3 Kendrick Mews

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first inspection for this newly registered service. This key question has been rated Good. . This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all clients on admission. They developed individual care plans which were reviewed regularly through a multidisciplinary discussion and updated as needed.

Staff provided a range of treatment and care for clients. The staff team included or had access to the full range of specialists required to meet the needs of clients. Staff from different disciplines worked together as a team to benefit clients. 

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at four care records. The service had a robust triage and assessment process that was completed for each client before their admission. Staff completed a four-stage triage and assessment process before clients started detoxification treatment to determine whether the client required medical treatment, detoxification, or monitoring that could be safely provided within the service. This assessment process included a medical assessment with the doctor prescribing them medicines, which included a neurological examination and a Wernicke’s assessment. Wernicke's encephalopathy can lead to irreversible brain damage and is treatable if identified. In addition, the service’s consultant psychiatrist reviewed all clients after their initial assessment with the doctor, within the first 72 hours of admission. During this review, a mental state examination was completed to establish whether the client had any underlying or presenting mental health condition.

Staff assessed clients’ physical health needs in a timely manner after admission. Staff checked client’s blood pressure, blood glucose, height and weight and completed a blood test upon admission before commencing any treatment. This helped to identify any abnormalities. For example, one client had undiagnosed severe hypokalaemia, which was identified from the blood test upon admission and the client was immediately sent to a local emergency department where they could receive appropriate care. Each client was also offered an electrocardiogram (ECG) prior to commencing any treatment, which is a non-invasive test that records the electrical activity of the heart to diagnose various heart conditions.

Staff considered whether clients needed support with blood borne viruses during the nursing and medical assessments. This meant they could support clients to get treatment if they had a virus and take precautions to reduce the spread of the virus. We saw that where required, the doctor requested liver function tests as part of the follow up plan after the medical assessment, before commencing any treatment for clients undergoing an alcohol detoxification.

Staff monitored client’s ongoing physical health that were going through a detoxification by completing a daily National Early Warning Scores (NEWS) tool. This monitored their respiration rate, oxygen saturation, blood pressure, pulse rate, temperature and level of consciousness. Staff escalated concerns appropriately if the scores showed abnormal rates, such as repeating the scores later or escalating immediate concerns to the doctor, so that a client could be promptly reviewed. These checks were completed more frequently for those undergoing detox. These checks were increased if the staff had concerns that the person’s physical health may be deteriorating.

Staff developed care plans collaboratively with clients that met the needs identified during their initial assessment. Nurses completed an initial 72-hour care plan nursing before a full detailed care plan was created for each client.

Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment, for all needs not just for substance misuse. One client said that the service helped them to identify and receive an autism assessment which had been undiagnosed for years. Clients were involved in developing their own care plans. Each person who used the service had a recovery and risk management plan in place that demonstrated the person’s preferences and recovery goals. All care plans we viewed were holistic, person centred and regularly reviewed.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the client group. These were medically assisted detoxification treatment for alcohol, opiates and non-opiates and psychosocial interventions, which included individual and group therapy and activities. The interventions were those recommended by guidance from the National Institute for Health and Care Excellence (NICE).

The service offered a range of therapies depending on the client’s individual needs. Clients were offered cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT), trauma informed therapies and eye movement desensitisation and reprocessing therapy (EMDR). Clients could also access psychoeducation and processing groups and other groups such as visualisation therapy and body simulation therapy.

Clients could access daily meditation and mindfulness to help strengthen their emotional resilience. Feedback from the clients about the one-to-one therapy sessions was very positive and they described them as high quality.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the client group.

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed. Staff gave examples of supporting clients to access medical appointments in the community or referring to other specialists when required, such as accompanying them to the local hospital for scans and required interventions.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. These included audits of pre-admission assessments, care records, recovery plans, clinical assessments, mental capacity assessments, therapeutic handovers, physical health assessments, medicines management, medical history, allergies, blood bourne viruses, safeguarding, and health and safety checks. Managers tracked audits and compliance rates on a dashboard.

