St Anne's Community Services - Alcohol Services

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm. The service was safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to clients and themselves well. Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed safety incidents well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We reviewed 5 incidents and saw that these were submitted in a timely manner and investigated appropriately. Staff we spoke with knew what incidents to report and how to report them. The service had a new electronic records system in place to report incidents which staff said worked well. Staff received feedback from investigation of incidents, both internal and external to the service during meetings and by email.

There had been 2 serious incidents during the 12 months prior to the inspection. We discussed these incidents with managers during the inspection, who could evidence how they identified learning following the incidents which had been embedded into practice. Staff were debriefed and received support after a serious incident.

Staff understood the duty of candour and could provide examples of when they had followed the duty of candour policy. Care records demonstrated staff were open and transparent and gave clients and families a full explanation, if and when, things went wrong.

Staff met to discuss feedback at daily handovers and weekly team meetings and there was evidence that changes had been made as a result of feedback. This included increasing staff awareness about new admissions and ensuring admission tasks were completed in a timely manner.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the client was received to determine if their needs could safely be met. All referrals were received from a partner community based, substance misuse service. Managers reviewed referral information in a timely manner ensuring key performance indicators were met.

The referral process determined whether clients needed treatment for detoxification, rehabilitation, or treatment for both. Clients were provided with information about the service prior to admission. Staff completed comprehensive assessments for all potential admissions.

Staff involved all the necessary healthcare and social care services to ensure clients had continuity of safe care, both within the service and post-discharge. There was evidence of effective joint working with the local authority, mental health services, prisons, and community substance misuse services. Managers discussed potential admissions during multiagency meetings.

We spoke with 3 external stakeholders who all spoke positively about the joint working arrangements with the service to maintain safe systems of care.

There was evidence of ongoing work with the local prison, and a community-based substance misuse service to develop a structured pathway for people discharged from prison transitioning into rehabilitation substance misuse services.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did so when appropriate. Safeguarding adults training compliance was 95% and safeguarding children training compliance was 90% at the time of our inspection.

Staff we spoke with could give examples of how to protect clients from harassment and discrimination, including those with protected characteristics under the Equality Act.

We reviewed 16 safeguarding alerts and saw these were detailed and submitted in a timely manner. Staff recorded what action they had taken to keep clients safe as a result. There was evidence that staff identified and shared learning from safeguarding concerns. This including learning about the services’ medicines scoring error tool and how to use this effectively.

There was a quality team within the organisation who monitored all safeguarding alerts to ensure the service was meeting its safeguarding responsibilities. Managers confirmed they had regular discussions with the team to ensure safeguarding concerns were appropriately triaged and that the relevant documentation was submitted.

There was an organisational safeguarding lead who staff could contact for advice and support. The registered manager confirmed they were the safeguarding lead for the service.

Staff followed safe procedures for children visiting the service. There was a visitor’s policy in place. Clients generally met with family and friends in the community.

We did not identify any restrictive practice or blanket restrictions during the inspection.

95% of staff had received training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it and knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable clients to make their own decisions. For clients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 7 risk assessments during our inspection. These were detailed and reflected current risks, and staff updated these regularly.

Staff developed a recovery plan for client on admission. We reviewed 7 recovery plans and saw that these were individualised to meet people’s specific needs. There was evidence within care plans that staff had liaised with outside agencies where appropriate. Recovery plans showed evidence of involvement and input from family and carers. Staff regularly reviewed and updated recovery plans when clients’ needs changed.

Managers described ongoing work to improve the quality of information captured within care records for the rehabilitation service. They told us case file audits had identified that staff did not always record when care interventions had been successful or when something had gone well. They confirmed that there was a 90-day project plan in place which included an action to address this.

Staff involved clients in the care planning and risk assessment process. Clients we spoke with told us they knew what their risks were, including risk of relapse and could describe how staff supported them to mitigate against these risks. Staff supported clients to create unexpected event plans which included action to take if they relapsed.

Staff communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties.

Staff enabled clients to give feedback on the service they received via community meetings, and treatment perception questionnaires

Staff ensured that clients could access advocacy.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We found the service to be clean and well-maintained. The building was old, and managers described it as susceptible to wear and tear, including possible subsidence. This was identified on the service’s risk register. Whilst communal areas had plenty of space, some of the doors and corridors were quite narrow. We observed some minor cracks in walls and ceilings.

Managers could provide evidence of ongoing work to maintain the care environment. This included work to repair a garden wall which had collapsed.

Staff did regular risk assessments of the care environment. These included a COSHH risk assessment, which identifies and manages risks from hazardous substances to prevent workplace harm. They also completed fire safety assessments, window restrictor assessments, kitchen risk assessments, and ligature audits. We observed a fire safety test taking place during the inspection.

