31/07/2019
During a routine inspection
We rated East Coast Recovery as good because:
- All premises where clients received care were clean, well equipped, well furnished, well maintained and fit for purpose. The service had a full range of rooms and equipment to support treatment and care. The residential accommodation was homely, well-decorated and furnished and had quiet areas where clients could meet visitors and relax.
- Staff completed comprehensive assessments with clients on admission to the service. They worked with clients to develop individual recovery plans and updated them as needed. We reviewed six recovery plans and found these were comprehensive, reflected the assessed needs, were personalised, holistic and recovery-oriented.
- Staff treated clients with compassion and kindness. They understood the individual needs of clients and supported them to understand and manage their recovery, care and treatment.
- The service treated concerns and complaints seriously, investigated them and learned lessons from the investigation outcomes. These were shared with the whole team.
- Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible in the service and approachable for clients and staff.
However:
- There were blind spots and ligature points throughout the recovery centre and the residential houses (a ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation). The provider risk assessment did not identify individual ligature anchor points within any of the buildings or state how the risk of these could be mitigated. We were concerned that the service was admitting clients with a history of self-ligation without staff being fully aware of the environmental risks and how to mitigate these. The lack of a ligature risk assessment was an issue at the last inspection.
- Bedroom corridors contained a mixture of male and female bedrooms. There were no locks on the bedroom doors, so clients could not lock the door to maintain their safety, privacy, and dignity.
- The service did not have an alarm call system in place within the bedrooms and communal areas of the residential houses. Staff did not carry personal alarms. Staff would be unable to summon assistance quickly in these areas if a client or staff member required assistance in an emergency. Alarms were situated in the offices of the residential houses.
- We found that the risk management plans for clients were generic, all had the same wording and did not give details of how specific risks for individual clients should be managed. We could see evidence from talking with staff, and from client recovery plans, that staff had good knowledge of clients and were aware of their risks. However, this was not reflected in the risk management plans and we were concerned that new staff would not be aware of how to manage client risks by looking at this part of the risk assessment.