Ciconia Recovery London (Harley Street)

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

At our last assessment we rated effective as good. At this assessment the rating has remained 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.

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 8 care and treatment records during the assessment. Staff completed a comprehensive mental health assessment of patients in a timely manner at, or soon after, their referral.

Staff assessed patients’ physical health needs. The medical practitioner carried out physical health observations with patients before commencing treatment. These included blood pressure, height, and weight. This helped inform treatment plans for the patient.

Staff ensured that patient assessments were personalised, holistic and recovery oriented. For example, one patient was being supported to access self-help groups and mutual aid as part of their recovery. Another patient was being supported to receive coaching sessions to support with their attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

Staff routinely reviewed patient’s care needs.

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 patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. The team worked with patients to reduce health and other problems related to mental health and addiction.

For clients receiving assessment and treatment for their attention deficit hyperactive disorder (ADHD) staff followed NICE guidelines. This included completing baseline blood tests, blood pressure, height, and weight. In addition, the doctor reviewed the client’s current medication with their GP and completed a mental health and social circumstances review. Staff used screening tools such as the Diagnostic Interview for ADHD in adults (DIVA) to help determine a diagnosis for ADHD.

Staff offered treatments for depression, anxiety and obsessive compulsive disorder (OCD).

The service offered opioid detoxification to clients and followed best practice guidance Opioid dependence: buprenorphine prolonged-release injection. They had a protocol for staff to follow when commencing clients on an opioid detoxification. The doctor offered buprenorphine as treatment for an opioid detoxification. There were not any patients undergoing this treatment at the time of the assessment.

Staff signposted patients to other psychosocial support and therapies, such as family therapy.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. We saw evidence of staff referring patients to their GP for routine physical health checks.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The manager used results from audits to make improvements, by implementing and monitoring action plans. For example, improvements were made to appointment times because of patient feedback.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. This included doctors, nurses, and assistant psychologists.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. The doctor was a member of the Royal College of Psychiatry and provided seminars on ADHD and dual diagnosis. The manager provided new staff with appropriate induction. The doctor was supported by the nurse to treat patients receiving mental health treatment.

Staff at all levels had opportunities to learn, and poor performance was managed appropriately. Staff received supervision every three months and a yearly appraisal of their performance. In addition, the doctor met regularly with the medical director for clinical supervision, who had a specialism in addictions. Supervision records showed that staff discussed complex cases, well-being, training and development.

The manager identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. For example, a staff member had recently completed a coaching course to support them into a leadership role.

The manager ensured that staff received the necessary specialist training for their roles. For example, suicide prevention, autism awareness, learning disability training and drug awareness and harm reduction.

Mental Health Act

All staff had received training in the Mental Health Act. Staff had a good understanding of the Mental Health Act.

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 patients care, treatment and improve their care.

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 medical team met regularly to discuss handover of patients.

Staff shared information about patients at effective handover meetings within the team to plan the day. Staff attended a daily handover to discuss the patients being seen that day.

The teams had effective working relationships with teams outside the organisation, for example, the local authority, social services and GPs.

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 patients to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice and dealing with issues relating to substance misuse.

Staff helped promote a healthy lifestyle for patients, for example giving advice about caffeine intake.

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 effective approaches to monitor people’s care and treatment and their outcomes. Staff used recognised rating scales to assess and record severity and outcomes. Staff used the ADHD clinical outcome scale (ACOS) when assessing patients for ADHD. Staff also completed the generalised anxiety disorder assessment (GAD-7) with those patients receiving other mental health treatment. Staff sent a questionnaire at the beginning of a patient’s treatment and then at the end. This was a way of measuring effectiveness of treatment for patients.

Although staff were not treating anyone for addictions at the time of the inspection, policies reflected how staff would assess and treat patients. For example, staff would complete the Alcohol Use Disorders Identification Test (AUDIT) with patients to assess the degree of their alcohol dependency. The doctor completed the clinical opiate withdrawal scale (COWS) for patients receiving opiate detoxification. This helped the doctor assess a patient’s withdrawal from opiate medicines and monitor this throughout their treatment.

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

Staff received training in the Mental Capacity Act and knew to seek support from the consultant psychiatrist if they needed to discuss a person’s capacity.

There was a clear policy on the Mental Capacity Act, which staff knew how to access. Staff understood mental capacity and were aware of how substance misuse can affect capacity. Staff worked under the principle that capacity is always assumed and where they queried a patients’ capacity this was discussed as a team.