The Care Quality Commission
  • Community
  • Community substance misuse service

The OAD Clinic

Overall: Good read more about inspection ratings

25a Eccleston Street, London, SW1W 9NP

Provided and run by:
Seagrave Healthcare Ltd

Important: The provider of this service changed. See old profile

All Inspections

11 July 2023

During a routine inspection

Our rating of this location stayed the same. We rated it as good because:

  • Feedback from clients we spoke with was full of praise for the staff at the service. Clients felt listened to, and appropriately supported and said that the service was very flexible in meeting their needs.
  • Staff managed clients’ risks safely and effectively. Staff carried out appropriate physical health checks on clients. Client records addressed potential safeguarding risks and the risk of early exit from the treatment programme.
  • Significant work had been undertaken to reduce the prescriptions of patients who had previously been on very high doses. Medical staff followed best practice guidance when prescribing medicines for clients.
  • Staff provided appropriate care and treatment interventions suitable for clients’ recovery. Interventions addressed reducing harmful or risky behaviours associated with the misuse of drugs, optimising personal physical and mental wellbeing, and achieving personal goals.
  • The staff team was very motivated, appropriately knowledgeable, and qualified. Staff were supported by managers and reported being able to speak up and contribute to the development of the service. They received regular supervision and had opportunities for professional development.
  • The service environment was clean, well maintained, comfortably furnished and welcoming, with appropriate equipment in place.
  • The introduction of quality dashboards for managers to monitor performance within the service was very positive in ensuring a high quality of care for clients.
  • The introduction of the role of medical secretaries was having a positive impact on the service, allowing care coordinators more time on clinical work such as client contact and care planning.

However:

  • Arrangements were not formalised for reviewing the limits of the service’s threshold for managing clients with complex needs. However, we did not find any clients with needs that the service could not support.
  • There was no clear protocol in place for looking at possible learning following the deaths of patients using the service.
  • Induction training for new staff and the content of weekly team meetings was not recorded at the time of the inspection.
  • Some older clients found it challenging to manage the stairs at the service, although they said that they were supported to do so.

12 and 13 March 2019

During a routine inspection

We rated The OAD Clinic as good because:

  • Staff managed clients’ risk safely and effectively. Staff safely carried out appropriate physical health checks on clients. Client records addressed the potential risks of early exit from the treatment programme.
  • Medical staff followed best practice guidance when prescribing medicines for clients.
  • Staff completed risk assessments and recovery plans. minimised the risk to clients and children from abuse and avoidable harm. Staff worked closely with the local safeguarding lead to seek guidance and support.
  • Staff provided appropriate care and treatment interventions suitable for clients’ recovery. The staff team worked with clients to reduce health and other problems directly related to drug misuse. Interventions addressed reducing harmful or risky behaviours associated with the misuse of drugs, optimising personal physical and mental wellbeing and achieving specific personal goals.
  • Staff demonstrated a compassionate understanding of the impact clients’ care and treatment could have on their emotional and social wellbeing and demonstrated an understanding of the needs of people with protected characteristics. Clients were positive about the care they received from staff.
  • Staff actively engaged with GPs, social services as well as other care organisations if necessary. This ensured staff could plan, develop and deliver the service to meet the needs of the clients.
  • The service made sure staff were competent for their specialist roles working in substance misuse. Medical staff received an annual appraisal of their work and performance. The service manager and recovery workers received regular managerial supervision to provide support and monitor the effectiveness of the service.
  • The service was well-led at team level and by the senior leadership team who had the skills, experienced and leadership to lead the team. Staff had access to information they needed to provide safe care and treatment to clients.

However,

  • The service did not store controlled drugs in a controlled drugs cabinet or record the receipt of controlled drugs. Although the controlled drugs were stored in a locked cupboard within a locked room. The medical director and service manager responded promptly to our concerns and took the necessary action.
  • The service had not checked whether staff were up to date with routine vaccinations or advised that they should get vaccinated specifically for hepatitis B on commencing employment
  • Whilst care and treatment was discussed and agreed with clients, this was not systematically recorded in the care planning template
  • The service did not have a policy on the Mental Capacity Act.

20 July to 21 July 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

We undertook this inspection to check the progress the provider had made in addressing the breaches of regulation identified at the previous inspection in March 2017. The regulations breached were regulation 12(safe care and treatment) and regulation 17(good governance). The provider had made improvements in all of the areas we identified at the last inspection.

We found the following areas of improvement since the last inspection:

  • At the March 2017 inspection, we found that the provider did not supervise clients who were prescribed their initial dose of medicine. At the July 2017 inspection, we found that the provider had put plans in place to ensure that clients were supervised whilst taking the first dose of medicine. The service had implemented a new supervised consumption protocol and assessment tool.

  • At the March 2017 inspection, we found that clients did not receive the appropriate physical health checks including regular drug screening. At the July 2017 inspection, we found that clients received comprehensive physical health checks during treatment and clients frequently completed drug screenings.

