Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Littledale Hall Therapeutic Community Littledale Hall, Lancaster, LA2 9EY Tel: 01524771400 Date of Inspection: 07 January 2014 Date of Publication: January 2014 We inspected the following standards as part of a routine inspection. This is what we found: Care and welfare of people who use services Cleanliness and infection control Management of medicines Safety and suitability of premises Requirements relating to workers Assessing and monitoring the quality of service provision Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 1
Details about this location Registered Provider Registered Managers Overview of the service Type of services Regulated activity Littledale Hall Therapeutic Community Limited Mrs. Nicola Anne Agliolo Mr. Keith Robertson Littledale Hall provides a rehabilitation service to people whose lives have been adversely affected by substance misuse. The service supports up to 31 men and women to recover from previous addiction through a structured programme of interventions. The service will assess participants to the programme through referral. Littledale Hall is a Grade 2 Listed Building set in rural Lancashire with no direct access to local transport. Care home service without nursing Residential substance misuse treatment and/or rehabilitation service Accommodation for persons who require treatment for substance misuse Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 2
Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Cleanliness and infection control 8 Management of medicines 9 Safety and suitability of premises 10 Requirements relating to workers 11 Assessing and monitoring the quality of service provision 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 3
Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 7 January 2014, observed how people were being cared for and talked with people who use the service. We talked with staff and talked with other authorities. What people told us and what we found People who received treatment and care from Littledale Hall were very positive about their experience. Comments we received included: "It is amazing, it has given me my life back, my kids and my family." "I have learned loads about addiction and how to keep safe." "I have the best chance, and have been offered a place in the flats." "With the support of the Hall and the staff I am able to give something back. I am applying for voluntary work and college; and am being helped to set up these connections." "It is a community and run like a community. It is the safest place I`ve felt in a long time. Staff support you." It`s been brilliant for me. It`s been hard but I've got good relationships with staff." We looked at the arrangements for the prevention and control of infection in Littledale Hall. We saw that bathrooms, toilet areas and bedrooms were kept clean and tidy and to a good standard. As part of our inspection we checked how medicines were being handled. Overall we found that there were safe systems in place to manage and administer medication that help protect the health and wellbeing of people. We saw there were safe recruitment procedures in place to ensure people were protected and supported by staff with the skills and experiences to meet their needs. Our discussions with a range of staff confirmed they felt well supported in their roles. Although the house was a listed building and was very old it was clear that a programme of work was underway to upgrade and improve the home. We saw evidence of redecoration taking place. There were a range of audits and systems in place to monitor the quality of the service being provided. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 4
You can see our judgements on the front page of this report. More information about the provider Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 5
Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement We looked at three care plan records to show us how staff supported people with their care and treatment. We saw that a detailed pre assessment process was undertaken to identify whether Littledale Hall could support people with their assessed needs. This was carried out in partnership with the individual, to ensure that they understood what rehabilitation services were available to support them to recover from their addiction. It is the personal choice of individual's whether or not they want to go to this service for treatment. People have the option of visiting Littledale Hall and there is a brochure available with a range of information to assist them to make an informed choice. Once a place has been confirmed, people are assigned a key worker and are matched up with another resident for support. This is the first step to living and being part of a therapeutic community, whereby residents also contribute to supporting one another. We saw that detailed care plans and risk assessments were devised in partnership with the individual. Staff had to sign and date all risk assessments to ensure they were aware of potential risks posed to people and what actions were required to minimise the risks. The information in the care plans identified the range of support that was required. The days and activities were very structured. Everyone was responsible to the contribution of the running of the home, which included meal preparation, cleaning and other domestic activities. There were a range of systems in place to gain feedback from people regarding how the treatment and support was working for them and to raise any concerns or worries they may have. There were formal reviews in place every 3 months, and Littledale Hall worked closely with other professionals as part of the review process. We saw that at all stages of treatment people had been involved in decisions made and they had signed to show their involvement in the process. We met six members of the staff team, all of whom had different roles and responsibilities. All the staff we met were dedicated and highly motivated. As well as individual treatment programmes, Littledale Hall also provided family support. Whilst restrictions were in place, Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 6
