Archived: Holgate House Limited

We do not currently rate independent standalone substance misuse services.

The location was registered to provide accommodation for people requiring treatment for substance misuse.

This was an announced comprehensive inspection. We also looked again at issues identified at a previous inspection.

Following the last inspection in January 2016, we issued requirement notices relating to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The breaches were in relation to:

• Regulation 5: Fit and proper persons: directors
• Regulation 12: Safe care and treatment
• Regulation 17: Good governance
• Regulation 18: Staffing

At this inspection, we assessed whether the service provider had made improvements to the issues we identified in the requirement notices. We found that the provider had made the improvements and had met the requirement notices.

At the last inspection in January 2016, we also found areas that the provider should take steps to improve. These were:

• The provider should ensure that staff members are not line managed by a person to whom they are related.
• The provider should ensure complaints relating to family members are investigated independently.
• The provider should ensure complaints information is accurate and appropriate.
• The provider should ensure that staff have a clear understanding of the principles of the duty of candour.
• The provider should ensure that they are only registered for regulated activities that they provide.

During this inspection we were assured by looking at records and speaking with staff on duty that the provider had taken steps to ensure that these areas had been addressed.

We found the following areas of good practice:

• The environment was very clean, well maintained, welcoming and comfortable.

• Staff managed risk effectively. They identified risks for clients on admission. All clients had detailed risk management plans and staff reviewed the risks regularly according to the level of risk.

• Staff had a good understanding of the duty of candour.

• Clients were involved in decisions about their care and the service. There were agreed house rules and a behavioural code of conduct.

• Staff carried out assessments before clients were admitted to ensure that the service could meet their individual needs.

• There was a structured programme of care, therapy and activities. Discharge planning included an aftercare package to support clients following rehabilitation.

• Care plans were recovery focused. They were comprehensive and detailed. In the records we examined, it was clear what the client’s goals were and how they would achieve them. The service and clients reviewed the care plans regularly together.

• Care and treatment was underpinned by best practice. Clients had access to psychosocial therapies, group sessions and individual one to one sessions with a counsellor.

• Staff worked with clients to help them develop the skills they needed to sustain their recovery and maintain their independence when they returned to the community.

• Staff established therapeutic relationships with clients and involved them in their care.

• Staff treated clients with respect and kindness and supported them throughout their stay.

• There was a structured programme for staff supervision and appraisal of work performance.
• Staff we spoke with were highly motivated in their work and told us they felt very well supported by senior management. There was an open and transparent culture. Staff told us they felt comfortable raising any concerns or issues.
• Staff had a good understanding of the statutory principles of the Mental Capacity Act 2005. The provider had a Mental Capacity Act policy to provide guidance for staff.

• There were effective systems and processes to ensure that the provider complied with the fit and proper person requirements.

We do not currently rate independent standalone substance misuse services.

We inspected Holgate House on 25 January 2016. The location was registered to provide accommodation for people requiring treatment for substance misuse and for treatment for disease, disorder and injury.

However, the evidence we found showed that the service had not provided treatment carried out by or under the supervision of a listed health care professional (as listed in paragraph 4(4) of Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, or from a social worker during the 12 months prior to our visit.

We asked the provider to consider our scope of registration document. The managers agreed that the treatment being provided did not fall within the scope of registration for this regulated activity.

We have therefore asked the provider to consider cancelling their registration for treatment for disease, disorder and injury in line with regulatory requirements as they do not provide this regulated activity at, or from, this location. In the meantime, we consider this regulated activity dormant.

We found:

• Staff did not manage risk effectively. Although staff identified some risks on admission, most clients did not have risk management plans and staff did not review risks regularly. Staff relied on verbal information from discussions with clients and information recorded in the handover notes.
• There were no effective systems and processes to ensure that all directors were, and continued to be, fit, and that no appointments met any of the unfitness criteria set out in Schedule 4 of Regulation 5 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• There was a whistle blowing policy. Staff were aware of this and understood it. However, the policy did not cover the duty of candour and we were not assured by speaking with staff that they understood the duty.
• Care plans were not complete. In six of the eight records we reviewed it was unclear what the client’s goals were or how they would achieve them. The service did not review the care plans regularly.
• Staff did not receive training on the Mental Capacity Act 2005 (MCA) and did not demonstrate understanding of the guiding principles of the MCA. The service did not have a MCA policy.

• Some staff received supervision and appraisal from their own family members. This meant supervision and appraisal of these staff may not be wholly objective.
• The welcome pack and complaints policy provided inaccurate information about how clients could make a complaint.
• A member of the family who ran the service took the lead in investigating complaints, which meant investigations may not be wholly objective.

However:

• The environment was clean, well maintained, welcoming and comfortable.
• Clients were involved in decisions about their care and the service. There were agreed house rules and a behavioural code of conduct.
• Staff carried out assessments before clients were admitted to ensure that the service could meet the individuals’ needs.

• Care and treatment was underpinned by best practice. Clients had access to psychosocial therapies, group sessions and individual one to one sessions with a counsellor.

• Staff worked with clients to help them develop the skills they needed to sustain their recovery and maintain their independence when they returned to the community.

• Staff established therapeutic relationships with clients and involved them in their care.

• Staff treated clients with respect and kindness and supported them throughout their stay.

• There was a structured programme of care, therapy and activities. Discharge planning included an aftercare package to support clients following rehabilitation.
• There was a structured programme for supervision and appraisal of work performance.

• Staff we spoke with were highly motivated in their work and told us they felt supported by senior management. There was an open and transparent culture. Staff told us they felt comfortable raising any concerns or issues.