  • At the March 2017 inspection, staff did not regularly liaise with clients’ individual general practitioners (GPs). At the July 2017 inspection, most clients had agreed for the provider to communicate with their GPs. When clients refused for the service to communicate with their GP liaison, the service commenced a reducing medicine dose regime with a view to discharge them. This was to ensure their safety.

  • At the March 2017 inspection, the provider did not manage medicines safely because the providers systems were disorganised. At the July 2017 inspection, the provider managed medicines safely.The provider had put effective systems in place to ensure that prescription records were maintained.

  • At the March 2017 inspection, staff did not comprehensively assess risks for individual clients. At the July 2017 inspection, staff assessed potential client risks and put risk management plans in place to support them.

  • At the March 2017 inspection, not all clients received regular medical reviews with an appropriately qualified clinician. At the July 2017 inspection, clients received regular medical reviews with the prescribing doctor or the non-medical prescriber (NMP).

  • At the March 2017 inspection, the provider did not have comprehensive policies and procedures in place that covered the care and treatment of clients using a community based substance misuse service. At the July 2017 inspection, the provider had updated the policies, which followed best practice guidance.

  • At the March 2017 inspection, the provider did not have robust systems in place to ensure that the delivery of care and treatment was safe.At the July 2017 inspection, the service had put effective governance systems in place to ensure the quality and safety of the service was assessed and monitored.

  • At the March 2017 inspection, clients did not always have care plans in place that supported their needs. At the July 2017 inspection, clients’ needs were assessed and care planned.

  • At the March 2017 inspection, the service had not updated the training and development policy to reflect the training expectations for all staff. At the July 2017 inspection, the training and development policy clearly outlined the training requirements for all staff.

  • At the March 2017 inspection, the provider did not regularly service and clean medical equipment. At the July 2017 inspection, the service manager had put an effective system in place to ensure that all medical devices was serviced and cleaned regularly.

  • At the March 2017 inspection, staff did not always record when they had carried out psychosocial interventions with clients. At the July 2017 inspection, staff carried out brief interventions with clients and recorded when this had taken place.

  • At the March 2017 inspection, the provider did not document when staff had received an initial work induction. At the July 2017 inspection, the provider had implemented new staff induction forms and recorded when a work induction had been completed.

  • At the March 2017 inspection, clients did not have access to a range of leaflets that informed clients about opening times, or community groups such as alcoholics anonymous. At the July 2017 inspection, clients were able to access a range of leaflets that provided information about treatment and community support networks.

However, we also found the following area for improvement:

  • Whilst the provider had updated and introduced new policies, the supervised consumption assessment tool did not include the assessment of a client’s cognitive abilities and parts of the prescribing policy were not clearly explained.

  • At the March 2017 inspection, the provider had not yet implemented unplanned exit forms. This meant that staff may not understand how to contact or support clients who suddenly exit treatment or disengage with the service. At the July 2017 inspection, this was still the case but the service had a plan of when these forms would be available.

At the last inspection in March 2017, we found that the service was providing unsafe care and treatment. We wrote to the provider expressing our concerns and asked the provider to take immediate action. The provider voluntarily agreed to not admit new clients into the service until the service had improved. After this inspection it was agreed that the provider could start to accept new referrals.

29 March to 31 March 2017

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:

  • Clients were not supervised when commencing the use of prescribed medicines for detoxification after the initial dose.

  • Clients did not all have comprehensive physical health assessments before or during their treatment.

  • Staff did not regularly communicate with clients’ GPs to ensure they were aware of the care and treatment the service provided.

  • The service did not manage medicines safely. The system in place to manage prescription pads was not well organised.

  • Random drug testing did not take place at appropriate intervals.

  • Staff did not comprehensively assess the health and safety risks to clients, despite the service treating high-risk clients.

  • Clients did not always receive regular reviews from an appropriately qualified professional.

  • Clients did not have comprehensive care plans in place.

  • Comprehensive and robust policies and procedures were not fully in place to cover all aspects of the care of clients using a community substance misuse service.

  • The service did not have appropriate governance systems in place that assessed and monitored the quality and safety of the service.

  • Clients did not have access to a range of leaflets to inform them about the types of treatment that are available at the service and other support networks.

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

  • Staff discussed incidents and lessons learned. The service had an effective reporting system in place.

  • Staff received regular clinical and managerial supervision with their line manager.

  • The service reported medicine related incidents to NHS England and carried out medicine audits to ensure that clients were prescribed safe dosages of controlled medicines.

  • The service provided online appointments and an evening clinic once a week for clients who worked or could not always attend the service.

  • Staff ensured that they followed up clients who did not attend appointments or disengaged with the service.

  • The service handled complaints appropriately.

  • Clients we spoke with gave positive feedback about the service and staff. Clients felt their care and treatment met their needs.

  • All staff attended a monthly-integrated governance meeting where staff discussed incidents, complex cases and good practice.

As a result of the safety concerns identified during the inspection, we proposed to impose a condition (Section 31 of the Health and Social Care Act 2008) on the provider unless the provider voluntarily stopped accepting new clients into the service. The provider agreed to not admit new clients into the service until improvements had taken place. We took this action as we believed people using this service might have been exposed to a serious risk of harm.