The Care Quality Commission
  • Residential substance misuse service

Archived: Brook Drive

Overall: Inadequate read more about inspection ratings

124 Brook Drive, London, SE11 4TQ (020) 7820 9942

Provided and run by:
Equinox Care

All Inspections

20, 21, 22, 23 and 26 July 2021

During a routine inspection

Our rating of this location went down. We rated it as inadequate because:

Our rating for this service has been limited by the enforcement action we have taken. We imposed urgent conditions on the registration of this service under section 31 of the Health and Social Care Act 2008. This means the service can only admit clients when there are experienced, qualified and suitable medical staff always available. The service can only admit clients whose needs it can safely meet. We also served two warning notices on the provider, concerning safeguarding clients and governance.

We found:

  • The service admitted clients with serious and significant physical and mental health problems, which the service could not safely provide care and treatment for. There was no inclusion and exclusion criteria for the service. Since the beginning of 2021, 13 clients had been transferred by emergency ambulance from the service to hospital.
  • Staff did not have an understanding of safeguarding and did not know how to make a safeguarding referral. No staff had undertaken safeguarding children training and only 25% had recently undertaken safeguarding adults training. Two incidents which should have prompted a safeguarding referral had not.
  • Not all medical staff had qualifications to safely treat clients with complex problems in the service. Medical staff did not receive supervision for their substance misuse work. Clients’ mental health and cognition was not adequately assessed on admission. There was no psychiatrist working in the service to assess and support clients with mental health problems. Out of hours medical cover consisted of medical staff who did not have specific experience in substance misuse treatment and detoxification.
  • There were frequent occasions when there were not enough staff on shift. It was common for there to be a shortage of registered nurses on shift. There was no system for assessing how many staff were required to support clients.
  • The governance system for the service was ineffective. Safeguarding and complaints were not standard agenda items at meetings, there was a lack of clinical audits and limited learning from incidents. There were no prescribing protocols. The service risk register did not include the risks we identified during the inspection. There was no single document or system for managers to have oversight of staff mandatory training. Almost without exception, less than 50% of staff had undertaken mandatory training.
  • Staff did not understand the Mental Capacity Act 2005. When clients were intoxicated on admission their capacity to consent to admission and treatment was not assessed.
  • Clients’ care plans did not identify their specific needs during treatment.
  • The service did not notify the CQC of incidents which it was legally required to. These incidents concerned serious injury to clients and alleged abuse.

However:

  • Staff treated clients with compassion and kindness. Staff were supportive, developed good relationships with clients and treated clients as individuals. Clients said that staff were very helpful and understanding.
  • Eighty per cent of clients completed treatment and had a planned discharge from the service.
  • Staff were positive regarding the manager of the service and their leadership style. They said that the culture of the service had improved during the previous year.
  • Staff in the service had undertaken an audit of clients who had alcohol withdrawal seizures. The number of clients having seizures had reduced.
  • When clients were unable to obtain support for their pet during their detoxification treatment, they could bring their pet into treatment with them.

14 November to 15 November 2018

During a routine inspection

We rated Brook Drive as good because:

  • The service supported clients with complex needs whilst they undertook a programme of detoxification from drugs and alcohol. This treatment was provided in line with best practice and national guidance.
  • The service worked collaboratively with a GP service and a mental health trust to ensure the clients had access to staff with the necessary clinical expertise to meet their needs. The service also employed multi-disciplinary staff in sufficient numbers to support the people using the service. Staff worked together well to share information and meet the individual needs of each clients.
  • Staff had access to a range of training to ensure they had the skills to deliver treatment.
  • The environment was designed to keep clients safe. People with the most complex needs had bedrooms nearest to the staff office. A separate floor was available for female clients with access to a female only lounge.
  • Potential clients were assessed very thoroughly and there was clarity about when the service could not meet their needs. Staff were able to develop detailed care plans and risk assessments.
  • Staff knew about the clients’ physical and mental health care needs and were able to monitor them closely and escalate concerns if the client was deteriorating.
  • Staff understood and discharged their roles and responsibilities under the Mental Capacity Act 2005.
  • Staff treated clients with compassion and kindness, respected their privacy and dignity and understood their individual needs. They actively involved clients in care decisions.
  • The service managed beds well so that a bed was always available to a person who would benefit from admission. Staff ensured that discharge plans were in place before a client was admitted to the service. The service worked well with other agencies to plan each person’s discharge.

