The Care Quality Commission
  • Residential substance misuse service

Archived: PCP Clapham

Overall: Requires improvement read more about inspection ratings

Unit 2, 376-378 Clapham Road, London, SW9 9AR (020) 7498 7659

Provided and run by:
PCP (Clapham) Limited

Important: We are carrying out a review of quality at PCP Clapham. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

18 September 2019

During an inspection looking at part of the service

This was a focused inspection to follow up enforcement action. The rating for the service has not been updated as we only looked at very specific issues. The purpose of the inspection was to see if the provider had made significant improvements to the service following the issue of a section 29 warning notice in June 2019. We also followed up on whistle-blowing information we received about the service.

  • The provider had improved the process for obtaining clients’ mental and physical health history prior to accepting clients for treatment.

  • The provider had improved processes to ensure, where there were concerns about a client’s cognition, that an assessment was carried out prior to alcohol detoxification treatment commencing.

  • The provider had improved their assessment and management of patient risk. At our previous inspection we found that clients’ risk assessments did not clearly describe how staff were to manage clients’ withdrawal symptoms safely during detoxification. At this inspection we found risk assessments now detailed how staff were to manage clients’ withdrawal symptoms.

  • The provider had made improvements to medical and nursing assessments. At our previous inspection we found that nursing and medical assessments for clients receiving detoxification contained only limited information and the rationale for the chosen treatment/s was missing. This was no longer the case.

  • The provider had made improvements to the use of monitoring tools to assess clients’ withdrawal symptoms during alcohol detoxification treatment. Staff now used the appropriate tool every four to six hours to better monitor withdrawal symptoms.

However:

  • At our previous inspection we found that that there was no clear system to ensure that blood tests and electrocardiograms (ECG) were undertaken promptly. At this inspection we found that there were still some shortfalls in this area. The manager reported they were working on arrangements with a local private clinic so that any investigatory procedures were carried out quickly. The shortfalls meant there was an on-going breach of Regulation 12.

17 and 18 June 2019

During a routine inspection

This is the first time we have rated PCP (Clapham).

We rated PCP (Clapham) as requires improvement because:

  • The provider had not addressed all the issues CQC highlighted in its 2017 briefing which was circulated to all providers of substance misuse services and remains on our website:

  • Following this inspection, we issued a letter of intent to the provider informing it that we proposed to impose conditions on the provider’s registration in accordance with section 31 of the Health and Social Care Act 2008 because of the serious concerns we had about the safety of the care being delivered to clients. We asked the provider to take immediate actions to address the issues. The provider responded quickly describing actions it was taking to minimise risks to clients in the service. We subsequently decided not to impose conditions on the provider. Instead we issued a Warning Notice which required the provider to make improvements to the medical and nursing assessments of clients and ensure it obtained information on clients’ medical history from healthcare professionals prior to detoxification treatment.

  • At the last inspection in April 2018, we told the provider that it must develop an effective system to manage the risks to clients’ physical health and that it must have governance systems in place to ensure the quality and safety of the service.. At this inspection, we found that the provider had not made sufficient improvement in these areas and the risks to clients having detoxifcation treatment had not been reduced.

  • Clients’ medical and mental health history was not always obtained from other healthcare professionals prior to detoxification treatment. This meant important information concerning clients’ health was not always known. There was no record that staff considered whether it remained appropriate to provide treatment without this information; this could place clients at risk.

  • Medical and nursing assessments of clients, prior to detoxification treatment, contained only limited detail. A full history of clients’ substance misuse, physical and mental health problems, and social circumstances, was absent and did not follow best practice guidance from the National Institute for Health and Care Excellence and Department of Health. Clients’ detoxification treatment plans did not always include clear reasons for the plan, including the choice of medicines and dose.

  • Clients’ risk management plans did not clearly describe how staff should manage the clients risks from detoxification treatment, including potential physical and mental health risks. When a client experienced physical health problems shortly after commencing treatment, the service did not ensure appropriate investigations were undertaken and as a result placed the client at risk of serious harm. As the service did not identify the risk, staff did not follow the duty of candour requirements of informing and apologising to the client.

