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Archived: Oasis Recovery Community Bradford

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Inspection Summary


Overall summary & rating

Updated 23 May 2016

We found the following areas of good practice

  • The environment at Oasis Recovery Community Bradford was clean, safe and well maintained and there was adequate staffing in the service. The low use of agency staff meant that patients received consistent care and treatment from staff that they were familiar with. The service had systems in place to assess and manage risk effectively. All patients had a risk management plans in place, including detailed contingency plans for patients that left treatment early. A doctor and a manager were on call twenty-four hours a day, seven days a week to support staff and patients. The service recorded one serious incident and one accident in the last six months. We observed evidence of an investigation, feedback to staff and patients, and actions taken from the lessons learnt.

  • The service had good systems in place to assess the patient prior to their admission to the service, and during their treatment. Staff worked in collaboration with the patient to agree a care plan in a one to one care plan meeting. All patients had a current care plan in place that they had signed and dated. Evidenced based psychological therapies, group-based interventions, medications and detox regimes recommended by the National Institute for Health and Care Excellence were used in the service. Staff with the necessary skills, experience, supervision and training administered and delivered this treatment and care. Patients engaging in treatment at Oasis Recovery Community Bradford were highly likely to achieve their detoxification treatment goals at the service. Between 1 September 2015 and 9 February 2016, 87% of patients left Oasis Recovery Community Bradford in a planned way having completed their treatment.

  • All the patients we spoke to told us that the staff were caring, approachable and were always available to speak to if they needed further support. Staff were caring and respectful and their interactions were person-centred, friendly, and recovery focused. Relatives and carers were also offered support by the service, as well as in their local area.

  • Oasis Recovery Community Bradford was able to admit patients within 14 days from being referred by a community substance misuse team, or from referring themselves. The service was responsive to emergency referrals from hospital or the community and could admit patients within 48 hours in these situations. Patients were seen by a doctor immediately on admission and a full assessment was completed. All patients knew how to complain. The staff we spoke to were clear about the complaints procedure. However, complaints about the service were rare. There had been one formal complaint since 1 September 2015, escalated to the senior management team that was not upheld.

  • Oasis Recovery Community Bradford was well led, with local governance arrangements in place to ensure good quality care, including a range of performance indicators, policies and procedures and clinical audit. Staff understood and followed safeguarding, incident reporting, complaints and Mental Capacity Act (2005) procedures. Staff, patients, relatives and carers were able to give feedback on the planning, delivery and development of the service. The directors completed detailed quarterly quality audits, reviewing the service governance structures to ensure that treatment and care was safe, effective, and continued to improve.

However, we also found areas that the service provider could improve:

  • Oasis Recovery Community Bradford did not have patient call alarms in the bedroom, or panic alarms for staff in the building in the event of an emergency or an incident of violence or aggression. There were contingency arrangements in place. However, there were no formal risk assessments completed to assess if these systems were required.

  • Whilst risk management plans were in place for all patients, these were generic for each patient and lacked person-centred detail. The plans centred fully on the service delivery, rather than including the patient’s own strategies to manage the risk, which they had perhaps used prior to attending the service, or ones that they could use when they were discharged.

  • The service had systems in place for the clinical staff to audit the patient records weekly. However, the service did not use a standard clinical audit tool and so could not be sure that these record audits were completed consistently to the same standard.

  • Formal complaints were recorded. However, most concerns and complaints were resolved locally. These were not recorded. Therefore, recurrent themes may not be identified by the service.

  • The documents for supervision, appraisal and training were not held in one central place which made it difficult to ensure the data collected was correct.

Inspection areas

Safe

Updated 23 May 2016

We found the following areas of good practice:

  • The environment at Oasis Recovery Community Bradford was clean, safe and well maintained.

  • Environmental and ligature risk assessments were in place and there was evidence of a recent infection control audit.

  • There was adequate staffing at the unit with low use of agency staff.

  • A doctor and a manager were on call twenty-four hours a day, seven days a week.

  • Ninety-six per cent of staff had completed their mandatory training.

  • All ten patients had a risk management plan in place, including detailed contingency plans for patients that left treatment early.

  • Medicines were stored securely in locked cupboards and on a locked trolley, within a locked clinic room. This included the safe storage of controlled drugs. There were processes in place for the safe disposal of medicines.

  • Staff had a good understanding of safeguarding adults and children and one hundred percent of staff had completed the mandatory training required.

  • There was one serious incident and an accident at the service since 1 September 2015. Where an incident occurred, there was evidence of an investigation, feedback to staff and patients, and lesson learnt being actioned.

