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Allington House - Bournemouth Good

Inspection Summary


Overall summary & rating

Good

Updated 19 March 2019

We rated Allington House good because:

  • Staff treated clients with dignity, respect, compassion and kindness. Clients told us that staff were empathic, caring and approachable. Staff involved clients and carers in decisions about their care, treatment and changes to the service. Staff supported clients to maintain contact with their families and carers and provided a space for them to meet. The service encouraged dog owners to attend rehabilitation by enabling them to bring their dog with them.
  • Clients who used service were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each person. The service had a strong recovery ethos with staff devoted to ensuring that clients had excellent outcomes. Clients praised the staff in helping them open-up and talk about areas of their life they had previously kept to themselves.
  • All clients we spoke with said they felt safe. Clients described Allington House as a quiet, calm and homely environment. Clients told us that the service had a community spirit, and that everyone looked out for each other. They felt that the staff were very interested in their welfare and that they “went the extra mile” to ensure they were happy and able to succeed in their recovery. Clients described the service as having ‘saved their lives’ and felt that the skills staff taught them would enable them to move back into the community safely.
  • Managers and staff shared a clear definition and vision of recovery for clients that was embedded throughout the service. Staff understood their roles in supporting clients in their recovery journey and treated them as partners in their care. Staff said they felt respected, supported and valued, and were proud of the work they did.
  • The provider actively worked to reduce barriers to treatment for their clients. For example, the service had admitted clients with their pets, purchased support from domiciliary care agencies for clients requiring personal care and employed a driver who collected clients when public transport was a barrier to treatment.
  • Staff were very motivated and inspired to offer care that was kind and promoted clients’ dignity. Staffing levels were safe and there were plans in place to cover vacancies, sickness and annual leave. There was a positive culture within the house, staff felt respected and valued as members of the team and there was support from the registered manager. Staff received the specialist training needed to carry out their work effectively. Through safeguarding training and information, staff understood how to protect clients. Staff had two monthly supervision and yearly appraisal.
  • Staff had good knowledge of safeguarding procedures that helped them protect vulnerable adults from abuse. Staff reported incidents as they arose and learnt from accidents and incidents in the house.
  • The service was clean, well equipped, well-furnished and had good facilities. The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity and there were adaptations for people with disabilities. The manager completed environment health and safety checks, this included an assessment of ligature points. A ligature point is anything which could be used to attach a cord, rope or other material for hanging or strangulation.
  • The service provided care based on National Institute for Health and Care Excellence guidance. Allington House provided one to one time and group work to clients. Staff monitored and addressed physical health of clients in the house. Staff received mandatory and specialist training and they had a good understanding of the Mental Capacity Act.
  • There was no waiting list for the service. In the event of clients relapsing, staff tried to work around triggers for relapse. The service had a range of rooms for clients, including living rooms, a large dining room and a multi-faith room. There was wheelchair access and access to outside space. Staff provided care according to ethnic, cultural differences and personal preferences. Staff supported clients to access and attend external support groups.
  • Clients knew how to complain. There were policies in place to guide staff within their work. The provider maintained and discussed the organisational risk register. Clients had regular opportunities to give feedback about the service, including; house meetings, evaluation forms, suggestion box and a feedback book.

However:

  • Staff did not complete comprehensive risk assessments for clients admitted to the service and there was no evidence of crisis planning. Staff did not complete individualised care plans for clients accessing the service. Staff did not document discharge plans. Staff kept a lot of information in their heads and this was not translated into the documentation. There were blanket restrictions in place.
  • Medicines were not always prescribed safely due to staff not using medicines reconciliation processes as routine. This means that staff did not routinely check that the medicines they were giving were the ones prescribed by the GP.
  • The service did not have sufficient governance systems in place to ensure sufficient oversight and risk management of incidents and safeguarding. Managers therefore did not monitor to look for trends, this meant that if the same incident kept on occurring then there was no oversight to look at the reasons why or for example, if there was a gap in staff training.
Inspection areas

Safe

Requires improvement

Updated 19 March 2019

We rated safe as requires improvement because:

