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Winstone House - Horizon Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 31 May 2019

Following this inspection, we issued a warning notice to the provider in relation to poor safeguarding procedures.

We rated Winstone House - Horizon as requires improvement because:

  • Staff did not follow safeguarding policies and procedures. They did not refer vulnerable clients to the local authority safeguarding team as identified within the safeguarding policy and national guidance. There was routine disregard of standard operating safeguarding procedures. The service had not submitted any notifications to the CQC in relation to safeguarding concerns.

  • Staff had not created recovery plans and risk management plans that included all risks and needs as identified in the clinical assessment and risk assessment. This was an issue that we flagged up at our last inspection. Although some improvements had been made, the recovery plans and risk management plans were still not as good as they should have been.
  • The managers had not ensured that all staff had received appraisals within the last 12 months. The service had ensured that all staff would have completed appraisals by February 2019. This meant that all staff would have been appraised within a 14 month timeframe.

However:

  • The facilities and environment were spacious and clean. There were enough rooms to see clients and hold group sessions.
  • Staffing levels were sufficient to meet the needs of clients. All staff had completed mandatory training. Staff received regular supervision. Managers understood the service well and provided clinical leadership to staff.
  • The service targeted vulnerable groups and offered specific support to meet their needs. This included clients who were homeless or pregnant. There was a plan to run a clinic for people with chronic obstructive pulmonary disease who used the service.
  • There was a range of interventions to support recovery. There were interventions aimed at maintaining and improving clients’ social networks, employment and educational opportunities. Family and community relationships were promoted. The service had a separate pathway for clients who had achieved abstinence. Support was specific to maintaining recovery.
  • Staff demonstrated a compassionate approach to understanding clients’ needs. Clients described feeling involved in their care and treatment decisions.
  • The service was flexible to meet the needs of clients who had caring or employment commitments. Referrals were accepted and encouraged from a wide range of organisations. The service was responsive to feedback from patients, staff and external agencies.
Inspection areas

Safe

Inadequate

Updated 31 May 2019

We rated safe as inadequate because:

  • Staff did not follow safeguarding policies and procedures. They did not refer vulnerable clients to the local authority safeguarding team as identified within the safeguarding policy and national guidance. There was routine disregard of standard operating safeguarding procedures. The service had not submitted any safeguarding notifications to the CQC.

  • Staff had not created recovery plans and risk management plans that included all risks and needs as identified in the clinical assessment and risk assessment. This was an issue that we flagged up at our last inspection. Although some improvements had been made, the recovery plans and risk management plans were still not as good as they should have been.

However:

  • The facilities and environment were spacious and clean. Clinic rooms were well equipped with the necessary equipment to carry out physical examinations.
  • Staffing levels were sufficient to meet the needs of clients. The service utilised skilled agency staff during times of recruitment shortages.
  • All mandatory training had been completed by all staff.
  • Chronic obstructive pulmonary disease clinics were being developed in partnership with other agencies. There was a plan to provide chronic obstructive pulmonary disease clinics within the service.

Effective

Good

Updated 31 May 2019

We rated effective as good because:

  • Recovery plans had much improved. Information was more detailed and there was evidence of client input. With a few exceptions, recovery plans now included most of the clients’ needs as identified in the assessment.

  • There was a range of interventions to support recovery. This included employment support and psychological therapies.

  • Staff received regular supervision and felt supported by senior staff members.

  • Discharge support was available for clients who no longer needed care and treatment from Winstone House. The service had a separate pathway for clients who had achieved abstinence. Support was specific to maintaining recovery.

However:

  • Not all staff had received appraisals within the last 12 months. The service had ensured that all staff would have completed appraisals by February 2019. This meant that all staff would have been appraised within 14 months.

Caring

Good

Updated 31 May 2019

We rated caring as good because:

  • Staff demonstrated a compassionate approach to understanding clients’ needs. Staff showed positive and professional attitudes towards clients.
  • Clients described feeling involved in their care and treatment decisions.
  • There were interventions aimed at maintaining and improving clients’ social networks, employment and educational opportunities. Clients were encouraged to attend community resources.

Responsive

Good

Updated 31 May 2019

We rated responsive as good because:

  • Referrals were accepted and encouraged from a wide range of organisations.
  • The service was flexible to meet the needs of clients with caring or employment commitments. Evening appointments were regularly offered.
  • Vulnerable groups were targeted and offered specific support to meet their needs. This included clients who were homeless or pregnant.
  • There was a formal discharge pathway for clients who had achieved abstinence.
  • The facilities were sufficient to promote recovery, comfort, dignity and confidentiality. There were enough rooms to see clients and hold group sessions.
  • Family and community relationships were promoted. A family support worker delivered group and individual family and carer interventions. Staff were due to be trained in mediation skills.

Well-led

Requires improvement

Updated 31 May 2019

We rated well-led as requires improvement because:

  • Although we found the service was largely well led, it did not meet legal requirements relating to safeguarding procedures, meaning we could not rate well-led higher than requires improvement.

  • The governance structure did not identify that safeguarding processes were not being followed. This meant that the local authority was not able to investigate safeguarding concerns. The provider did not notify the care quality commission of safeguarding concerns as per guidance. There was routine disregard of standard operating safeguarding procedures.

However:

  • The service was responsive to feedback from patients, staff and external agencies.
  • Managers understood the service well and provided clinical leadership to staff. Managers were a visible presence and were approachable.
  • The service reviewed incidents and analysed emerging themes. The service was working with other agencies to reduce the number of client deaths. Common themes had been identified and plans put in place to minimise risks.
  • The service welcomed learning, continuous improvement and innovation. The service was involved in a number of projects designed to enhance the service and improve client care and outcomes.
Checks on specific services

Substance misuse services

Updated 30 January 2018

See overall summary

Community-based substance misuse services

Requires improvement

Updated 31 May 2019

See overall summary