The Care Quality Commission
  • Residential substance misuse service

Archived: 2nd Stage House

13 Donnybrook Road, Streatham, London, SW16 5AT

Provided and run by:
HOPE Worldwide

Important: This service was previously registered at a different address - see old profile

All Inspections

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. 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. The provider’s management of medicines had improved, the medicine 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 and what staff should do if there was a medicines incident out of hours. Staff no longer stored over the counter medicines. The provider had improved clients’ crisis planning and management, this included plans to minimise the risk of overdose when clients had completed opiate detoxification. The provider ensured safe staffing, they had systems in place to ensure pre-employment checks were carried out and improvements made for compliance with mandatory training. The provider had made improvements to ensure a safe and clean environment, there were improved fire safety procedures in place that clients were aware of and there was an improved system for infection control risk.
  • The provider had made improvements from the issues found at the May 2016 inspection, which related to the effectiveness of the service. At this inspection, the provider ensured 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.

In addition, we found the following areas of good practice:

  • The house was visibly clean and furnishings well maintained. Volunteers completed weekly health and safety checks of the house to ensure the kitchen was clean, fire doors were fit for purpose and the naloxone supply was in date.
  • The provider had a system in place to deal with staff shortages. Staff sickness levels were low and there was no staff turnover in the last 12 months. There was always a manager on call for clients to contact out of hours. The provider had clear systems in place in the event a client had an unplanned exit. Staff demonstrated a sound understanding of safeguarding issues and their responsibilities. Staff used incident-reporting processes appropriately.
  • Staff completed comprehensive admission assessments for clients. 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). There were good working relationships between the staff and volunteers, and good working relationships with external healthcare professionals. Staff and volunteers supported clients to the GP and hospital appointments to support them with physical healthcare needs. Staff received regular supervision.
  • Staff had a good understanding of clients’ recovery and 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. Feedback from clients confirmed that staff treated them well and with compassion.
  • The service offered treatment to clients who had no access to funding through the provision of a bursary. The service offered clients a variety of support and activity groups. The service supported with their spiritual needs. The service had access to an interpreter. Clients knew how to complaint and the service held service user forums for clients to raise concerns.
  • Senior management were visible throughout the service and volunteers and clients said they were approachable. Staff and volunteers enjoyed working at the service and were committed to providing good quality care and support to clients with their substance misuse abstinence. Staff and volunteers were able to feedback on the service and they felt valued. The service had a risk register in place and senior management reviewed it regularly. Staff had access to the equipment and information technology to do their job.

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

  • On this inspection, we found that the provider did not have appropriate systems in place to assess clients’ ability to self-administer their medicines upon their admission to the service. Although the provider had made effective changes to the management of medicines policy and procedures, these had not been fully embedded yet.
  • The service admissions policy did not clearly describe the criteria for accepting a client with complex mental health needs.
  • Whilst the service carried out appropriate checks on the environment to ensure client and staff safety, these were not always recorded. Similarly, we saw that for one client a small number of their key working sessions had not been recorded in their care and treatment records.
  • The provider carried out a clinical audit regarding infection control. However, staff did not conduct any other monitoring which meant the provider had not assured themselves of the quality of the service they provided for client. The provider had recently introduced measures to identify treatment outcomes for clients, which required further embedding into practice.
  • Although the provider reported safeguarding alerts through NHS systems or local council systems, they did not have a policy in place for notifying CQC.

25th - 26th 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
  • The two fire doors were ill-fitting and there were no fire extinguishers in the property.
  • The service did not have an adequate system to check that the residents cleaned the property properly and food hygiene was maintained to a satisfactory standard.
  • The property had three first aid boxes. They contained out of date items and staff had not checked the contents.
  • There were low completions rates of all aspects of mandatory training for volunteers except professional boundaries.
  • The provider did not offer specialist training relevant to the client group. Staff were not provided 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 child safeguarding concerns.
  • Staff did not have a clear understanding of how the principles of the Mental Capacity Act were 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 service had implemented a buddying system for new clients. The system allowed new clients to receive informal support from other clients who were further along  in the recovery programme. This peer support was helpful to new clients. The house had a senior peer, this was a client who was further along in their treatment and was able to offer additional support and guidance.
  • The service 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.
  • The provider had no waiting list and was able to admit clients without delay. The service provided free care and treatment (bursary) beds for clients who could not secure funding for treatment. Clients who successfully completed this aspect of the programme were supported to access the provider’s third stage accommodation or were signposted elsewhere.
  • The service 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.