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Gloucester House Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 13 March 2019

We rated Gloucester House as outstanding because:

  • Staff truly respected clients and valued them as individuals. Staff were dedicated to working with clients, empowering them to be active partners in their care. People who use services had an active role in shaping the delivery of services. For example, clients were involved in recruitment of new staff, clients had reviewed the “house rules” for the service, and the service had made multiple changes to the care programme in response to client feedback.
  • Staff always treated clients with compassion and kindness and respected their privacy and dignity.
  • There was a strong, visible person-centred culture. People’s individual needs and preferences were central to the planning and delivery of care. Services were flexible, provided choice and ensured continuity of care. Staff developed innovative approaches to providing integrated person-centred care that involved other service providers, and the community resources, particularly for people with multiple and complex needs.
  • Feedback from people who use the service was continually positive about the way staff treated people. Clients said that staff go the extra mile. Clients highly valued their relationships with staff.
  • The service worked creatively with other providers to promote positive outcomes for clients. Staff maintained close links with local military veteran charities and hoped to improve access to care for this group. Staff planned and managed discharge well and liaised well with services that would provide aftercare. Staff made early exit plans with all clients. Staff supported clients to access move on housing and community support services.
  • The service belonged to a ‘treatment loop’ which enabled clients to continue treatment at another centre for no additional cost when they had breached specific treatment requirements. For example, those who may have relapsed while in treatment.
  • The service had a ‘buy-a-bed’ fundraising scheme to provide treatment for men who are unable to access local authority funding or fund treatment themselves. Staff worked with the local community to generate charitable funds.
  • The service provided safe care. The environments were safe and clean. The facility had enough staff with the right skills to provide safe care. Staff assessed and managed risk well. They managed medicines safely 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 in line with national best practice guidance, and which were suitable for clients cared for in a substance misuse rehabilitation unit. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • Gloucester House included or had access to the full range of specialists required to meet the needs of clients. Managers ensured that staff received training, supervision and appraisal. Gloucester House staff worked well together and with those outside the service who would have a role in providing aftercare.
  • Staff understood and carried out their roles and responsibilities under the Mental Capacity Act 2005.
  • The service worked to a recognised model of substance misuse rehabilitation. It was well led and the governance processes ensured that unit procedures ran smoothly.

However:

  • The service’s ligature risk assessment and management plan could be improved to offer staff better oversight and awareness of ligature risks in the environment.
  • The main building did not accommodate wheelchair users but staff signposted clients to other suitable services when they were unable to meet their needs.
Inspection areas

Safe

Good

Updated 13 March 2019

We rated safe as good because:

  • Gloucester House was safe, clean, well equipped, well furnished, well maintained and fit for purpose.

  • The service had enough staff, who knew the clients and received basic training to keep people safe from avoidable harm.
  • Staff assessed and managed risks to clients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate clients’ recovery. Staff made early exit plans with clients. Clients participated in making their risk assessment and management plans.
  • The service only admitted clients whose care and treatment needs could be safely met.
  • Staff understood how to protect clients from abuse and/or exploitation and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and/or exploitation 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 – whether paper-based or electronic.
  • Staff followed best practice when storing, dispensing, and recording the use of medicines.
  • 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.

However:

  • The service’s ligature risk assessment and management plan could be improved to offer staff better oversight and awareness of ligature risks in the environment.

Effective

Good

Updated 13 March 2019

We rated effective as good because:

  • Staff completed a comprehensive assessment of all clients on admission, including physical health, mental health, social needs, and substance misuse history. They developed individual care plans which were reviewed regularly. 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. This included access to psychological therapies, help to access education, volunteering opportunities, and supporting clients to develop daily living skills.

  • Staff 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 service included or had access to the full range of specialists required to meet the needs of clients. Managers made sure they had staff with a range of skills need to provide high quality care. They supported staff with appraisals, supervision, reflective practice sessions 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 service had effective working relationships with staff from services which enabled collaborative pieces of work, and effective aftercare following clients discharge. Staff engaged regularly with clients care managers/coordinators.

  • Staff supported clients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded consent and capacity when needed.

Caring

Outstanding

Updated 13 March 2019

We rated caring as outstanding because:

  • Staff truly respected and valued clients and treated them as partners in their care. They respected client’s privacy and dignity. Staff considered people’s needs regarding their gender, ethnicity, religion, sexual orientation, age and disability and understood how these might relate to their substance misuse.

  • Feedback from people who use the service was continually positive about the way staff treat people. Clients said that staff go the extra mile. Clients highly valued their relationships with staff.

  • People who use services were active partners in their care and there was a strong person-centred culture. Clients were given a voice and helped influence the delivery of care. For example, a client was working with the local inter-faith community to make an accessible spiritual and faith library for other service users.

  • Staff found innovative ways to enable people to manage their own health and care and actively encouraged clients maintain their independence as much as possible.

  • The provider ensured that needs of clients were met, even when there was no funding in place using the “buy a bed” scheme.

  • Staff empowered clients but also ensured they had access to an advocate when needed. The service had a chaplain who supported and advocated for clients, for example at court and health care appointments. Staff ensured patients understood their care and treatment.

  • The provider actively engaged the families and carers of clients receiving treatment. The service offered families general information about substance misuse treatment. The service referred families and carers to agencies that could provide them with support.

Responsive

Outstanding

Updated 13 March 2019

We rated responsive as outstanding because:

  • Clients’ individual needs and preferences were central to the planning and delivery of care. The service was flexible, provided choice, and ensured continuity of care.
  • The service used innovative approaches to deliver person-centred pathways for clients, which used the expertise of other providers and opportunities available within the local community.
  • The service belonged to a ‘treatment loop’ which enabled clients to continue treatment at another centre for no additional cost when they had breached specific treatment requirements. For example, those who may have relapsed while in treatment.
  • The service had a ‘buy-a-bed’ fundraising scheme to provide treatment for men who are unable to access local authority funding or fund treatment themselves. Staff worked with the local community to generate charitable funds.
  • Staff took a proactive approach to understanding the needs of different groups of people and delivered care in a way that met clients’ needs and promoted equality. This included people who were in vulnerable circumstances or who have complex needs. Staff helped clients with communication, advocacy and cultural and spiritual support.
  • People who use the service and others were involved in regular reviews of how the service managed and responded to complaints. The complaints process allowed for clients to appeal to an external senior manager if they were unhappy with the local response. The service demonstrated where improvements had been made as a result of learning from reviews.
  • The design, layout, and furnishings of the service supported client’s treatment, privacy and dignity. Each client had their own bedroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • The food was of a good quality and clients could make hot drinks and snacks at any time. Staff supported clients to self-cater, providing training and support.

However:

  • The provider had completed a disability access assessment, but the main building was listed and could not be adapted to accommodate wheelchair users. Staff signposted clients to other suitable services when they were unable to meet their needs.

Well-led

Good

Updated 13 March 2019

We rated well-led as good because:

  • Leaders had a good understanding of the service they managed and it adhered to a recognised model of care. Leaders had the skills, knowledge and experience to perform their roles, 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 service level and that performance and risk were managed well.
  • Staff had access to the information they needed to provide safe and effective care and used that information to good effect.
  • Staff engaged actively in local and national quality improvement activities.
Checks on specific services

Substance misuse services

Updated 7 March 2017