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Inspection Summary


Overall summary & rating

Good

Updated 18 January 2019

We rated Western Counselling as good because:

  • The service had sufficient staff to ensure the identified needs of clients were met. Staff were compassionate and respectful and treated clients with dignity. Staff provided practical and emotional support to a high standard.

  • Risk assessments and recovery plans were personalised, thorough and reviewed regularly. Staff acted appropriately to keep people safe. Recovery plans were person-centred and included physical, psychological and social needs.

  • Clients could access specialist services, support and urgent care when needed, and were supported to live healthier lives. Staff aimed to involve clients in all aspects of the service.
  • The service was responsive to concerns identified and acted on these to make improvements.
  • The service recruited volunteers, many of whom went on to be offered permanent roles.

  • Staff we spoke with felt that leaders and managers of the service encouraged an open, supportive and honest culture. They valued the open-door policy that had been put in place. Staff received regular supervision and annual appraisals.

However:

  • The service did not have a clear set of values that staff were able to articulate. Policies and procedures were not all up to date, accurate and fit for purpose despite having been recently reviewed.

Inspection areas

Safe

Good

Updated 18 January 2019

We rated safe as good because:

  • There were sufficient staff to meet client needs.

  • Risk assessments and recovery plans were personalised, thorough, and understood by all staff.

  • Staff were confident in identifying abuse and could act on this appropriately to keep people safe.

  • Meijer House had separate sleeping areas, bathrooms/toilets and lounge areas for men and women.

  • There was good support for staff and clients after incidents and leaders identified actions and provided feedback to staff and clients following investigations.

  • The service had clear protocols around the searching of clients, and a code of conduct for behaviour. Clients understood this and felt reassured by the boundaries in place.

However:

  • There was stained flooring in a lounge and bathroom, and no handwashing facilities in the clinic room to help control infection.

Effective

Good

Updated 18 January 2019

We rated effective as good because:

  • Assessments and care plans were holistic, personalised and included physical health care checks. Care plans promoted recovery and met the individual needs of each client. Plans also addressed the potential of early exit from the programme and included a back-up plan in case this happened. All clients saw a GP on the day of admission and had access to a daily GP appointment if needed.

  • Staff received regular supervision and had annual appraisals of their work performance.

  • There were systems in place to check the competence of staff to administer medicines safely and to ensure all clients received physical health checks. Clients going through assisted withdrawal from alcohol or opiates were overseen by the GP.

  • Health screening was routinely carried out as part of clients’ care and treatment.

  • The service recruited volunteers, who had access to a comprehensive induction and training programme. Many volunteers had been offered permanent roles.

However:

  • Staff did not all have a good understanding of the Mental Capacity Act 2005. While the service did not admit clients lacking mental capacity to consent to the treatment programme, capacity to consent to treatment was assessed at the pre-admission stage. There was no evidence of consideration of fluctuating or deteriorating mental capacity to show that staff could respond appropriately if clients lacked capacity to make a decision whilst under the influence of alcohol or drugs.

Caring

Good

Updated 18 January 2019

We rated caring as good because:

  • Staff showed compassion, dignity and respect towards clients, giving responsive, practical and emotional support as appropriate.

  • Staff supported clients to understand and manage their care and treatment.

  • Staff showed a good understanding of the impact care and treatment can have on clients’ emotional and social well-being.

  • People who used the service and those close to them were provided with access to appropriate emotional support including access to mutual aid groups. The service also offered a carers programme of support.

  • The service offered interventions aimed at maintaining and improving clients' social networks, employment and education opportunities and provided support for people to attend community resources.

Responsive

Good

Updated 18 January 2019

We rated responsive as good because:

  • The service could assess and admit clients to the programme on the same day in urgent cases.

  • The service did not have a waiting list.

  • At the pre-admission assessment stage, the admissions department discussed an unplanned discharge and crisis plan with all clients

  • Each client had a named allocated counsellor on admission to the programme with identified skills, knowledge and experience to meet their individual assessed needs.

  • Recovery and risk management plans were regularly reviewed with the patient and adjustments made as appropriate.

  • The service had links with and referred people to advocacy services.

  • Clients understood the complaints system and knew how to access it. The service had a complaints policy and could demonstrate its responsiveness to complaints.

Well-led

Good

Updated 18 January 2019

We rated well-led as good because:

  • The service had been proactive in capturing and responding to clients concerns and complaints.

  • The leadership team were responsive to concerns raised during the inspection and acted on these without delay.

  • Staff we spoke with felt the leadership and management of the service encouraged an open, supportive and honest culture. They valued the open-door policy that had been put in place.

However:

  • Staff were not able to articulate a clear set of values for the service.

  • Not all policies and procedures were up to date, accurate and fit for purpose despite having been recently reviewed.

Checks on specific services

Substance misuse services

Good

Updated 18 January 2019

Western Counselling is a residential rehabilitation service for substance misuse.