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Inspection carried out on 22, 23, 24 & 29 August 2017

During a routine inspection

We do not currently rate standalone substance misuse services.

This was a short notice announced, comprehensive inspection. However, also during this inspection we checked the progress the provider had made in addressing the breaches of regulations identified at the previous inspection in May 2016.

At this inspection we found the following improvements:

  • The provider had made improvements on the issues found in the May 2016 inspection, which related to the safety of the service. At the last inspection in May 2016 the provider's medicines policy did not offer clear guidance on how to support clients who could no longer self-administer medicines. During this inspection, the provider’s management of medicines had improved, the medicines policy now included guidance on monitoring and recording changes to client’s medicines, action to be taken by staff if a client could no longer self-administer. The policy included what staff should do if there was a medicines incident out of hours. Staff no longer stored over-the-counter medicines and the provider’s medicine’s policy indicated this.

  • At the last inspection in May 2016 we found that clients did not have appropriate risk assessments and crisis management plans. During this inspection the provider had improved clients’ crisis planning and management, this included plans to minimise the risk of overdose when clients had completed opiate detoxification.

  • At the last inspection in May 2016 we found the provider had not ensured safe staffing. During this inspection the provider had systems in place to ensure pre-employment checks were carried out and staff take up of mandatory training had improved. Staff received specialist training in substance misuse, mental health concerns and safeguarding children from abuse. The service now kept a stock of naloxone for clients at the recovery house and staff and volunteers were trained on how to use it. Staff had a good understanding of the Mental Capacity Act

  • At the last inspection in May 2016 the provider did not ensure a safe and clean environment. During this inspection, the provider had improved fire safety procedures and the service had new carbon monoxide detectors installed. The service had an improved system for infection control risk.

In addition we found the following areas of good practice:

  • Staff completed comprehensive risk assessments with clients on admission. Care records were personalised, holistic and recovery orientated.

    The service offered clients a range of psychological therapies recommended by the National Institute for Health and Care Excellence (NICE).

  • Staff had a good understanding of clients’ recovery needs. Clients reported staff treated them with dignity and respect. We observed good interactions between staff and clients and this impacted positively on client’s recovery. The service offered treatment to clients who were in need with no access to funding through the provision of a bursary.

  • Senior management were visible throughout the service. Clients and volunteers fedback that they knew who the senior management were and worked closely with them. Volunteers received regular supervision from management. Staff and volunteers had worked at the service for a number of years and turnover was low.

However, we also found the following issues that the provider needs to improve:

  • At this inspection, we found the provider did not have appropriate systems in place to assess client’s ability to self-administer their medication upon admission. Although, the provider had made effective changes to the management of medicines policy and procedures these had not been fully embedded yet.

  • Although staff reported safeguarding concerns to the local authority, the provider did not have a policy in place for notifying the CQC of incidents. Managers and staff were not aware that they needed to notify the CQC of incidents. 

  • The service’s admissions policy did not clearly describe the criteria for accepting a client with complex mental health needs.

  • Staff did not conduct regular monitoring of the quality of care and treatment provided. This meant staff could not monitor and improve the running of the service.

Inspection carried out on 23rd and 24th May 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

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

  • The service did not have formal written risk assessments to ensure that their volunteers were fit to work with the client group. A number of volunteers had commenced working at the service without a criminal records check or a written risk assessment of their suitability to work with the client group. The service did not have policies in place to routinely update the criminal records of the staff.
  • The service did not have robust procedures to deal with the disposal of clinical waste.
  • There were no carbon monoxide detectors in the property. The one fire door was ill-fitting and there were no fire extinguishers in the property.
  • The service did not have a system to check that the residents cleaned the property properly and food hygiene was maintained to a satisfactory standard.
  • There were low completions rates of all mandatory training for volunteers except professional boundaries.
  • The provider did not offer specialist training relevant to the client group. The service did not provide staff with training in substance misuse, mental health or domestic violence. These issues regularly presented themselves in this particular client group.
  • The service admitted adults only. Staff were provided with safeguarding adults training but did not provide staff with training in safeguarding children. However, a number of the clients had children or had contact with children. The lack of training in safeguarding children meant that staff and volunteers might not identify possible safeguarding concerns.
  • None of the staff had a clear understanding of how the principles of the Mental Capacity Act would be relevant to their role.
  • Risks assessments were not robust, none of the risk assessments/care plans looked at the risks of overdose post opiate detox, which was a particular risk for this client group. Staff did not undertake contingency planning in a robust manner and did not plan in advance what action they would take place should a client leave the service unexpectedly.

