Care and Social Services Inspectorate Wales

Transcription

1 Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for younger adults Brynawel House Alcohol Rehabilitation Centre (Care Home) Brynawel House Llanharry Road Llanharan Pontyclun CF72 9RN Date of publication 18 October 2010 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers

2 Care and Social Services Inspectorate Wales Mid & South Wales 4-5 Charnwood Court Heol Billingsley Parc Nantgarw Nantgarw CF15 7QZ /28/ Home: Brynawel House Alcohol Rehabilitation Centre (Care Home) Contact telephone number: Registered provider: Registered manager: Brynawel House Alcohol Rehabilitation Centre Jacquelyn Wood (Registration pending) Number of places: 16 Category: Care Home - Younger Adults Dates of this inspection from: 5 July 2010 to: 8 September 2010 Dates of other relevant contact since None last report: Date of previous report publication: 10 September 2009 Inspected by: Pauline Richards Introduction Accommodation is provided in two buildings in a rural location with countryside views. Both buildings have eight bedrooms. The buildings are set in attractive gardens with lawned areas, several patio areas and a vegetable plot. A number of lounge facilities are available which are used for therapy work and for relaxation. They were observed to be decorated in a homely fashion and provided a comfortable environment. The manager informed the inspector that the home is decorated every year if required. All service user rooms are single occupancy and have en-suite facilities. The en-suites include shower facilities in all rooms except two rooms that share a bathroom. Bathing facilities are provided to those whose service users who prefer a bath. Separate toilet facilities are available in both buildings. Readers of this reports, as well as the registered persons, should note that in line with national policy direction and guidance on proportionality and focus in regulation, action needing to be undertaken by a home to meet regulatory or good practice requirements Page 1

3 may in some instances be shown only in the body of the text, and not specifically and separately set out and identified as a formal requirement with a defined timescale for compliance and for notifying the CSSIW of that compliance. This does not absolve the registered persons from their statutory duty of care or remove or reduce the need for them to comply fully with the Care Standards Act 2000, the Care Homes (Wales) Regulations 2002 (as amended) and the National Minimum Standards. Summary of inspection findings What does the service do well? Developed specialist knowledge in the field of substance misuse and therapeutic interventions Staff feedback to CSSIW indicated a personal commitment to working with service users who access the service Service user feedback to CSSIW indicated a high level of satisfaction with the service and support received What has improved since the last inspection? No regulatory requirements identified at the last inspection What needs to be done to improve the service? a.) priorities No regulatory requirements made during this inspection b.) other areas for improvement Ensuring the complaints procedure is developed to include the timescales for dealing with local and formal resolution complaints Inspection methods Consideration of the registered persons completed self-assessment documents Consideration of policies, procedures and other documents at the home Case tracking three service use files and the files of staff recruited since the last inspection Discussions with the manager, some staff and service users at the home CSSIW questionnaires completed by four service users CSSIW questionnaires completed by four members of staff Observations made during the inspection visit to the home It is acknowledged that the questionnaire responses obtained during this inspection episode cannot be considered as a statistically representative sample, however responses are referred to in order to provide some insight into individual perspectives of the care Page 2

4 provided at the home. A thematic inspection on infection control standards was undertaken during this inspection. A separate section for the report on this thematic inspection will be found at the end of the report headed Infection Control. Page 3

5 Choice of home Brynawel House Rehabilitation Centre accommodates up to sixteen service users in the age range of eighteen onwards who have an alcohol dependency. The short-term treatment programme is usually sixteen weeks in duration. All individuals are referred either privately or by the statutory sector. Emergency admissions are not accepted. Service users are invited to visit the home as part of the assessment process where opportunity is given to look around the facilities. Terms and conditions relating to their stay at the home are discussed at this time. The home has a statement of purpose and a service user guide. These provide an overview of the service for prospective service users. Service users are given copies of these documents during their assessment visit to the home. These documents are regularly reviewed and were last reviewed in July Upon arrival at the home, service users complete an initial health check and are assigned a counsellor. The home produce a client information booklet, designed as a quick reference guide to assist service users to settle into the home, New arrivals are allocated a mentor, selected from current service users, which have been at the home for over ten weeks. As part of the inspection process, three service users completed CSSIW questionnaires. All respondents confirmed that they had received written information relating to the home and had the opportunity to visit prior to admission. All three service users stated they had received a good welcome into the home. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 4

6 Individual needs and choices Three service user files were examined. There was evidence that the home provides treatment and rehabilitation in the form of a structured treatment programme. This includes individual counselling, group work, employment and education. Service user plans are reviewed every four weeks with the case manager. The manager has identified the need to review the format of the service delivery plans and will be developing these plans for all service users. All questionnaires and discussion with three service users indicated that staff knock and wait for a reply before entering a bedroom. Service users are issued with a key to their room and a lockable cabinet is provided for storage of valuable possessions. Personal records are held securely. Comments from staff questionnaires confirmed that records are kept confidential and that all staff sign a confidentiality agreement. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 5

