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Inspection Summary


Overall summary & rating

Requires improvement

Updated 29 January 2019

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.
Inspection areas

Safe

Inadequate

Updated 29 January 2019

We rated safe as inadequate because:

  • There was insufficient attention to safeguarding children and adults. The service did not adhere sufficiently to safeguarding principles. Staff did not consistently recognise or identify safeguarding concerns. Staff were not trained in child safeguarding.
  • The service had blanket restrictions in place that  impacted on client’s freedom. Clients told us that the environment was too restrictive. There was no blanket restrictions policy in place and use of blanket restrictions was not recorded or reviewed.
  • There was a lack of regard around infection control. Staff carried used urine specimen pots across the house to the clinic room for disposal. Staff could not wash their hands in the clinic room because there was no hand washing sink.
  • Staff did not lock the door to the clinic room. This meant that clients could access sharps bins and medical equipment which could pose risks to themselves or others.
  • The medicines reconciliation process put people at risk of harm. There was no process in place to ensure that the service had an up to date and accurate list of clients’ medications.
  • Staff did not complete crisis planning, including unplanned discharge plans, with clients. This meant there was no plan in place if a client’s mental health deteriorated or they left treatment early.

However:

  • A multidisciplinary team screened potential clients prior to admission to ensure the service could meet their needs and safely manage any risks.
  • All care records contained an up to date risk assessment and risk management plan. Risk assessments were comprehensive and included physical health risks.

Effective

Good

Updated 29 January 2019

We rated effective as good because:

  • 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. For example counsellors had training in cognitive-behavioural therapy and had completed the provider's Advanced Practitioner Substance Misuse (APSM) handbook, which included training such as group facilitation. 

  • Staff considered physical health needs. We saw examples of physical health issues that had been planned for and were being monitored. For example, the provider had trained staff and clients to administer lifesaving treatment for a client with a nut allergy.
  • All care records had a comprehensive assessment completed prior to admission. Staff completed personalised, holistic and collaborative care plans with clients shortly after admission.

However:

  • The service did not quality assure their individual or group therapy programs. The service did not audit the program against NICE guidelines and did not monitor the efficacy of the therapeutic program.
  • Staff did not regularly liaise with community services and there was a lack of interagency working.
  • The service did not routinely supply take home naloxone to all clients and carers following treatment for opiate rehabilitation.

Caring

Good

Updated 29 January 2019

We rated caring as good because:

  • Staff treated clients with kindness, dignity and respect. We observed staff interacting with clients in a respectful, caring and appropriate manner.
  • Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards clients without fear of consequences.
  • Clients were involved in their care. Staff ensured care plans were written in collaboration with the client and recorded client’s goals in their words.
  • The provider involved clients in the recruitment process of new staff.

Responsive

Requires improvement

Updated 29 January 2019

We rated responsive as requires improvement because:

  • The location of the clinic room compromised client’s privacy, dignity and confidentiality. The clinic room formed the internal walkway into the dining room. A white board with clients’ names and medication times written in dry-wipe marker was visible to all clients. This information could be easily amended by anyone walking through, and did not afford client privacy and dignity. The internal door to the dining room was locked if a client needed treatment or medication during meal times and a screen was pulled down across the window.
  • Staff did not complete discharge planning with clients. Community staff completed a discharge plan prior to a client’s admission but this was not revisited during the client’s treatment.
  • Several of the bedrooms were double rooms and were shared between two clients. We did not see documented risk assessments for sharing bedrooms and the provider did not have a policy in place.
  • Clients had limited access to the community within the first four weeks of treatment. Clients were required to take a “senior peer” with them on family visits and visits in the community.

However:

  • The provider did not have a waiting list. The service consistently met their target of admission within three weeks of referral.
  • The service had clear referral criteria to ensure they could safely manage peoples care. Referrals were screened and assessed to check for suitability. Admissions were agreed at a weekly multidisciplinary team meeting.
  • Staff supported clients to access and attend external support groups such as Alcoholics Anonymous.
  • Clients had access to a local community project for women in recovery from addiction. The centre provided counselling, housing support, outreach, a therapeutic group program and parenting support.

Well-led

Requires improvement

Updated 29 January 2019

We rated well-led as requires improvement because:

  • Longreach had not had a manager in post since April 2018. The chief executive officer (CEO) held the registered manager position. However, staff told us that the CEO wasn’t seen often on site.
  • The service had 47% unplanned discharges in the last reported quarter. There was not any analysis in trends in reasons for discharge.
  • The provider did not ensure robust risk monitoring of the service as there was no risk register in place.

However:

  • Managers were developing a female only detoxification service on the Longreach site. This involved converting the cottage into a residential unit with a clinic room and observation bedrooms.
  • Staff reported that senior members of the organisation were approachable and supportive.
Checks on specific services

Substance misuse services

Requires improvement

Updated 29 January 2019