  • Clients were not offered testing for blood borne viruses, as recommended in best practice guidance from the Department of Health.

  • The governance system did not provide effective oversight of the medical and nursing assessment and decision-making at the point of clients’ admission. There was a general lack of understanding by staff and managers of the importance of obtaining clients physical and mental health history before deciding it was safe to provide treatment at the service. There was a general lack of clinical leadership.

  • The responses to complaints were brief, and did not always address each point of complaint. Complainants were not informed in the response that they could appeal against the decision or the way the investigation was undertaken. The providers’ complaints policy required complainant’s to contact the service again to find out how to appeal.

  • There had been no registered manager for the service since 5 November 2018 and an application had not been submitted to CQC. After the inspection, the manager submitted an application to become the registered manager.

However:

  • Clients had early exit plans if they left detoxification treatment early. Clients were given information about the risks of leaving treatment early and actions to take to minimise these risks.

  • At our previous inspection in April 2018, we found the provider did not effectively addresspotential safeguarding concerns, particularly regarding children. At this inspection, there was a clear process and procedure in place for safeguarding vulnerable adults and children. There was a safeguarding lead in the service and referrals to the local authority safeguarding team were made when required.

  • Staff knew what incidents to report and how to report them. Learning from incidents was shared with the staff team in team meetings and during staff handover.

  • Staff demonstrated compassion, dignity and respect for clients and provided emotional and practical support. Staff dealt effectively with disrespectful, discriminatory or abusive behaviour or attitudes without fear of the consequences.

  • The provider had made improvements to the governance system since our inspection in April 2018 although still needed to be embeded.

  • A new manager had started in the service six months before the inspection. They had already had a positive impact on the quality of the service and were a capable and effective leader. They also had an understanding of how a governance system can provide assurance on the quality of care clients receive. The new manager was visible and accessible to clients and staff.

19 April 2018

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We undertook this unannounced, focused inspection to determine whether PCP Clapham had made the required improvements following the January 2018 inspection. At the January 2018 inspection, the provider was served a warning notice for not providing safe care and treatment. The main purpose of this inspection was to focus on the concerns raised in the warning notice. We also looked at other areas where we had required improvements to be made.

At this inspection, we found the provider had made sufficient progress for the warning notice to be lifted and requirement notices had been fully or partially met. There was however further work needed to ensure the provider safely met the needs of people using the service.

  • Whilst all clients had risk management plans further work was needed for clients with physical healthcare needs to ensure this was addressed as part of the treatment delivered by the service.

  • The provider needed to review the exclusion criteria for the service. This must clarify whether the service will accept clients for alcohol detoxification and confirm it had the appropriate care and treatment in place to deliver this safely.

  • Staff needed to complete the mandatory training and also other training to meet the specific needs of the clients. This included break-away training for staff working on their own at weekends.

  • The provider needed to ensure that client outcomes were measured including following up their progress after discharge.

  • The provider needed to ensure robust governance processes were in place to ensure safe and effective care and treatment is delivered at all times to clients. This needed to include ongoing clinical audits to provide assurance.

However, we found the following areas of improvement:

  • At our previous inspection, we identified that staff did not routinely complete cognitive assessments for clients starting detoxification . At this inspection, we observed that staff now conducted routine cognitive assessments for all clients at risk

  • The provider had calibrated all physical health monitoring equipment.

  • The provider now had an adult’s safeguarding policy, safeguarding lead and flow chart to support staff to make decisions around safeguarding, although further work was needed to ensure they safeguarded children.

  • The provider now had an on-call rota with a senior manager and service manager available on weekends.

  • The provider developed an action plan, and had begun making improvements, to minimise the risk of fire.