7 Lifestyle Brynawel House has a routine for service users. It is designed to give service users a structure to their lives which can be replicated when they return to their own home. Through communication with the referring agency, the home ensures that all service users have mental capacity to understand the limitations placed on their freedom whilst undertaking the rehabilitative programme which is subsequently agreed in a contract. Service users are encouraged to be self-caring and are expected to contribute to the running of the home and are required to undertake domestic duties. The home has a policy of full service user involvement. Weekly meetings are held and a service user takes the residential lead in these meetings. Minutes are taken and actions followed up at the next meeting. Service user comments included: house meetings are very helpful you can say if there is anything wrong with rooms. As part of the rehabilitation programme, the home provides the opportunity to become involved in a variety of social activities and hobbies depending on the service user s care plan. The manager and service users spoken with confirmed the extensive social and leisure activities that are provided inside and outside the home. All service user rooms are equipped with television, DVD player, alarm clock radio / CD player. Service users are responsible for keeping their own finances and possessions. There are kitchen facilities for service users to prepare their own breakfast, snacks and refreshments. Two main meals a day are prepared by a cook in the main kitchen. The service users spoken with confirmed there was a varied menu with a choice of meals offered. The new cook advised the inspector of the fresh and homemade food that he prepares. In discussion with service users and from questionnaire responses, positive comments were made regarding the food, and one stated: New cook is excellent. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 6

8 Personal and healthcare support Staff roles focus on encouragement and support with social skills development. Personal care service is not provided by the home. On admission all service users are given a timetable and they are expected to attend one hundred percent of the treatment programme, with the exception of illness or medical appointments. The programme consists of small and large group therapy, assignments and one to one support. All therapy programmes are overseen by qualified counsellors. The home also use peer support and separate counselling programmes are offered to service users family members if required. Brynawel House has established positive working relationships with the local GP practice who are experienced in the treatment of alcohol dependency. The home registers all service users as temporary patients with this GP practice. Service users are supported to attend medical appointments as and when required. Service users medication, other than inhalers and creams, are stored securely. The home has a medication policy that was revised in March Medication training is part of the staff induction programme. A sample of service users medication demonstrated appropriate arrangements for the administration, storing and recording of the medication were in place. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 7

9 Staffing The home employs both genders as rehabilitation workers and a therapeutic team who come under the direction of the clinical lead officer. Volunteers are also used for specific roles. Staff files examined included three recently recruited members of staff. These demonstrated a robust recruitment process was in place. The recruitment process now includes exploring gaps in employment and written references verified with a telephone call. One written reference on the file of a staff member who had been working at the home for a number of years was observed. The home must ensure appropriate checks as listed in the Care Homes (Wales) Regulations 2002, including two written references, have been carried out for all staff employed at the home. Enhanced Criminal Record Bureau (CRB) disclosures had been received for staff and volunteers prior to them commencing work or placement at the home. The manager explained the procedure in place to renew the CRBs on a three-yearly basis. When issues are identified on the CRB disclosures, the registered persons should maintain a record of the decision-making process regarding suitability of the applicant. Two-monthly staff supervision is held and counselling staff have monthly clinical supervision. It is recommended that the induction programme completed by newly recruited rehabilitation staff is in line with the guidance from the Care Council for Wales. Evidence was provided that staff hold or are working towards the recognised qualification approved by the Care Council for Wales. Core and updated training is provided. Also specific training necessary to support the identified needs of service users is provided. Staff questionnaires indicated that they received relevant training and that they worked well as a team. Specific comments included: Brynawel is a safe haven for clients and a good place to be employed ; the staff are a team, we endeavour to help each individual to succeed with their therapy. Comments from service users indicated that they all felt they were treated with dignity and respect by staff members. Comments included: very good staff ; they are all nice ; no problem approaching staff ; they ve always got time ; they make conversation. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 8

10 Page 9

11 Conduct and management of the home Brynawel House Alcohol Rehabilitation Centre has charitable status and is managed by a Board of Trustees, including a former service user. The new manager of the centre is the acting chief executive officer who previously held the position of deputy chief executive officer. An application is currently in process for the registered manager. Senior management roles are being reviewed and the manager described the support from the Responsible Individual on behalf of the board of trustees and from other staff. The manager also manages Brynawel House Domiciliary Care agency and is supported in her role. Staff from the rehabilitation centre sometimes provide domiciliary support to service users, however this does not affect the staffing ratio at the home. The home has a number of mechanisms in place to monitor and evaluate the quality of service provision. An annual planning day is held with trustees, managers, staff, service users and former service users where a strategic three-year plan is established and the annual operating plan updated. The chair of the board of trustees undertakes regular audit visits to the home. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 10

12 Concerns, complaints and protection A complaints procedure is in place with three complaints received since the last inspection. There were no outstanding complaints. The complaints procedure needs to be developed to include the timescales for dealing with local and formal resolution of complaints. Of the service users spoken with, none expressed any concerns or complaints to the inspector. One service user stated: No concerns at all, everything as I expected even better. There is a Protection of Vulnerable Adults (PoVA) policy to inform staff of the appropriate action to take should they suspect a service user is subject to abuse. PoVA training is provided, however regular refresher training needs to be provided and the training dates recorded. The home does not use any form of physical restraint and operate a zero tolerance attitude to violence. This is outlined in the terms and conditions signed by service users upon admission. The manager and some members of staff have received training in the Deprivation of Liberty Safeguards (DoLS), and the manager reported that there have been no requests for DoLS authorisations. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: The registered persons should ensure that the complaints procedure is developed to include the timescales for dealing with local and formal resolution of complaints. National Minimum Standard 35 Page 11

