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Inspection Summary


Overall summary & rating

Outstanding

Updated 17 May 2019

We rated Sefton Park as outstanding because:

  • The staff had an overwhelming passion for the work they did. Staff were highly motivated to involve clients in their care and empower clients to have a voice and realise their potential. The culture of care ran throughout the organisation from the provider to the kitchen staff. Clients spoke highly of the care they received from staff, the registered manager and the provider. The provider fostered a caring recovery community amongst clients past and present. They hosted weekly community walks where previous clients, now in recovery, offered hope to current clients. The provider also organised a weekly coffee morning for previous clients to drop in and access peer support around any issues they were facing and to share successes.
  • Staff supported clients to plan for their discharge from Sefton Park. Discharge planning began from the beginning of treatment episodes and staff created resettlements plans with clients to ensure there was support in place when they left. The service provided aftercare to all clients. Clients had access to a 28-day intensive support program after discharge from Sefton Park and access to regular support groups indefinitely. Clients could repeat the 28-day program at any time. The provider offered sponsored beds, free of charge, to clients whose funding had run out and had nowhere to go or clients who required longer residential treatment. This prevented any clients from becoming homeless or discharged when they weren’t ready.
  • Staff managed opiate detoxification safely. Prescribing staff had appropriate qualifications and experience to undertake their roles. Staff assessed clients for suitability for detoxification prior to admission and clients received a full prescribing assessment on the day of admission. Prescribing regimes were in line with “Drug misuse and dependence: UK guidelines on clinical management (2017)” and relevant National Institute of Health and Care Excellence (NICE) guidelines. Staff monitored withdrawal symptoms effectively and were knowledgeable about what actions to take if a client’s health deteriorated during detoxification.
  • Clients’ individual needs and preferences were central to the planning and delivery of care. Staff fully involved clients as active partners in their care. Care plans reflected clients’ individual preferences and clients’ voices were intrinsic to the care plan review process. Care plans contained clients’ goals and creative solutions to achieve these goals. The service held service user forums to provide clients with an opportunity to give feedback on service delivery and discuss potential changes to the service. Clients could give feedback on the service through formal feedback forms provided at the end of each treatment phase.
  • Clients had access to a range of evidence based therapies. This included one to one counselling and eye movement desensitisation and reprogramming (EMDR) and a group program based on cognitive behavioural therapy and dialectical behavioural therapy. Clients could access relapse prevention work and complementary therapies, such as auricular acupuncture.
  • Staff managed medicines safely. Medicines were stored at the correct temperature and stock was regularly audited. Staff checked that medicines brought in by clients were prescribed for them. Staff were trained to administer medicines and their competency was regularly assessed.
  • The registered manager had suitable governance processes in place. There were effective systems to ensure that staff training was up to date. The system automatically flagged when training was due to expire and populated training requirements by job role. Staff checked the training weekly, recorded additional information, such as when training had been booked, and reported any necessary actions to the registered manager. Effective governance systems were also in place for reviewing policies, procedures, incidents and complaints. Senior staff met regularly in governance meetings and shared actions with the team in wider team meetings. Managers reviewed incidents and complaints for themes and trends and made changes to service provision in response.
Inspection areas

Safe

Good

Updated 17 May 2019

We rated safe as good because:

  • Staff ensured the safety of clients during opiate detoxification regimes. Prescribing staff assessed clients for suitability prior to commencing detoxification regimes. Staff monitored clients for withdrawal symptoms and were aware of what actions to take if a client’s health deteriorated during a detoxification.
  • Staff managed medicines safely. They were stored at the correct temperature, audited weekly and medicines errors were reported and dealt with internally. Clients’ own medicines were checked on arrival. Staff were confident and competent when discussing the medicines policies and procedures.
  • Staff assessed clients risks at initial assessment and completed risk assessments on admission. Staff completed risk management plans if there were any identified risks. All records we reviewed contained risk assessments and risk management plans where appropriate.
  • There were effective systems in place for safeguarding. Staff were confident with identifying and reporting signs of abuse. Managers reviewed all safeguarding referrals and maintained oversight of safeguarding concerns. Staff supported clients, where appropriate, to contact safeguarding authorities themselves.
  • Staff knew what incidents to report and how to report them. Staff were aware of their duty of candour responsibilities. The manager reviewed and investigated all incidents. Incidents were also reviewed at the governance meetings and necessary changes were made to service provision.

However:

  • Although some blanket restrictions remained in place, such as witnessed urine samples, the provider was undertaking an ongoing review of restrictions that were in place.
  • Rooms did not have emergency call alarms, apart from the accessible bedroom.

