The Haynes Clinic Limited Also known as Chicksands

We rated The Haynes Clinic as good because:

• 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.
• The team had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team.
• 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 well led, and the governance processes ensured that its procedures ran smoothly.

However:

• Blood pressure and temperature monitoring for one client on a detox regime was not present within their file. This was not in line with The National Institute for Health and Care Excellence guidance which states close monitoring and review is needed.
• The provider’s accommodation was mixed sex. Bathrooms were not designated for males or females and sleeping areas were not separated for males and females.
• The client’s kitchen area at the clinic where clients could make hot drinks was unclean.

We did not rate this inspection. The ratings from the inspection which took place in February 2019 remain the same.

This was a focused, unannounced inspection, to follow up on enforcement action following the warning notice we issued after our last inspection in February 2019.

We also reviewed the providers progress against the requirement notices we issued after our last inspection in February 2019.

We found that the provider had made improvements in the areas identified by the warning notice:

• The provider had updated and amended all policies in May 2019. Policies were in-line with current guidance and national standards.

We found improvements had been made in most areas identified in the requirement notices issued after the February 2019 inspection:

• Maintenance issues identified on our previous inspection visit had been rectified. Fire risk assessments for accommodation houses had been completed by a competent third-party person. Cleaning chemicals were stored in accordance with the Control of Substances Hazardous to Health Regulations 2002.
• Staff had completed individual ligature risk assessments for the treatment centre and accommodation houses.
• Staff completed urine testing in a private area. The service had contracted a clinical waste disposal company to collect and dispose of clinical waste.
• All staff had completed the providers mandatory training. Staff had access to monthly managerial supervision.
• The provider had placed locks on bedroom doors.
• Audits were recorded using a standardised auditing tool.

However, the following areas required further action by the provider:

• The provider had still not notified the Care Quality Commission of an incident we found during our inspection of the service in February 2019. This was rectified during inspection and the provider submitted a notification immediately to the Care Quality Commission.
• Risk assessments did not include plans to manage or mitigate risks.
• Staff supervision records lacked detail and did not have a set agenda of items for discussion.
• Staff were not meeting regularly to ensure the manager had oversight of what actions had been completed and what actions were awaiting completion from the external fire risk assessments.
• The provider did not operate a corporate or local risk register. Governance meetings were not taking place to ensure that any risks were being identified, updated and mitigated.

These issues will continue to be monitored with the provider through future engagement meetings.

We rated Haynes Clinic as requires improvement because:

• The provider’s arrangements of governance oversight were not robust. We found policies were not detailed and did not include current national guidance for staff on how to deliver care. Including the safe guarding policy, infection control, fire, medicines management, duty of candour, supervision, Mental Capacity Act, Equality Act, mandatory training, emergency and business continuity, the control of substances hazardous to health and the complaints policy.

• There was no evidence of learning from incidents. For example, we found an unreported Care Quality Commission notifiable incident were a client drank half a bottle of bleach and was taken to hospital by paramedics. During the inspection we found cleaning chemicals including bleach in the bathrooms and kitchens.

• Ligature risks were not adequately mitigated. We found the ligature risk assessment was generic for all locations and did not identify specific risks. Fire risk assessments were not updated annually. We noted fire risk assessments were completed in 2013 and 2016.

• Client risk assessments did not include risk management strategies.

• There were blanket restrictions in place. Clients were not able to lock their bedroom doors and did not have anywhere secure to store their valuables in their bedroom.

• The provider did not store emergency medications in line with guidance such as Naloxone which is used to reverse the effects of an opioid overdose or an Epi Pen which is used to reverse an allergic reaction.

• We were not assured staff knew and understood the vision and values of the service. We reviewed the vision and values which were honesty, integrity and caring. There was no description detailing what the values meant and how the provider ensured staff applied them in their daily working.

• Maintenance issues were not identified at the at the residential houses. We found splits in the laminate flooring in the hallways and broken kitchen floor tiles.

• Cleaning chemicals were not stored in accordance with the Control of Substances Hazardous to Health Regulations 2002. We found cleaning chemicals including bleach in and disinfectants in the kitchen and bathrooms.

However

• The treatment centre had adequate space for staff to meet with clients. There was a small room where clients were seen on admission and received a physical health check. The service had access to emergency defibrillation equipment which was stored in the staff office and was calibrated and checked regularly. The three accommodation houses and treatment centre were visibly clean.

• Staff had access to individual alarms. Staff told us they were aware of personal safety procedures.

• Mixed gender accommodation at the three houses was managed appropriately.

• The registered manager had established the number of support workers and therapists required to meet the needs of the clients. At the time of inspection there were no staffing vacancies.

• Staff screened client’s physical health observations on admission and regularly reviewed the client’s vital observations during detoxification in line with best practice guidance.

• Clients were given information regarding the service and the detoxification programme and the risks involved in the process. Clients spoken with confirmed this. We saw clients were involved in planning their care. Care and treatment records were recovery focused and based on smart goals. Clients completed life stories and a 12-step recovery booklet that included preparation for discharge.

• We observed staff interacting in a kind and respectful manner throughout the day. Clients told us that staff at the service were supportive. Generally, the staff knew their clients and were aware of their needs. Clients told us they felt supported through the admission process and reported the pre-assessment was thorough.