However:

  • Whilst staff had access to supervision this did not always take place regularly.
  • Staff team meetings did not take place regularly and did not routinely discuss learning from incidents and complaints.
  • There was no system in place to ensure concerns raised at the client meeting were addressed.
  • Staff had not safely managed controlled stationery stocks such as FP10 prescription pads. However, staff ensured this was rectified during the inspection.

1 August to 2 August 2017

During a routine inspection

We do not currently rate independent standalone substance misuse services.

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

  • Not all staff had received training in supporting clients with substance misuse or alcohol related seizures, which was highlighted as a concern at our last inspection. Whilst training had been delivered on supporting clients with seizures, a number of staff had changed and this had not been repeated for new staff.

  • Staff did not regularly discuss the risks of leaving treatment early with clients.

  • Staff did not report all incidents or have regular opportunity for supervision and discussion and learning from incidents.

  • Staff did not keep accurate records of the daily client meetings, so could not be assured that feedback was recorded and responded to.

  • The governance systems in place were not effective in identifying areas for improvement across the service.

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

  • There were enough staff to meet the needs of clients and client feedback about staff was mostly positive. Staff involved clients in their treatment. Staff were positive about working at the service.

  • Nurses and doctors were available to support clients at all times. Clients were assessed by a doctor before starting their detoxification. Staff completed risk assessments and supported clients with managing any risks they had, including physical health needs.

  • Clients said the food tasted good and they could keep their possessions safe. There was a female only lounge on the top floor. Staff responded to formal complaints quickly.

  • The service had addressed three of four issues raised at the last inspection, and now completed medicines audits and disposed of controlled drugs safely.

2 and 3 February 2016

During a routine inspection

We do not currently rate substance misuse services.

  • The inspection of Brook Drive took place at a time when the service was planning to take more clients with complex needs. A number of changes were going to take place including more specialist staff joining the team, access to a new clinical room and additional staff training.
  • The service demonstrated very good practice in a number of areas. There was a highly motivated team and the feedback from clients using the service was very positive about the care they were receiving. The care was very person centred and clients were involved in all aspects of their care. The programme of detoxification followed good practice guidance and the outcomes for clients were monitored. Clients could access a range of therapeutic activities, although they would have liked more at the weekends.
  • There were a few areas for improvement to ensure the service was safe. This included ensuring all clinical equipment was maintained and ready to use, disposing of control drugs in line with guidance, ensuring risk assessments were up to date and plans to mitigate risk were in place and finally to ensure staff had received training on how to support clients when they had a seizure.

3 October 2013

During a routine inspection

Up to date, individual care plans were in place for people who used the service which addressed their care and support needs and protected them from risks. One person we spoke with said, "I've been given all the help I need and staff involved me fully in deciding my programme of support.'

The service worked in partnership with other providers to ensure people's health, safety and welfare needs were met. Information about people who used the service was obtained and shared appropriately.

People were supported in premises and an environment that was suitably designed and adequately maintained to meet their rehabilitation needs. One person told us, 'My room is lovely.'

There were effective recruitment and selection processes in place and people were supported by, suitably qualified, skilled and experienced staff.

People's personal records, staff records and other records relevant to the management of the services were, in most respects, up to date, accurate and fit for purpose.

At the time of our inspection the provider did not have a registered manager in post.

12 December 2012

During a routine inspection

The people using the service told us they were given helpful information when they arrived at the service so that they could make informed choices about the detoxification programme. One person said they were given 'superb information', the programme was fully explained to them and they understood exactly what it would involve.

The people we spoke with said that staff were always available if they had any concerns or worries. There was a daily 'check in' session where they were given the opportunity to tell staff how they were feeling and to raise any issues about their treatment and the running of the service.

People told us they liked the service, felt safe there and received good support from the staff, who treated with them dignity and respect. One person said, 'The staff are absolutely wonderful. It has been such an inspiration coming in here'.

We spoke to one of the local authority commissioners of the service. They told us that they had no concerns about the service and it did comparatively well in retaining people in the detoxification programme.

Although people told us they were satisfied with their care, we found other evidence that people were not always protected against the risks of receiving inappropriate or unsafe care and support.

10 February 2012

During a routine inspection

During our visit we spoke with some of the people who were staying at the home. They told us that they were very happy with the service provided and received excellent care and treatment. One person said that the staff 'always go the extra mile'. Another said that there was 'not a bad word to say about the service'. People felt that staff were well trained and knowledgeable and always approachable if they had any questions or concerns.