  • The provider’s medicines policy was not robust and did not offer guidance on action to be taken in an event of a medicines incident out of hours or how to support clients who could no longer self-administer or what action should be taken before giving clients over the counter medication.

However we also found the following areas of good practice:

  • The staff consistently modelled the values and visions of the provider. They were committed to ensuring that the clients using the service were supported. A range of therapeutic interventions and activities that promoted health and recovery were provided by the service. Clients were encouraged to undertake activities to improve employability. The service liaised with other organisations when necessary and advocated for the clients when necessary.
  • The provider had no waiting list and staff were able to admit clients without delay. They accepted referrals for clients throughout the United Kingdom and were able to provide free treatment to individuals who could not secure funding. Clients who successfully completed the 1st stage of treatment were offered a place at the provider’s second stage house.
  • The service supported clients through a range of therapeutic interventions and activities that promoted health and recovery. The service had implemented a buddying system, which assisted new clients to receive informal support from other clients who were further along the recovery programme. This peer support was helpful to new clients. The house also had a senior peer. This was a client who was further along in their treatment and was able to offer additional support and guidance to other clients.
  • The provider had complied with housing legislation and had licensed the property as a house in multiple occupation. This meant that the property met government guidelines regarding the suitability of the accommodation for people to share and that the providers were considered “fit and proper” to manage this type of housing.
  • The provider supported staff to undertake additional studies and attend events to enhance their career development.
  • The service had governance systems in place to ensure that learning was shared across the organisation as a whole. Staff were positive about the local management and felt supported to undertake additional qualifications

Inspection carried out on 11, 12 July 2013

During a routine inspection

People were supported to continue with their rehabilitation programme and access a range of support through one to one and group therapy sessions. The service focussed on people regaining their independence and taking further responsibility for aspects of their life. In addition to the therapy programme people were encouraged to access voluntary work or attend college courses, and to take further responsibility in managing their finances.

The service had a range of skilled and experienced staff available to support people. This included a team of volunteers who were graduates of the programme.

The building provided a range of private and communal areas. Any maintenance requests raised were dealt with quickly through the home management team.

There were processes in place to review the quality of service provision and obtain the views of people using the service.

Inspection carried out on 8 February 2013

During a routine inspection

People moved to 2nd Stage House after they completed the first part of their programme at the provider’s other house. We were told that they had more responsibilities with regards to the daily running of the home and more freedom regarding how they worked on their recovery programme. The day to day running of the service was still overseen and managed by the staff. People told us that ‘Everything is cool’ and ‘It’s a good organisation’. One person told that ‘This is a safe place and there’s a good supporting network’.

People told us they were informed about the service before they moved in and knew the difference in what was expected from them at 2nd Stage House. They’re needs were assessed and reviewed frequently previously at 1st Stage House and they were well-known to staff. People focused and worked on their recovery more and their needs were reviewed less frequently at this stage of the programme. People told that they felt safe in this house as well and that they got help from staff with any kind of problems when they needed it.

Staff told that the programme at 2nd Stage House was well-designed and had a high success rate of completion. Some of the staff members completed the programme earlier and told us they felt motivated to give something back and support other people who were going through the same problems.

We found that care and treatment was continuously developed with people who used the service and with those who already completed the programme.