16, 17 and 22 January 2018

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We identified areas that the provider needs to improve. We issued a warning notice under Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

  • During this inspection we saw that whilst some improvements, identified at our previous inspection in December 2016, had been made, other previously identified areas remained outstanding. In addition, some new issues were identified that required improvement.

  • Improvements were needed to the premises and equipment. Physical health monitoring equipment was not routinely calibrated to ensure that observations were accurate. This was an ongoing issue from our last inspection in December 2016. A robust plan detailing when and how actions identified in a recent fire risk assessment to make the premises fire safe was yet to be developed. Whilst the premises were visibly clean, records demonstrating the frequency of cleaning were not maintained.

  • We identified a lack of effective governance systems by the provider to ensure that safe, effective care was being delivered. For example, the provider did not use key performance indicators to monitor the ongoing performance of the staff team. The provider did not have a formalised audit process to detect areas for improvement in care records, for example. This had not improved since our previous inspection in December 2016. A business continuity plan that outlined how the service would be provided in an emergency, for example if the premises were not able to be used, was not in place.

  • Further improvements were needed to ensure that staff were suitably skilled and competent to provide safe care and treatment. During our last inspection in December 2016 we found that the provider did not have a system in place to assess whether staff were competent to administer medications. During this inspection, we found this had not improved. Not all staff had received training to meet the needs of the client group, for example managing self-harm and seizures. Whilst all staff were able to access regular group supervision, volunteers did not receive one to one supervision.

  • The provider did not adequately mitigate risks to the health and safety of people using the service. Risk assessments did not provide information about how to safely manage or mitigate potential risks.

  • The provider did not have a clear policy or procedure in place detailing the local arrangements for identifying and referring adult safeguarding incidents to the local authority. Staff had a poor working knowledge of safeguarding.

  • Clients did not have care plans in place. Although staff and clients told us that a holistic approach to treatment and recovery was taken during their time with the service, there was no framework in place to ensure that the full range of individual needs were identified and appropriately managed. Where clients were prescribed medicines outside of best practice guidance, the rationale for this was not clearly recorded in client care and treatment records.

  • Robust arrangements to ensure the safety of staff and clients when staff were working alone on site were not in place.

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

  • Since our last inspection in December 2016 the provider had assessed infection risks, and undertook weekly checks to help minimise the risk of infection. The provider had also ensured that the clinic room and physical health monitoring equipment within the clinic room was kept clean.

  • Since our last inspection in December 2016 the provider had ensured that disclosure and barring checks had been completed for all staff.

  • Staff worked hard to support ongoing recovery. Links were made with numerous mutual aid groups, both in the local area and for specific communities such as the Lesbian Gay Bisexual and Transgender community. Staff also identified support groups in clients’ local areas so they continued to engage with recovery when they left the service. An aftercare group was available for all ex-clients to attend. This helped to embed the principles that were taught during client’s time with the service.

  • The service employed former clients as volunteers. They were able to offer mutual support and encouragement. The opportunity to volunteer also helped support their own long-term recovery.

  • Feedback encouraged in various ways from clients. Families were invited to provide feedback during families meetings. Staff took time to discuss and reflect on feedback and kept clients updated about progress against issues that they had raised.

  • Staff reflected on and identified key learning points or changes that could be made following incidents. Staff understood how to report incidents and discussed these at staff meetings and handovers, aiming to prevent similar incidents reoccurring.