people were able to maintain family relationships. Visits by families usually took place at weekends so as not to interfere with the daily programme of rehabilitation. One person we spoke with told us how they valued this support and told us, "It is amazing; it has given me my life back, my kids and my family." Our discussions with staff confirmed they were knowledgeable regarding meeting the needs of the people they supported. The provider told us the treatment programme had been developed using contemporary theory and current social work practise. It was based upon a culture of supporting people to feel safe, and the approach was to enable people to gain an insight and understanding into their addiction. We spoke with three people regarding their treatment programmes and life at Littledale Hall. People were very open and honest with us. In our discussions they showed us they had developed a great insight and understanding of their needs through their rehabilitation process. They explained to us how their individual treatment plan had helped them to learn about their substance misuse, and how this has helped them to move forward with their lives in a safe way. One person told us, "I have learned loads about addiction and how to keep safe." Another person told us, "It is a community and run like a community. It is the safest place I`ve felt in a long time, staff support you." Two people told us about some of their future plans and how Littledale Hall was supporting them. They explained there was a range of accommodation options available to move on to, with support from an "aftercare service". This meant that ex residents could access individual and group support to assist them to remain safe and well and continue with their recovery. One person told us, "I have the best chance, and have been offered a place in the flats. "With the support of the Hall and the staff I am able to give something back. I am applying for voluntary work and college; and am being helped to set up these connections." Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 7
Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. Reasons for our judgement We looked at the arrangements for the prevention and control of infection in Littledale Hall. Everyone who lived at Littledale Hall with support from staff were responsible to the contribution of the running of the home, which included cleaning and other domestic activities. Infection control training was delivered in house and involved everyone. We looked at the cleanliness of people`s bedrooms, communal areas, and the bathroom and toilet facilities. We saw that they were kept clean and tidy and to a good standard. There were hand washing facilities in the bathroom and toilet areas. There were no unpleasant odours present. We were shown around the home by one of the people who lived there. They told us there was a daily cleaning schedule in place that everyone had to adhere to. There were daily checks in place by staff to ensure that standards were maintained. We saw records were documented as an audit record to demonstrate that the daily checks took place. This included the removal of rubbish from the waste bins in the bedrooms, which helped to minimise fire risks. We were told that equipment was available for cleaning, and the use of coloured coded equipment was available to ensure that kitchen and toilet areas were cleaned with separate materials and products. This showed us that people had been made aware of how to follow prevention of infection control procedures in the home. Because of the nature of the home, specialised cleaning products were locked away, with only members of staff who could access them. We looked in the two laundry areas, one used for cleaning kitchen items, and the second for personal items of clothing. Because of the ongoing renovations taking place, the new central heating pipework had been routed through this area. This meant there was some exposed piping on the walls and ceiling area. However we were told that they were going to be boxed in and the ceiling patched up. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 8
Management of medicines People should be given the medicines they need when they need them, and in a safe way Our judgement The provider was meeting this standard. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines Reasons for our judgement As part of our inspection we checked how medicines were being handled. We checked the storage of medicines, medication records, and the policies of Littledale Hall to ensure that people were protected from the unsafe use of medicines. Overall we found that there were safe systems in place to manage and administer medication that help protect the health and wellbeing of people. The local GP, who had a special interest in the type of service provided, was involved in the care of people and provided advice regarding medication and any medical problems. This meant that people received a consistent service. Medication was administered by trained members of staff and people were supported by staff to take their medication safely. We saw that medication was safely stored in a secure area. Individual boxes were in place to ensure medicines were kept separate from other people`s. This minimised the risks of people not receiving the correct medication. There was a policy in place for managing pain control and strict records had been set up to ensure staff could overview the frequency of this in case there were concerns regarding the potential for substance misuse. Littledale Hall used the local pharmacist who was available for advice. There was a contingency in place for managing emergency situations. This included an on call system provided by the senior management team. One of the staff team was responsible for undertaking monthly audits. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 9
Safety and suitability of premises People should be cared for in safe and accessible surroundings that support their health and welfare Our judgement The provider was meeting this standard. People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. Reasons for our judgement We looked at this outcome because at the last inspection we had identified that many of the rooms had visible damp. Some of the walls around the windows ran wet with condensation. We asked the provider to send us an action plan to tell us how what steps they were going to take to ensure the health of people living in the community was protected from the unnecessary conditions. Since that inspection, the provider had sent us a copy of their action plan. On our visit we looked at the measures the provider had taken. The provider told us the damp had been caused by aged pipe work and gutters to the external walls and roof area. Work had since been undertaken to replace some of the old piping, and measures taken to ensure regular checks took place to clear any debris from the external pipework. Internally there was work being undertaken to replaster the affected areas in the white room lounge and the upstairs bedrooms. A new boiler had recently been installed. The downstairs rooms and external office were noticeably warm and at a comfortable temperature. Upstairs, work was underway in one of the bathrooms; therefore the heating system in that area of the building had been switched off whilst the work was in progress. However one of the residents assured us that the bedrooms were always warm and comfortable. Bedrooms were decorated with personal effects to help to make them homely. There was no evidence of the damp conditions that had been reported at the previous inspection. Although the house was a listed building and was very old it was clear that a programme of work was underway to upgrade and improve the home. We saw evidence of redecoration taking place. The second lounge was no longer a smoking area, and an alternative smoking area had been provided. This meant that people who did not smoke were able to spend time in the second lounge if they chose to. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 10
