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Inspection Summary


Overall summary & rating

Good

Updated 10 January 2019

We rated Fleming House good because:

  • The service had enough staff to safely meet client’s needs. Staff at all levels of the organisation had appropriate skills, knowledge, and experience to provide the right care and treatment.

  • The service had clearly defined and embedded processes to keep people safe. Staff understood their responsibility to report incidents and managers took actions to improve safety.

  • The service had clear and robust policies in place for safeguarding adults and children. Staff received safeguarding training. Staff identified safeguarding concerns and took steps to prevent abuse from occurring. Management had established links with the local authorities safeguarding team and reported concerns.

  • Staff received training in the Mental Capacity Act 2005 and applied this in practice.

  • The service took a holistic approach to assessing, planning and delivering care. Clients received a comprehensive assessment before entering treatment. Clients personal preferences, strengths and goals were reflected in care plans. Clients were involved in developing their own risk assessment and crisis plans. Staff supported clients to develop timely, holistic and personalised discharge plans. Clients records were clear, up to date and were accessible for staff.

  • The service provided care and treatment in line with national guidance. The service provided treatment for clients, which included medication, psychological therapies, and occupational activities intended to help patients acquire living skills. There were a range of activities for patients to take part in including gardening, games, acupuncture, bowling, and classes in computer skills and digital photography.

  • The service monitored and reported client treatment outcomes. Staff used structured assessment tools to regularly review client’s recovery and needs.

  • The service sought to work collaboratively with other providers and agencies to promote high quality care and positive treatment outcomes. The service exchanged knowledge and skills with other providers. The service worked in collaboration with other providers to develop a ‘treatment loop’ which allowed clients to continue their recovery at another centre after breaching specific treatment requirements.

  • Staff displayed positive attitudes and behaviours when interacting with clients. Clients described staff as approachable and helpful. The service sought to accommodate client’s preferences and needs, such as dietary, cultural, religious, communication, and needs arising from disability.

  • The service sought feedback from people using its service and had a clear policy for managing complaints. Managers promptly investigated complaints, apologising and acting on them where required. Management involved clients in resolving complaints.

  • The service had suitable premises and equipment and looked after them well. The premises provided separate floors of accommodation for male and female clients. The premises provided a range of private and communal areas for socialising, individual and group therapies. Clients had access to a garden and spaces to meet visitors.

  • The service had a manager in post with the right skills, knowledge and experience who was approachable and visible for staff and clients.

  • The service had governance systems that collected, analysed and used information to monitor and improve care. The service had effective systems for identifying and managing risk.

However:

  • The service maintained thorough cleaning records for the environment but held no cleaning records for medical equipment, such as sphygmomanometer, also known as a blood pressure meter. This is posed a potential infection control risk. However, on visible inspection these devices appeared clean and staff told us they cleaned them regularly.

  • The service was not using disposable breathalyser mouthpieces. However, the service was sterilising breathalyser mouthpieces between use.

  • The services ligature risk assessments identified areas of concern but did not adequately document how risks were mitigated or removed.

  • The service did not have a written procedure for managing bathing safety for clients undergoing detox. Clients who are detoxing from alcohol can be at higher risk of experiencing seizures.

  • The service did not maintain records of whether clients had been offered copies of their care plans.

Inspection areas

Safe

Good

Updated 10 January 2019

We rated safe as good because:

  • The service assessed and managed the risks associated with clients care and treatment. The service encouraged client participation in identifying, reviewing and managing risk. Where client’s risks changed, the service responded promptly and updated documents to reflect this. The service had an early exit protocol and sought to reduce harm for clients who did not wish to remain in treatment.

  • The service only admitted clients whose care and treatment needs could be safely met. A doctor, manager, and member of the therapy team reviewed all referrals to assess their safety and suitability.

  • The service kept detailed, clear and up to date client records. These could be easily accessed by staff.

  • The service had staff with the skills, knowledge and experience to meet the needs of service users. The service provided mandatory training and ensured staff completed it. The service had recruitment procedures which meant that clients were protected from the risk of receiving unsafe care or treatment. Vacancy rates, turnover and sickness absence were all low. The service had contingency plans to manage unforeseen staff shortages.

  • The service provided staff with training on how to recognise and report abuse and staff knew how to apply it. The service worked effectively as a team, across services, and with other agencies to promote client safety. The service had systems and practices for information sharing.

  • The service prescribed, administered, recorded and stored medicines well.

  • The service had suitable premises and equipment and looked after them well. The service had a proactive approach to health and safety and sought specialist advice when needed. The service maintained comprehensive cleaning records for the building.

  • The accommodation for males and females was provided on separate floors of the building.

  • The service dealt with issues of harm or risk thoroughly. The service conducted reviews and investigations of incidents and acted promptly to reduce risk of reoccurrence and future harm. The service shared learning from incidents. When something went wrong staff demonstrated openness and honesty.

However:

  • The service did not maintain cleaning records for medical equipment. Although, at the inspection we found medical equipment appeared to be clean and in a good state of repair. Staff reported that they cleaned medical equipment regularly.