  • Staff did not document comprehensive risk assessments for clients admitted to the service and there was no evidence of crisis planning. We reviewed six care records for clients at Allington House and there was a lack of detail to inform staff of clients’ risks. Staff told us that they kept a lot of client information in their heads but this was not translated into documentation.
  • Medicines were not always prescribed safely due to staff not using medicines reconciliation processes as routine. This means that support workers transcribed medicines from the boxes that clients brought in with them on admission, there was no standard double checking of the charts or routine contact with the clients GP to ensure that medicines brought in were ones that had been prescribed.
  • Despite the service reviewing blanket restrictions there were still a number that remained in place. This meant that restrictions affecting someone in the house were not individually assessed, for example, access to a phone.

However:

  • Allington House was clean and there were arrangements in place to ensure the service was kept clean and tidy. Clients staying at the service were supported by staff and peers to clean and tidy the communal areas of the house as well as their own bedrooms. Clients had their own bedroom and most of the rooms were en-suite. Staff admitted clients into a shared bedroom with another client who were ahead in treatment for peer support if they were having an assisted withdrawal. An assisted withdrawal is a period where a client is prescribed medication to help them safely withdraw from a substance.
  • The registered manager completed environment health and safety checks, this included an assessment of ligature points. Staff followed infection control principles such as hand washing and disposing of clinical waste. There was an automated external defibrillator (AED) within the building; this had been acquired following the last CQC inspection. Allington House also had a de-choking device and ventilated pillows for use in emergencies.
  • Staffing levels were safe and there were strategies in place to cover vacancies, sickness and annual leave. Volunteers and recovery champions were part of the team. Staff kept up to date with mandatory training. There was a low level of sickness and turnover of staff was also low.
  • The care records held plans for unexpected exit from treatment plans and staff described how they supported clients who wanted to leave. Care records showed that there was prior agreement of where a client would go if they left treatment early.
  • Fire safety training was offered to clients to make sure that they knew fire procedures and the risks of smoking inside the house. The manager completed regular fire safety checks and practiced regular evacuation procedures.

Effective

Good

Updated 19 March 2019

We rated effective as good because:

  • A range of therapeutic groups supported the needs of the clients and aided them in their recovery journey.
  • The provider followed national best practice guidelines treatment such as National Institute for Health and Care Excellence guidelines (NICE). Staff we spoke with told us they used the Department of Health drug misuse and dependence UK guidelines on clinical management (also known as the ‘Orange Book’).
  • The provider employed a private psychiatrist to assess and work with clients who had symptoms of mental illnesses in circumstances when they could not access local mental health services. Staff demonstrated an understanding of the individual needs of clients.
  • Staff completed care plans with clients shortly after their admission. Staff demonstrated an understanding of the individual needs of clients.
  • Staff enabled clients to access physical healthcare including GPs, dentists, physiotherapists and hospital appointments.
  • Staff had regular supervision and appraisals.
  • Staff attended weekly team meetings.
  • Staff had been trained in and understood the Mental Capacity Act.
  • The provider had provided specialist training for staff to enable them to deliver therapeutic interventions such as, cognitive behavioural therapy, harm reduction, family therapy and motivational interviewing.

However

  • While staff completed care plans they were not always individualised. Care plans were generally generic templates with names added.

Caring

Outstanding

Updated 19 March 2019

We rated caring as outstanding because:

