Archived: Closereach

Updated 29 January 2019

Broadreach House provides substance misuse services at three registered locations: Broadreach, Longreach and Closereach. Before this inspection of Closereach, inspections took place at Broadreach and Longreach. Reports have been published separately for each registered location.

Closereach is an 18-bed substance misuse rehabilitation service for men. At the time of this inspection there were 12 people using the service. Closereach has a mirror service in a different location, called Longreach, for female clients. Both locations admit clients who had completed detoxification (detox) predominantly from the Broadreach House location. However, they did also admit clients from other detox services.

Closereach has a large main building with staff offices, therapy rooms, kitchen and dining areas on the ground floor, with bedrooms and showering facilities on the second floor and two single rooms on the third floor. There is also an adjacent, listed building called the ‘Joshua Reynolds building’ which has laundry facilities, a gym and music room.

The service provides a programme where clients learn strategies for maintaining their recovery and set personal goals. The length of programme is a minimum of three months, with an option for a further three months if required. The majority of clients are funded by community drug and alcohol services and by local authorities.

The service is registered to provide accommodation for persons who require treatment for substance misuse.

At the time of the inspection the provider’s chief executive officer was the registered manager and nominated individual. There was a unit manager in post who was in the process of applying to CQC to become the registered manager.

Closereach was previously inspected in July 2017. This was 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. We did not rate the service in 2017.

The service had outstanding requirement notices:

• The provider must ensure the environment is clean and well maintained.
• The provider must ensure that clients are assessed by the service upon admission and that identified risks have a clear risk management plan in place for all staff to follow.
• The provider must ensure the safe management of medicines.
• The provider must ensure that clients have up to date, personalised information about their physical and mental health conditions, recorded in their care plans and that routine physical health monitoring takes place.
• The provider must ensure that governance processes are in place to ensure it is delivering safe and good quality services.

Updated 29 January 2019

We rated Closereach as good because:

• Staff provided safe treatment for clients based on national guidance and best practice. Pre-admission assessments used by the service were high quality and included questions which assessed current substance use, risk of blood borne viruses and physical health needs. Staff used the pre-admission assessment to develop risk assessments and guide the completion of individually tailored treatment plans. 
• Recovery treatment was provided based on the cognitive behavioural therapy programme. There were adequate rooms to provide psychosocial therapies and activities. All areas were safe, clean, well-equipped, well-furnished and well maintained. The design, layout, and furnishings of the service supported clients’ privacy and dignity.
• Staff were skilled, competent and knowledgeable in meeting the needs of people who used the service. The service provided training in key skills to all staff and made sure everyone completed it. Qualified counsellors provided psychosocial therapies. The manager of Closereach had the right skills and abilities to run a service providing a good quality of care.

• Clients spoke highly of the staff, and said they felt safe in the comfortable environment and found the treatment was positively impacting their lives. Clients told us they were treated with respect, compassion and kindness.
• Staff spent extensive time with clients through various activities to provide exceptional person-centred care. Staff were passionate about providing extra opportunities to clients that would be individually meaningful for them during their recovery and after discharge. 
• Staff supported clients to make decisions on their care for themselves. They understood the service policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly when appropriate. 
• There were systems in place to record, review and discuss complaints, compliments and incidents. Improvements had been made in response to this.
• Leaders within the service were visible and approachable for both clients and staff. The staff team felt respected and valued, worked well together and were supported by their managers.
• Leaders had effective systems in place to regularly support their staff and improve the quality of care they provide. This was achieved by regular managerial and clinical supervision, appraisals and staff meetings.

However:

• Although there was a sink in the clinic room, there was no sink dedicated to handwashing and the collection of urine samples did not ensure good infection control. 
• The service had sought medical histories and medication information from clients GP’s up to four weeks prior to admission. This meant clients medication could have changed before they arrived at the service. However, the manager had ensured that clients were registered with a local GP within 48 hours and medicines reconciliation was completed with the local GP at registration. 
• Although there were procedures in place to respond to an overnight emergency, there was no provision of staff at the premises overnight.
• The provider had some blanket restrictions which did not have a clear rationale. However, the manager allowed clients to make ‘special requests’ to allow them temporary alleviation from these restrictions.

Updated 29 January 2019