The Care Quality Commission
  • Community
  • Community substance misuse service

Archived: Compass - Enfield

Forest Primary Care Centre, 2nd Floor, 308a Hertford Road, London, N9 7HD (020) 8344 3180

Provided and run by:
Compass - Services To Improve Health And Wellbeing

All Inspections

20 May 2016

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • The provider had two separate care record systems in place, which included an electronic and paper system. The system did not operate smoothly as staff did not have access to a working scanner to ensure information was saved in local authority held records.

  • Overall, communication with local GPs had improved and communication was documented within some of the care records. Staff supported patients to engage with GPs, although documentation was not recorded in 19% of 122 care records listed.

  • A new system had been introduced into the service, which indicated when clients should receive a medical review. The system included a number of indicators but did not include indicators for a person who was symptomatic (HIV positive or hepatitis positive) and required reviews more frequently.

  • The clinical room door was found open on one occasion. This was raised to the service manager in order to address as this presented a potential risk to patients.

  • The service had a contingency plan in place, which described how clients could receive help if the service was closed. This advised people to access the local accident & emergency department. However, the plan needed to be reviewed to ensure they met clients’ needs.

However, we also found the following areas of good practice:

  • The provider had made improvements and these new systems needed time to embed. However, the improvements ensured safe care and treatment was being provided. Positive improvements were made in order to meet the requirements of the warning notice and the separate requirement notice that was served after our last inspection in November 2015.

  • The service had carried out a full care record audit since our last inspection in November 2015 and had made improvements on completing risk assessments and care plans. Most people who used the service now had up-to-date risk assessments and care plans.

  • The provider had reviewed the prescribing policy and added in the requirements of an initial prescribing appointment, which included a doctor taking a full history and carrying out a physical examination. The provider had introduced a new medical assessment template.

  • The provider ensured that people who used the service were being medically reviewed on a regular basis. Out of 14 care records reviewed, only one care record did not demonstrate that the medical assessment had been completed. People who used the service were being offered blood bourne virus (BBV) testing.

  • The provider implemented a new medical review template form, which included the withdrawal side effect rating scales called severity of alcohol dependence questionnaire

  • Staff had received training in record keeping in March 2016 in order to ensure that staff were aware of the importance of recording information.

  • The service was monitoring client outcomes using the care planning outcome tool.

  • Discussions had taken place around childcare responsibilities and safeguarding of vulnerable children.

  • Overall, the supervision records had improved significantly since our last inspection in November 2015 and records demonstrated that staff performance was a priority.

12th & 13th November 2015

During a routine inspection

The service was actively engaging with patients from the wider communities and had created good links with the local hospital. The service provided flexible appointments and was accessible during the week.

However, staff had identified risks to patients undergoing alcohol and opiate detoxification but risk management plans did not demonstrate how staff were managing or mitigating the risks. There was an inconsistent approach to risk assessments as staff were using two separate risk assessment tools. Care plans were not meeting the national treatment agency (NTA) care planning guidance and staff were not using the care planning tool consistently.

Staff did not routinely conduct medical reviews of patients during the detoxification programme, which went against the provider’s policy and The Drug Misuse and dependence: UK Clinical Guidelines on clinical management (Orange book), 2007.

During medical reviews, staff did not assess patients’ withdrawal symptoms with an additional validated alcohol or opiate assessment tool. This meant that they were not able to assess the full extent of the patient’s dependency. The service carried out various audits within the past 12 months which demonstrated similar findings. The provider did not have systems in place in order to improve on the areas of concern. Overall, the service was providing inadequate, unsafe care and treatment to patients. 

As a result of the safety concerns identified, we issued the provider and registered manager with a warning notice under Section 29 of the Health and Social Care Act 2008. We took this action as we believed people using this service may have been exposed to a serious risk of harm.

4, 6 December 2013

During a routine inspection

People told us that they liked the service. One person described it as, 'brilliant' and the staff as having been, 'really good.' A second person said, 'it's a very good service, the staff are very helpful.'

People told us they were respected and involved in their treatment. One person said, 'I get enough information from staff. I can talk to them about things.' We saw staff working kindly and sensitively with people.

Care plans were detailed and included a range of risk assessments. There was evidence that people had been involved in drawing up care plan objectives and there were consent forms which had been signed by people using the service.

There were a range of staff available including project workers, nursing and medical staff as well as counsellors. We saw that there were good relations between staff and people using the service and staff told us that they worked together well and felt supported. One staff member said, 'my line manager is supportive and the staff team are excellent.'

The small amount of medication in use was being stored properly and there were records confirming the blood screening and vaccinations that were carried out. There were a number of initiatives in place to assess quality and monitor the service. Where identified, there were plans in place to take improvement action.

31 January 2013

During a routine inspection

We looked at the care and treatment records held for people who use the service, talked with members of staff and talked with people who use the service. We looked at staff supervision and training records. We also looked at the premises themselves and the facilities available for people.

People who use the service told us that they had been involved in planning their care and treatment and that staff had assisted them to consider different treatment options depending on individual circumstances. People also told us that the staff were accessible and had been flexible to meet their needs. People also told us that they had been able to access other relevant services including voluntary groups further to their contact with Compass Enfield. People told us that they were aware of the complaints process as operated by the provider.