Westcliffe House Limited

We rated Westcliffe House as requires improvement because:

• The unit did not have clear governance systems that could provide assurance that the service was delivering safe, effective care. The manager had not yet implemented systems and processes which meant they could record, review and audit information about the clients and their service despite this being raised as a concern on two previous inspections. The manager needed to update and review information about the service. This included information about staff training, staff supervision and appraisals, policies, staff files, client care records, risk assessments, incidents, complaints and client medication.
• There was no evidence of harm reduction advice provided, no evidence of the alcohol use disorders identification test (AUDIT)) or the severity of alcohol dependence questionnaire (SADQ) completion in clients’ care records
• Although staff stored, administered and recorded medicines safely, the medication policy and procedures to support staff administering medicines were limited and did not cover all aspects of the safe management of medicines. There was no evidence of staff being signed off as competent following medication training.
• There was little evidence to show that staff were up to date with their mandatory training. The manager did not have a clear training matrix in place to identify when staff had received, were due or were competent in their training. It had not been identified that staff who were first aiders had expired training certificates, and should have received refresher training.
• Staff meeting minutes were not easily located or filed in the appropriate place. There was no evidence of staff learning from incidents and adverse events.
• Client’s physical and mental health problems were not fully reflected in some of the care plans and risk assessments. Risk assessments could have included more individualised detail and crisis plans. Staff did not record information about unplanned exits in clients’ care records.
• Staff did not have a good understanding of the Mental Capacity Act. This meant that clients who might have lacked the capacity to make some decisions at a certain point of their treatment, including the impact of substances, were at risk of not being represented appropriately.
•  The service did not have a formal admissions policy. There was a potential risk to other clients and staff of admitting an unsuitable client due to not having a formal admission policy.

However:

• The service was well staffed and had a low turnover rate. Staff had worked at the service for a long time and demonstrated a deep understanding of the service’s recovery model. Staff treated clients with compassion and dignity. Clients described a culture of honesty and openness within the service and said they trusted the staff team.
• Clients felt as though changes had been made as a result of their feedback. Staff supported the involvement of families and provided support to develop and maintain these relationships.
• Staff offered a wide range of therapies and reviewed these regularly with the client to ensure they were effective. Clients had lots of activities to choose from, especially in their local community. There was a strong emphasis on education which included clients educating each other about their culture, heritage and life stories. Staff supported clients to live healthier lives.
• Clients said that they felt the environment was homely and could personalise their bedrooms. The service documented lots of compliments and had thank you cards displayed around the building. Clients said the food was good and staff had a good knowledge of how to support people who had specific dietary requirements.
• Staff and client morale was high. Staff felt happy about coming to work and felt proud to be working at the service. The manager respected and empowered the staff team. The manager had identified areas for improvement working with employers of clients with addiction. The manager demonstrated how they had successfully raised awareness about keeping people in employment with employers and the wider community. Staff felt supported by the manager.

This was the third time the service has been issued a requirement notice due to concerns about the governance of the service under regulation 17 of the Health and Social Care Act 2008. We have discussed this with the provider and will return to inspect the service to see if they have made the necessary improvements and to consider further action if the requirement notice has not been met.

We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Westcliffe House was in December 2016. At that inspection, we issued five requirement notices. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards.

On 9 May 2018 we undertook an unannounced, focused inspection to see whether the provider had made the required improvements. We found that the improvements were either underway or complete.

• Since the previous inspection, the provider had started to update their policies and staff records.

• The provider had also completed work to ensure the privacy and dignity of patients was respected at all times.

• The provider had ensured that incidents were recorded and learning was acted upon and disseminated to all staff.

However:

• Further work was needed to ensure the provider had the appropriate systems in place to ensure that all staff had regular recorded supervision and that all staff had completed the training needed to undertake their roles.