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Inspection Summary


Overall summary & rating

Good

Updated 18 December 2018

We rated Chelmsford as good because:

  • The service was clean and tidy and furnishings were of good quality. The clinic room was clean and well organized. Emergency equipment was in date, regularly tested and ready for use. There were enough rooms for clients to use for groups and therapy.
  • The service had developed protocols for opiate and alcohol detoxification. The doctor and registered nurse completed medical assessments for all clients on the day of admission, including physical health checks, to ensure they were suitable for the detoxification programme. Clients who were not suitable for the detoxification programme were signposted to other services. Staff had completed mandatory training including how to support clients undergoing detoxification.
  • The doctor saw all clients on admission and staff could contact the doctor for advice and to visit the service if required, seven days a week and out of hours. Access to the service was quick and easy and there was no waiting list.
  • Staff completed risk assessments and reviewed them regularly. Staff completed assessments which were holistic and focused on discharging clients back to living in the community. Client records contained contingency plans in the event of patients unexpectedly discharging themselves from treatment.
  • The service followed good practice in prescribing medication in line with current guidance and best practice. Staff used recognised treatment outcome measures. There were safe processes in place for the management and administration of medication. Staff were trained in medicines management and administered medicines safely.
  • Clients had access to psychological therapies and individual counselling sessions with an identified counsellor. Staff developed care plans with clients and reviewed and updated these regularly.
  • Staff received management supervision in line with the provider’s policy. Therapy staff also received monthly clinical supervision with an external counsellor. Most staff reported that morale was good and they felt respected and supported.
  • Staff treated clients with kindness, compassion and respect, showed an understanding of their needs and offered appropriate emotional support. Staff helped clients understand their condition and treatment and access specialist services where appropriate. Clients told us staff were caring and kind and genuinely interested in their wellbeing. Clients were involved in their care, reviewed their plans with staff weekly.
  • Clients told us that staff listened when they raised concerns and took action to resolve them. Staff discussed client requests at the daily handover meetings and agreed what actions they would take. Staff supported clients to maintain contact with their families and with outside agencies such as fellowship meetings, housing, education and employment.

However:

  • The ligature risk audit classified all ligature risks as low, including in areas where clients had unsupervised access, and identified no additional control measures. There was no sink or facilities to dispose of waste water in the clinic room. Staff used urine testing equipment in the toilet area.
  • Numbers of therapy staff at the centre had decreased since the last inspection. The provider had introduced a rota to provide additional staff to the detoxification house but had not recruited additional therapy staff to facilitate this.
  • Staff did not document that clients received copies of their care plan and three of the six care plans we looked at did not record client views or involvement.
  • Managers had not ensured that learning took place consistently in relation to all incidents and complaints. Documentation was inconsistent, lacked detail and was sometimes contradictory. Managers had not ensured that staff had reported medication administration errors as incidents and shared learning about this across the service.
  • Mental Capacity Act training was brief. Two staff told us they had not received any training in the Mental Capacity Act. Some staff were not aware of policies in relation to lone working and the management of seizures.
  • The service did not admit people with mobility issues to the detoxification programme. Although the centre could accommodate people with mobility difficulties, all bedrooms at the detoxification house were upstairs and there were no lifts.
  • Managers did not have easy access to information to monitor the quality of the service and did not have performance indicators to highlight strengths and risks.
Inspection areas

Safe

Good

Updated 18 December 2018

We rated safe as good because:

  • The service was clean and tidy and furnishings were of good quality. The clinic room was clean and well organized. Emergency equipment was in date, regularly tested and ready for use. This included naloxone, used to reverse the effects of opioids, and a defibrillator.

  • There were safe processes in place for the management and administration of medication. Staff were trained in medicines management and administered medicines safely.

  • The service had developed protocols for opiate and alcohol detoxification. Staff had completed mandatory training including how to support clients undergoing detoxification.

  • The doctor saw all clients on admission. Staff could contact the doctor for advice and to visit the service if required, seven days a week and out of hours.

  • Staff completed risk assessments and reviewed them regularly. Client records contained contingency plans in the event of patients unexpectedly discharging themselves from treatment.

However:

  • Numbers of therapy staff at the centre had decreased since the last inspection. The provider had introduced a rota to provide additional staff to the detoxification house but had not recruited additional therapy staff to facilitate this.

  • Staff not attending team meetings did not get access to learning from incidents and complaints. Documentation was poor and sometimes contradictory.

  • Some staff were not aware of policies in relation to lone working and the management of seizures.

