Ciconia Recovery London (Harley Street)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had no serious incidents in the last 12 months

Staff reported all incidents that they should report. The service had an incident reporting policy for staff to follow. The service had reported 6 incidents since 2023. Incidents included medicines management and patients in distress.

Staff were debriefed and received support after an incident occurred. The manger supported staff after an incident was reported. Staff met each monthly to discuss incidents in team meetings and supervision.

Raising concerns helped to proactively identify and manage risks. Lessons were learnt from incidents, resulting in changes that improved the care for people. Staff documented the lessons learnt on the service’s incident reporting form. Staff told us about the lessons learnt from incidents, for example the manager created a robust system for communicating with the GP about medicines after an incident.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation when things went wrong.

Staff received feedback from investigation of incidents, both internal and external to the service.

The service worked with people and their partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. Staff ensured continuity of care, including when people move between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Referrals came through the service’s administrative team. Patients self-referred to the clinic. Staff discussed referrals at monthly team meetings. The service had a risk exclusion criterion to ensure that patients’ needs could be safely met.

Staff were aware of the risks to patients across their care journey. The effectiveness of these processes was monitored by the manager to keep people safe. Staff kept a register of patients that had a higher risk and signposted these patients to other services. This included people who were on complex medication regimes and residing outside of the country.

Patients told us they were involved in discharge planning. We spoke with 10 patients, and they confirmed that staff supported them after they had finished treatment to ensure a smooth transition back to primary services.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Staff worked collaboratively with GPs and community services to ensure continuity of care through shared care agreements.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. At the time of the inspection, all staff had received training in level 2 and level 3 safeguarding vulnerable adults and children.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff were committed to taking immediate action to keep people safe from abuse and neglect. The consultant psychiatrist described patients who had high risks of self-harm or neglect and the support that staff had provided to keep them safe

Staff had reported one safeguarding concern in the last 12 months. Staff discussed this safeguarding incident and how they had worked with the local agencies to protect patients from harm.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 6 risk assessments and risk management plans during the assessment. Staff used a recognised risk assessment tool which included areas of potential risks such as overdose or suicide. Staff demonstrated a good understanding of the risks associated with mental health and substance misuse, such as self-harm, suicidal ideation and the risks to physical health.

Staff understood individual patient needs and the risks to them. Staff completed risk management plans relating to the individuals identified need and discussed patients who were high risk. This was recorded in a risk management tool which the manager and the consultant psychiatrist oversaw. Staff were clear about what action they took to manage patient's risk. For example, only offering face to face appointments for assessments and medical reviews. Staff provided additional support through regular telephone calls to check on patients’ welfare.

Even though the service has not provided a community alcohol detoxification for patients since 2023, staff still had a protocol to follow when a patient did undergo a community alcohol detoxification. The protocol identified who could be safely detoxed at home. Staff excluded patients who were too high risk to commence a detoxication at home. There weren’t any patients undergoing a community alcohol detoxification in the last 12 months.

Staff informed patients about any risks and how to keep themselves safe. Patients described being involved in their care, including options of medication. We saw evidence of patient involvement in their care records.

Staff only treated patients who consented to sharing information with their GP. The doctor undertook regular assessments of patients’ physical health and referred them to their GP if they identified signs and deterioration in their health.

Prior to commencing treatment, the doctor referred the patient for baseline blood tests and electrocardiograms (ECG) to their GP where appropriate. These baseline blood tests included a full blood count and liver function tests. This helped to assess the treatment pathway that a patient underwent.

Staff followed clear personal safety protocols, including for lone working. Staff made sure their diaries were up to date with appointments to ensure the team knew where staff were within the building.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the care environment. The manager conducted safety risk assessments of the premises. Environmental audits were carried out once a month by the manager. These included managing the risks of fire and infection control. Staff followed the service’s medical emergency policy in case of an accident or urgent situation. The premises had an automated external defibrillator (AED) installed in case of an emergency and staff knew where this was located.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff to keep patients safe. The team consisted of one full time consultant psychiatrist and a full-time registered manager. There were 2 full time assistant psychologists, a part time non-medical prescriber (NMP) and a part time consultant psychiatrist. In addition, the service had a business manager and a rotational medical student.

The service had robust and safe recruitment practices to make sure that all staff were suitably experienced, competent and able to carry out their role. We looked at the staff records for three staff working at the service. Each staff member had an up-to-date criminal record check to ensure they were safe to work with vulnerable adults. New staff provided valid references to ensure suitably for employment.

There was always medical cover available during office hours.

The team caseload was 424 at the time of the assessment. Staff members did not have individual caseloads. The doctor assessed each patient, including medical reviews and completing clinical decisions. The administrative staff and assistant psychologists supported the day-to-day running of the service.

Staff had received and were up to date with appropriate mandatory training. The training was appropriate for the patient group using the service including safeguarding vulnerable adults and children, basic life support and health and safety training.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The premises were clean, had good furnishings and were well-maintained. The main reception area, waiting rooms and consultant psychiatrists’ room were well maintained. Patients and visitors signed in and out at the main reception. There were no clinic rooms onsite.

Cleaning records were up to date and demonstrated that the building was cleaned regularly.

Staff adhered to infection control principles, including handwashing.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed good practice in medicines management. The service had arrangements in place for the safe management and control of prescription forms in line with national guidance. Prescriptions were stored electronically. Staff kept records of controlled stationery.

Staff sent prescriptions electronically to their partnership pharmacy. Patients would pick up their prescriptions from the provider’s chosen pharmacist or have their medication delivered direct to them.

Accurate, up-to-date information about patients’ medicines was available, particularly when they moved between health and care settings. Staff reconciled patients' medicines before they commenced treatment. The prescribing doctor ensured they received the patients’ medicines history from their GP before they were prescribed any medicines from the service. This ensured safe prescribing.

Staff informed the patient’s GP about what medicines they had prescribed as part of the shared care agreement. To ensure that medicines were prescribed safely, staff did not admit patients without consent to share information with their GP.

Staff reviewed each patient’s medicines regularly and provided advice to patients and carers about their medicines. This was clearly documented in their care plans. Patients told us that they were given information about their medicines and this was explained clearly. One patient told us that once they were prescribed the correct medicine things started to positively change.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with NICE guidance. Staff provided regular physical health checks such as electrocardiograms (ECG) and blood tests to commence patients’ medicines.

There were appropriate arrangements for the safe management, use and oversight of medicines and controlled drugs. Staff kept an audit to ensure the safe and effective management of controlled drugs.