Magda

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• 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 assessment for this service. This key question has been rated good.

Good: Staff assessed the physical and mental health of all clients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for clients based on national guidance and best practice. The service included or had access to the full range of specialists required to meet the needs of clients at the service. Staff from different disciplines worked together as a team to benefit clients.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

We scored the service as 3. The evidence showed a good standard. 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 reviewed 4 care records during our inspection. Staff completed a comprehensive assessment with the client in a timely manner prior to admission. Staff supported clients to access a doctor and where necessary other medical services shortly after admission. For example, clients were supported to access liver scans and staff supported a client’s referral to a cardiologist.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery-oriented and staff updated care plans when necessary. Care plans included considering clients goals on a range of issues including drug and alcohol use, self-care and money management. The plans were completed together with the client and supported the client in identifying their progress during their time at the service.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the client group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence and in line the Department of Health’s Drug misuse and dependence: UK guidelines on clinical management (often referred to as the Orange Book). These included group therapies led by accredited counsellors and activities such as yoga and meditation.

The provider had developed a positive addiction recovery programme which contained a core programme and positive addiction recovery group sessions. The core programme was a structured group programme and included group therapy, assignments such as life story work and reflective letters, developing healthy coping techniques and music therapy. The positive addiction recovery group sessions focused on building a valuable life through building recovery capital, focusing on client’s strengths and supporting them to focus on a positive recovery lifestyle. The programme used up to date research in the field of addiction recovery and took a trauma informed approach. Sessions included recovery protection, looking at unhelpful thinking, focusing on character strengths, mindfulness and equine therapy. Clients also engaged in training and work opportunities intended to help them acquire living skills.

Staff supported clients to engage in a structured weekly programme, which supported clients to build structure and routine into their lives. This included group therapy, household tasks and attending regular mutual aid meetings such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed. Staff supported clients to attend a range of health appointments including doctors and dental appointments. They also supported clients to access specialist health care appointments, such as dieticians and cardiologists.

Staff supported clients to access nutritious food that met their needs. They provided oversight and support where there were concerns about clients’ diets and made referrals to appropriate specialists.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. For example, staff used the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and the Brief Assessment of Recovery Capital 10 (BARC-10) to assess and support clients to identify progress made and areas where they were struggling.

The team included or had access to the range of specialists required to meet the needs of clients in the service. These included counsellors and psychologists. Staff supported clients to access other specialists where further support was required.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the client group. For example, staff were trained in person centred counselling and used a range of tools such as cognitive behaviour therapy and dialectical behaviour therapy during therapeutic support and group sessions.

Managers provided new staff with appropriate induction. The induction was comprehensive and thorough. Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The percentage of staff that received regular supervision was 100%. Managers carried out continuous appraisal through a step further framework. This included managers and staff carrying out quarterly reviews of objectives through coaching style sessions and reviewing how these were aligned with service goals.

Managers ensured that staff had access to regular team meetings. Team meetings were held across all the residential rehabs. They had a standardised agenda, action points were identified and minutes were taken and shared between staff.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively.

We scored the service as 3. The evidence showed a good standard. 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 shared information about clients at effective handover meetings within the team. Staff held a flash meeting every morning where they discussed any concerns about the clients in the service.

The teams had effective working relationships, including good handovers, with other relevant teams (for example, care co-ordinators, community mental health teams, and the crisis team). Care coordinators described communication as excellent and said they received regular feedback about their client’s progress. The teams had effective working relationships with teams outside the organisation and shared resources with other organisations. For example, staff held training sessions at other organisations and developed links with organisations who could provide housing support and volunteering opportunities for clients.

We scored the service as 3. The evidence showed a good standard. 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 – for example, clients could access smoking cessation schemes, healthy eating advice, screening for health conditions, and dealing with issues relating to substance misuse.

Activities within the service helped promote a healthy lifestyle for clients, for example attending walking groups, yoga, being supported to cook healthy meals and providing gym passes for a local gym.

The service had arranged blood borne virus testing every 6 weeks and provided support for clients at risk of contracting blood borne viruses.

We scored the service as 3. The evidence showed a good standard. 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 recognised rating scales to assess and record severity and outcomes (for example, staff used the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the Treatment Outcome Profile System (TOPS) and the Brief Assessment of Recovery Capital 10 (BARC-10) to assess and support clients to identify progress and areas where they were struggling.

Staff used technology to support clients effectively for example, staff used digital technology to support clients who struggled with literacy.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable clients to make their own decisions. Client records included consent to treatment, and this included recorded decisions about who staff could share information with and whether they wanted information sharing on national surveys.

All clients were assumed to have capacity. Where there were concerns, for example if a client relapsed or there were concerns about a client’s mental health staff liaised with social workers and mental health professionals for advice and support. Staff had received training in the Mental Capacity Act and were aware of the principles of the Act and how to apply them.