Review of compliance

CRI (Crime Reduction Initiatives) St Thomas Fund

Region: Location address: South East 58 Cromwell Road Brighton Sussex BN3 3ES Type of service: Date of Publication: Overview of the service: Residential substance misuse treatment and/or rehabilitation service May 2012 St Thomas Fund is part of the Crime Reduction Initiatives (CRI) which is a health and social care charity. It works with individuals affected by drugs, alcohol, crime, homelessness, domestic abuse, and anti-social behaviour. The project at 58 Cromwell Road is a supported living house which accommodates a maximum of 7
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residents. They are supported by staff to undertake a residential and therapeutic programme to enable them to regain control of their lives and to tackle their problems.

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Summary of our findings for the essential standards of quality and safety
Our current overall judgement St Thomas Fund was meeting all the essential standards of quality and safety inspected.
The summary below describes why we carried out this review, what we found and any action required.

Why we carried out this review

We carried out this review as part of our routine schedule of planned reviews.

How we carried out this review

We reviewed all the information we hold about this provider.

What people told us

During our visit we spoke with people who lived at the service and staff members. The people we spoke with told us they felt safe living at the home and felt supported by the staff team. Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.

What we found about the standards we reviewed and how well St Thomas Fund was meeting them
Outcome 01: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run We found that people were respected and their independence maintained at St Thomas Fund home. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their support and treatment. Overall, we found that St Thomas Fund home was meeting this essential standard. Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights We found that service users had their support and welfare needs met.
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People had treatment and support that met their needs and protected their rights whilst adhering to the rules and regulations of the home. Overall, we found that St Thomas Fund home was meeting this essential standard. Outcome 07: People should be protected from abuse and staff should respect their human rights We found people living at St Thomas Fund home were protected from the risks of harm because staff received safeguarding training. Staff knew how to recognise abuse and how to act in the event of any concerns. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Overall, we found that St Thomas Fund home was meeting this essential standard. Outcome 13: There should be enough members of staff to keep people safe and meet their health and welfare needs We found that the concerns raised by staff around staffing levels had already been acknowledged by management and that there was evidence that concerns were being addressed. We felt confident that the services manager had acknowledged the need for more staff at the home and was actively seeking to increase staff numbers. Although there was sufficient staff at during weekdays the services manager recognised that providing an additional staff member would increase the stability of the team. We found that there were sufficient numbers of staff employed at St Thomas Fund home with the exception of weekends where a skeleton team was in operation. We found that service users had their support needs met and that the staff team had the knowledge to meet each person's identified needs. Overall, we found that St Thomas Fund home was meeting this essential standard. Outcome 16: The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care We found that a quality assurance system was in place at St Thomas Fund home that enabled the services manager to regularly assess and monitor the quality of the service that people received. The views of people living at the home and staff had also been sought to improve the quality of care delivery. The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.
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Overall, we found that St Thomas Fund home was meeting this essential standard.

Other information
Please see previous reports for more information about previous reviews.

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What we found for each essential standard of quality and safety we reviewed

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The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, linked to specific regulated activities where appropriate. We will have reached one of the following judgements for each essential standard. Compliant means that people who use services are experiencing the outcomes relating to the essential standard. Where we judge that a provider is non-compliant with a standard, we make a judgement about whether the impact on people who use the service (or others) is minor, moderate or major: A minor impact means that people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. A moderate impact means that people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. A major impact means that people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly. Where we identify compliance, no further action is taken. Where we have concerns, the most appropriate action is taken to ensure that the necessary changes are made. More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety

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Outcome 01: Respecting and involving people who use services

What the outcome says

This is what people who use services should expect. People who use services: * Understand the care, treatment and support choices available to them. * Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support. * Have their privacy, dignity and independence respected. * Have their views and experiences taken into account in the way the service is provided and delivered.

