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Inspection Summary


Overall summary & rating

Good

Updated 13 November 2018

We rated Broadway Lodge as good because:

  • Staff treated clients with kindness, dignity and respect. Staff demonstrated an understanding of the individual needs of clients.
  • The provider had addressed the issues we raised at our last inspection. Records were accessible to all staff. The provider held records in paper and electronic format. The provider was in the process of moving to an electronic record keeping system with a completion date of end of this year.
  • At our comprehensive inspection in 2016 we found that records were not accessible to authorised people as necessary to deliver clients care and treatment in a way that met their needs and kept them safe. During our focused inspection on 4 April 2018, we found that staff did not have access to records contain all relevant information that need to be aware of risk and in order to deliver clients care and treatment in a way that meets their needs and keeps them safe. This was a breach of regulation 17 (2)(c). At this inspection we found this requirement had been met; staff told us and we saw that records were accessible to all staff. The provider held records in paper formats and these records were also stored on computers. We were told the provider was in the process of moving to electronic record keeping system with a completion date of the end of this year.

  • Staff screened clients prior to admission to ensure the service could meet their needs; they completed care plans with clients upon admission. Staff enabled clients to access physical healthcare including GPs, dentists and hospital appointments.
  • All clients had a risk assessment. There was an initial risk assessment followed by a further ongoing one. The initial risk assessment was robust and comprehensive. The ongoing risk assessment was more standard with less details.
  • The service was fully staffed. Staff received regular supervision and they attended team meetings and handovers. Staff told us morale was very good, they worked well as a team and supported each other.
  • Staff ran a weekly house meeting for clients to raise concerns and complaints informally. Clients knew how to complain. Staff actively sought the opinions of clients. There were systems to record, review and discuss complaints and incidents in place and there was evidence of change in response to these.
  • The service had a range of facilities for clients including an art room, a chapel, extensive grounds, table tennis and yoga equipment. There were a range of activities for clients to take part in including art, gardening, games, meditation, reiki, acupuncture and shopping trips. The provider supported clients to access community based substance misuse support groups.
  • The provider followed national best practice guidelines treatment such as National Institute for Health and Care Excellence guidelines (NICE). Staff we spoke with told us they used the Department of Health drug misuse and dependence UK guidelines on clinical management (also known as the ‘Orange Book’).

  • The provider had established systems and processes to monitor and improve the safety of the environment. The provider completed regular risk assessments of the environment and action plans were developed based on the risks identified.

  • The provider had effective systems and processes in place to ensure its workforce were equipped to deliver treatment. Staff had an annual appraisal and six-monthly reviews.

  • The service had a dedicated registered manager. The registered manager had been working in this role for several years. Leaders and managers were visible and experienced in working in substance misuse.

However:

  • Not all clients had a discharge plan and were involved in the planning of their discharge.
  • Staff did not monitor the temperature of the clinic room environment where they stored medicines to ensure they were kept within the correct range.
Inspection areas

Safe

Good

Updated 13 November 2018

We rated safe as good because:

  • The provider ensured the environment was safe. There were no obstacles to fire exits and trip hazards were marked. Hazardous cleaning products were locked away.
  • The service was fully staffed.
  • Staff screened clients prior to admission to ensure they could provide for their needs and to assess their suitability for the service.
  • All clients had a risk assessment. There was an initial risk assessment followed by a further ongoing one. The initial risk assessment was robust and comprehensive. The ongoing risk assessment was more standard with less details.
  • Staff knew how to identify abuse and understood the principles of safeguarding. Staff knew how to raise a safeguarding concern with the local authority.
  • Equipment used to measure alcohol consumption, weight and blood pressure were calibrated.
  • All information needed to deliver client care was available to all staff.

However:

  • Staff did not monitor the temperature of the clinic room to ensure the medicines kept in the cupboard were kept within the correct temperature range.

Effective

Good

Updated 13 November 2018

We rated effective as good because:

  • Staff completed care plans with clients shortly after their admission.
  • Care plans were kept up to date.
  • Therapeutic groups addressed the needs of the clients and supported them in their recovery journey.
  • The provider followed national best practice guidelines treatment such as National Institute for Health and Care Excellence guidelines (NICE). Staff we spoke with told us they used the Department of Health drug misuse and dependence UK guidelines on clinical management (also known as the ‘Orange Book’).
  • Staff demonstrated an understanding of the individual needs of clients

  • Staff enabled clients to access physical healthcare including GPs, dentists, physiotherapists and hospital appointments.
  • Staff had regular supervision and appraisals.

  • Staff attended weekly team meetings.
  • Staff had been trained in and understood the Mental Capacity Act.
  • The provider had provided specialist training for staff to enable them to deliver therapeutic interventions such as, cognitive behavioural therapy, harm reduction, family therapy and motivational interviewing.

Caring

Good

Updated 13 November 2018

We rated caring as good because:

  • Staff attitudes and behaviours when interacting with clients were discreet and respectful. Staff provided appropriate practical and emotional support.
  • Staff treated clients with dignity and respect.
  • The service enabled families and carers to be involved in the care of clients if indicated.
  • The provider had introduced a weekly care plan review involving the clients which enabled them to set appropriate goals and review their progress.

Responsive

Good

Updated 13 November 2018

We rated responsive as good because:

  • The service had clear admission criteria. Staff screened all referrals and conducted an assessment before admission to ensure all clients met the service criteria.
  • Staff ran a weekly house meeting for clients to raise concerns and complaints informally.
  • The service had a range of facilities for clients including an activity room, communal lounge and dining area, quiet lounge, chapel and extensive grounds.
  • Clients had a choice of food and specific dietary requirements were catered for.
  • The service was fully accessible with access ramps and walk in showers for people with limited mobility.
  • There were a range of activities for clients to take part in including art, gardening, games, meditation, and shopping trips. The provider took clients to community based substance misuse support groups.
  • Clients knew how to complain. Staff actively sought the opinions of clients.

  • There was information on display to inform clients how to complain or access an advocate. Staff gave clients a welcome pack on admission which included information about treatment and the service and information on how to complain was also provided.

However

  • The provider did not ensure all clients had clear relapse prevention plans and discharge planning was not consistently done for all clients.

Well-led

Good

Updated 13 November 2018

We rated well led as good because:

  • The provider had a clear aim and vision for the service.
  • Systems to record, review and discuss complaints and incidents were in place and there was evidence of improvements made in response to these.
  • Staff told us morale amongst the staff team was very good. They told us stress levels were low.
  • Staff told us they worked well as a team and supported each other.
  • The director and managers had the right skills and knowledge to effectively lead the service. Staff told us the managers, the directors and the chief executive officer were approachable and were positive influence on staff morale.
  • There was a commitment towards continual improvement.
  • The service was responsive to feedback from clients, staff and external agencies.

  • Staff evaluated the effectiveness of treatment and clients` progress by using an in-house tool called entry and exit questionnaire. These were reviewed to inform improvements.
Checks on specific services

Substance misuse services

Good

Updated 13 November 2018

Broadway Lodge offers a number of treatment

programmes that include detoxification, residential

rehabilitation and recovery support for people living at home.