You are here

Turning Point - Smithfield Detoxification Unit Good

Inspection Summary


Overall summary & rating

Good

Updated 16 March 2020

We rated Smithfield as good because:

  • The service provided safe care. The clinical premises where clients were seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
  • Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service was tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
  • The service was flexible, provided informed choice and ensured continuity of care post discharge with the group that ran on a Sunday for past clients
  • The service had created strong links with the local community. This offered clients choice not only around which abstinence meetings they wanted to attend but also hobbies and interests they could take up to aid their own sobriety in the future.
  • The service was easy to access and clients never waited for a bed. Staff planned and managed discharge well. The service had alternative care pathways and referral systems for people whose needs it could not meet.
  • The service was well led, and the governance processes ensured that its procedures ran smoothly.

However,

  • We found that the monitoring and recording of withdrawal symptoms and when required medication was given were not always complete. Although nurses were keeping patients safe by assessing their symptoms and dispensing when required medication accordingly, this was not always being documented. This meant there was a risk to patients that physical health was not monitored effectively throughout withdrawal.
  • Controlled drugs that were delivered from the pharmacy prior to the patient being admitted were checked on arrival but then they were not checked again until the day the patient was admitted. This meant that staff may not be aware if medication had gone missing.
  • We found one example of a patient who had brought their own inhaler to the service but the self-medication chart was not completed.
Inspection areas

Safe

Requires improvement

Updated 16 March 2020

We rated safe as requires improvement because:

  • We found that the monitoring and recording of withdrawal symptoms and when required medication was given were not always complete. Although nurses were keeping patients safe by assessing their symptoms and dispensing when required medication accordingly, this was not always being documented. This was not in line with the providers policy. This meant there was a risk to patients that physical health was not monitored effectively throughout withdrawal.

  • Controlled drugs were delivered from the pharmacy prior to the patient being admitted were checked when the service received them but then not checked again until the patient was admitted.

  • We found one example of a patient who had brought their own inhaler to the service, but the self-medication chart was not completed.

    However,

  • The clinical premises where clients received care were safe, clean, well equipped, well furnished, and fit for purpose.

    The service had enough nursing and medical staff, who knew the clients and received basic training to keep them safe from avoidable harm.

  • Staff screened clients before admission and only offered admitted them if it was safe to do so. They assessed and managed risks to clients and themselves well. They responded promptly to sudden deterioration in clients’ physical and mental health.

  • Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.

  • The service had a good track record on safety. The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave clients honest information and suitable support.

Effective

Good

Updated 16 March 2020

We rated effective as good because:

  • Staff completed comprehensive assessments with clients on admission to the service. They worked with clients to develop individual care plans and updated them as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.

  • Staff provided a range of care and treatment interventions suitable for the client group and consistent with national guidance on best practice. They ensured that clients had good access to physical healthcare and supported clients to live healthier lives.

  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.

  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers made sure that staff had the range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.

  • Staff from different disciplines worked together as a team to benefit clients. They supported each other to make sure clients had no gaps in their care. The team(s) had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.

  • Staff supported clients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2015 and knew what to do if a client’s capacity to make decisions about their care might be impaired.

Caring

Good

Updated 16 March 2020

We rated caring as good because:

  • Feedback from the people that used the service was universally positive about the way staff treated them.

  • Clients felt that staff went the extra mile and their care and support exceeded their expectations. One client commented “Smithfield never shuts the door on you”.

  • Staff were highly motivated and many have lived experience of substance misuse. Staff treated clients with compassion and kindness. They respected patients’ privacy and dignity. They fully understood the individual needs of clients and empowered clients to understand and manage their care and treatment.

  • Staff involved clients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that clients had easy access to additional support.

  • Clients emotional and social needs were seen as being just as important as their physical needs. Clients felt genuinely cared for and that they truly mattered. Relationships between people who use the service, those close to them and staff are strong, caring, respectful and supportive.

Responsive

Outstanding

Updated 16 March 2020

We rated responsive as outstanding because:

  • The service was tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.

  • The service was flexible, provided informed choice and ensured continuity of care post discharge with the group that ran on a Sunday for past clients.

  • The service had created strong links with the local community. This offered clients choice not only around which abstinence meetings they wanted to attend but also hobbies and interests they could take up to aid their own sobriety in the future.

  • The service was easy to access and clients never waited for a bed. Staff planned and managed discharge well. The service had alternative care pathways and referral systems for people whose needs it could not meet.

  • The design, layout, and furnishings of the ward supported clients’ treatment, privacy and dignity. Each client had their own bedroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • The service met the needs of all clients, including those with a protected characteristic or with communication support needs.

  • The service used innovative ways to ensure communication needs were met. For example, a programme on the computer system to translate care plans into different languages.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Good

Updated 16 March 2020

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for clients and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.

  • Teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff collected and analysed data about outcomes and performance.

Checks on specific services

Residential substance misuse services

Updated 9 November 2016

Inspected but not rated

Residential substance misuse services

Good

Updated 16 March 2020