What we found
Our judgement The provider is compliant with Outcome 01: Respecting and involving people who use services

Our findings What people who use the service experienced and told us We found that independence and individuality were promoted within the home. People living at St Thomas Fund home told us they were supported and enabled to do things for themselves. One service user told us 'there is a supportive staff team here..staff support me with issues with social services'. Another service user told us 'we get a choice of what we want to eat and then cook it ourselves'. Other evidence Care plans had been developed for each service user living at the home. The care plans we looked at provided appropriate and detailed information to staff on service user's support needs. The care plans also showed evidence of people setting their own individual goals to achieve. We saw that each service user had their personal belongings in their rooms and their own furniture and decorative effects.
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During our visit we observed staff talking to people and supporting people in a professional manner. We saw that, where required, support was offered and provided in a way that ensured that people's rights to privacy and dignity were respected. During the inspection, we observed a service user who was talking to a staff member about leaving the service. The staff member spoke with him in a respectful and professional way. She provided him with advice around risks and consequences and current (drug) issues on the street to help the service user make an informed decision. We saw that care plans were signed by service users. We saw a section in the care plans on 'things I would like to change' to enable the service users to make decisions about the goals they wanted to achieve. In the care plans we looked at we saw a key worker agenda signed by service users and a medication storage form signed by service users. The service users we spoke with said they were fully involved in decisions made about their care plans. Our judgement We found that people were respected and their independence maintained at St Thomas Fund home. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their support and treatment. Overall, we found that St Thomas Fund home was meeting this essential standard.

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Outcome 04: Care and welfare of people who use services

What the outcome says

This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

What we found
Our judgement The provider is compliant with Outcome 04: Care and welfare of people who use services

Our findings What people who use the service experienced and told us Service users we spoke with told us about the staff at the home and how they liked things done. One service user told us 'I feel healthier since being in here and have started eating again. There is a supportive staff team here' Another service user told us 'I can talk with staff about my care plan'. Other evidence Care records we saw confirmed that people living at St Thomas Fund home were registered with a local GP and had access to healthcare professionals as necessary. There was a key worker scheme in operation at the home. During our visit we looked at the care plans for some of the people living at the home. The plans were up-to-date and contained evidence of regular review. They provided information to staff on how people preferred things to be done. The care plans had risk managements plans and substance misuse assessments that related to specific and identified risks to people's safety. The care plans contained details of actions to be taken by staff and service users to minimise the identified risks. The care plans we saw demonstrated evidence of people's individual needs to include individual goal setting, support networks and significant events sheets. We saw
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evidence of up-to-date daily evaluation sheets being used. We saw service user signatures on care plans and updated reviews were observed, with the review due date clearly documented on the care plans. One care plan we looked at was over due for a review. We were told that service users attended daily group and therapeutic sessions and completed assignments during their residential programme. The home also provided group sessions for people not residing at the service. Our judgement We found that service users had their support and welfare needs met. People had treatment and support that met their needs and protected their rights whilst adhering to the rules and regulations of the home. Overall, we found that St Thomas Fund home was meeting this essential standard.

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Outcome 07: Safeguarding people who use services from abuse

What the outcome says

This is what people who use services should expect. People who use services: * Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld.

What we found
Our judgement The provider is compliant with Outcome 07: Safeguarding people who use services from abuse

Our findings What people who use the service experienced and told us The staff we spoke to said that they had undertaken recent safeguarding training. They told us if they witnessed abuse they would speak with the services manager or contact external agencies. One staff member told us 'I have completed recent safeguarding training and have completed fire warden training also'. Another staff member told us 'I completed safeguarding training recently. If I witnessed abuse I would go to a manager and alert other agencies as needed'. A service user told us 'I feel safe living here'. Other evidence The services manager at the home confirmed that St Thomas Fund home operated in accordance with the Pan Sussex Multi Agency Policy & Procedures for Safeguarding Adults at Risk. We saw evidence of internal safeguarding policies and procedures used by the home. The internal safeguarding policy was updated in March 2012. We saw examples of other policies to include a Mental Capacity Act policy and joint working protocols regarding safeguarding the needs of children. We also saw evidence of a 'Whistleblowing' procedure in place at the home. We
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advised the services manager that the policy needed to inform employees of external agencies they could contact to discuss whistleblowing concerns. The services manager told us that the home ensured, as far as is practicable, that people were safeguarded from all forms of abuse. During our visit we were told there were no safeguarding investigations taking place within the home. We were told that the home attended the Multi-Agency Risk Assessment Conference (MARAC) when required to discuss high risk cases of domestic abuse between relevant external agencies. The services manager told us that staff attended safeguarding training regularly to increase their knowledge of safeguarding practices and procedures. The services manager told us that she attended a local manager's safeguarding 'hub'. This enabled them to identify risks and undertake prevention work with service users within their specialist service sector. The services manager told us that quarterly management meetings were held to discuss safeguarding issues. We were told that the Deputy Director for the Crime Reduction Initiatives (CRI) was the safeguarding lead for the organisation and that she was very supportive and there was good communication around safeguarding issues. We saw evidence in team meeting minutes of regular safeguarding discussions held. We were told that safeguarding issues were discussed by staff members at shift handover times and an electronic handover of safeguarding issues was also in operation within the home. The services manager told us that the home worked closely with the community police team and had developed a good working relationship with them. This enabled the home to support service users where safeguarding issues arose. This often led to appropriate negotiation of bail conditions; planned arrests, use of plain clothes police officers to support a balanced and measured safeguarding process. Our judgement We found people living at St Thomas Fund home were protected from the risks of harm because staff received safeguarding training. Staff knew how to recognise abuse and how to act in the event of any concerns. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Overall, we found that St Thomas Fund home was meeting this essential standard.