However, we also found areas that the service provider could improve:

  • The equipment in the accessible bedroom had not been assessed for ligature points.

  • There was no service risk assessment in place regarding the use, or requirement of patient call alarms in the bedroom, or panic alarms for staff in the event of an emergency or an incident of violence or aggression.

  • The risk management plans were generic for each patient, lacking person-centred detail, and centred fully on the service, rather than drawing on patients’ individual strategies.

  • There was no evidence in the visiting policy that visits were risk assessed with regard to safeguarding children and vulnerable adults.

Effective

Updated 23 May 2016

We found the following areas of good practice:

  • All patients had current care plan in place that were signed and dated by the patient.

  • Confidentiality and information sharing, and the treatment contract was discussed and agreed on admission, and then at each care plan meeting.

  • Patients had a full physical examination on the day as admission with the nurse and the doctor.

  • Medication was given to service users in a private, person-centred manner and the ten treatment charts in use at the time of the inspection were accurately completed.

  • Patients were required to attend a therapeutic recovery programme five days a week, and activities were available seven days per week.

  • Psychological therapies, group-based interventions, medications and detox regimes used were evidence based and recommended by the National Institute for Health and Care Excellence.

  • The nurses completed weekly clinical audits on patient records to check that care plans, risk assessments and risk management plans were in place for each patient.

  • Staff had the necessary skills, experience, supervision and training to fulfil their role.

  • Patients were discussed by the multi-disciplinary team twice daily in handover sessions. Patient did not attend but their opinions, thoughts and feelings were fed into the handover through the daily diaries that they completed each evening.

However, we also found areas that the service provider could improve:

  • Despite the service completed regular file audits, they did not use a standard clinical audit tool to ensure that the files were audited to the same standard each time.

Caring

Updated 23 May 2016

We found the following areas of good practice:

  • Staff were caring and respectful. Their interactions were person-centred, friendly, and recovery focused.

  • Family members and carers were offered one to one support when they attended for visits, and were signposted to a local service for on-going support in their area.

  • Patients were able to input into the treatment and care they received through daily diaries, daily house meetings, and monthly community meetings.

Responsive

Updated 23 May 2016

We found the following areas of good practice:

  • There were no waiting times to access the service and the service had accepted emergency referrals from hospital or the community within 48 hours.

  • Patients were seen by a doctor immediately on admission and a full assessment was completed.

  • Between 1 September 2015 and 9 February 2016, 87% of patients left Oasis Recovery Community Bradford in a planned way, having completed their detoxification treatment goals.

  • Oasis Recovery Community Bradford had a full range accessible rooms to support patients’ treatment and care, including a fully equipped clinic room. Patients could also access a clean and well-maintained outside space.

  • The service met the needs of all the patients who used the service. This included accessibility to the service, their access to religious and spiritual support, ensuring that their spiritual and dietary requirements were addressed, and that treatment information was in a format that they could understand.

  • There had been one formal complaint since 1 September 2015. Patients knew how to complain and staff were clear about the complaints procedure.

However, we also found areas that the service provider could improve:

  • There was no input from a dietician into the menu choice, and no specific input for patients with cross-addictions including eating disorders.

  • Formal complaints were recorded. However, most concerns and complaints were resolved locally. These were not recorded. Therefore, recurrent themes may not be identified by the service.

Well-led

Updated 23 May 2016

We found the following areas of good practice:

  • All staff could explain the service’s mission, vision and values. They represented and demonstrated these through their behaviours and interactions with the patients.

  • All staff knew the most senior managers by name. They told us that these managers were approachable and attended the service regularly.

  • There were local governance arrangements in place to ensure good quality care, including a range of performance indicators, policies and procedures and clinical audit.

  • All staff we spoke to were highly motivated and talked positively about their work at the service and said that morale was good.

  • Staff followed safeguarding, incident reporting, complaints, and Mental Capacity Act (2005) procedures.

  • Staff and patients, families and carers were able to feedback into the planning, delivery and development of the service.

  • The company directors completed detailed quarterly quality audits, reviewing the service governance structures to ensure that treatment and care was safe, effective, and continued to improve.

However, we also found areas that the service provider could improve:

  • The documents for supervision, appraisal and training were not held in a central place, which made it more difficult to ensure the data collected was correct in the first instance.

  • We observed two medicines policies that had been reviewed in January 2015 but these did not reflect current practice in the service.

Checks on specific services

Residential substance misuse services

Updated 23 May 2016