  • The services approach to decontamination of reusable breathalyser mouthpieces did not appear to be fully in line with best practice guidance. The service did not have a decontamination lead. Although, reusable breathalyser mouthpieces were sterilised between use in line with a written protocol. The client group may be at higher risk of contracting infectious disease due to health complications and risk-taking behaviours related to substance misuse.

  • The services ligature risk assessment identified all potential ligature points but did not document mitigations in use. However, staff could describe how they would seek to mitigate risks for clients at risk of self-harm. Staff reported they took an individualised approach to managing ligature risks which would be documented in client’s records

  • The service did not have a written protocol for managing detoxing clients wishing to use the bath who were at higher risk of seizure. However, staff were aware of who was bathing and reported they would check on a client’s welfare if there were known concerns.

Effective

Good

Updated 10 January 2019

We rated effective as good because:

  • The service comprehensively assessed all clients before starting their treatment, including their physical and mental health needs. The doctor always met with clients face-to-face before prescribing any medicines. Clients had personalised and holistic care plans.

  • Treatment pathways followed “Drug misuse and dependence: UK guidelines on clinical management (2017)” and the relevant National Institute for Health and Care Excellence (NICE) guidelines.

  • The service completed outcome measures and the results were used to guide clients care and treatment.

  • The service promoted the continuing development of staff skills, competence and knowledge. Staff received regular supervision in line with the providers policies and most staff had received an appraisal in the last 12 months. The service holds partnerships with other providers and academic institutions to support staff to acquire new skills and share best practice.

  • The service actively works with other agencies to support and plan for client’s discharge. The service seeks to work in a joined-up way with community agencies such as addiction support groups, housing providers, health and social care agencies to promote positive outcomes for clients.

  • The service provides training on the Mental Capacity Act 2005 and staff applied this in their practice. Staff showed good awareness of how substance misuse can impact on a client’s ability to provide informed consent. Consent practises and records are monitored and updated when necessary.

Caring

Good

Updated 10 January 2019

We rated caring good because:

  • Staff treated clients with dignity and respect. Staff were compassionate and provided support for clients at times of emotional distress.

  • Clients were involved in decisions about their care and treatment. Staff sought to work in partnership with clients to develop recovery plans. Clients reported feeling fully involved in their treatment. Clients records were person centred and reflected their personal preferences, strengths and goals.

  • Clients could provide feedback via weekly community meetings, quality questionnaires and feedback sheets. The service had a ‘you said, we did’ board which displayed actions taken by the provider in response to client feedback.

  • The provider actively engaged the families and carers of clients receiving treatment. The service offered families education on substance misuse, gave support and sign posted to community agencies, such as AL-ANON. The provider sought feedback from families and carers via surveys.

However:

  • Staff did not record when clients had been offered copies of care plans. Although, clients reported they were involved in the development of care plans and the care plans we looked at were signed by clients. Sharing copies of care plans helps clients to understand their care and treatment.

Responsive

Good

Updated 10 January 2019

We rated responsive good because:

  • The service took account of individual’s needs and preferences. The service worked with other agencies to meet the needs of clients who were vulnerable or who had complex needs.

  • The service belonged to a ‘treatment loop’ which enabled clients to continue treatment at another centre for no additional cost when they had breached specific treatment requirements.

  • The service planned clients discharge and had a protocol for managing unplanned exits from treatment. The service offered free aftercare for life, allowing clients to access groups and support at the centre following discharge.

  • The service worked flexibly with clients and commissioners when needed. Staff would collect clients by car from anywhere in the country when they started treatment.

  • The service had a clear complaints policy which supported staff to respond effectively to concerns. The service made improvements where necessary and acknowledged when things went wrong. Clients were involved in the review of complaints. Clients were aware of how to complain and felt able to do so if needed.

  • The service employed a chef who provided clients with regular, varied and nutritious meals. The service had adapted the menu in response to client feedback and worked with individual clients to ensure their religious, cultural or other dietary preferences were met.

  • The facilities and premises are appropriate for the services being delivered. The service had one wheelchair accessible bedroom, toilet and shower. The building had a range of private and communal spaces to facilitate individual and group work.

Well-led

Good

Updated 10 January 2019

We rated well-led as good because:

  • The service had a clear statement of its vision and values. This statement was developed by staff at all levels of the organisation.

  • The service had leaders at all levels with the right skills and abilities to run a service. Managers were visible and approachable to staff and clients.

  • The services senior staff could demonstrate knowledge of the depth and breadth of the service provided and sought to provide high quality care.

  • Staff felt able to raise concerns without fear of consequences

  • The services operating strategy and performance were monitored, and the sustainability and quality of the service regularly reviewed. The service had effective measures in place to identify, monitor and adapt to future risks.

  • The service had a clear management structure, processes and systems of accountability and governance.

Checks on specific services

Substance misuse services

Good

Updated 10 January 2019

Substance misuse services

Updated 6 July 2018