Liberty House Clinic Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as good. At this assessment the rating has remained as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. This included 12-step therapy and dialectical behavioural therapy. Some recognised rating scales were used to support people through detoxification.

However, people told us that more activities could be available to support their recovery. Not all client records had a copy of their GP medical summary.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 6 care records during our inspection. All care records we reviewed included a comprehensive assessment on admission and an assessment of mental capacity. All care records had a risk assessment and risk management plan in place. Risk assessments were reviewed and updated regularly. Care plans were present in all care records, were regularly reviewed and were personalised to meet individual needs. Plans were put in place for discharges, including unexpected exits from treatment. Information and advice on how to stay safe was given prior to discharge.

Mental capacity assessments were completed with people on admission to the service, where checks on spatial awareness, understanding information and ability to retain information were assessed. On admission to the service, people were assessed virtually by an addiction specialist GP.

Staff provided care and treatment interventions suitable for the patient group. This included 12 step therapy, one to one sessions with a therapist, dialectical- behavioural therapy (DBT), as well as yoga, meditation sessions and daily walks. People we spoke with were positive about therapy sessions and one to one sessions. However, some people felt there could be more exercise and activities at weekends to support their recovery.

Liberty House is a medically-monitored treatment facility. There were no nurses at the service and doctors completed their assessments virtually. Staff told us that if people had healthcare needs, they would be taken to a walk-in GP surgery or to hospital in an emergency. People told us they had been taken to a walk-in GP surgery, where they had any physical health concerns. Managers told us that a nurse at another UKAT site could be contacted for support if needed.

People told us they were confident that the treatment they were receiving would help them and they had seen the treatment programme work for others.

During our inspection we attended a handover meeting, which included the multidisciplinary team. This consisted of the service manager, support workers and therapy team. Staff discussed risk management, progress in treatment, therapy engagement and safeguarding concerns for people in treatment. Staff were aware of people’s individual needs and risks. We reviewed handover meeting minutes, and the agenda ensured that relevant information was discussed. For example, new admissions, appointments out of the service and detoxification were included in the agenda. We also found good evidence of safeguarding taking place, where families were contacted to ensure welfare of children.

However, people did not always give consent for their GP to be contacted on admission to allow the prescriber access to a medical summary. Obtaining a medical summary from the GP allowed the prescriber to access information on medications prescribed and ongoing health issues.

We spoke with 6 people about treatment at Liberty House. Most people we spoke with were positive about their treatment and told us that staff were supportive and caring. People told us that food at Liberty House was healthy.

Staff supported people to manage their health and wellbeing through meditation, yoga and daily walks. Some people told us they felt more activities could be available at weekends to promote a healthy lifestyle. Following our inspection the provider implemented an activities timetable, which increased options for both therapeutic activities and exercise. People had access to aftercare on successful discharge from Liberty House Clinic and were able to attend virtual calls weekly for support.

We did not see all recognised rating scales being used as part of assessment. In the care records we reviewed, we did not see any evidence of alcohol use disorder identification test (AUDIT) being used. This is a rating scale used to identify an alcohol use disorder. There was some evidence of severity of alcohol dependence questionnaires (SADQ) being used to assess the severity of alcohol dependence.

However, appropriate rating scales were used to assess people during detoxification. This included the use of Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), which is a ten-item scale used in the assessment and management of alcohol withdrawal. Close monitoring of CIWA-Ar at the beginning of treatment can help identify alcohol withdrawal and ensure safe care and treatment. CIWA-Ar was used regularly to monitor alcohol withdrawal at Liberty House.

For people having an opiate or a benzodiazepine detoxification, staff assessed their withdrawal using validated tools, which followed best practice guidance.

In all care records we reviewed, we found evidence of consent to treatment and sharing of information had been completed. A confidentiality agreement had also been completed with each person. Most care records we reviewed showed information had been shared with the person’s GP.

While consent to share information had been completed, people did not always agree for information to be shared with their GP. Department of Health drug misuse and dependence guidelines highlight the importance of regular communication between specialist services and the client’s GP because of “the significant physical and psychiatric morbidity associated with drug use and complex pharmacological interactions between medications used to treat drug dependence and other medications.” The guidelines further state “in exceptional circumstances, treatment may continue despite a patient having withheld consent for sharing information with their GP.”