• Residential substance misuse service

Archived: Broadreach

Overall: Requires improvement read more about inspection ratings

465 Tavistock Road, Roborough, Plymouth, Devon, PL6 7HE (01752) 790000

Provided and run by:
Broadreach House

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Background to this inspection

Updated 15 February 2019

Broadreach House provides substance misuse services at three registered locations in Plymouth: Broadreach, Longreach and Closereach. Following the inspection at Broadreach on 13 November 2018, inspections took place at Longreach and Closereach. These reports are published separately.

Broadreach offers alcohol and opiate detoxification and rehabilitation therapy for clients who require treatment for substance misuse. The service’s therapeutic programme typically runs for 12 weeks and is available to men and women who are 18 years old and above. The service has 30 beds available.

At the time of the inspection, the service was undergoing a staffing restructure. The staff team previously consisted of nurses, counsellors, and support workers. A keyworker role was being implemented to work alongside counsellors to provide support to clients.

Clients can refer to the service by their GP, by their local authority, or are able to self-refer and self-fund. Broadreach accept referrals nationwide and work closely with care managers from clients’ local areas.

Broadreach was initially registered in 2010 for accommodation for persons who require treatment for substance misuse, diagnostic and screening procedures and for the treatment of disease, disorder or injury.

At the time of the inspection the provider’s chief executive officer was the registered manager and nominated individual. There was also a unit manager in place who was not present at the time of inspection.

Broadreach was previously inspected in July 2017. This was an unannounced, focussed inspection of this location to check a number of issues that had come to our attention through the information we hold about the provider. During this inspection the service was not rated. The service has no outstanding requirement notices.

Overall inspection

Requires improvement

Updated 15 February 2019

We rated Broadreach as requires improvement overall because:

  • The service’s medicines management was not robust. The medical officer was signing prescription charts for alcohol detoxification prior to assessing clients. Without a full face to face assessment an incorrect detoxification regime could be started resulting in incorrect medication, dose or frequency being administered. Staff received a client’s summary record from their local GP up to four weeks before the client arrived at the service. This meant that clients may not receive up to date medication.
  • The service had a number of blanket restrictions in place. These restrictions were not assessed on an individual basis. The provider did not have a blanket restriction log that justified the use of the restrictions. The provider did not routinely review these restrictions and the provider did not seek client feedback on the restrictions. Clients had no access to mobile phones throughout treatment including when on community leave in the local area but were able to take mobile telephones on home leave and when travelling distances. Clients were not allowed to bring food or drink, including water into groups, and clients were unable to leave the service unescorted until week eight of treatment. Clients had to seek approval from staff for their visitors and visitors with current substance misuse would not be approved. Clients were asked to sign a contract agreeing to these restrictions. Staff witnessed client’s giving a urine sample on admission. However, at the time of inspection the service’s policy relating to urine testing did not state it should be witnessed. There was also a bench in the service’s car park that only staff were allowed to use.
  • There was a lack of crisis plans in place for clients. This means that staff and clients may not know what their support needs were during a time of crisis. Crisis plans should include relapse prevention strategies personalised to the client’s support needs and treatment goals. Crisis plans and relapse prevention strategies should be written with clients to ensure staff know how to support a client if their mental health deteriorated or if they relapsed. Clients did not have a person-centred unplanned discharge plan. Client records contained a basic unplanned discharge form, but risk management plans did not identify those at risk of unplanned discharge from treatment.
  • Staff were not adhering to infection control principles in the clinic room. We found plastic cups, a syringe and a beaker with residual methadone liquid inside. The syringe had not been cleaned between uses and the beaker was left on top of the medication cabinet. Methadone is an opiate medication prescribed for the treatment of heroin addiction and is a controlled drug. Staff were also transporting urine samples from a toilet at the front of the building to the clinic room at the back for testing, which could result in a spillage.
  • The provider did not have robust and comprehensive governance and quality assurance processes in place to ensure sufficient oversight, quality assurance and risk management of the service. For example, the service did not audit or review service provision and outcomes of client’s care to ensure the therapeutic programme offered was effective.

However:

  • All seven of the client care and treatment records reviewed contained a current risk management plan and person-centred recovery plans.
  • Staff provided a range of care and treatment interventions suitable for the client group. These included medication, psychological therapies, complementary therapies, and activities. The service had enough skilled staff to meet the needs of clients. The majority of staff had completed mandatory training. Staff were provided with a comprehensive induction and had relevant qualifications to provide clients with effective care and treatment. Managers had appropriate qualifications to perform their role. Counsellors were qualified to deliver the therapeutic programme.
  • Clients told us that staff attitudes and behaviours were kind, respectful and showed an interest in their wellbeing. Clients said that staff understood them and that they felt safe in the service.
  • Clients had lockable safes in their bedrooms to securely store personal possessions. This was an improvement from the previous inspection.