St Anne's Community Services - Alcohol Services

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

• St Anne’s Alcohol services were not assessing and managing risk effectively. Service risk assessments had not been completed on the use of mixed sex accommodation and client call alarms in the 18 bed residential rehabilitation unit. The medication and equipment required in an emergency, including a defibrillator, and the response time from the emergency services and distance to the nearest accident and emergency had not been risk assessed. Also, the service could not be sure that their equipment was in working order, for example, the staff communication radios. The system to record client risks was unclear and in the care records reviewed, risk assessments and risk management plans were either not present or incomplete. Not all staff were clear about reporting incidents where they felt intimidated as a risk. In addition, risk assessment was not included in the visit’s policy to safeguard children and vulnerable adults.

• Patient physical observations and baseline observations were either not completed or not recorded, or discussed in the staff handover sessions. Similarly, assessments and observations for medication prescribed as the patient required it were either not completed or not documented in line with the services’ policy.

• St Anne’s Alcohol Services had low compliance for some of its mandatory training, including moving and handling patients. This could impact the safety of the staff and the patients. Staff could not all identify child safeguarding risks and concerns, and staff had not received any child-safeguarding training to an appropriate level for their role. There was no formal programme of specialist substance misuse training for the administration of medication, including a schedule of competency assessments or supervised practice.

• Care plans were not holistic and individually tailored to the client’s needs, and clients in the alcohol detoxification service did not get a named nurse on admission. None of the care plans had clear actions, and were not signed and dated by both the client and the staff member. Similarly, the alcohol detox could not be tailored to the client as there was no use of alternative medications.For example where a client had poor liver function. Clients in the alcohol services did not have a discharge plan in place on admission. Staff did not document decision specific mental capacity assessments in the client record where capacity had been a concern. Also, the services did not have any input from a dietician to ensure that they were meeting the nutritional requirements of the clients.

• The mission, vision and values (core principles) were not embedded in St Anne’s Alcohol Services because staff were unclear what they were. Also, there was not a vision or statement of recovery specific to alcohol misuse for staff to embed in their practice, and for clients to work towards. The governance systems established had not operated effectively and were not embedded to assess, monitor and improve the quality and safety of the service provided. In addition, information required by the alcohol services management team to manage the services, for example for supervision, appraisal and training, was not held in one place, and was not accurate.

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

• Staff were caring and treated clients with kindness and respect. The staff had a strong person-centred approach. The service tried to meet the needs of all the clients who used the service and where they were unable to meet a client’s needs, they were transparent with the client and found them alternative service provision in partnership with the community, substance misuse service.

• The psychological therapies, group-based interventions, medications and detox regimes used were evidence based and recommended by the National Institute for Health and Care Excellence. Staff received regular managerial and clinical supervision, and completed annual appraisals. The service completed a number of outcome tools to demonstrate that clients were making progress and meeting their goals. The alcohol services outcomes demonstrated that clients were making changes and leaving treatment having met their goals.

• The environment at St Anne’s Alcohol Services was clean and well maintained, including the outside space. The services were responsive in their approach with clients. Clients had a pre-admission assessment within 10 days of being referred to the service and the usual wait time to access the alcohol services was 11 days from the pre-admission assessment to admission for both the alcohol detoxification service and the residential rehabilitation service. Clients had also been admitted immediately following the pre-admission assessment where this had been required. The doctor saw clients in the alcohol detoxification service immediately on admission. Also, St Anne’s Alcohol Services had been proactive in taking action to reduce their waits to enter the service and improve the service for the clients.

• St Anne’s Alcohol Services were committed to improving the quality of treatment for clients, and the treatment outcomes, through their involvement in national research and projects. Staff, clients, relatives and carers felt able to feedback into the planning, delivery and development of the service. All staff told us that the service manager was approachable and supportive. They felt confident in being able to approach them with concerns without fear of victimisation. Lessons learned from incidents and complaints or compliments were also used to develop and improve the service.