No 4

Updated 11 May 2020

No 4 is a three-bedded unit based in a mews house in Kensington. It is run by PROMIS clinics, which has two other services on the same street called No 11 and No 12. While the three are registered separately, they operate as one service with the same manager and the same staff covering the three locations. We completed one inspection which reviewed all three registered locations and wrote three separate inspection reports.

Clients in the three services use the same communal areas in No 11, including a kitchen and a living room. The clinic room for the three services is in No 11. There are some therapy rooms, which are used by clients across the services, in No 12.

The service provides medically monitored alcohol and medically monitored drug detoxification which also included a psychological therapy programme.

A registered manager was in place for the service.

The service is registered to provide the following regulated activities:

• Accommodation for persons who require treatment for substance misuse
• Treatment for disease, disorder and illness

No 4 was first registered with CQC in June 2016. We have inspected No 4, three times since June 2016 (August 2017, May 2019 and October 2019). All inspections of No 4 have been carried out simultaneously with an inspection of No 11 and No 12.

At the time of our inspection, there were no clients in residence at No 4.

We undertook an unannounced inspection of No 4, No 11 and No 12 in May 2019. This inspection identified concerns about safety and quality of the service which put clients at risk of harm. The service was rated as inadequate overall and was placed into special measures. We also took enforcement action against the provider and issued warning notices in relation to regulation 12, Safe Care and Treatment and regulation 17, Good Governance. Following the inspection in May 2019, the service made the decision to not admit any clients for alcohol detoxification who had a history of alcohol withdrawal seizures and delirium tremens.

We undertook an unannounced focused inspection of No 4 in October 2019 where we looked at the progress the provider had made in addressing breaches identified in the warning notice made as a result of our inspection in May 2019 in respect of Regulation 12, Safe Care and Treatment and Regulation 17, Good governance. We did not rate the service as a result of this inspection.We saw that significant improvements had been made to ensure that clients received safe care and treatment however further work was needed to strengthen and embed governance systems.

Updated 11 May 2020

At a previous inspection in May 2019, we identified concerns about safety and quality of the service which put clients at risk of harm. The service was rated as inadequate overall and was placed into special measures. Following the inspection in May 2019, the service made the decision to not admit any clients for alcohol detoxification who had a history of alcohol withdrawal seizures and delirium tremens.

During this inspection our rating of the service improved. We rated each domain as good and the service overall as good. As a result of this inspection, the service was removed from special measures.

We rated No 4 as good because:

• The service provided safe care. The clinical premises where clients were seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
• Staff treated clients with compassion and kindness, and understood the individual needs of clients. They actively involved clients in decisions and care planning.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
• The service was well-led and leaders had the skills, knowledge and experience to perform their roles.

However:

• Forty-five percent of clients using the service did not give permission for the provider to obtain or share information from their GP. Whilst the service had measures in place to mitigate the risks associated with this, they recognised that to improve the overall safety of the service further work was needed.
• The provider did not have a system in place for staff to raise an alarm from within the clinic room in an emergency.
• Further work was needed to strengthen the providers audit programme to ensure that outcomes were consistently rated across the range of measures used and that the sample included clients who had completed each of the various treatment pathways.
• The provider had recently strengthened its governance systems. Further work was needed to ensure that these were embedded and sufficiently robust to drive quality, safety and improvement in the service.