Nest Healthcare

Updated 31 January 2024

Nest Healthcare is a residential service located in Clacton-on-Sea, Essex that provides rehabilitation for mental health and substance misuse. The service has five beds. At the time of the inspection there were 4 service users staying at the service.

The service has been registered with the Care Quality Commission since January 2017.

The service is registered to provider the following regulated activities:

• Accommodation for persons who require nursing or personal care.

• Accommodation for persons who require treatment for substance misuse.

• Treatment of disease, disorder, or injury

The service has a registered manager and nominated Individual.

This was our second inspection of the service. We conducted this inspection to follow up our previous concerns found during the first inspection of Nest Healthcare, conducted between 28 July - 6 September 2022.

During our previous inspection of Nest Healthcare, we issued the provider with requirement notices against Regulation 12 Safe care and treatment and Regulation 17 Good governance. We asked the provider to act, to make improvements and keep service users safe from harm. The service was rated Inadequate.

During this follow up inspection, we checked to see if the provider had made the required improvements. Following inspection we issued a Letter of Intent to the provider, as they had not made the improvements required to keep service users safe from harm. The provider was asked to respond to the issues raised and provide an action plan indicating that appropriate action has and will be taken to mitigate risk. Following inspection, the provider voluntarily decided to temporarily cease admissions whilst they improved the quality of staff training and their governance processes.

Following submission of the providers action plan, the initial action plan and documents submitted were reviewed but did not provide us with assurances that appropriate action had been taken to reduce the risk of harm to people using the service. Further information was requested and submitted but this still did not provide the assurance needed. Following review of the action plan and documents, we were not assured that safety was addressed and so issued further urgent enforcement action to impose conditions on registration.

The overall rating for this service is 'Inadequate' and the service is therefore placed in 'special measures'. Full information about CQC's regulatory response to the serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

What people who use the service say

We spoke with two people who were using the service. Overall, the feedback we received from people staying at the service was positive. Clients said the service was comfortable and clean and they felt safe. Clients felt that staff treated them with kindness and respect, and they could ask for help when they needed it.

The team that inspected the service included two CQC inspectors, one CQC medicines inspector, and one specialist advisor with experience of working in substance misuse.

Before the inspection visit, we reviewed information that we held about the location. During the inspection visit, the inspection team:

• visited the service and looked at the quality of the environment.

• spoke with two clients who were using the service.

• spoke with three staff members: including the manager and support workers.

• reviewed six care and treatment records of patients; and

• carried out a specific check of the medication management.

You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 31 January 2024

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

• The service did not provide safe care. The service did not have a full ligature risk assessment in place.

• The mandatory training programme was not comprehensive and did not meet the needs of clients and staff.

• The service did not assess and manage risk well. Staff did not complete thorough risk assessments for each client on admission. Risk assessments were not regularly updated. Staff did not assess risks including the risk of early exit from treatment and did not complete risk management plans.

• The service did not use information from other agencies to support client’s treatment. Information from GP’s and others was not used as part of the decision-making process to admit service users or to manage any ongoing risks.

• Audit processes were not in place to ensure that observations were being carried out in line with the providers policy. Staff did not take part in regular audits, benchmarking, and quality improvement initiatives to evaluate the effectiveness of the service they provided.

• Staff did not follow systems and processes to prescribe and administer medicines safely. Staff did not review each client’s medicines regularly or provide advice to clients about their medicines. Staff did not complete medicines records accurately. Staff did not store and manage all medicines and prescribing documents safely. National practice was not followed to check clients had the correct medicines when they were admitted. Staff did not recognise and report medicines incidents and there was no learning taking place to improve practice.

• The blood pressure machine and alcometer (used to measure level of alcohol in breath) had not been calibrated.

• Incidents had not been reviewed or thoroughly investigated by competent staff. Incidents and learning from incidents were not discussed at multidisciplinary team meetings or clinical governance meetings.

• Staff did not develop a comprehensive recovery plan for each client that met their substance misuse, mental health, and physical health needs.

• Staff did not use recognised rating scales to assess and record the severity of clients' conditions and care and treatment outcomes.

• The service did not have a clear admission and exclusion criteria. Pre-admission assessments lacked specific detail. Information was missing prior to admission that would have supported risk assessment and recovery planning.

• Leaders failed to implement safe systems and processes to provide safe and good quality care to clients accessing the service.

• The governance system was not structured. Individual elements, such as audits, training and learning from incidents were not collated into overarching systems so that performance, themes, and trends could be monitored and proactively addressed.

However:

• The service was clean, well-furnished, and fit for purpose.

• The service had enough staff to provide care for clients.

• Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.

Action the service MUST take is necessary to comply with its legal obligations. Action a trust SHOULD take is because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall, to prevent it failing to comply with legal requirements in future, or to improve services.

Action the service MUST take to improve:

• The service must ensure staff develop a comprehensive recovery plan for each client that meets their substance misuse, mental health, and physical health needs. (Reg 9)

• The service must ensure thorough risk assessments are completed for each client on admission, are updated regularly and include the risk of early exit from treatment and risk management plans. (Reg 12)

• The service must ensure information from the clients GP is used as part of the decision-making process to admit clients. (Reg 12)

• The service must ensure staff follow systems and processes to prescribe and administer medicines safely. (Reg 12)

• The provider must ensure that equipment is appropriately maintained and calibrated. (Reg 12)

• The service must ensure staff review each client’s medicines regularly. (Reg 12)

• The service must ensure staff store and manage all medicines and prescribing documents safely. (Reg 12)

• The service must ensure staff report medicines incidents. (Reg 12)

• The service must ensure incidents are reviewed, investigated and learning is identified. (Reg 12)

• The service must ensure that recognised rating scales are used to assess and record the severity of clients' conditions and care and treatment outcomes. (Reg 12)

• The service must ensure that comprehensive pre-admission assessments are completed. (Reg 12)

• The service must have naloxone in stock to reverse the effects of an opiate overdose. (Reg 12)

• The service must ensure that they have clear admissions criteria in place. (Reg 17)

• The service must ensure that governance systems and process including audits are in place. (Reg 17)

• The service must ensure it has a comprehensive ligature risk assessment and ligature risk management plan in place. (Reg 17)

• The service must ensure its mandatory training programme is comprehensive and meets needs of clients and staff. (Reg 18)

Updated 4 January 2023

Nest Healthcare is a residential service located in Clacton-on-Sea, Essex that provides rehabilitation for mental health and substance misuse

This was our first inspection of Nest Healthcare. We rated it as inadequate because:

• Staff had not received basic mandatory training with overall training compliance at 31%. No staff had completed basic life support training at the time of inspection so could not provide immediate assistance if a client became unwell.
• Staff had not completed medicines administration training and did not record full details of medicines administered. There were no audits of medicines records, so errors had not been identified.
• Staff did not have access to clinical records as client risk assessments and care plans were stored on an electronic system that they did not have access to.
• The service had not completed an assessment of potential ligature risk points despite there being several points where someone could tie a ligature in order to harm themselves.
• Staff prepared meals for clients without having any training in food hygiene.
• The service did not have governance systems and processes in place and did not assess or audit the quality and safety of the service. The service did not hold clinical governance meetings or have any structure for clinical governance.

However:

• The service was clean, well-furnished and fit for purpose.
• The service had enough staff to provide care for clients.
• Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapies and physical healthcare.
• Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which were personalised, holistic and recovery oriented.
• Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.
• Staff planned and managed discharge well. The service provided aftercare for clients post discharge and signposted clients into local services where required.