Gladstones Clinic Cotswolds

Updated 3 November 2021

Gladstones Cotswolds Clinic provides accommodation and treatment for up to 12 clients who require residential substance misuse treatment which can include medically monitored detoxification from alcohol and opiates. The service only accepts privately funded clients.

At the time of this inspection there were 11 clients at the service. There were five clients undergoing detoxification.

The service is registered to provide accommodation for persons who require treatment for substance misuse and treatment for disease, disorder or injury. There was a registered manager in post. Currently the registered manager from London maintained oversight of the service while a new clinic manager was due to start their role the week following this inspection. The service had employed an operational director in April 2021 to improve the governance and quality of the service but they had left the service the week prior to this inspection.

Our last inspection of the service was in October 2018, when the service was rated good. However, there were recommendations around; completing appraisals in a timely manner, ensuring a service strategy and values were developed for staff, that information on the website was correct and the collection of information for governance systems was timely and not burdensome. During this inspection we saw that the website had been updated and a set of values had been developed for the staff to work with. Some work had also been done on the service strategy. We saw that staff were still not having their annual appraisals and governance systems remained an issue.

What people who use the service say

Clients told us they felt safe at the service and there were always staff available when they needed them. Clients felt comfortable and confident to speak with staff about their care without fear of repercussions. Clients spoke very highly of all the staff and the ‘amazing’ food, with the chef taking extra care to meet individual nutritional needs.

Clients we spoke with told us about different aspects of their bedrooms needing replacement or repair. They felt that the lounge area was cramped, needed modernisation and were not happy that it was used as therapy space in the day. Clients also told us that there was a lack of hot water in the evening, so it was uncomfortable to have a shower.

Clients told us that the internet was poor, or sometimes not available at all. This had impacted on their ability to access 12-step meetings as they were being run as online sessions.

Updated 3 November 2021

Our rating of this location went down. We rated it as requires improvement because:

• Staff in the service were not receiving regular supervision or an annual appraisal. This was identified as an issue at the last inspection and we saw no improvement at this inspection.
• Staff had a limited understanding of safeguarding processes and procedures.
• Risk management plans did not always address the risks identified and were not updated after incidents.
• Incidents were not always reported in a timely manner and learning was not being disseminated to staff.
• Care plans were not being completed. Care planning was documented in varying ways by staff.
• Staff were planning for discharge towards the end of clients’ treatment with a lack of inter-agency working.
• The service had not maintained the security of non-clinical records as these records could be deleted.
• The governance processes of the service had not ensured that its procedures ran smoothly. Leaders had not ensured that staff were using tools effectively to ensure the service was delivering high-quality care.

However:

• The clinical premises where clients were seen were clean.
• Staff completed a comprehensive assessment of clients’ needs and provided a range of treatments suitable to the requirements of the clients and in line with national guidance about best practice. Staff engaged in medicine audits to evaluate the quality of medicine management.
• The teams had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received the appropriate training. Staff worked well together as a multidisciplinary team.
• Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients and their families, in decisions and care planning.
• The service was easy to access with little or no waiting times.

Updated 3 November 2021

Our rating of this service went down. We rated it as requires improvement.

See the summary above for details.