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Archived: Cranstoun - Trelawn House

Reports


Inspection carried out on 22 to 23 May 2017

During an inspection to make sure that the improvements required had been made

We do not currently rate independent standalone substance misuse services.

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

  • At the last inspection in September 2016, we identified that staff were not always completing client’s risk information appropriately or in enough detail. During this inspection, we found that the quality of risk assessments and management plans was inconsistent.

  • Clients’ risk assessments and care plans did not always identify risks associated with clients’ physical health. Care plans did not always specify how best to support clients with complex physical health needs.

  • After the service had been inspected in September 2016, the provider had undertaken a service risk assessment in response to our findings. However, the provider had not reviewed the service’s risk assessment since December 2016.

  • The provider had identified a range of formal audits that needed to be undertaken to ensure that the quality and safety of the service was monitored. The provider had not fully implemented the schedule of audits.

  • The service was not routinely using early unplanned exit plans for clients. Clients were not being given information as to how to minimise the risk of overdose should they decide to leave treatment early. Clients who have recently undergone alcohol or drug detoxification are at increased risk of overdose.

  • Staff were not having regular documented supervision. This meant that staff did not have regular monthly one to one support in line with the provider’s supervision policy.

  • Staff were not routinely monitoring the temperatures in the medicines and food fridges. Staff were not undertaking regular fire drills, routine checks of fire equipment and checks on emergency lighting.

  • At the last inspection in September 2016, we found that there were a number of medicine errors in the service that had not been reported or acted upon. During this inspection, we found that there had been 17 medicine errors reported between February 2017 and May 2017. We found that staff had not identified two medicines errors.

However, the service had made some improvements since our last inspection in September 2016. We found the following areas of good practice:

  • During the inspection undertaken in September 2016, we found that medicines management was unsafe. Multiple medicine errors had occurred. The service had not assessed staff as competent to dispense medicines. During this inspection, we found that the provider had trained staff in medicines management.

  • At the last inspection in September 2016, we noted that staff had a poor understanding of safeguarding adults and children. During this inspection, we found that the provider had trained staff in safeguarding adults and young people. All staff knew how to make safeguarding referrals.

  • At the last inspection in September 2016, we found there were low completion rates of mandatory training. During this inspection, we found that the completion rates of mandatory training had improved.

  • At the inspection in September 2016, we asked the provider to improve their pre-employment checks. The provider had improved their recruitment processes and there were now procedures in place to ensure that pre-employment checks were completed for new staff.

  • When the service was inspected in September 2016, we identified that the provider’s governance processes did not ensure the safety and quality of the service. Since that inspection, the provider had reviewed their governance processes. The new processes were not fully embedded at the time of this most recent inspection, though work had begun on this. The provider had begun the process of reviewing their policies to ensure that they were in line with best practice guidance.

  • At the last inspection in September 2016, we found that the service was not reporting all incidents that occurred in the service. During this inspection, we found that the service had acted on the findings of the September 2016 inspection. The service was reporting and reviewing all incidents that happened in the service.

  • When we inspected the service in September 2016, we identified that clients’ care plans were not specific or measurable. During this inspection, we found that the service was introducing new care planning documents. The new plans allowed clients to identify specific measurable goals. The process was not fully embedded at the time of this inspection.

  • At the last inspection we found that the staff working in the service did not understand the principles of the Mental Capacity Act. During this inspection, we found that the service had acted on the findings of the September 2016 inspection, and had provided staff with training in the Mental Capacity Act.

  • When the service was inspected in September 2016, we found that the service was not clean. During this inspection, we found there was regular cleaning of the service. Staff were monitoring the cleanliness of the service.

  • At the last inspection in September 2016, we found that food was being stored incorrectly in the fridge. During this recent inspection, we found that the service was now storing food items on the correct shelves in the fridge.

Inspection carried out on 20-22 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:

  • Medicines management was unsafe. Multiple medicine errors had occurred. Staff were not assessed as competent to dispense medicines.

  • Risk information was not always appropriately recorded or detailed. Clients did not have risk management plans.

  • Staff did not always recognise issues which were safeguarding matters. Staff did not know how to make safeguarding referrals.

  • The providers senior management team had not acted on the findings of a previous CQC inspection at another location with sufficient speed or impact. The same and similar issues were identified during this inspection.

  • Rates of mandatory training for staff were low. Not all staff had the core skills and knowledge necessary for their role.

  • Some staff did not have the required pre-employment checks before they started their employment.

  • All incidents in the service were not reported as incidents. Only one incident had been reported in the previous year.

  • Clients care plans were not specific or measurable. They did not reflect clients involvement and preferences.

  • The manager and staff had little or no understanding of the Mental Capacity Act.

  • There was no integrated governance system to underpin the quality and safety of the service.

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

  • Clients were very positive regarding staff in the service. They reported that staff were approachable and supportive.

  • Clients had an induction pack and a peer mentor when they were admitted to the service.

  • Feedback from clients was sought and clients could make suggestions for improvements in the service.

  • Staff discussed and agreed new procedures, documents and changes before they were put in place.

We issued Warning Notices to the provider and took other regulatory action. Details can be found at the end of the report.

Inspection carried out on 29 November 2013

During a routine inspection

People who used the service understood the care and treatment choices available to them. We spoke to five people who used the service, they told us they were given the opportunity to ask questions about the service prior to taking up residence. People told us that staff explained what treatments were available to them. They were treated with “respect” and their opinions were “valued.”

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We read the files of four people who used the service and found that these included a full assessment of their needs and the support measures to be taken by staff.

Appropriate arrangements were in place in relation to the recording of medicine. We saw records confirming that medicines that were booked in were recorded appropriately and that medicines were managed safely.

We reviewed the staff files that were available at the home and found that staff had the appropriate training and skills related to their jobs. The people we spoke to were confident in the ability of the staff to meet their needs. One of the people we spoke to said "the staff are fantastic, they treat information with the greatest of confidence and are always able to answer questions I have about my treatment."

Staff received appropriate professional development and had opportunities for training and feedback on their performance.

Inspection carried out on 4 December 2012

During a routine inspection

The unit was clean and well furnished and there appeared to be adequate staff on site.

The property had well kept grounds where the people using the service were able to relax .Smokers were catered for with a covered area. The accommodation for people was newly decorated and in good order. People were actively involved in their own care, there were weekly home meetings were any issue could be aired and resolved.

People who use the service told us that the service was helping them to get their life back on track and to take decisions about their future.

They believed that the staff ensured that the site was safe and well run and that the therapy received was really helping them.

One person said that it is fantastic and I have tried many others -this is the best.

Another person advised us that it has lived up to my expectations -we are treated like adults.

All people we spoke with were unanimous in their approval of the therapy delivered and the high level of support from all of the staff. One person said that the staff here have helped me get my life back on track and helped and encouraged me to take decisions about my future.

Reports under our old system of regulation (including those from before CQC was created)