Archived: Ravenscourt

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• The majority of mandatory training was delivered during monthly staff meetings, by members of the staff team. We were concerned that the quality of the training provided was unsatisfactory due to insufficient skill on the part of the in-house facilitators (who were not professional trainers) and an insufficient amount of time to properly cover the subject area.

• Risk assessments were of poor quality, lacking necessary details of identified risks. Furthermore, none of the client records we examined contained a plan to manage/mitigate the identified risks.

• There were no policies in place in relation to safeguarding children, duty of candour or mental capacity.

• There was no dedicated system for the recording or investigation of incidents. Notes present in the daily records book were excessively brief. There was no system in place for the auditing of incidents by type or number. There was a lack of clear documentary evidence that incidents had been discussed openly with staff or clients, and so there was no way of evidencing that information had been appropriately shared or that learning had taken place.

• The report resulting from the internal investigation into the death of a client during 2015 was very poor. Although senior personnel were able to communicate their findings and subsequent actions verbally, they were not clearly evidenced in written form.

• Staff occasionally used physical restraint although they had not been trained how to carry it out safely or appropriately. No records were kept on the number of instances of restraint or the type of restraint used.

• The GP assessment for new detox clients was brief, primarily consisting of the GP asking the client to confirm the accuracy of the information they had received from the client’s own GP. The GP did not conduct a test to check for the presence of opiates. The prescription written for methadone only cited the total amount of methadone needed for the forthcoming week, rather than stipulating how much methadone was to be administered each day. No record of the information from the client’s own GP or the assessment from the detox GP were forwarded to Ravenscourt. None of the six care records we examined contained details of a medical assessment.

• Medicine records were confusing, since each client had a separate recording sheet for each medicine and there was no differentiation between charts for regularly administered medicines and those for ‘as needed’ (PRN) medicines. Some entries on the medicines charts had been amended using correction fluid. Medicines were administered by unqualified members of care staff whose training had only consisted of a brief session delivered by one of their colleagues, during the course of a staff meeting.

• There were no formal arrangements in place for structured clinical supervision of the two nurses employed by the service. Staff did not receive an appraisal. Instead, they merely completed a self-assessment questionnaire. Personal development plans were not completed and there was no evidence of a discussion between the members of staff and their line manager, resulting from the questionnaire.

• The minutes of monthly staff meetings were not recorded.

• None of the six care records we examined were signed by the client.

• Some clients perceived that the regime imposed by the service was inflexible and lacked a common-sense approach. As a result, they felt that their dignity had sometimes been infringed.

• Some clients felt that the daily programme was very repetitive, and said there was a shortage of physical activities on offer. The financial contribution expected from clients to attend a weekly swimming session discouraged some clients from attending.

• Audits were infrequent, with some aspects of the service not audited within the last 12 months. The service did not use a risk register; nor did it use key performance indicators (KPIs), to gauge the performance of the team; or, improvement methodologies. There were no clear systems in place for explicitly inviting feedback from clients, or for providing information on how the service had been adapted as a result of comments and suggestions received.

• The general state of the décor and furnishings within the premises was poor and in need of updating.

• The use of twin rooms and lack of gender segregation did not adequately safeguard the privacy and dignity of clients.

However, we also found the following areas of good practice:

• The staff team had no vacancies and a low level of turnover and sickness. The service did not use agency staff, so clients benefitted from being cared for by workers familiar with them and the service.

• Staff had improved the pre-admission assessment process, following a serious incident in 2015, by introducing a list of medical exclusion criteria for admission to the detox service.

• The service had strong links with two local GPs, local charities, and their local community mental health team.

• Three members of staff received specialist advice and support for the counselling and group therapy aspects of their work from an external professional.

• We observed staff treating clients in an appropriate, respectful and supportive manner.

• The facilities contained a range of rooms and spaces that could be flexibly used to meet the needs of clients, including large areas for group sessions, and smaller rooms for individual meetings. Clients had unrestricted access to the kitchen and garden.

• Staff we spoke with did not raise any concerns relating to bullying or a fear of victimisation and there had not been any whistleblowing concerns raised during the period 17 January 2014 to 04 March 2016.