The Care Quality Commission
  • Residential substance misuse service

Archived: The Recovery Hub Ipswich

Overall: Good read more about inspection ratings

175 Felixstowe Road, Ipswich, Suffolk, IP3 8EB (01473) 402841

Provided and run by:
The Recovery Hub Ipswich Community Interest Company

All Inspections

3rd July 2019

During a routine inspection

We rated The Recovery Hub Ipswich as good because:

  • The service had a sufficient number of staff to monitor clients for the first 24 hours of detoxification from both drugs and alcohol and for clients to receive weekly one to one keywork sessions.

  • Staff completed a thorough risk assessment including risk of early exit from treatment and reviewed these in weekly sessions.

  • Staff completed comprehensive assessment with clients on admission that included physical and mental health, accommodation and social needs. Staff screened clients before admission and only offered admitted them if it was safe to do so

  • Staff collaborated with clients to set holistic personalised and recovery focussed care plans. The service offered a variety of treatment and therapies including 12-step therapy groups, cognitive behavioural therapy, relapse prevention and one to one keywork sessions.

  • Clients told us that staff were caring, kind and went above and beyond expectation to help them. Staff helped clients understand their treatment and demonstrated that recovery was achievable.

  • The service offered a monthly family group and individual family therapy interventions where required. Clients had positive feedback about the family therapy they had attended.

  • The service offered weekly aftercare groups to clients after completion of treatment. Clients could attend these for as long as needed.

  • Staff supported clients with resettlement plans including accommodation, financial support and employment.

  • Staff told us they felt supported in their roles and were proud to work for the service. They had good morale and worked well as a team. 

 

However: 

  • The service did not have good medicines management and administration procedures. There were not always two members of staff administering medicines as specified in their policy. Staff completed medicines administration training but were not signed off as competent by an experienced person prior to dispensing medicines.

  • Sixty five percent of staff had completed the required mandatory training for them to complete their roles safely.

  • Managers had oversight of supervision and training but had not identified or addressed the gaps in management supervision or the mandatory training compliance.

  • Managers did not have sufficient oversight of detoxification and medicine administration to be aware of the issues we raised around these.

17th July 2018

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • Staff managed medications safely and recorded weekly audits.

  • Staff completed risk assessments on all clients on admission and updated these weekly.

  • We reviewed eight care records and found that they all had an assessment completed on admission.

  • The service registered any clients with physical health concerns with the local GP surgery for ongoing monitoring and treatment. This included blood borne virus testing and vaccination.

  • The service offered a weekly aftercare group for up to a year after leaving treatment and telephone calls to those clients who were not able to attend the group.

  • Client feedback was positive, with clients feeling cared for and supported in their recovery.

  • Clients were involved in setting their care plan goals and were all offered a copy of their care plan.

  • Managers held weekly governance meetings to review audits outcomes, incidents and complaints.

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

  • The detoxification policy did not specify how regularly observations should take place on clients during detoxification, and we saw a record where no observations had taken place for 18 hours.

  • The policy for detoxification did not match practice, with staff implementing a standard alcohol detoxification regime for clients that did not reflect their clinical alcohol withdrawal scale score.

  • The service did not offer Naloxone to clients who used opiates on discharge from treatment. Naloxone is an opioid antagonist that provides short-term reversal of an opiate overdose.

  • The service did not provide supervision for the non-medical prescribers. However, they had recently recruited a consultant to provide supervision.

22nd August 2017

During a routine inspection

We do not currently rate independent standalone substance misuse services.

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

  • Managers had not fully addressed the previous requirement and warning notices issued by the Care Quality Commission. This meant that the service remained in breach of regulations and was not delivering safe care and treatment in regards to medication.

  • The service’s pre-admission process did not include a full assessment of the client’s physical health. Staff told us that they asked clients to bring a health summary from their GP on admission but that not all clients arrived with the documentation. The service did not contact GPs to request healthcare summaries and staff did not record summaries in client notes.

  • The non-medical prescribers did not monitor clients’ physical health during detox as recommended by the ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management (2017). The service did not offer staff any training in how to undertake observations for clients who were on detoxification programmes.

  • Serious health concerns had arisen during client’s detoxification and the service had not monitored the clients fully or followed up on these concerns.

  • Senior staff were not aware of the latest guidance issued as ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management (2017). A copy was not available in the service.