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Outcome 13: Staffing

What the outcome says

This is what people who use services should expect. People who use services: * Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

What we found
Our judgement The provider is compliant with Outcome 13: Staffing

Our findings What people who use the service experienced and told us As part of our inspection we looked at staffing levels at St Thomas Fund home. We spoke with service users to obtain their views on staffing levels in the home. One service user told us 'every now and again they are short staffed'. We also spoke with members of staff during our inspection about their experience of working at St Thomas Fund home. One staff member told us 'I feel there is an environment of open communication now. I can talk to management about issues and concerns'. Another staff member told us 'I have a concern with regard to lone working at weekends. I have discussed this with management and they have listened to my concerns. Another staff member is needed particularly at weekends'. Another staff member told us 'It has been short staffed here, however it doesn't feel like we are short staffed, as any issues are addressed quickly by management'. Other evidence We were unable to speak with the registered manager for the service as she was temporarily absent from post. We discussed staffing arrangements at St Thomas Fund home with the services
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manager. We were told that interim management of the service was being provided by the services manager who was available at the service several days per week and contactable by telephone. In addition a senior project officer was providing an interim management role and worked between three locations and attended the service on a daily basis. She was also available at short notice to attend the service when needed. The services manager confirmed that the staff team consisted of two project workers, one sessional worker and a volunteer working on a shift from 9am to 5pm. At night there was one permanent night worker working at the home. At weekends there was one project worker or sessional worker at the home. This was confirmed when we looked at duty rotas. The services manager told us that having interim management had been unsettling for staff. Staff had been supported by weekly staff meetings being held. Staff supervisions were also undertaken. The services manager was confident that the staff team was sufficiently experienced and competent to meet the demands of the service. The services manager told us that there was one staff vacancy which they were due to advertise for. The services manager told us that the service could benefit from an additional staff member at weekends and a change in how the existing staff team was utilised. She was satisfied that the current staff team was competent to manage all issues arising, however staffing changes needed to take place to better meet the needs of the service. The services manager told us she was developing a staff action plan. This action plan would include the need to refocus existing resources within the three local homes run by the Crime Reduction Initiatives (CRI). At the time of the inspection we were told that this had been agreed in principle by management at CRI. The services manager forwarded an action plan to us on future staffing arrangements and we were satisfied with the proposed action being taken. The services manager told us that an additional project worker was required at weekends as this had been identified as a time when crises can occur. Also service users required more structure at weekends to reduce the risk of such crises occurring. We were told by the services manager that the service could manage with the current staff team, but that it was currently 'fire fighting' situations. With the changes proposed in the action plan the service would be more stable. We observed staff to be working and interacting with service users in a calm and responsive way during our inspection. We observed that staff dealt with a crisis during out inspection in a calm, responsive and professional manner. Our judgement We found that the concerns raised by staff around staffing levels had already been acknowledged by management and that there was evidence that concerns were being addressed. We felt confident that the services manager had acknowledged the need for more staff at the home and was actively seeking to increase staff numbers. Although there was sufficient staff at during weekdays the services manager recognised that providing an
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additional staff member would increase the stability of the team. We found that there were sufficient numbers of staff employed at St Thomas Fund home with the exception of weekends where a skeleton team was in operation. We found that service users had their support needs met and that the staff team had the knowledge to meet each person's identified needs. Overall, we found that St Thomas Fund home was meeting this essential standard.

