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Charterhouse Clinic Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 March 2019

We rated Charterhouse Clinic as Requires Improvement because:

  • The service did not robustly manage the risks associated with detoxification from drugs and alcohol. Staff did not regularly review client’s physical health observations during detoxification in line with national guidance. The provider did not use dependency scales on admission or consistently use withdrawal scales such as the opioid withdrawal scale to monitor the severity of the client’s withdrawal symptoms in line with national guidance.
  • Governance systems were not robust. The service did not have a system to monitor areas for improvement identified through self-auditing and leaders did not maintain a robust risk register.
  • Staff did not robustly mitigate the risks associated with mix gender accommodation by conducting risk assessments.
  • The service did not hold regular staff team meetings. The last team meeting was held in August 2018.
  • The training matrix was not up to date and did not accurately reflect the dates staff had completed their annual training.

However:

  • Staff spoken with, reported good team morale and said they were proud to work for the provider.
  • Staff provided a range of psychological therapies recommended by The National Institute for Health and Care Excellence. These included cognitive behavioural therapy and group therapy. Some of the topics covered in group therapy were mindfulness, meditation, reflection and relapse prevention.
  • The provider had a whistle blowing policy in place. Staff were aware of the policy and told us they were confident in raising a whistle blowing.
  • We observed staff interacting with clients in a kind and respectful manner throughout the inspection.
  • Clients told us they felt safe whilst in treatment and that staff were kind and caring. All clients had a named key worker who met with their client weekly.
  • We saw evidence that clients were involved in developing and setting their own care plan and goals.
Inspection areas

Safe

Requires improvement

Updated 8 March 2019

  • Staff did not regularly review client’s physical health observation during detoxification in line with national guidance.

  • Staff did not robustly mitigate the risks associated with mix gender accommodation by conducting risk assessments.

  • Staff did not manage clinical waste effectively. We found a clinical waste bin that was full, and there was no open or closed date on the label. This did not meet the safe requirements for the disposal of clinical waste. This was an issue identified at our inspection in 2018.

  • The provider did not use dependency scales, for example severity of alcohol dependence questionnaire on assessment, in line with national guidance and best practice.

  • The provider did not consistently use withdrawal scales such as the opioid withdrawal scale to monitor the severity of the client’s withdrawal symptoms during detoxification.

  • Staff did not have access to emergency alarms to summon help in an emergency.

However

  • The provider had an infection control policy in place which staff were aware off.

  • The service was clean and well maintained.

  • The registered manager had established the number of recovery workers to meet the needs of the clients.

  • We reviewed the staffing rota and found shifts were appropriately filled by regular staff.

  • The provider had a service level agreement with a consultant psychiatrist who attended site one day per week.

  • We found 100% of core staff had completed their mandatory training which included, safeguarding, mental capacity act and medication management.

  • The provider had a process in place for clients who unexpectedly left the treatment programme.

  • The service had a duty of candour policy which staff were aware of.

Effective

Requires improvement

Updated 8 March 2019

We rated effective as Requires Improvement because:

  • Not all staff received annual appraisal. We found 38% of staff had received an annual appraisal within the last 12 months.

  • Staff did not consistently use recognised risk assessment tools including the clinical withdrawals scale and the clinical opioid scale or substance dependency scales such as the severity of alcohol dependence questionnaire in line with national guidance.

However:

  • We reviewed six care files and found care plans were person centred and goal orientated.

  • The provider had a plan in place for clients who unexpectedly left their treatment programme early.

  • Clients had access to local physical health services such as the GP and dentist if required.

  • The service had an equality and diversity policy in place. Staff had undertaken equality and diversity training as part of their induction and mandatory training.

  • Staff spoken with had a good understanding of the Mental Capacity Act.

Caring

Good

Updated 8 March 2019

We rated Caring as good:

  • We observed staff interacting in a kind and respectful manner throughout the inspection.

  • Clients told us they felt safe whilst in treatment and that staff were kind and caring.

  • We saw evidence that clients were involved in developing their care plans setting their smart goals.

  • Weekly community meetings were held. Clients spoken with told us they were able to raise issues or concerns at the meetings and staff would address the concerns promptly.

  • Clients completed a satisfaction survey when they had finished the programme and were ready for discharge.

  • All clients had a named key worker who met with their client weekly.

Responsive

Good

Updated 8 March 2019

We rated responsive as good because:

  • Clients had access to healthy and balanced meals.

  • Clients spoken with told us the service catered for cultural and dietary preferences, for example, cooking with halal meat or preparing vegetarian dishes.

  • Clients were able to access local cultural and religious facilities if requested.

  • The service had a complaints policy in place. Posters were displayed throughout the location detailing how to raise a complaint.

  • Clients spoken with told us they knew how to raise a complaint and were comfortable in doing so.

  • The service had an activity time table that covered seven days per week and included evening activities for clients to participate in.

However

  • We were told if a client could not speak English they would not be admitted to the service. The provider should ensure they consider the Equality Act when assessing clients needs.

  • The provider did not have disabled access for clients with mobility difficulties.

Well-led

Requires improvement

Updated 8 March 2019

We rated well-led as Requires Improvement because:

  • Governance systems were not robust. The service did not have a system to monitor areas for improvement identified through self-auditing.

  • Managers did not maintain a robust risk register. Risks identified included generic risks such as not meeting the Care Quality Commission standards, however there were no specific risks identified. There was no evidence staff were able to contribute towards the risk register.

  • The provider did not hold regular staff team meetings.

  • Managers did not keep the training matrix (used to monitor staff training compliance) up to date.

  • Managers did not have a robust system to maintain oversight of staff supervision and appraisal.

However

  • Staff spoken with were aware of the services vision and values.

  • The service held daily handover meetings which were comprehensive and person centred.

  • Clients and staff were aware who the senior managers were.

  • Staff reported good team morale.

  • The provider had a whistle blowing policy in place. Staff spoken with were aware of the policy and told us they were confident in raising a whistle blowing.

  • Staff we spoke with said they were proud to work for the provider.

Checks on specific services

Substance misuse services

Updated 13 April 2018

See overall summary