14 and 28 December 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • The service had made improvements since our last comprehensive inspection in May 2015 and our focussed re-inspection in December 2015 and they were focussed on continuing to improve.
  • The service had written protocols in place in respect of assisted alcohol or opiate withdrawal for clients. The staff were familiar with the protocols and had been trained to use them in the management and treatment of clients withdrawing from alcohol or opiates. Care plans addressed the needs of clients going through alcohol detoxification.
  • The service had made improvements in their admission process since the last inspection. Clients completed a pre-admission screening checklist. Staff undertook an assessment of client needs. At the last inspection, we found that the service’s assessment of client risk prior to admission was not robust. During this inspection, we found that the service obtained information prior to admission and now undertook a thorough and holistic assessment of risk. Staff reviewed risk on a regular basis and took action to manage client risk.
  • Since the inspection in May 2015, all staff had been trained in safeguarding adults and had a good understanding of how to raise a safeguarding alert. The majority of staff had been trained in safeguarding children. The staff had an understanding of the risks posed to children and young people.
  • At the inspection in May 2015 we found that the service was not obtaining disclosure and barring checks for their employees. Additionally the provider had not explored the gaps in staff members’ work histories. The provider could not be assured that employees were safe to work with the clients. Since that inspection, the service had obtained disclosure and barring checks for their permanent employees. The provider now also explored the gap in prospective employees’ work histories during the interview process.
  • At the inspection in May 2015, we found that there were not proper systems to monitor the safety of the environment. During this inspection, we found that staff completed an environment checklist. The checklist had been completed regularly since November 2016. The service undertook regular fire drills.
  • Since the last comprehensive inspection, the service had made improvements in providing supervision to staff and completing annual appraisals. Staff received regular managerial and clinical supervision. Staff had appraisals. The service had a range of skilled staff including doctors and nurses.
  • When the service was inspected, in 2015, we found that there were no systems in place to check the competence of staff who administered medicines. Staff were not always following medicines management policies. We found the service had made improvements since that time and provided training for staff in the administration of medicines. Staff had been observed undertaking this task to ensure that they were competent and able to do it safely. The service had appropriate arrangements for obtaining medicines for clients.
  • Staff were caring and committed to the clients who used the service.
  • The provider had made improvements to their complaints handling system since the last comprehensive inspection and employed a member of staff to deal with complaints. Complainants received written responses to complaints.
  • At the last inspection in May 2015, we found that the provider had little oversight of the service and had no proper processes to monitor and improve quality and safety. At this inspection we found that the provider had improved their clinical governance processes. Senior staff attended regular clinical governance meetings and had undertaken a number of audits which were clearly recorded. There had been some improvements in the quality of care plans as a result of these audits.

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

  • At the last inspection in May 2015, we identified that there were no up to date training records for staff working in the service. At this inspection, we found that there were now training records but not all staff had completed their mandatory training. Training completion rates were low (70%) and some members of staff had not updated their mandatory training. The provider had not matched the training requirements to the staff members’ roles and responsibilities.
  • There was a lack of records confirming that staff had calibrated the equipment used for physical health monitoring and there were no records of when the equipment had been cleaned. The service could not provide assurance that the equipment was safe or clean to use. During this inspection, we found that the clinic room was not clean. There were areas in the clinic room that were dusty. This had not been identified when an infection control risk assessment had been completed in December 2016.
  • The provider did not have a schedule of when clinical audits should be undertaken. Audits were undertaken on an ad hoc basis.
  • Nor had the service obtained Disclosure and Barring Service checks for the doctors who worked in the service. This meant that the provider could not be assured that the doctors did not present a risk to the clients at the service. The service could not be assured that one of the doctors had undergone re-validation and had demonstrated that they had kept their skills and knowledge up to date.
  • The service had one fixed panic alarm in the building. If clients or staff were in other parts of the building they may have had difficulty in summoning assistance.
  • The provider’s assessment did not consider whether the client had contact with children or adults at risk. There was no consistent process to assess these risks when clients were admitted to the service.
  • Not all clients had an unplanned early exit plan. It was not always clear what clients should do if they left treatment early. Clients who have recently undergone detoxification are at high risk of overdose.
  • The business continuity plan was not up to date. It should have been reviewed in February 2016. There was a possibility that the guidance contained in the plan might no longer be up to date.

22 December 2015

During an inspection looking at part of the service

During our last inspections of the service in May and July 2015, we identified serious concerns regarding the care and treatment of patients admitted for alcohol and opiate detoxification. There were no detailed protocols in place to support staff caring for patients going through detoxification from alcohol or opiates.

