Nest Healthcare

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of regulation for safe care and treatment as there were issues with the quality of risk assessments and how staff managed medicines.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We scored the service as 2. The evidence showed some shortfalls. They did not always manage or monitor people’s safety.

Some people told us there was a lack of conversation with the service prior to their admission. They felt there was a missed opportunity to discuss their risks and their treatment needs before arriving to start.  

People’s records did not include information on what to do if someone left treatment early or in an unexpected way. This was a breach identified at the last assessment and had not been addressed or resolved by the service. Leaders described this as a ‘work in progress’. Staff told us protocol said that people could leave following a discussion with management.  

The service expected staff to read people’s admission record prior to them arriving for treatment. All 5 people using the service had taken part in a pre-admission assessment. The assessment looked at different areas of their life, including substance misuse, family and relationships and health.  

The service had an admission policy which listed what would make someone unsuitable for treatment. Staff knew this policy and were able to give examples of why someone may be too high risk for treatment in the service.   

The service had admitted patients following permission from the CQC in line with the conditions placed on their registration, at the last inspection.  

The service had agreements in place with local organisations, including mutual aid groups, local community substance misuse services and the local authority. 

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People did not feel their risks were well supported and they did not feel involved in their risk assessments.  People felt the service did not have a personalised approach to treatment and was a lack of individualised treatment. People felt they prescribed medications to everyone in the same way and did not consider what might be best for the person.  

The content of people’s files was not consistent. Not all files contained risk assessments or assessment information that may support staff to keep people safe. Risk assessments were provided after the site visit and were kept electronically. Client risk assessment templates included risks to self and others, indicated the need for review and the opportunity to personalise the assessment. Staff assessed risk on admission.  

The service managed client safety and risk where there was mixed sex accommodation. The service had separate bathroom facilities and clients could lock their bedroom doors. 

The provider had processes in place to manage emergencies and had access to a car to transport clients to medical appointments. A manager made themselves available on call 24/7 and a staff could contact a medic if required.  

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People said that facilities and equipment met their needs overall.

Staff kept the premises clean and recorded cleaning daily. Staff followed infection control policy, including washing their hands.

All areas were clean, well maintained, well-furnished and fit for purpose.  

Gas, electrical and fire safety certificates showed appropriate checks had been completed.

All equipment had been PAT (portable appliance testing) tested to ensure it was safe to use.  

The service’s environmental risk assessment was not completed in full. Whilst the service did record mitigation's to reduce risk they had not assessed and graded the severity of the risks in the building. It was not possible to determine what risks were present and which were not by looking at the risk assessment. Out of 7 peoples files we reviewed, only one contained an individual self-harm risk assessment. The self-harm risk assessment indicated if the environment may pose a risk to someone with suicidal thoughts or thoughts of self-harm.

Staff knew what to do and who to contact if there were equipment failures or issues with utilities.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

People told us they did not see a doctor as much as they would like to. They knew about the medication they were receiving but people felt they were all prescribed the same level of medication and that their individual circumstances were not considered. Some people felt they were on too much medication, whilst others talked about not being on a high enough dose to be comfortable to manage their withdrawal symptoms, particularly when they started their detoxification.  Staff told us the Doctor saw people once a week and could be seen more frequently if needed.

We looked at all 5 medication records for the people using the service. Staff recorded information such as allergies and dates of birth. One record stated a person’s health condition as ‘substance misuse’ but showed a prescription for mental health medication and medication for a physical health condition. There was no reference to either condition on the record. One record showed a person had refused medication for multiple days but did not record the reason for this. Staff had also returned unused medication to an open blister pack when the person refused, despite the medication being signed as given.  

The providers admission and exclusion policy was clear that clients deemed as high risk would not be accepted for treatment.  

Equipment required to support people undergoing detoxification was stored in the manager’s office. It was calibrated and well maintained.  

Staff used SADQ (severity of alcohol dependence audit questionnaire) and Clinical Institute Withdrawal Assessment for Alcohol, (CIWA-Ar) scales to assess people’s detoxification. Staff stored medicines appropriately and maintained an accurate controlled drugs book. The service had naloxone on the premises to reverse the effects of opiates in the event of an overdose.