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The needs and aspirations of prospective service users are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the service users have been referred through care management processes. As a result detailed information is provided at the point of referral. Staff also conduct an assessment, which involves either a telephone assessment or a face-to-face assessment at the service. As a home that works with people who are addicted to alcohol the main focus of assessment is to determine the readiness of an individual for treatment. The staff ensure that all needs and risks are highlighted through the referral process including physical and mental health issues. Two current service user files were examined that contained a good level of assessment information covering all relevant aspects of need and support including social, medical and psychological issues. One prospective service user was spoken to who confirmed that the process is useful, informative and well managed by the service. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 9 Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. An individual support plan is developed for each service user and risk assessments completed. Service users are supported to make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service user support plans were examined during the course of the site visit. Both plans contained suitably detailed information to address the support needs of each individual. The plans focus on the primary aspects of the treatment programme and are in a generic format initially. Continual assessment continues through group and individual work and the plan of support is developed through out this time in line with the needs of each individual. Where other specific issues are identified the service ensures that Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 11 these aspects of care are also addressed. All service users are fully self-caring therefore no personal care support is required. The independence and autonomy of each service user is actively promoted throughout the programme. Individuals, following a two-week period of ‘buddying’ from a peer within the service, are supported to take full responsibility for their own lives and make choices and decisions in all aspects of life. The staff provide a resource to discuss issues and promote problemsolving and peer support. All service users manage their own finances throughout their period of residency. The home has risk management processes in place and adequately assesses the perceived risks associated with individual service users. Risk assessments identify and provide guidance to minimise risks encouraging responsible risk taking. Risk assessments are regularly reviewed and updated as required. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. The service users have a lifestyle that suits their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user’s time in the service is clearly structured with a range of group and individual work organised throughout the week. The groups address process issues, anger management, social skills, self awareness and goal setting amongst other things. Whilst individual work concentrates on the progress made and issues arising for each individual. Out of these times service users take responsibility for their own affairs within a context of collective responsibility for the day-to-day running of domestic duties in the home such as cooking, cleaning and shopping, etc. All individuals are expected to take a full and active role in all aspects of life within the home. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 13 Following the initial two weeks of treatment when new service users are not encouraged to go out alone residents are free to come and go as they please as long as they attend all groups. Service users confirmed that they go out as they wish and access the local facilities and resources offered by the city of Canterbury. As part of the rehabilitation programme service users generally have limited contact with external families and friends, but opportunities are made regularly available for people to visit their homes and to have visitors to the service. Service users are responsible, on a rota basis, for all aspects of food in the service including planning, shopping, preparation and cleaning. Residents stated that this works well and everyone supports each other with aspects that people may find difficult. This responsibility is an important part of the treatment programme both in developing skills and personal development. The menus are collectively agreed on a weekly basis ensuring a healthy, balanced diet with choices as required. Should any individual have specific dietary needs these are catered for appropriately. Menu records demonstrate a balanced diet and a good choice of food; drinks and snacks are available at all times. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. The personal and healthcare needs of individuals are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individuals admitted for treatment must be fully self-caring, which is assessed as part of the admission process. Staff stated that the only support may be through encouragement alone. All service users sign on temporarily with a local GP if they are admitted from outside the local area. Individuals are responsible for managing their own healthcare needs and staff monitor any issues and ensure that appropriate actions are taken and outcomes followed up after consultation where appropriate. Additional healthcare needs are addressed as and when required due to the relatively short-term nature of the placement and rehabilitation programme. Service users are responsible for managing their own medication and have an assessment on admission to the home ensuring their competency in this Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 15 regard. All bedrooms are equipped with a lockable cupboard for storage purposes. