The Care Quality Commission
  • 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

All Inspections

13 November 2018

During a routine inspection

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.

6 July 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

Broadreach has been inspected twice previously, in 2013 and 2016. The comprehensive inspection in September 2016 did not fully comply with CQC policy and guidelines for inspection activity. Consequently the report was not published.

We will undertake a further comprehensive inspection in the near future.

In July 2017 we carried out an unannounced, focussed inspection of this location to check on a number of issues that had come to our attention through the information we hold about the provider.

At this inspection we found the following areas of good practice:

  • All medicines were stored safely and administered by staff apart from those required for immediate relief of symptoms such as asthma inhalers.
  • There were systems in place to ensure the repair of faulty equipment in a timely manner; there was a schedule for safety testing of equipment and staff now carried personal alarms.
  • Medication risk management plans were in place to give staff permission to manage and administer medicines. This included some disease specific risk assessments. For example, diabetes plans which detailed triggers and symptoms and what actions to take if the client’s health deteriorated.
  • The provider had reviewed its policy on locking bedroom doors. Bedroom doors did not lock but this was for the safety and wellbeing of clients. We talked to clients about this policy and they were in agreement with it.
  • Physical health checks were carried out on admission and clearly documented.
  • Risk assessments were clearly documented in client’s files.
  • There was a programme of audits in place to ensure required improvements in the services were identified and actioned in a timely manner and the vision and values of the provider were clearly displayed on a noticeboard.

26 - 28 September 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • Clients did not have comprehensive risk management plans. We raised this with the provider during the inspection who confirmed that they would take action to address this. Risk assessments were not completed by the nurses on any of the records we looked at. Risk assessments were completed by the counselling team but these did not include risk management plans. Care plans were not always individualised and did not appear to take into account service users’ views or preferences.

  • Some physical healthcare provision was required improvement. For example records for one client who had insulin dependent diabetes did not contain enough information for staff to administer additional insulin doses in response to high blood sugar levels and there was no evidence of specialist diabetic input into their care. We raised this with the registered manager, and saw that the provider had started to address this by the end of our inspection.

  • Portable appliance testing for the electrocardiogram (ECG) machine was two months overdue. Staff walkie-talkies were not checked to ensure they were working and staff told us they did not work and that they did not have access to other forms of alarm to access help in an emergency.

  • Clients’ asthma inhalers were taken out of their original packaging whilst stored in the medicines cupboard. This meant the prescribing information, including dose, was not available.

  • Validated dependence tools recommended by the National Institute for health and Care Excellence (NICE) such as the severity of alcohol dependence questionnaire or alcohol problem questionnaire were not used. These tools are recommended by NICE for clients being admitted for alcohol detoxification. However, nurses were using Clinical Institute Withdrawal Assessment from alcohol (CIWA) and the Clinical Opiate Withdrawal Scale (COWS) throughout the detox process.

However, we also found the following areas of good practice:

  • Clients accessed a range of therapeutic groups as part of their treatment. Clients told us that they thought the therapies were helpful and the food was of good quality.

  • Staff completed detailed assessments of client’s drug use, injecting history, previous treatment interventions and physical health. Staff demonstrated good practice in following National Institute for health and Care Excellence (NICE) guidelines for detoxification and “drug misuse and dependence: UK guidelines on clinical management (2007)’ guidelines”.

  • Clients who were at risk of self harm could be assigned one of three rooms with reduced ligature points. Clients who left detoxification before the end of treatment were discharged safely.

  • The clinic room was clean, tidy and had all necessary equipment. Controlled drugs were ordered, stored and recorded correctly. Environmental risk assessments were undertaken and identified risks were managed. A risk management plan showed what action was to be taken by what date.

  • At the time of inspection, there were no nursing staff vacancies. There was always a nurse on duty. The provider only used agency nurses as a last resort.

  • All staff were up-to-date for all mandatory training and all staff received supervision and appraisal.

4 November 2013

During a routine inspection

We met and spoke with most of the 14 people who used services and spoke to people about the care and support they had received at Broadreach. We talked with most of the staff on duty and checked the provider's records.

Comments from people who were staying in the Broadreach included, "Would recommend the place to anyone' and 'They have really helped me'.

We saw that people's records described people's care and treatment programme and how these would be met. We saw that people consented to the care and treatment they would be receiving.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a professional way that demonstrated a good understanding of people's individual needs and preferences.

We looked at care records for six people; this included two new admissions on the day of the inspection. We spoke with staff about the care and treatment given to some of these people, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their planned treatment how those treatments would be arranged and met.

There were effective systems in place for safeguarding people from abuse. All the staff we spoke with were clear about the actions they would take should they have any concerns about people's safety.

We spoke with many of the staff working during our visit. Comments included 'Great team work' and 'Plenty of support.' Staff said they were supported to deliver care and treatment safely and received appraisals and supervision to promote good practice.

We saw that Broadreach House held all records securely to protect people's confidentiality.