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The Manor Clinic Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 22 January 2019

We rated The Manor Clinic as Good because:

  • Staff completed comprehensive assessments prior to admission and completed care plans with clients on the first day in the service. Clients felt involved in their care and treatment.
  • Staff felt supported and respected. Staff were passionate about the service that was delivered. Morale amongst staff was good, sickness and turnover of staff was low and the team worked well together.
  • Staff worked with National Institute of Health and Care Excellence guidelines. Staff supported clients in line with “Drug misuse and dependence: UK guidelines on clinical management (2017)”.
  • The service had a range of staff to support clients’ recovery. Staff were skilled to carry out their roles. All staff received a comprehensive induction.
  • The service offered weekly family therapy which was free of charge and life-long. Therapists also provided a free of charge life-long after care service for clients.

  • The service had made adjustments for clients with disabilities. There were adjustments to two of the bedrooms and wheelchair accessible ramps throughout the ground floor. The service had developed easy read documents and large print documents for clients with visual impairment.

However:

  • Staff had not ensured that sufficient information regarding clients’ medical history and the current medicine prescription was available before treatment started.

  • The provider had not considered the confidentiality and safety of clients from ‘other patients’ attending the service as an outpatient.
  • Staff had not considered the safety of female clients sleeping in areas where there were male clients.
  • Staff did not document clear rationale for risk ratings in clients’ risk assessments.

  • Staff did not report disclosures of historical abuse to the local authority safeguarding team.

  • Clients’ records were kept in paper format and electronic format and the current system was confusing and disorganised.
Inspection areas

Safe

Requires improvement

Updated 22 January 2019

We rated safe as requires improvement because:

  • Staff had not ensured that sufficient information regarding clients’ medical history and current medicine prescription was available before treatment started. The lack of information available to the prescribing doctor posed a significant clinical risk to clients receiving detoxification regimes.
  • The provider had not considered the confidentiality and safety of clients from other clients attending the service as an outpatient. Private outpatient clients that had appointments with the psychiatrist and not related to the provision of the Manor Clinic were left in a communal area without supervision.
  • Staff did not always make appropriate safeguarding referrals. Staff were unclear about whether to make a safeguarding referral regarding cases of historical abuse that clients had disclosed in therapy sessions. There was a policy in place, but it did not cover disclosing historical abuse.
  • Staff had not considered the safety of female clients sleeping in areas where there were male clients. There was no consideration of risk or risk management around sleeping arrangements.
  • Clients’ risk ratings were not clear. Staff had not clearly documented the reasons for individual clients’ risk ratings.

However:

  • Staff received mandatory monthly training in addictions including withdrawal from alcohol and drugs.
  • Staffing levels were good, agency usage was low and there was low sickness rates and low staff turnover.
  • Following our inspection, the provider assured us they would relocate the outpatient clinic to another more suitable location because we raised concerns about client’ safety and confidentiality.
  • Following our inspection, the provider transferred the female client sleeping in the area where there were other males to another more suitable area.
  • The provider held regular emergency drills to prepare staff for medical emergencies.

Effective

Good

Updated 22 January 2019

  • Staff completed a comprehensive assessment of every client prior to admission to the service.

  • Staff followed National Institute for Health and Care Excellence (NICE) guidelines. Staff supported clients in line with “Drug misuse and dependence: UK guidelines on clinical management (2017)” and guidance from the National Institute for Health and Care Excellence.

  • Staff completed outcome tools to measure clients’ health and social functioning.

  • The service had a range of staff to support clients’ recovery. Staff were skilled to carry out their roles. All staff received a comprehensive induction.

  • Staff had a good understanding of the Mental Capacity Act. Clients only completed admission and consent paperwork when staff considered them to have full capacity to do so. If clients came in under the influence of alcohol or drugs, staff would wait until the substances were no longer affecting their capacity before they completed paperwork.

However:

  • Supervision records were not always up-to-date.

Caring

Outstanding

Updated 22 January 2019

We rated caring as outstanding because:

  • Feedback from clients who used the service was continually positive about the way staff treated people. All clients spoke highly of staff and felt they were respectful and supportive.

  • Clients thought that staff went the extra mile and the care they received exceeded their expectations.

  • Staff recognised and respect the totality of clients’ needs. They always took clients’

    personal, cultural, social and religious needs into account.

  • All clients stated they felt safe at the service.

  • All clients felt involved in their care through community meetings and feedback questionnaires. Clients were involved in their care planning.

  • The service provided a life-long free of charge service to families of clients who had received care at the Manor Clinic and access to free aftercare groups for life which occurred once per week.

Responsive

Good

Updated 22 January 2019

We rated responsive as good because:

  • The service had made adjustments for clients with disabilities. There were adjustments to two of the bedrooms and wheelchair accessible ramps throughout the ground floor. The service had developed easy read documents and large print documents for clients with visual impairment.

  • Staff and clients had a full range of rooms to support treatment and care.

  • All clients said the food was of good quality. The chef catered for clients that had special dietary needs including those that had religious dietary needs.

  • The service had made improvements to the way it handled complaints. Staff were trained to handle complaints and had a good understanding of the duty of candour.

Well-led

Good

Updated 22 January 2019

We rated well-led as good because:

  • Staff felt supported and respected. Staff were passionate about the service that was delivered and worked well together as a team.
  • Morale amongst staff was good. There were high levels of staff retention and minimal levels of sickness. Staff we spoke to reported feeling proud to work at the Manor Clinic.
  • Staff were aware of the whistleblowing procedure. Staff said they felt comfortable to raise any concerns with the service manager.
  • There was a clear framework of what should be discussed at team meetings to ensure essential information and learning was shared. There was a site improvement plan which identified areas that needed to be improved and actions that were to be taken, by who and by when.
  • The provider recognised staff’s contribution through the ‘pride awards’.

However:

  • Clients’ records were kept in paper and electronic systems which were disorganised and could lead to staff not having the most up-to-date information about clients.
  • The management team did not have oversight of the quality and frequency of staff supervisions. The records did not reflect that supervisions were being completed as often as they were and the management team had not addressed this.
Checks on specific services

Substance misuse services

Updated 17 May 2016

This report describes our judgement of the quality of care provided within this core service by The Manor Clinic Limited.

Where relevant we provide detail of each location or area of service visited.

Our judgement is based on a combination of what we found when we inspected, information from our ‘Intelligent

Monitoring’ system, and information given to us from people who use services, the public and other organisations.

Where applicable, we have reported on each core service provided by The Manor Clinic Limited and these are brought

together to inform our overall judgement of The Manor Clinic Limited.

Substance misuse services

Good

Updated 22 January 2019