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Turning Point - Smithfield Detoxification Unit Good

Reports


Inspection carried out on 19 and 21 November 2019

During a routine inspection

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 carried out on 23 August 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • The environment at Smithfield was safe and comfortable. There were regular health and safety audits carried out that included fire safety. There were safe levels of staff on duty to ensure clients were supported 24 hours a day.

  • Ligature points (a place where someone could tie something round to harm themselves) were mitigated by the use of risk assessments and observation.

  • Medicines management practices were thorough and effective.

  • There was a clear process around reporting incidents, staff understood what they should report and how to do this.

  • The medications and detoxification plans used at Smithfield were based on the National Institute for Health and Care Excellence guidelines. These were also tailored to suit individual needs.

  • There were good links with the local general hospital and GP surgeries for ongoing assessment of physical health.

  • All interactions we observed between staff and clients were caring, kind and compassionate. Clients all described the staff as approachable and that they were genuinely interested in them.

  • Pre-admission work including a five week pre-detox course ensured appropriate admissions to the service. There was a robust admission process and discharge plans were required to be in place before the client commenced detox.

  • The hospital had information leaflets for a wide range of treatments, medications and conditions. The hospital was able to get these in other formats easily from the intranet such as easy read and different languages. The electronic notes system had a function where staff only had to click a button to change care plans into another language

  • The food was described by all clients as excellent and there was a wide range of choice.

  • There was a lift for disabled people to access the first floor.

  • The organisation has a clear vision and a set of values, the hospital used these in their everyday practice and put them at the heart of all the work they did. Staff we spoke to described the managers as caring and supportive.

  • The provider used key performance indicators to monitor how well the service was performing.

  • The service had a very low level of sickness so this meant that clients received care from a stable team of staff who knew them well.

  • The hospital had regular audits that assessed the quality of the work. These were reviewed in governance meetings and outcomes from this were fed back to staff at local level to action.

  • All staff received six weekly supervision which followed the hospital’s supervision policy. The staff training and appraisals were also up to date.

  • The service had introduced naloxone training for all service users with a history of opiate misuse with the aim of improving the safety of all service users discharged from the service.

Inspection carried out on 9 September 2013

During a routine inspection

People we talked with said Turning Point Smithfield provided good quality care and support. People felt the treatments provided were effective in promoting wellbeing and helping them to deal with their addictions. We talked with five people who used the service, two members of staff, including the registered manager and one student nurse.

We were told: �I�ve got no problems with any of it... I came here to extricate myself from illicit substances, which is what has happened.� �Staff are very kind. By my heart- I�m very happy about being here.� �It�s great I�m back to my old self.�

And:

�It�s good here-the staff listen and if they can help you they will. The atmosphere is calm here.�

The student nurse told us the staff worked well and were effective. They said: �It�s been great, staff conduct is very good and they do everything usually in seven days...I wish I was here for longer. The staff work and collaborate with each other which is good.�

We found that people were supported to give informed consent to their care and treatment. The assessment, care planning and review systems in place promoted peoples wellbeing and safety. Medication was also safely managed at Smithfield.

We saw that suitable staff were employed because a robust recruitment and selection process had been followed.

People who used the service were able to influence the development of the service and checks were made to make sure the service was as safe as possible.

Inspection carried out on 21 June 2012

During a routine inspection

People who talked to us were content with the way they were treated during their time at Smithfield Detoxification Unit. We were told that the service took appropriate steps to meet people�s needs and promote wellbeing.

We were told:

�It�s very good here, there�s no stigma.�

�They don�t over react to things, and they help us to get on.�

�They know what to do and I feel much better after just a couple of days.�

"Everything's going fine for me."

And:

�I�m not missing out, I get the same as everyone else here.