Archived: SALUS - Withnell Hall - Health, Wellbeing & Addiction Treatment Centre Limited

We rated SALUS – Withnell Hall Health, Wellbeing and Addiction Treatment Centre as good overall because:

• The findings of this inspection mean the service is being removed from special measures.
• The service had implemented an action plan following our last inspection that addressed all of our previous concerns. There was clear evidence that the service had improved.
• The service provided a safe and effective psychosocial rehabilitation service (therapies and interventions that support recovery) for individuals with substance misuse problems. The environment was safe, clean and supported recovery. The service had enough staff. Staff assessed and managed risks associated with the client base and rehabilitation well.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice.
• Staff engaged in clinical audit to evaluate the quality of care they provided.
• The service had access to the full range of specialists required to meet the needs of clients and deliver a rehabilitation service. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a team and with relevant services outside the organisation.
• Staff treated clients with compassion and kindness. They understood the individual needs of clients. They actively involved clients in decisions and care planning.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
• The service was well led. Governance processes had been embedded and they ensured that its procedures ran smoothly.

However:

• We found one risk assessment where the section on blood borne viruses had not been completed. We found one risk assessment that did not have a full assessment of previous alcohol and substance misuse.

We rated Salus Withnell Hall as inadequate because:

• The service was not offering safe or effective care. Staff did not follow the policy that set out the pre-admission process and not all clients had had a comprehensive assessment of their risks and needs. Not all care plans fully reflected all clients’ needs nor were they based on a full assessment of each client’s risks and needs. The provider had not completed physical health checks of clients when clients may be still going through some withdrawal from alcohol or opiates. The service did not provide routine physical health checks. Staff did not always share important information on discharge.

• The provider did not maintain and check the premises to ensure that they were safe for clients. Staff did not have access to an alarm system to summon assistance throughout the premises. The fire risk assessment confirmed that staff should be trained in the use of fire extinguishers, hose reels and basic fire protection. This had not been completed. There was no planned date on the fire risk assessment for this training. A fire door on the bedroom corridor was broken.

• The provider did not have effective policies, procedures and training related to medicines management.

• The provider did not implement a fit and proper recruitment process and pre-employment checks and procedures were not followed when employing staff. Staff had not received an induction to the service.

• There were insufficient, appropriately qualified, trained and supported staff on duty throughout the day, night and at weekends to meet clients’ needs. Staff had not received mandatory training to carry out their role safely and effectively. Staff did not receive regular supervision and no staff had had an appraisal of their performance in the last 12 months. Not all staff had a clear understanding of the Mental Capacity Act and the implications of this on their practice.

• Staff did not fully assess clients’ physical health needs. The privacy and dignity needs of individual clients were not taken into consideration and appropriate measures had not been taken to ensure all clients were afforded privacy and dignity within their shared dormitories.

• The service did not offer clients access to an advocate and no information about advocacy was displayed throughout the organisation.

• The provider’s approach to improve the quality and safety of its services and standards of care was not effective. The governance systems were not fully embedded, established or operated effectively. Staff had undertaken a clinical audit for care records but had not recorded what action they had taken to make the improvements identified as being needed. Systems to assess, monitor and mitigate risks to clients’ health, safety and welfare were not embedded and records relating to clients were not complete.

However:

• Clients were made aware of the risks of continued substance misuse through the therapy programmes, including the risks associated with unplanned exit from the programme.

• Staff worked well with outside agencies involved in individual client's care and treatment. The clients were temporarily registered with a local GP who visited weekly.

• People with lived experience volunteered, and some were employed by, the service.

• Feedback from the clients who used the service was positive about the way staff treated them. Clients were positive and complimentary about the support and care they received from staff. Staff spent time with clients to help them understand their care, treatment and condition. Staff listened to and responded to clients positively; treating each client with dignity, respect, compassion and in a caring manner.
• Staff supported clients during referrals and transfers between services for example, if they required treatment in an acute hospital or temporary transfer to an in-patient psychiatric ward or other service.

• There was a choice of good quality food catered to individual dietary need on request.