The admission criteria were unclear. Staff had no guidance regarding the safe admission and treatment of patients undergoing detoxification. They had not received training regarding the health complications of withdrawal from alcohol and/or opiates or the physical health checks they needed to carry out.

Due to the serious concerns identified, we served the provider a Section 31 of the Health and Social Care Act 2008 notice, on 3 August 2015, to impose a condition in relation to their registration to provide the regulated activity of treatment of disease, disorder or injury. PCP (Clapham) Limited was not to admit patients who required assisted withdrawal from alcohol or opiates to PCP Clapham, Unit 2, 376 - 378 Clapham Road, London SW9 9AR until improvements had been made.

We carried out a focussed inspection of the service on 22 December to check whether the provider had developed improved arrangements and systems to ensure the service could provide safe care and treatment to patients during detoxification.

At this inspection, we found that the provider had put new procedures and protocols in place to make sure detoxification could be safely provided. Staff had received training in how to care for patients undergoing alcohol and/or opiate detoxification. They knew the checks they needed to carry out and the possible health risks to patients during detoxification. The provider had complied with the condition imposed upon them and had made improvements.

6 and 7 May 2015 and 29 July 2015

During a routine inspection

PCP Clapham is registered to provide the following regulated activity:

  • Treatment of disease, disorder or injury

There is a registered manager in place.

PCP Clapham provides a day therapy service for people with substance misuse problems, including rehabilitation and alcohol and opiate detoxification where needed.

During the inspection we identified serious concerns about the care and treatment of patients going through alcohol and opiate detoxification. There were no detailed protocols in place to support staff caring for patients going through detoxification from alcohol or opiates. There were no written admission criteria identifying who could be safely admitted to the service and which patients needed to go through assisted withdrawal in a hospital setting. Most staff, other than the recently appointed nurse, had not been trained in the complications of withdrawal from alcohol and/or opiates and had only a superficial knowledge of the signs and symptoms they needed to look for. There had been three incidents of patients suffering seizures during withdrawal between January 2014 and May 2015.

As a result of the serious concerns identified we served the provider a Section 31 of the Health and Social Care Act 2008 notice, on 3 August 2015, to impose conditions in relation to their registration to provide the regulated activity of treatment of disease, disorder or injury. PCP (Clapham) Limited is not to admit patients who require assisted withdrawal from alcohol or opiates to PCP Clapham, Unit 2, 376 - 378 Clapham Road, London SW9 9AR, until adequate arrangements and systems are in place to provide safe care and treatment to patients requiring alcohol or opiate detoxification.

1 August 2013

During an inspection looking at part of the service

We spoke with four people who used the service during our inspection. They told us they received good quality care from the provider. One person told us "I can't fault the care here". We reviewed a sample of care records, six in total, and found that each contained an assessment of people's needs and a plan as to how to meet those needs.

The provider had safeguarding policies and procedures in place. The staff were able to explain what the reporting processes were to the local authority safeguarding adults team if any concerns were identified regarding a person's safety.

They were recruitment processes in place and associated information regarding the recruitment process was found on the two staff records we reviewed.

The provider had in use quality assurance tools for assessing and monitoring the quality of service provision. The provider had met the requirements relating to registered managers and a registered manager was in place.

3 April 2013

During an inspection looking at part of the service

When we visited in February 2013, we had major concerns with how the provider was managing medicines. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. We asked the provider to send us a report informing us how they would address these issues. We visited again in April 2013 to follow up on this, and we found that the provider had taken action to address the issues. Appropriate arrangements were now in place to manage medicines safely.

5 February 2013

During an inspection in response to concerns

People who use the service told us that they felt that their needs were being met. They said the counsellors were ' very caring and helpful'. However we found that people did not experience care, treatment and support that met their needs or protected their rights. People were going through a detoxification process and clinical support was not available.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff told us that there was 'limited training provided' Staff were not trained in protecting vulnerable people and were not aware how to recognise potential abuse or how to report with the local authority.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.