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Service users views are listened to and acted upon and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place and robust systems to address any issues of concern. There have been no complaints since the last inspection. Regular group meetings are held to enable individuals to feedback about the service and address any issues of concern. One current service user said, “We regularly fill out feedback sheets and you know that any problems or suggestions will be dealt with.” There are policies and procedures and clear guidance in place regarding issues of abuse and adult protection. All staff receive in-depth training as part of the organisation’s induction programme. Staff showed good levels of awareness of how to respond and report any potential issues of abuse or concern should they arise. Such issues are also addressed through the induction programme and additional training. There have been no adult protection alerts since the last inspection. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The environment is comfortable, clean, homely and suitable for the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is large, comfortable and well maintained. There is adequate living space throughout with a good range of communal space. There are three double rooms and six single rooms all of which are adequately equipped and of a good size. Double rooms are generally used for newer service users to ensure peer support throughout the day, but service users confirmed that as the treatment programme progresses they generally move on to single accommodation. There is a good sized garden to the rear of the home and areas of the building provide office space. The home is bright and airy. The house is situated on a main road leading into Canterbury and has good local Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 18 transport links. It was reported that service meets the requirements of the local fire and environmental health departments. The home was maintained to a good standard of cleanliness and hygiene in keeping with domestic premises. There are adequate laundry facilities suitable for the needs of the home. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. Service users are supported by a competent and qualified staff team in sufficient numbers for the needs of the service. The home’s recruitment practices are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff working in the home have either achieved relevant qualification in the field of addiction/counselling services, which are equivalent to a higher NVQ level or hold a degree in a relevant subject. In discussion with staff it was apparent that there is a very good understanding of the needs of individuals and the process of rehabilitation. Service users also confirmed that the staff provide clear, consistent and focussed support through individual and group work. The service is only staffed during daytime hours with an effective on-call system in place should any emergencies arise overnight. In discussion with service users it was apparent that if and when the on-call system is required there is a quick and effective response from service staff. As part of the Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 20 assessment process the competency of service users is defined and the home would not accept referrals for individuals requiring 24 hour care or support. A weekend meeting is held on a Friday and Monday to address any issues raised during the weekend. Residents must complete fire safety questionnaires and are acquainted with other key health and safety issues Recruitment issues are managed from the regional office and copies of relevant information are provided to the service. Only one new staff member has joined the service since the last inspection. It was not possible to view any staff files during this site visit, but information gained from previous inspections provided evidence that all recruitment checks are routinely and satisfactorily completed. Staff reported that they receive good levels of training to enable career progression in the field of substance and alcohol addictions. The organisation provides a good training package covering a range of topics including foundation training and service specific issues. The home has a positive induction programme ensuring all issues relating to the service are addressed and there is also an organisational induction programme addressing general and staff issues. There is clear and unequivocal guidance covering all foundation training topics and health and safety information, however, it is recommended that all staff complete suitable manual handling training and food hygiene training is updated. Refer to recommendation 1. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The home is well run in the best interests of the service users. The health, safety and welfare of service users is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was not present at the time of the site visit. She has many years of experience working in the field of addiction and specifically with alcohol related problems. She has managed the service for a number of years and demonstrates a clear sense of direction and vision for the development of the service and programmes of rehabilitation. She has obtained a wealth of Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 22 qualifications relating to her field of expertise and has also attained management qualifications to supplement this. The home has developed very good quality assurance systems at a local level and through the organisation. A range of forums and methods are available for all service users to feedback about the quality of the service. Regular questionnaires are completed, including exit questionnaires for service users and the results are collated and action points taken to address any perceived shortfalls. The home is regularly visited by a senior manager for the organisation who audits records and other relevant information. All health and safety information was well maintained and up to date including maintenance and service checks. Fire safety records were up to date and environmental risk assessments and monthly health and safety audits completed. It was reported that the home meets the requirements and legislation pertaining to health and safety issues. Adequate policies and procedures are in place to ensure safe working practices. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA35 Good Practice Recommendations To ensure all staff have updated training covering manual handling and food hygiene. Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Turning Point DS0000023617.V352342.R01.S.doc Version 5.2 Page 26 - 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. 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