Requirements relating to workers People should be cared for by staff who are properly qualified and able to do their job Our judgement The provider was meeting this standard. There were effective recruitment processes in place. Reasons for our judgement We looked at the recruitment procedures Littledale Hall had in place. We found that all relevant checks were undertaken before new staff members commenced their employment. This included Disclosure and Barring checks (DBS) and for the exception of one staff file, there were two references checks. We were told there was a second reference for this staff member, and the provider told us they would send us a copy. We discussed with the provider that they may like to consider using a checklist at the front of individual staff files to indicate the dates when application forms had been received, interview date, DBS clearance, start date, shadowing and induction period. This would assist them with auditing their records without the need to search through the files for the specific information. The provider told us they had a stable staff team and there were no vacant positions. New staff received an induction period, which included mandatory training and shadowing opportunities with an experienced member of staff. A record was maintained of the induction process, and this included inviting feedback from staff regarding their development in their new role. Certificates in staff files showed us staff had completed a range of training courses. Staff we spoke with told us they felt well supported in their roles and were provided with personal development and supervision. Although there were formal systems in place, it was clear from our discussions that staff felt informal support was always accessible to them. Some of the staff we met had worked for a long period of time at Littledale Hall. Some told us how they had been supported to take on new roles and responsibilities as the service had developed. There were a range of meetings that took place, including staff meetings. This meant staff had opportunities to contribute their ideas and experiences to the way the service was provided. Staff were supported to undertake regular reflective practise sessions each month and attend the daily handover meetings. Littledale Hall also provided volunteering opportunities and a range of student placement opportunities. On the day we inspected there were plans to induct 5 social work students. Other opportunities available to professional students were for counselling placements, Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 11
clinical psychologist placements and community placements for medical students. This meant that there were opportunities for people to work with individuals from various disciplines and extend the existing provision of activities available. Volunteers adhered to the same recruitment processes as paid employees. Professional students had to provide a copy of their DBS clearance before a placement could take place. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 12
Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to health, safety and welfare of people using the service and others. Reasons for our judgement There were a range of audits and systems in place to monitor the quality of the service being provided. There was a senior management team who met regularly. Meetings were structured to include staffing, induction and admissions, personalisation, décor and the treatment programmes. The provider prepared an annual service report, which reflected on the previous year, and identified new areas for development. This means that the service benefitted from clear leadership. There were a range of communication systems and recording systems in place to ensure that people`s views could be listened too. Programmes and activities were regularly reviewed and care plan records were well structured and organised. This meant they could easily be audited. Accidents and incidents were recorded and monitored. The use of medication was very closely supervised and monitored. Daily handover meetings were very structured and well documented with action points recorded and followed up. Handover meetings included identifying any safeguarding or medication issues. This meant that any potential risks posed to people would quickly be identified and acted upon. Littledale Hall had been awarded Investors in People, and were planning to maintain their accreditation. They worked alongside a range of professional bodies, to ensure they kept up to date with best practise. The provider had a complaints procedure; there were no complaints currently being investigated. We contacted the local authority who advised us they had no concerns with the provider and there were no safeguarding investigations at the time of the inspection. People who used the service spoke very highly about the support they received. There were many thank you cards from people, families and other professionals regarding the services provided at Littledale Hall. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 13
About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social 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 essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 14
How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 15
How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - 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. Moderate impact - 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. Major impact - 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 We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 16
Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 17
Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 18
Contact us Phone: 03000 616161 Email: enquiries@cqc.org.uk Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: www.cqc.org.uk Copyright Copyright (2011) 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. Inspection Report Littledale Hall Therapeutic Community January 2014 www.cqc.org.uk 19