13 The environment Accommodation is provided in two buildings in a rural location with countryside views. Both buildings have eight single-occupancy bedrooms. The buildings are set in attractive gardens with lawned areas, several patio areas and a vegetable plot. A number of lounge facilities are available which are used for therapy work and for relaxation. They were observed to be decorated in a homely fashion and provided a comfortable environment. Redecoration is undertaken when needed. Service user rooms were equipped with entertainment equipment and had en-suite facilities. The en-suites included shower facilities in all rooms except two rooms that shared a bathroom. Bathing facilities are provided for those service users who prefer a bath. Separate toilet facilities are available in both buildings. The provider s self-assessment confirmed compliance with fire, electrical, gas, water, environmental health, COSHH and clinical waste certificates / testing regimes. The inspector observed however that one fire door had been left wedged open. This was immediately addressed and staff and service users to be reminded to keep fire doors closed. Risk assessments need to be undertaken where necessary for any upstairs windows without window restrictors. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Page 12

14 A note on CSSIW s inspection and report process This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations. The primary focus of the report is to comment on the quality of life and quality of care experienced by service users. The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards. CSSIW`s inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with: Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards. The service`s own statement of purpose. At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users` and their relatives`/representatives` experiences. Such methods may for example include selfassessment, discussion groups, and the use of questionnaires. At any other time throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service. Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times. The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section. As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year`s report which are not listed as outstanding have been appropriately complied with. Where key requirements have been identified, the provider is required under Regulation 25B (Compliance Notification) to advise CSSIW of the of any action that they have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome. Page 13

15 CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW. Should you have concerns about anything arising from the inspector`s findings, you may discuss these with CSSIW or with the registered person. Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: Page 14

16 Thematic Inspection: Infection Control Summary of inspection of infection control findings What does the service do well? All rooms are single occupancy and have en-suite facilities Well maintained environment Each week a client co-ordinator takes responsibility for implementing a rota for service users to clean communal areas in the home No outbreaks of infection since the last inspection What needs to be done to improve the service? a.) priorities No regulatory requirements b.) other areas for improvement Ensuring a system is in place for the regular checking of the condition of items such as pillows Ensuring infection control training is provided for all staff Ensuring the home s policy and procedure on infection control is expanded and updated Ensuring further monitoring of the effectiveness of the cleaning regime in all areas of the home Inspection methods Consideration of the infection control self-assessment checklist completed by the registered persons Consideration of the home s infection control policies and procedures Discussions with the manager, some members of staff and some service users Observations made during a tour of the premises Page 15

17 Personal and healthcare support All service user rooms are single occupancy and have en-suite with shower facilities, except two rooms that share a shower facility. Each service user has his/her own toiletries and personal hygiene items. Service users attend to their own personal care needs. Service users maintain their own rooms for the duration of their stay. There is a checklist in each bedroom and on a weekly basis staff check that the rooms have been satisfactorily cleaned. Three service users agreed to the inspector checking their rooms. The rooms and ensuites were generally found to be clean. Mattresses and bedding were clean however the inspector observed that some pillows were badly stained. Immediate action was taken to replace the pillows. The inspector was advised that new duvet covers and pillows had been purchased. Requirements from this inspection: The registered persons should ensure a system is in place for the regular checking of the condition of items such as pillows. Page 16

18 Staffing Service users are responsible for cleaning their own rooms and communal areas. Staff are required to monitor that these areas are kept clean. The registered provider s self-assessment confirmed that staff have an awareness of infection control issues and they follow safe systems of work to minimise cross infection. Staff are updated via meetings and supervision to reinforce safe systems of work. However the inspector advised the manager that training in infection control should be provided to all staff. Requirements from this inspection: The registered persons should ensure that infection control training is provided to all staff. Page 17

19 Conduct and management of the home The home s infection control policy and procedure was revised in March However areas of the policy need to be expanded and updated. Each week there is a client co-ordinator who is responsible for implementing a rota for service users to clean communal areas in the home. Most areas of the home were clean however there were areas where further monitoring of the effectiveness of the cleaning regime was required. Requirements from this inspection: The home s policy and procedure on infection control should be expanded and updated. Further monitoring required of the effectiveness of the cleaning regime in all areas of the home. Page 18

20 Concerns, complaints and protection No outbreaks of infection or complaints or PoVA issues in relation to infection control had been reported since the last inspection. Requirements from this inspection: Page 19

21 The environment There are laundry facilities in both units. Service users are responsible for their own laundry. All service users have their own laundry basket and the client co-ordinator is responsible for allocating laundry days/times for each service user. Requirements from this inspection: Page 20