We carried out a review of the data available to us about Crouch House and Crouch Cottage on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Crouch House and Crouch Cottage, you can give feedback on this service.
During our comprehensive inspection in July 2019 we had serious concerns about some aspects of the safety of the environment in Crouch House (the accommodation for the service). The provider had not ensured that the premises where clients slept had appropriate locks on the external door, despite this being raised by previous clients, or that clients were able to call for assistance if needed. We served a warning notice which required the provider to make immediate improvements.
We also served a warning notice which related to the provider not having appropriate governance procedures in place. However, following the inspection the provider clarified the governance arrangements which we were assured were appropriate for the model of service it was delivering.
The provider took immediate action to make improvements and decided not to take another cohort of clients until we had completed a follow up inspection. The provider developed and implemented a comprehensive improvement action plan.
We undertook a follow up inspection a few months after our original inspection to ensure the provider had taken the appropriate action.
During this inspection we found that the provider had made all the required improvements and had taken the opportunity to ensure it was able to deliver a high quality, safe service prior to the next cohort of clients commencing the programme in January 2020.
We therefore lifted the warning notice.
We also found that:
We do not currently rate independent standalone substance misuse services.
We found the following areas of good practice:
The service received a requirement notice under regulation 18 Staffing at the last inspection in relation to mandatory training. On this inspection, the service had implemented a mandatory training schedule for all staff. Current compliance rates were 100% and medicines awareness training was included within this schedule.
The service received a requirement notice under regulation 12 Safe care and treatment at the last inspection in relation to risk assessments for clients. On this inspection, the service undertook risk assessments for all clients and risk was discussed daily by staff. The service had clear exclusion criteria and signposting procedures to ensure that clients did not carry greater risk than it could safely manage. Additionally, the service implemented a thorough safeguarding adults policy and all staff were trained in safeguarding of adults at risk.
The service received a requirement notice under regulation 19 Fit and proper persons employed at the last inspection in relation to disclosure and barring service checks. On this inspection, the service ensured all staff were disclosure and barring service checked with an appropriate policy in place for the employment of ex-offenders.
The service received a requirement notice under regulation 9 Person centred care at the last inspection in relation to care plans. On this inspection, the service had implemented appropriate recovery plans for all clients to discuss with staff and agree goals and actions to aim for throughout their treatment
However, we also found the following issues that the service provider needs to improve:
The service did not include a safeguarding procedure for use if a risk to a child was identified. This meant that staff did not have a clear procedure to follow if they identified a safeguarding issue with a child at risk.
The service did not record expiry dates of medicines or routes of administration for medicines on client medicine administration records. This meant that staff could not immediately identify on the medicine administration records if the dispensed medicine was in date and taken by the route with which it was prescribed.
We do not currently rate independent standalone substance misuse services.
We found the following issues that the service provider needs to improve:
The service did not undertake client risk assessments or formulate appropriate risk management plans for identified risks.
The service did not appropriately check all staff backgrounds using the Disclosure and Barring Service before allowing contact with clients.
Staff at the service had not received medicine administration training even though they administered medicine to clients prescribed by their personal GPs.
Staff were not trained in safeguarding and there was no safeguarding policy in place.
The service did not use a holistic recovery plan that was developed and agreed with clients.
There was no mandatory training schedule in place for staff to complete.
There was no management system to monitor the regularity or quality of supervision for staff members.
However, we also found the following areas of good practice:
The environment was well maintained and offered an array of suitable rooms for client use. Health and safety and fire safety provisions for the buildings were well met and monitored regularly.
The service undertook a thorough pre-admission assessment of clients to ensure suitability for the service. The service temporarily registered clients with a local GP to monitor their physical health needs throughout their treatment.
The service was proactive in their discharge planning and offered appropriate aftercare to all clients leaving the service.
We saw interactions between staff and clients that were kind, dignified and fostered mutual respect. The service received positive feedback from all clients.
Staff were selected for their specific skills and appropriate recruitment checks were undertaken before they started work. Comments about the staff included: 'All the staff are very experienced' and 'The staff are fantastic and help break down barriers'. We saw that the provider monitored people's views to monitor the quality of the service.
We found that medicine management was insufficiently robust and we judged that the provider was not compliant with this standard. Although people using the service were satisfied with the procedures, the provider had not ensured that people's medicines were stored and administered safely.
They were positive about the quality of their treatment programme which they said reflected their needs. People told us that they found the programme an 'Unbelievable experience.' They described it as 'Inspiring and uplifting' and said the structure of daily programme was very important and helpful.
People were very complimentary about the skills of the people providing support, saying, for example, 'They seem handpicked' and 'They are very good at their jobs and have experience and understanding.' Another said; 'They are the best.' People completed feedback forms before leaving the programme. We read comments such as; 'It was excellent,' 'Very good and helpful' and 'great experience and I have learned a lot.'