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Inspection carried out on 25 June 2019

During a routine inspection

We rated Brighton Oasis Project as Good because:

  • People’s individual needs and preferences were central to the delivery of services. People could access services and appointments in a way and at a time that suited them. Staff had alternative pathways for people whose needs it could not meet. The provider ran a separate therapeutic counselling service for the children affected by family drug/alcohol use in treatment. The provider operated a separate creche for the children of parents in treatment. Staff were proactive in their attempts to re-engage clients who missed appointments or stopped the programme before completion. The service was flexible and innovative in meeting the needs of all clients, including those with a protected characteristic or with communication support needs.

  • Staff treated clients with kindness, compassion, dignity and respect. Feedback from clients confirmed that staff treated them well and offered them personalised care. Clients were involved in their care planning and encouraged to give feedback about the service. Staff were able to offer support to the children of clients. The service offered clients sanitary products, contraception and essential toiletries. The service organised a ceremony for those clients who completed structured programmes.

  • The service provided safe care. The premises where clients were seen were safe and clean. 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 female clients undergoing treatment for alcohol and drug addictions and in line with national guidance about best practice. Clients’ physical health was monitored throughout their treatment. Clients gave their consent to treatment and had been given enough information about treatment options and risks. Staff engaged in clinical audit to evaluate the quality of care they provided.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff had the knowledge and ability to monitor and recognise the signs of deterioration in clients’ physical and mental health during treatment and how to seek or provide help. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.

  • The service was well led, and the governance processes ensured that its procedures ran smoothly.

However:

  • Clients’ notes did not clearly document whether clients had received a copy of their care plan.

Inspection carried out on 4 July 2017

During an inspection to make sure that the improvements required had been made

We do not currently rate independent standalone substance misuse services.

This was a focused inspection just to follow up some areas for improvement from the previous inspection.

We found the following areas of good practice:

  • Staff members informed their colleagues when they were due to meet with a client with a history of aggression in the building. This meant that they ensured other staff members could monitor outside their meeting room door in case they needed assistance.

  • There were up to date disclosure and barring services checks in place for all staff, volunteers and trustees of the service to allow them to work with vulnerable adults and children.

  • The service had a clear incident reporting process which all staff we spoke with understood and had used to record incidents. The process also meant that managers were able to review the reported incidents, debrief team members of review outcomes, and make relevant changes to practice to show learning from incidents. Staff had completed training in and understood the Mental Capacity Act.

  • Changes had taken place to the environment to improve the privacy for clients taking part in therapeutic groups.

Inspection carried out on 8 - 9 November 2016

During a routine inspection

  • Brighton Oasis Project did not always undertake pre-employment checks on staff before they commenced employment. The service did not undertake disclosure and barring service (criminal records) checks (DBS) for staff in administrative and trustee roles. There were no records to show us how it had assessed and mitigated this risk to clients or their children.

  • The ground floor toilet area had three cubicle toilets and sinks. Staff used this area to complete urine drug screens of clients, to test for substance use, pregnancy tests and client self-tests for sexually transmitted diseases.Whilst the toilet area was used daily, routine cleaning of the area was undertaken twice weekly. The service had not identified this as a cross contamination risk.

  • Risks to staff were not properly assessed and reviewed. Staff did not carry the personal alarms available for them to summon assistance in the event of an incident.

  • We found that there was no record of calibration of the breathalysing equipment.

  • The service was unable to show us how it learned from incidents and serious events as staff were not recording incidents through the service’s reporting system. Not all staff were confident in what incidents should be recorded. The Care Quality Commission (CQC) were not notified of reportable events in the service.

  • Brighton Oasis Project did not undertake audits to measure the quality of the service provided or improve its performance. Clients’ care records were not audited so there was no means of measuring the quality of risk assessments or care plans. There was no system for learning from incidents or identifying incident themes and trends. Where monitoring was undertaken by another provider there was no record of how the service responded to the information so that the service could be improved.

  • Staff at Brighton Oasis Project prioritised safeguarding children in families and maintained strong links with the local safeguarding team. There were comprehensive child and adult at risk safeguarding protocols which were in line with national guidance. Staff were clear and knowledgeable about their role in protecting clients and their children.

  • Staff developed strong therapeutic alliances with clients. This ensured clients felt safe in the service. Interventions provided were in line with national guidance.

  • Staff were proactive in engaging and maintaining contact with clients who were disengaging with the service. Staff provided outreach services to clients with complex needs and with whom services had difficulty engaging. The sex workers’ outreach project routinely offered women self-tests for sexually transmitted diseases. All clients accessing the needle exchange or using opiates were offered Naloxone to take with them. Naloxone is used to reverse the effects of opiate overdose in an emergency.

  • There was an established staff team in the service who knew the vision and values of Brighton Oasis Project and told us they felt supported in creating an empowering culture for women. Management, including the director, were visible around the service and regularly met with staff and clients. This open approach was reflected in the service’s low staff sickness and turnover rates.

  • The service had commissioned a comprehensive fire risk assessment and were acting on its recommendations.