Mental Health Act

The service did not accept clients who were detained under the Mental Health Act, and this was listed in their admission and exclusion policy.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings to discuss client's care, treatment and how to improve their care. Staff shared information about clients at effective daily handover meetings within the team to plan the day. Each client received a daily therapy and nursing handover, which included the client’s current risks.

Information was shared between the team to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services. For example, the daily handover notes were shared with the GP and consultant psychiatrist if relevant and uploaded onto the electronic record system.

The teams had effective working relationships with teams outside the organisation. This included the local authority, social services and local GPs. The service GP produced a discharge letter with the client’s consent that was sent to their GP.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives. Staff had completed nutrition training and provided healthy eating advice to clients. Clients told us that they were supported to access the local health and leisure facilities to use the gym and swim.

Activities helped promote a healthy lifestyle for clients. Clients could access daily meditation, yoga and could access an art therapy group and a planning recovery group. Staff and clients reported that groups were well attended and were available every day of the week.

Clients were provided with information on how to live a healthier lifestyle. For example, one client’s liver function test showed that they had some liver damage, so the GP gave health promotion information to the client so this could be improved.

Staff ensured that clients had good access to physical healthcare. Clients would be referred to see specialists if required. Clients with an eating disorder were always referred to a dietician.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used appropriate tools to measure dependency and withdrawal risks from substances using recognised tools recommended by the National Institute for Health and Care Excellence (NICE). Staff completed breath alcohol readings, and drug screening, alongside assessments of risks such as alcohol withdrawal seizures, delirium tremens and Wernicke's encephalopathy for clients. Wernicke's encephalopathy can lead to irreversible brain damage and is treatable if identified. 

Staff used recognised rating scales to assess and record severity and outcomes on substances. We reviewed four care and treatment records and saw that clients had clear recovery and treatment goals. Records showed that staff used recognised rating tools, such as the Alcohol use disorders identification test consumption (AUDIT-C) and the Severity of Alcohol Dependence Questionnaire (SADQ).

Staff used a recognised withdrawal assessment tools to assess withdrawal symptoms for clients undergoing detoxification treatment. Staff used the Clinical Institute Withdrawal Assessment for Alcohol, (CIWA-Ar) to assess the severity of alcohol withdrawal. Staff also used the Clinical Institute Withdrawal Assessment Scale Benzodiazepines (CIWA-B) as a tool to evaluate the severity of benzodiazepine withdrawal symptoms. Staff also completed the clinical opiate withdrawal scale (COWS) for clients receiving opiate detoxification for who were at risk of withdrawal symptoms from opiates. 

The service aimed to treat a person holistically for their addictions and included assessments for behavioural addictions, as well as substances. Clients were asked to complete the Shorter PROMIS Questionnaire (SPQ), a validated 16-scale self-report tool that assesses multiple addictive behaviours at the same time, covering substances and behaviours such as gambling, shopping, working and eating to identify the strength of each. Therapy staff developed specific treatment-based goals with clients to also address these addictions in addition to their substance addictions.

The service recorded and scored client’s treatment outcomes regarding their therapy treatment at regular intervals. Staff used the Outcome Rating Scales (ORS) as an evidenced base framework whereby therapy staff could collect client feedback to evaluate the quality of the therapy received. Where scores showed the client’s progress has slowed, this was assessed by the team, and the therapy treatment was adjusted. This ensured that treatment remained collaborative and tailored to the individual, rather than following a fixed or one-size-fits-all approach.

Staff used technology to support clients effectively for example, prompt access to blood test results and online access to the client and staff information portals.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable clients to make their own decisions. Clients consented to entering the service for treatment and this was recorded in their notes.

The service had introduced a consent form to encourage clients to consent to share their current admission and treatment with their GP and to obtain their previous medical records.

The service had systems in place to ensure that clients received safe care and treatment that met their needs when they declined consent for the service to liaise with their GP. Staff said that information from the clients GP and/or other medical professionals was requested at the start of the assessment process. If a client declined to give consent for the service to contact their GP, the service doctor GP discussed this with the client during their assessment. If the client still declined, the service’s doctor assessed whether or not they could safely treat the client by either admitting them or refusing admission.

For clients who might have impaired temporary mental capacity due to their intoxication, staff waited to repeat this at a later time.