Effective

Good

Updated 17 May 2019

We rated effective as good because:

  • Prescribing staff supported clients in line with “Drug misuse and dependence: UK guidelines on clinical management (2017)” and relevant National Institute of Health and Care Excellence (NICE) guidelines. Prescribers had appropriate qualifications, training and support for their roles.
  • Staff completed holistic, person centred and goal orientated care plans with clients on admission. All client care records contained a care plan. Staff and clients conducted high quality reviews of care plans and used these reviews to formulate to inform subsequent care plans. This ensured care plans were meaningful and helped work towards their goals.
  • Counselling staff delivered evidence based psychosocial treatment. Clients could access one to one counselling and group therapy based on cognitive behavioural therapy and dialectical behavioural therapy. The service also offered mindfulness and eye movement desensitisation and reprocessing therapy for clients with post traumatic stress disorder.
  • Staff offered complementary therapies such as auricular acupuncture, drumming workshops and art therapy.
  • Staff completed face to face assessments of all clients prior to admission. Nurses conducted assessments of clients with complex physical or mental health needs. Admissions were agreed as a team on an individual basis. GP summaries and blood tests were obtained for all clients before agreeing admissions.
  • Staff were trained to do their jobs. Counselling staff were trained in specific therapies and had training to deliver the group therapeutic program.

Caring

Outstanding

Updated 17 May 2019

We rated caring as outstanding because:

  • A strong recovery ethos ran throughout service delivery and all staff shared a clear definition of recovery. Staff were motivated to deliver care that is kind and foster strong therapeutic relationships with clients. They spoke with overwhelming passion about their work. Clients described staff as insightful, understanding and ‘amazing’.
  • There was a visible person-centred culture. Clients were treated as active partners in their own care. Care plans reflected clients’ individual preferences and clients’ voices were intrinsic to the care plan review process. Client’s individual needs were always reflected in how care was delivered.
  • The provider fostered a caring recovery community amongst clients past and present. They hosted weekly community walks where previous clients, now in recovery, offered hope to current clients. The provider also organised a weekly coffee morning for previous clients to drop in and access peer support around any issues they were facing and to share successes.
  • Clients’ social needs were highly valued by staff and were embedded in care and treatment. Clients were encouraged to maintain positive relationships with their families. Clients could involve their families in their care plans and staff supported clients to go on home leave to visit their loved ones.
  • Staff listened to and respected clients’ views. There were regular service user forums to provide clients with an opportunity to give feedback on service delivery and discuss potential changes to the service. Clients told us they felt able to challenge the rules through this forum.

Responsive

Outstanding

Updated 17 May 2019

We rated responsive as outstanding because:

  • Staff supported clients to plan for their discharge. Staff created discharge and resettlement plans with clients and community staff from the start of treatment to ensure clients had support in place when they left. The service provided aftercare to all clients. Clients had access to a 28-day intensive support program after discharge from Sefton Park and access to regular support groups indefinitely.
  • The provider offered sponsored beds, free of charge, to clients whose funding had run out and had nowhere to go or clients who required longer residential treatment. This prevented any clients from becoming homeless or discharged when they weren’t ready.
  • The chef worked to actively involve clients in their diet and menu planning. Whenever a new client was admitted, the chef sat with the client to discover their likes and dislikes. The chef trained clients in knife and general kitchen skills. Clients said the food and menu were “incredible”.
  • The provider worked to provide clients with education and employment opportunities in the later stages of treatment and during the aftercare program. There were links with the local college and the provider offered paid employment to clients within the service.
  • Staff had worked with clients whose first language was not English. The provider had purchased educational materials to enable staff to teach clients to read and write and provided a Dictaphone to clients who found handwriting therapeutic assignments challenging.

Well-led

Outstanding

Updated 17 May 2019

We rated well led as outstanding because:

  • Leaders and managers were visible and accessible to staff and clients. Managers were experienced in substance misuse and provided clinical leadership to staff. Staff spoke highly of the leadership within the team.

  • Staff morale was high and staff were passionate about the work they did. The manager actively monitored staff passion and enthusiasm and addressed any concerns in supervision.

  • There was an effective governance system in place for reviewing policies, procedures, incidents and complaints. Senior staff met regularly in governance meetings and shared actions with the team in wider team meetings.

  • The manager had access to information relating to incidents, safeguarding referrals, sickness and complaints. Learning from these was shared with staff in team meetings, during supervision or to individual staff.

Checks on specific services

Substance misuse services

Outstanding

Updated 17 May 2019

Sefton Park is a residential rehabilitation service for substance misuse.