The service ensured that fire alarms were checked annually by an external company. Some fire alarms were reaching the end of their operational life cycle and managers confirmed they would ensure these would be replaced. This was documented on the risk register. Staff also completed weekly, documented, checks of fire alarms systems, doors, equipment.

All clients were assessed as being safe to use the environment at the point of admission. The layout of the service allowed staff to observe clients in communal areas. There were some potential ligature anchor points. There were ligatures cutters available on the unit for staff to use. The service had recently completed a review of its observations process and had developed an in-house training package for staff.

The unit was mixed sex. Staff made clients aware and documented that they consented to this prior to admission. All clients were assessed as being safe to use the service.

Staff carried radios to enable them to respond to client concerns, where needed.

There was disabled access to the building. Bedrooms for the detoxification service were located on the ground floor and there was a bedroom on the ground floor for clients admitted to the rehabilitation who had physical health or mobility needs.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Managers had calculated the number and grade of nurses and recovery workers required using a staffing risk assessment tool. Baseline staffing numbers for day shifts were a minimum of 1 recovery worker and 1 registered nurse for early, late and night shifts. Some shifts between Monday and Thursday had a minimum of 2 recovery workers due to planned weekly admissions and discharges taking place. Crossovers of shifts occurred regularly with early shifts and late shifts usually having a period of 90 minutes when staff from both shift patterns were on duty.

Staffing levels were sufficient for the client group. Clients told us staffing levels allowed them to have regular one-to-one time with their named nurse. Each client was allocated a key worker. Clients on the rehabilitation service met with their key worker on a weekly basis, and clients on the detoxification service met their key workers daily.

We reviewed staffing data for the 3 months prior to the inspection and found that baseline staffing numbers were always met. Managers could usually adjust staffing levels daily to take account of case mix and client need.

When necessary, managers deployed agency and bank staff to maintain safe staffing levels. Data showed that bank usage was 1.9% during the 3 months prior to the inspection, and agency usage was 1.3%. When agency and bank nursing staff were used, those staff received an induction and were familiar with the service and the client group.

Staff shortages rarely resulted in staff cancelling therapy sessions or ward activities.

The service did not employ a consultant. However, staff could support clients to access medical staff whenever they needed this. This included a contracted specialist substance misuse GP who attended the service twice a week to complete medical admissions for clients and to review client progress.

Staff had received and were up to date with appropriate mandatory training. Compliance for all training modules was 85% or above except for display equipment training (75%) and Prevent training (76%). Managers reviewed training records monthly and prompted staff to complete training modules which were due for completion. The training was appropriate for the client group using the service. Training modules included basic life support, duty of candour, and infection prevention and control training.

There were currently no vacancies within the service. Staffing turnover was very low, as no staff members had left the service within the 12 months prior to the inspection.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

During our tour of the environment, we found that staff maintained equipment well and kept it clean. All client areas were clean, had good furnishings and were well-maintained.

Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly. Staff completed monthly infection prevention and control audits including hand hygiene audits. Managers completed regular ‘walk arounds’ of the environment to ensure infection prevention and control standards were maintained.

Clients in the rehabilitation service completed housekeeping duties and there was a weekly rota in place for tasks such as cooking and cleaning. Managers described how this helped develop activities of daily living skills and formed an important part of the recovery programme. One client in the rehabilitation service was the nominated cleaning supervisor.

Managers used external services for the cleaning of specific equipment within the building where required.

Staff adhered to infection control principles, including handwashing. We observed staff handwashing where appropriate during the inspection. All staff were trained in infection prevention and control, and training compliance was 100%.

Staff disposed of clinical waste appropriately.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. They reviewed each client’s medicines regularly and provided advice to clients and carers about their medicines.

We reviewed 7 sets of care records and prescription charts for all clients within the service, which confirmed that medicines records were accurate staff kept them up-to-date. Staff stored and managed all medicines and prescribing documents safely.

Stock medicine for detoxification was present and stored appropriately. There was a controlled drugs cabinet at the service.

Staff ensured there were always sufficient stocks of emergency medicines on the premises, such as naloxone and adrenaline. There was an epi pen available for staff to use if needed.

Staff followed national practice to check clients had the correct medicines when they were admitted / assessed or they moved between services. Some clients were risk assessed as being able to self-administer their medicines which they stored in their bedrooms.

Staff learned from safety alerts and incidents to improve practice. They used daily handovers and multi-disciplinary team meetings to share feedback from medicines related incidents.

Staff reviewed the effects of each client’s medicines on their physical health according to National Institute for Clinical Excellence (NICE) guidance.

Staff managed client withdrawals in a safe way which was in-line with national guidance. When clients were first admitted they would be observed more frequently if it was necessary.