The BAC O'Connor Rehabilitation Centre - Burton Upon Trent

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The centre offered a clean, pleasant and homely environment and a range of facilities conducive to recovery.
• The centre offered a holistic recovery pathway that included detoxification, rehabilitation and aftercare services. The centre adopted a psychosocial approach to understanding clients’ addiction with access to a range of therapies, mutual aid, and other support services.
• Staff followed evidence-based practice and guidelines when treating and monitoring clients during their detoxification and rehabilitation. This included consideration of Wernicke's encephalopathy.
• The centre had a dedicated staff team that showed passion and genuine commitment to their work and their clients’ progress. The centre had a strong, qualified therapy team that provided a range of evidence-based therapies that they tailored to meet individual clients’ needs.
• Staff received the appropriate mandatory and specialist training for their roles, and had access to a range of training and development opportunities. Staff received supervision regularly and managers kept detailed, good quality supervision records.
• The centre had a strong person-centred focus with good client and family involvement. Staff held a graduation ceremony to celebrate a client’s successful completion of their recovery programme. The service supported clients with protected characteristics appropriately. The centre also responded to requests from the local community for help to set up support groups, for example, the lesbian, gay, bisexual and trans community, and the Muslim and Polish communities.
• Staff spoke highly of the new registered manager and said he was visible, proactive and supportive. Staff described an improvement in staff morale and operational management since he joined the organisation.
• Staff kept clients’ records up-to-date and in good order. Staff stored confidential records securely. The centre had robust incident reporting processes and shared lessons learnt with staff.

However, we also found the following issues that the service provider needs to improve:

• Staff did not always store medicines at the correct temperature, which affected the usefulness of the medicines. Staff recorded fridge temperatures daily but took no action when they were outside the accepted range. The provider had no protocol on how to deal with affected medicines.
• Staff did not destroy controlled drugs on the premises as required by legislation, and there was no reference to this in the controlled drugs policy. Staff did not check clients’ prescribed medicines before giving homely remedies, which presented the risk that staff might administer an incorrect dose. The provider did not stock an emergency medicine for rapidly reversing opioid overdose, for example, naloxone.
• Some clinical and medicines-related policies lacked standard operating procedures and protocols to help staff carry out clinical tasks. Some clinical and medicines-based audit tools and checklists were not sufficient for their purpose of ensuring compliance and highlighting issues.
• The centre did not have integrated care records along its care pathway. Each part of the service kept separate client records. The service did not have an integrated multidisciplinary team approach to reviewing clients’ care. Each part of the service conducted its own reviews.
• Some Disclosure and Barring Service (known as DBS) checks were more than three years old. Some of the provider’s policies were out-of-date.

This unannounced focussed inspection inspected aspects of the key questions of safe, effective and well led.

We do not currently rate standalone substance misuse services.

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

• BAC O’Connor Rehabilitation centre senior managers had not ensured the regular supervision of clinical staff or their completion of mandatory training in safeguarding, manual handling and infection control. This meant that staff lacked essential support to do their job safely.
• We found that staffs knowledge of how to report incidents was inconsistent. Staff missed opportunities to learn fully from incidents because the learning process was not clear to all staff.
• The storage of medication, in one of two areas, was inadequate meaning that there was no guarantee of the security of drugs. The BAC O’Connor centre did not have established links with a local pharmacist to support staff training in medication management and assistance in medicines audit.
• At the time of inspection the service was not able to provide treatment for a brain disorder, Wernicke’s Encephalopathy, sometimes found in alcohol dependent clients. Managers had suspended treatment until the nursing staff had received training in managing anaphylactic shock, a possible side effect of the injection used. This training was booked but had not been completed at the time of inspection.
• Records of staff supervision and training were incomplete and data provided shortly after the inspection showed significant non-compliance in meeting acceptable standards for the provision of clinical supervision and mandatory training.
• We found client care records were not securely stored meaning sensitive client information was vulnerable to misuse or loss.
• Senior staff had not always taken action in response to significant incidents involving client self-harm and personal injury.

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

• Staff were aware of safeguarding issues, could identify forms of abuse and knew to report them to senior management if they occurred. Comprehensive risk assessments also helped staff to manage client risk to themselves or others.
• Both the residential and detoxification sides of the centre had safe staffing levels and all staff had the standards of experience and qualification for their job roles.
• The GP had attended specialist training and received regular supervision for their work at the centre. The GP followed all national guidance for the treatment of substance misuse problems except in the one incidence above.
• All staff could describe the recovery agenda for the centre, were skilled in supporting clients through detoxification, and in supporting the resettlement of clients in the community. All clients we spoke to expressed positive opinions about their experiences, as residents.