The Care Quality Commission
  • Residential substance misuse service

Archived: Haywain Barn Also known as Regain Recovery

Overall: Good read more about inspection ratings

Barton Court, Barton Road, Buckland Brewer, Bideford, Devon, EX39 5LN (01237) 451526

Provided and run by:
TCH Therapy Services Limited

All Inspections

3 – 4 December 2018

During a routine inspection

We rated Haywain Barn as good overall because:

  • Staff managed alcohol detoxification safely in line with national guidance. Staff used and completed nationally recognised assessment tools. Clients had the necessary blood tests taken prior to commencing a detoxification regime. The doctor assessed all patients prior to the start of their detoxification regime and during the detoxification. Staff used the clinical institute withdrawal assessment of alcohol scale (CIWA-Ar) to identify and monitor withdrawal symptoms. Staff acted promptly by monitoring and administrating medication as required in such instances.
  • The service was completing relevant health and safety checks and had records in place to demonstrate this. The service had completed comprehensive environmental risk assessments. The provider had employed an external company to conduct a ligature audit of the service and planned to use the findings to improve the service’s ligature risk assessment. Although the service did not take clients who were at high risk of ligaturing, the management team recognised that client risk levels can change during treatment.
  • Staff completed risk assessments for all clients. These were completed at pre-admission, on admission and reviewed weekly with clients.
  • Client records contained a comprehensive assessment. Staff developed recovery plans that met the needs identified during assessment. Therapy staff completed person-centred treatment plans with all clients shortly after admission. Treatment and recovery plans contained client’s goals and aims for treatment and were reviewed weekly with clients.
  • There were very few blanket restrictions place on clients and those in place were clearly justified and understood by the clients. Staff supported clients to maintain contact with their families. Clients had access to their mobile phones and were not restricted in their use so they could maintain contact with families and friends. The service encouraged family to engage with the service and held weekend family days for family to get to know the service.
  • Staff, together with clients, developed discharge plans that included a crisis plan and an unplanned discharge plan. Clients were provided with information on the risks of leaving detoxification early. Clients discussed discharge in weekly sessions and those nearing discharge had a final discharge plan detailing where they were going and what aftercare they would receive from the service. The service provided clients with an aftercare programme following discharge. Clients typically received four follow-up calls to ensure the treatment the client received remained effective and staff provided support to clients when needed.
  • There was a positive and supportive culture within the organisation. Staff told us that senior members of the organisation were approachable and supportive. Staff told us that the manager was passionate about the service and felt supported by the service nurse.

However:

  • There were no formal arrangements in place to cover the service if the nurse and service GP went on leave. The nurse was not receiving formal clinical or peer supervision.
  • The provider did not use recognised outcome tools to determine the effectiveness of treatment. For example, by using the Treatment outcomes profile (TOP) or the Alcohol outcomes record (AOR).

26 July 2018

During an inspection looking at part of the service

Our last inspection of Haywain Barn was in April 2018 which was an unannounced, focused inspection to check that the provider had made all the improvements we required it to make following the comprehensive inspection in August 2017.

During the inspection in April 2018, we found the provider was not meeting the required standard of care set out in Regulation 12, safe care and treatment, of the Health and Social Care Act, 2008. We took enforcement action and issued a warning notice in May 2018.

We told the provider they must comply with the requirements of the regulation by 2 July 2018.

We carried out an unannounced, focused inspection on 26 July 2018 to check whether the provider had made the required improvements. We found that the provider had met the requirements of the warning notice and was now delivering safe care and treatment as required by Regulation 12.

24 April 2018

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Haywain Barn was in August 2017. At that inspection, we issued seven requirement notices. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards.

We inspected Haywain Barn in April 2018 to review the work the provider had told us they had undertaken to address the requirement notices.

We found that the provider had not met the requirements for regulation 9 person-centred care, regulation 12 safe care and treatment, regulation 17 good governance and regulation 18 staffing.

However:

We found that the provider had met the requirements for regulation 13 safeguarding service users from abuse and improper treatment, regulation 16 receiving and acting on complaints and regulation 11 need for consent.

2 - 3 August 2-17

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:

  • There was a lack of governance and leadership to ensure the quality and safety of the service and environment. For example, there was a lack of oversight of medicines management. The provider did not have a full schedule of environmental risk assessments and checks and therefore they did not properly mitigate against risks.
  • Staff had not completed essential training and their competence to do their job had not been assessed. Staffed had not received training in working with clients who misuse substances and therefore were not always able to identify the risks to clients’ physical and mental health. Staff had not completed training in risk assessment, care planning and record keeping and the provider did not audit care records to ensure risk assessments and care plans were being completed fully. In addition, staff had not been formally assessed to see if they were competent to undertake medicines tasks and there were some inaccuracies or omissions in medicines administration records such as missing stop dates for medicines. People’s allergies to medicines were clearly recorded on admission forms and medicines administration records.
  • There were no nurses on site and no qualified clinical staff visited the service. The service did not provide physical and mental health monitoring and there were no arrangements with local GPs to monitor mental and physical health.
  • When prescribing for clients, the service did not always ensure prescribing was safe by obtaining background information about clients’ medical history and prescribing did not follow national good practice guidelines.
  • There was no procedure for staff to follow in case of a medical emergency. Staff had not been trained to carry out first aid or cardio-pulmonary resuscitation. The service did not hold or prescribe emergency medicines to respond to medical emergencies such as seizures, which can occur during detoxification.
  • Staff completed risk assessments of clients that covered physical and mental health and wellbeing but risk assessments lacked information. There was a lack of active planning or monitoring to support clients with the risks identified.
  • However, we also found the following areas of good practice:
  • The service was clean throughout and there were good facilities for clients to relax and exercise. There was a treatment room with safe storage for medicines.
  • The provider offered a range of therapies recommended in the Department of Health’s ‘drug misuse and dependence UK guidelines on clinical management’.
  • Supervision arrangements were in place for all staff groups.
  • Staff were kind, compassionate, supportive and respectful to clients. Staff enabled clients’ families and carers to be involved in their care if the client wished.
  • Staff offered good follow up care to clients and supported clients to arrange where they would go and what they would do after their discharge to give them the best chance of remaining abstinent.
  • Staff organised a good range of activities for clients.
  • Staff said team relationships were supportive and they had good job satisfaction.

Following our inspection, we discussed our concerns with the provider. The provider recognised that the service it was providing was not safe for service users who required detoxification and voluntarily agreed to stop admitting service users who required detoxification immediately. Following the inspection we wrote to the provider setting out what action we would take if the provider broke the voluntary suspension on admissions for clients requiring detoxification. We told the provider it must submit an action plan detailing how it would make improvements in a timely manner. The provider sent us an action plan following the inspection highlighting the improvements it would make. The provider was keen to provide a good quality, safe service and was keen to ensure it took the required action needed to improve services. The provider made improvements to the service and we told them we would approve them admitting new clients for detoxification on 19th September 2017.