  • There was no sink or facilities to dispose of waste water in the clinic room. Where staff needed to use urine testing equipment, they did this in the toilet area. Staff washed their hands in the sink in the adjacent toilet or used hand gels when preparing medicines. Staff wore disposable gloves and washed their hands immediately prior to dispensing medication.

  • Staff had not reported medication administration errors as incidents; we did not see evidence that staff had addressed these and that learning had taken place across the service.

Effective

Good

Updated 18 December 2018

We rated effective as good because:

  • The doctor and registered nurse completed medical assessments for all clients on the day of admission, including physical health checks, to ensure they were suitable for the detoxification programme. Assessments were holistic and focused on discharging clients back to living in the community. The registered nurse oversaw clients on the detoxification programme.

  • The service followed good practice in prescribing medication in line with current guidance and best practice. The doctor managed and reviewed medicines following British National Formulary recommendations. Staff used recognised treatment outcome measures to monitor change and progress for people treated within the service.

  • Clients had access to psychological therapies and individual counselling sessions with an identified counsellor.

  • Staff developed care plans with clients and reviewed and updated these regularly.

  • Staff received management supervision in line with the provider’s policy. Therapy staff also received monthly clinical supervision with an external counsellor in line with policy.

However:

  • Mental Capacity Act training was brief. Two staff told us they had not received any training in the Mental Capacity Act.

Caring

Good

Updated 18 December 2018

We rated caring as good because:

  • Staff treated clients with kindness, compassion and respect.

  • Clients told us staff were caring, kind and genuinely interested in their wellbeing.

  • Clients were involved in their care and reviewed their plans with staff weekly.

  • Staff showed an understanding of clients’ needs and how to respond to feelings of isolation and offered appropriate emotional support.

  • Staff helped clients understand their condition and treatment and access specialist services where appropriate.

  • Clients fed back about the service and made requests through regular community meetings.

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However:

  • Three of the six care plans we looked at did not record client views or involvement.

  • Staff did not document that clients received copies of their care plan.

Responsive

Good

Updated 18 December 2018

We rated responsive as good because:

  • Access to the service was quick and easy. There was no waiting list at the service. Doctors admitted clients with the registered nurse on Tuesdays and Thursdays and outside those hours when needed. The service did not take emergency admissions and did not admit clients during the night. Clients who were not suitable for the detoxification programme were signposted to other services.

  • The service had a range of rooms available for individual therapy sessions, larger groups and quiet rooms where clients could go when needed. Clients could make hot or cold drinks throughout the day at the centre and there was a large communal relaxation area, where clients could eat and drink.

  • Clients had access to a locked area where their possessions could be stored securely.

  • Staff supported clients to maintain contact with their families and with outside agencies such as fellowship meetings, housing, education and employment.

  • Clients told us that staff listened when they raised concerns and took action to resolve them. Staff discussed client requests at the daily handover meetings and agreed what actions they would take.

However:

  • The service had no dedicated outside space. The entrance to the centre was on a busy road and there was no outside space at the back of the building.

  • The service did not admit people with mobility issues to the detoxification programme. Although the centre had disabled access and could accommodate people with mobility difficulties, all bedrooms at the detoxification house were upstairs and there were no lifts.

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Well-led

Requires improvement

Updated 18 December 2018

We rated well led as requires improvement because:

  • The provider had not ensured it had systems and processes in place to monitor the effectiveness of the service. Managers did not have easy access to information and did not have performance indicators to highlight strengths and risks.
  • Managers had not ensured that staff had reported medication administration errors as incidents; we did not see evidence that staff had addressed these and that learning had taken place across the service.
  • The ligature risk audit classified all ligature risks as low, including in areas where clients had unsupervised access such as the toilets. The ligature risk audit identified no additional control measures.
  • Managers had not ensured that the registered nurse received monthly clinical supervision, in line with the providers policy.
  • Managers had not ensured that learning took place consistently in relation to all incidents and complaints. Documentation was inconsistent, lacked detail and was sometimes contradictory. This meant the provider could not ensure learning for staff who could not attend the staff meeting.

However:

  • Most staff reported that morale was good and they felt respected and supported. There had been no unauthorised absences in the previous 12 months.
  • The provider had appointed a new experienced manager. Clients commented on how this had improved the quality of the environment at the service.
  • The provider had appointed a compliance manager to oversee all the provider’s services. The compliance manager had started to introduce performance indicators and was exploring a new electronic system to aid managers to monitor the performance and quality of the team.
  • The provider had responded to clients’ concerns about the support at the detoxification house and introduced a new staffing rota to ensure staff supported clients throughout the week, including weekends.

Checks on specific services

Substance misuse services

Good

Updated 18 December 2018