14 November 2018
During a routine inspection
We rated Longreach as requires improvement because:
- There was insufficient attention to safeguarding children and adults. The service did not adhere to safeguarding principles. Staff did not consistently recognise or identify safeguarding concerns. Staff were not trained in child safeguarding. Staff did not update the safeguarding log and information was not shared between staff about safeguarding concerns. Staff told us that if they identified a safeguarding concern, they informed their manager who made a referral to the local authority. Staff identifying the concern should be confident and competent to make the referral themselves.
- The service had blanket restrictions in place that impacted on client’s freedom. Clients told us that the environment was too restrictive. For example; 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 were unable to have unsupervised access to the community until week four of treatment. Clients had to seek approval from staff for their visitors and visitors with a current of substance use would not be approved. The provider did not have a blanket restrictions policy in place and a log of their use was not kept. The provider did not consider restrictions on an individual basis or regularly review the use of blanket restrictions.
- The medicines reconciliation process put people at risk of harm. Community staff were provided with a GP summary, including list of medication, up to four weeks prior to admission. Clients brought in 28 days of medication with them and this was checked against the GP list. There was no process in place to ensure this was the most up to date and accurate list of medication.
- The provider did not have governance processes in place to ensure sufficient oversight, quality assurance and risk management of the service. Managers did not ensure that staff supervision considered the quality of safeguarding practices within the staff team nor did they offer staff training in child safeguarding. The organisation did not hold a risk register for the service to ensure that all service risks are identified and managed. The provider did not have systems in place to monitor the effectiveness of their therapeutic program or have sufficient quality assurance processes in place. The provider did not have systems in place to ensure that client feedback was always acted upon.
- The service also did not audit the program against the National Institute for Health and Care Excellence (NICE) guidelines or have a quality assurance process. The service did not monitor the efficacy of the therapy program. This meant the programme was not evidence based.
- Staff did not follow infection control principles. Staff carried contaminated clinical waste, following urine drug testing, across the house for disposal in the clinic room. There was no hand washing sink available in the clinic room for staff to use.
- At the time of inspection, the location of the clinic room compromised safety, privacy, dignity and confidentiality of clients. The clinic room formed the walkway into the dining room. Confidential information was on display in the clinic room that was visible when clients accessed the dining room. The door to the clinic room was left unlocked. Clients could access sharps bins and medical equipment which could be used to cause harm to themselves or others. Following the inspection, the provider informed us they had moved the clinic room.
- There was no evidence of crisis plans or unplanned discharge plans for clients. Crisis plans should contain personalised information on what support is available during a deterioration of mental health and a relapse prevention plan. Staff were not assessing whether clients were at risk of unplanned discharge or creating robust unplanned discharge care plans with clients.
- The service did not routinely act on client feedback. Clients raised issues regularly through house meetings and evaluation forms but these were not addressed by the provider.
- The service did not routinely supply take home naloxone to all clients and carers following treatment for opiate rehabilitation.
However:
- Staff completed high quality, collaborative and individualised care plans.
- 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.
- Staff treated clients with kindness, dignity and respect. We observed staff interacting with clients in a respectful, caring and appropriate manner.
- The service had clear referral criteria and referrals were screened and assessed to check for suitability. Admissions were agreed at a weekly multidisciplinary team meeting.
- Clients had access to a local community project for women in recovery from addiction. The project provided counselling, housing support, outreach, a therapeutic group program and parenting support.