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Outcome 16: Assessing and monitoring the quality of service provision

What the outcome says

This is what people who use services should expect. People who use services: * Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

What we found
Our judgement The provider is compliant with Outcome 16: Assessing and monitoring the quality of service provision

Our findings What people who use the service experienced and told us During our visit to St Thomas Fund home we asked people their views about the home and whether they were happy living there. We also looked at service user consultation documents for more information. One service user told us 'there is a supportive staff team here'. Another service user told us 'staff sometimes have different views on policies which can be confusing'. Other evidence During our visit to St Thomas Fund home, we observed people who lived at the service being spoken with and supported in a friendly and professional manner. We observed that service users were able to express their views and make suggestions by talking directly to the staff where possible. We observed a suggestion box in the lounge where service users were encouraged to provide suggestions to improve the service. We saw that a service user consultation had taken place in January 2012. A staff team and service user training day had recently taken place to find out what people wanted from their residential and therapeutic programme. Feedback had been sought from current and previous service users and people who attended the structured day programme.
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In response to comments raised at the consultations, changes had been implemented at the home. As a result of the consultation a creative group and reflective learning sessions had been introduced. Another example involved working closely with The Princes Trust and Jobcentre to promote job opportunities for service users. We were told by the services manager that monthly care plan audits were completed on care plans. We were told that due to the absence of the registered manager this audit had recently not been completed. We saw that Incident Notification Forms were being used in the home and that incidents were communicated to regional managers to ensure lessons were learned. We saw clear evidence of risk issues being addressed at weekly team meetings. We were also told that work practice risk assessment forms were completed and six monthly reviews undertaken to address issues arising. We saw that a Brighton and Hove City Council Supporting People contract review had taken place on16th March 2012. The previous safeguarding rating of 'C' had been reassessed as a 'B' due to staff increasing their safeguarding awareness by attending a safeguarding hub. This review evidenced that the home had an 'A' rating for involving service users in decisions about the home and the service provision. We saw written evidence that an internal unannounced inspection had been completed in August 2011. Recommendations had been made regarding health and safety issues and an action had been set up for the registered manager to complete. We were told that some of the actions had been completed. Some actions were awaiting completion due to the absence of the manager. We saw that the home's policies and procedures were updated centrally on the intranet and that employees could access these at all times. The policies that we saw were upto-date. We were told that policy changes were communicated to staff via emails and employee consultations were also held as required. We saw evidence of a clear complaints policy within the home and evidence that this was being followed appropriately by the management team. The services manager told us that an unannounced internal health and safety audit had taken place in February 2012 and was due to be completed again in May 2012. The services manager acknowledged that the health and safety policy was not up-to-date and said that she had already started working on this. She expected to have it completed within two weeks of the date of the inspection. The services manager told us that an internet based governance tool was being introduced to enable effective auditing and action planning. The computer system would create triggers for managers to action any issues that needed to be addressed. The services manager told us that the audit tool should be fully operational within a three months period after audit information had been transferred onto the system. We saw that there was a fire safety policy at the home and the Sussex Fire Brigade completed a fire inspection in August 2011. A 'eurofire protection' assessment was completed in March 2012 where no issues were identified.
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The services manager told us that the Crime Reduction Initiatives (CRI) had recently bought the lease for the building and a new maintenance plan was due to be developed. We observed that a new kitchen had recently been fitted at the home. Our judgement We found that a quality assurance system was in place at St Thomas Fund home that enabled the services manager to regularly assess and monitor the quality of the service that people received. The views of people living at the home and staff had also been sought to improve the quality of care delivery. The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. Overall, we found that St Thomas Fund home was meeting this essential standard.

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What is a review of compliance?

By law, providers of certain adult social care and health care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The Care Quality Commission (CQC) has written guidance about what people who use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that is of concern and as a result decide we need to check whether a service is still meeting one or more of the essential standards. We also formally review them at least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with direct observations of care. Where we judge that providers are not meeting essential standards, we may set compliance actions or take enforcement action: Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. We ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make sure that essential standards are met. Enforcement action: These are actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people.

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Information for the reader

Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public 03000 616161 / www.cqc.org.uk Copyright (2010) 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 Quality Commission

Website Telephone Email address Postal address www.cqc.org.uk 03000 616161 enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

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