  • The service had a strong recovery ethos with staff devoted to ensuring that clients had excellent outcomes. The service put clients at the heart and staff consistently stated that they were there to support them and help them change their lives.
  • Clients were partners in their care. Staff worked in partnership with people who use the service. The service had a strong recovery ethos with staff devoted to ensuring that clients had excellent outcomes. Staff empowered clients to have a voice and to realise their potential. They showed determination and creativity to overcome obstacles to delivering care.
  • The provider ensured that needs of clients were met, even when there was no funding in place for example bursary beds were routinely offered to clients in crisis, clients who needed to remain in treatment longer or who did not have accommodation to return to when treatment had finished. Bursary beds were also routinely offered to clients in crisis. The chief executive officer (CEO) and the board of directors had policies and processes in place in these circumstances to support these clients in their recovery.
  • Feedback from clients using the service was positive about the way staff treat people. Clients told us that staff went the extra mile and the care they received exceeded their expectations.
  • Clients praised the staff in helping them open-up and talk about areas of their life they had previously kept to themselves. They were supported to be truthful and honest as well as being supported to take care of themselves physically and emotionally.
  • Clients took part in a football competition called the Unity Cup set up by the company and invited local recovery services to join. The registered manager told us there was a volley ball tournament and barbecue in the summer and they put on a reunion where they invited over 300 ex-residents to an open evening.
  • Staff involved client’s families in their care and treatment if the client wanted to. Carers could access carers assessments to ensure that their needs were assessed and met.
  • Staff held a graduation ceremony for clients when they completed treatment. Staff, clients, family and friends were invited to attend and celebrate their achievements.

Responsive

Good

Updated 19 March 2019

We rated responsive as good because:

  • There was no waiting list for the service. Staff assessed referrals for suitability. The admissions manager assessed referred clients and discussed with the registered manager before agreeing admission. There were no documented criteria as admissions were agreed on an individual basis.
  • The service provided rapid access to treatment for clients in crisis. There was no waiting list and the service admitted urgent referrals, in some instances, in under 48 hours.
  • The service provided aftercare. Clients accessed 10 days of treatment in the house following discharge to facilitate the transition from treatment back into the community. The clients also had access to lifelong aftercare through the provider’s supported housing provision.
  • Allington House had a range of rooms for clients, including living rooms, a large dining room and a multi-faith room. Clients had private spaces to make telephone calls from. Bedrooms were individual and shared rooms with an en-suite bathroom. One of the bedroom located downstairs had a door with chair access leading to the garden for clients with mobility issues.
  • The provider employed a driver to collect clients on their day of admission from anywhere in the country to support clients if public transport was a barrier to them getting to the house.
  • Staff supported clients to access and attend external support groups such as Alcoholics Anonymous and Narcotics Anonymous. Day trips were organised on a regular basis for all clients.
  • Allington House provided psychological based groups and sessions on Chemsex. Chemsex is sexual activity engaged in while under the influence of stimulant drugs such as GHB & GBL also known as "G”, methamphetamine or mephedrone (these drugs have a relaxing, anaesthetic effect which reduces users' inhibitions), typically involving several participants.

However:

  • Staff did not document discharge plans. None of the client care records we reviewed contained a discharge plan, however, staff were aware of the discharge arrangements for clients.

Well-led

Good

Updated 19 March 2019

We rated well-led as good because:

  • The registered manager led the service well and had leadership qualifications and experience to do the job. Staff were aware of the organisational values and were dedicated to deliver care in line with these values.
  • There was a positive culture within the house, staff felt respected and valued as members of the team and there was support from the registered manager. There were good working relationships within the team. Staff were proud working for the organisation.
  • Staff received supervision every two months from an external supervisor and had appraisals yearly. Staff were aware of the whistleblowing policy and said that felt they could use it without fear of victimisation.
  • Policies were in place to guide staff within their work. Staff monitored outcomes and effectiveness of client treatments.
  • The provider maintained and discussed the organisational risk register at the business meeting and agreed to escalate risks to senior management and board level if needed. The provider had emergency procedures in place to mitigate potential obstacles to business continuity.
  • Clients records were kept safely in locked cabinets and staff had access to those when needed. Staff felt they had the necessary tools to do the job both on paper and electronically on the computer.
  • Clients had regular opportunities to give feedback about the service, including; house meetings, evaluation forms, suggestion box and a feedback book. A “you said, we did” board was kept up to date to demonstrate changes made.

However:

  • The service did not have thorough governance systems in place to ensure good oversight and risk management of incidents and safeguarding. Managers therefore did not monitor to look for trends, this meant that if the same incident kept on occurring then there was no oversight to look at the reasons why or for example, if there was a gap in staff training.
Checks on specific services

Residential substance misuse services

Updated 27 May 2016

Substance misuse services

Good

Updated 19 March 2019