All inspections: St Thomas Fund - Care Quality Commission

We rated St Thomas Fund as good because:

Staff supported clients to safely complete their community drug or alcohol detoxification treatment with a local substance misuse service. St Thomas Fund provided accommodation for clients completing their community detoxification treatment programme in premises that were safe, clean, well equipped, well furnished and well maintained.
Staff carried out a comprehensive assessment with each client, before they accessed the service. The assessment incorporated physical and mental health, plus social support needs. Staff referred clients to partner agencies as appropriate.
The prescribing doctor at the local community substance misuse service conducted a face-to-face consultation with all clients before prescribing medicines to them. Staff reviewed the effects of medicines on patients’ physical health regularly and in line with National Institute of Health and Care Excellence guidance.
Client care records contained a comprehensive, up-to-date risk assessment, which included a risk management plan in relation to potential risks associated with an unexpected exit from treatment.
Client recovery plans were written with the joint input of the clients and their support worker. The recovery plans were holistic, addressed all the identified needs of the clients and based upon the strengths of the client, to enable the client to build upon their personal strengths towards recovery.
Staff had completed all mandatory training, including safeguarding children and adults. Staff also completed a wide range of specialist training, to enable them to effectively carry out their roles.
Staff were discreet, respectful, and responsive when caring for clients. They gave clients help, emotional support and advice when they needed it. Staff understood and respected the individual needs of each client.
Clients expressed strong, positive views about the service accepting dogs, subject to individual risk assessment. They told us that not allowing dogs into the service would have constituted a significant barrier to accessing treatment for some people.
Clients could give feedback on the service and their treatment and staff supported them to do this. Clients participated in recruitment interviews for new members of staff and service contract review meetings with commissioners.
Clients had access to a range of activities and complementary therapies, such as massage, meditation, acupuncture, creative writing, mindfulness, yoga, cycling and badminton. Clients attended mutual aid groups throughout the week.
The management team had the skills, knowledge and experience to perform their roles. They had a thorough understanding of the service and a clear understanding of how their service worked with other agencies, to meet the needs of clients.
Staff expressed enthusiasm and pride in their work. They felt supported and respected by their managers and able to raise concerns without fear of retribution.

However:

At the time of our inspection, there was no risk assessment in place for a selection of exercise equipment in the garden.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

Following our inspection in December 2016 we found that disclosure and barring service checks had not been renewed by all staff in line with the organisation’s policy of renewing these every three years. Disclosure and barring service checks provide information to approve people who work with vulnerable adults and children.
However, at this inspection we saw evidence that all staff had a current disclosure and barring service check and there was a procedure in place to ensure these were renewed every three years.
Following our inspection in December 2016 we found that not all staff were up to date with their Mental Capacity Act training. At this inspection we saw staff training records which showed that staff had completed Mental Capacity Act training.

We do not currently rate independent standalone substance misuse services.

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

Not all staff at the service had renewed their disclosure and barring service check in line with the organisation’s policy of renewing these every three years.

However, we found the following areas of good practice:

Staff completed a thorough risk assessment of all clients prior to them moving in to the service. All six of the client care records we reviewed had an up to date risk assessment signed by staff and client. The risk assessment included physical and mental health as well as current and historic substance misuse issues.

The service had a comprehensive safeguarding policy for adults and children which made reference to the six principles of safeguarding within the Care Act 2014. All staff had completed adult safeguarding training, and 12 out of 13 staff had completed child safeguarding training. Staff were aware of the safeguarding process and how to make referrals to the local authority.

Staff started the assessment process when they received the referral and before the client moved in to the service. Staff completed these assessments at a local community drop in group. Care plans were holistic and recovery focussed including physical health, mental health and substance use. Care plans showed good evidence of client involvement.

The service ran a comprehensive programme of therapy throughout the week which allowed time for group sessions and individual keyworker sessions. Clients were supported to meet twice daily with staff for a feelings check when they could talk about positive experiences or concerns they may have.
The service had good access to physical healthcare when needed, including dentists and the blood borne virus clinic which took place at the local community substance misuse team.

Staff received core training in equality, diversity and inclusion, safeguarding adults and children, first aid, data protection and the Mental Capacity Act. Additional specialist training was available in assessment skills, group work, motivational interviewing and psychoactive substances. Supervision and appraisals were up to date for all staff and appraisals had been booked for the following year.
We observed staff treating clients with kindness and respect at all times. Staff promoted clients’ independence and recovery and encouraged clients to access community facilities wherever possible. The service held community meetings which gave all clients the opportunity to raise any concerns or issues they may have with the running of the service.
The service had rooms for clients to speak with staff confidentially and to have keyworker sessions. There were communal areas for clients to use and specific rooms for group therapy. Clients could make hot drinks and snacks throughout the day and had all day access to the kitchen and garden areas.

There was a ground floor bedroom which allowed the service to accommodate one wheelchair user. The service had an additional temporary bed for clients from their move on houses who might have needed additional support on a short term basis.
Staff reported high levels of job satisfaction and motivation. There was a supportive culture within the staff team and morale was good amongst all staff we spoke with.

At the last inspection in May 2013 we found St Thomas Fund non-compliant with Regulation 12 of the Health and Social Care Act (HSCA). This was because not all relevant guidance in relation to infection control had been followed.

At this inspection we found that the provider had taken the steps they needed to achieve compliance. We found that systems were now in place that meant people were cared for in a clean, hygienic environment because appropriate guidance had been followed. The manager told us, "I am pleased with the systems we now have in place and the progress that has been made."

We spoke with three people who used the service, the manager, two care workers and a student social worker on practice placement.

We found that staff sought people's consent before providing care and support. A care worker said, "This is an abstinence based rehabilitation service. People are continually being given the opportunity to reaffirm that they want to be here. People being here every day I see as the most positive form of consent".

People told us they were safe and happy in the home. They said their key workers and support workers listened to them and worked with them to address their issues. One said "The staff are kind. I feel very safe now I'm here and it's taken a long time to get in because of the waiting list". People's needs were assessed and care plans made to meet those needs.

We had some concerns regarding the cleaning of the home. We saw that a new floor had been laid in part of the house. However, we also found the oven dirty with no evidence of recent cleaning within it. There was food waste in the bottom of the fridge and freezer and the kitchen window sill was dirty with cobwebs and dead insects on it. There was no provision of hand towels in the kitchen or men's toilet.

People were protected by having staff who had skills needed to safely support them.

We saw that audits of the service were completed. This ensured that people who used the service benefited from a service that had monitored the quality of care that people received.

During our visit we spoke with people who lived at the service and staff members.

The people we spoke with told us they felt safe living at the home and felt supported by the staff team.

Staff we spoke with knew the people living at the home well and had a good understanding of their support needs.

St Thomas Fund

All Inspections

25/06/2019

During a routine inspection

18 July 2017

During an inspection looking at part of the service

13 December 2016

During a routine inspection

20 September 2013

During an inspection looking at part of the service

21 May 2013

During a routine inspection

30 April 2012

During a routine inspection