  • Care and treatment records did not contain individualised risk assessments or harm reduction plans. Care plans were not holistic and did not include actions to address physical health needs, relationship and social needs or financial concerns including debt management.

  • Managers did not seek references from previous employers prior to staff starting work at the service or conduct risk assessments on staff with previous criminal convictions.

  • Staff had not received management supervision on a monthly basis in line with service policy.

However we found the following areas of good practice:

  • The service provided a variety of treatment, including structured group sessions and one to one sessions.

  • The service offered access to mutual aid support groups.

  • The service had a peer buddy system. This enabled clients to support each other through treatment.

  • Senior managers worked at the service and delivered group sessions, attended meetings and worked some of the sleep in shifts. All staff knew who the management were and said that they were approachable.

30 January 2017 IMS3

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

We found the following issues the provider needs to improve:

  • The service did not prescribe medication in a safe way. Staff did not re-assess one clients medication following a break and did not always establish dependency before the medication was re-started. Staff did not follow best practise guidance. Staff did not record that the consultation with the prescriber took place before re-starting medication.

  • Staff did not update risk assessments when risk to clients changed. Staff did not transfer risks identified at initial assessment to the initial risk assessment. Staff did not routinely re-assess risk during treatment.

  • The safeguarding lead for the service had completed basic safeguarding awareness training which posed a risk that they did not have sufficient knowledge for their role.

  • Information was missing from client records and staff files. Staff did not record if clients were able to safely manage any physical health conditions.

  • Managers did not complete appropriate checks to determine that staff were safe to transport clients to appointments.

  • Managers did not have a clear definition between the roles of volunteers and peer mentors and the responsibilities of each role.

However, we also found the following areas of good practice:

  • Staff took part in regular handovers to discuss client care and treatment.

  • Managers provided staff with up to date safeguarding and medicines administration training. Managers had addressed infection control issues raised from the last inspection.

  • Clients said they felt safe at the service and that staff listened to them and treated them as individuals.

  • Staff reported good morale and were committed to supporting clients in recovery.

04 October 2016 IMS3

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 adequate medical cover. at the time of inspection, the service employed one nurse prescriber to prescribe medication for detoxification and to provide advanced guidance to all staff.

  • The service did not communicate regularly with the clients’ GPs about medications prescribed. They did not request historical medication information that may have been relevant to a client’s treatment or risk assessment. Staff did not request GP notes or share information with the clients GPs relating to treatment. Staff wrote in clients notes if they had visited the GP and gave an update to the non-medical prescriber of any changes to other medication. However, staff kept client notes separate from their files and medical charts. This meant staff could not access all information about a client easily.

  • Staff did not carry out correct procedures with the storage, administration and disposal of medicines. Staff did not log or audit medication. There was no medication fridge. Staff and the prescriber wrote extra notes on the medication records that meant the charts were disorganised and unclear.

  • There were no hand hygiene facilities in the clinic room, the site did not have any clinical waste bins to dispose of clinical waste appropriately

  • Staff did not update clients’ notes regularly. Staff did not record on clients’ risk assessments what clients and staff could do to prevent or eliminate risks to clients. Staff did not update risk assessments during treatment.

  • Managers did not have an effective way to communicate messages across the team. Staff did not complete daily handovers. Staff did not have opportunity to debrief after an incident and if there had been lessons learnt, managers did not share these among the team. There were no full team meetings.

  • Two members of staff did not have a disclosure and barring certificate, managers had not risk assessed these individuals, both had client contact.

However, we also found the following areas of good practice:

  • The accommodation was clean and tidy both at the main site and in the separate house. Clients had full use of the lounge, kitchen and garden. The garden at the Recovery Hub Ipswich was well maintained and had several projects that client’s had worked on.

  • Staff discussed with clients harm minimisation and the risk of overdose if or when they left treatment. All files contained a signed document explaining these risks.

  • We observed, appropriate and respectful interactions between staff and clients. Staff felt passionate about their roles. Clients told us they felt they had always been treated with respect, staff had been available to support them through the day and night.

  • Clients could request for a family visit whilst engaging in treatment. There was a large open area designated for children and families to visit.

  • There was a variety of structured group sessions, one to one sessions and meetings. Staff provided a range of activities for the evenings and weekends.