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Winstone House - Horizon Requires improvement

Reports


Inspection carried out on 28 - 29 January 2019

During a routine inspection

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 carried out on 14 June 2018

During an inspection to make sure that the improvements required had been made

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • Recovery plans and risk management plans were of poor quality. Recovery plans and risk management plans were vague and lacked specific detail. There was not enough information to clearly identify client needs and manage risks. This was a breach of a regulation. You can read more about it at the end of this report.

However, we also found the following areas of good practice:

  • Assessments and risk assessments had been completed for all clients and were of a good standard. Assessments and risk assessments were up to date and contained detailed information needed to deliver safe care and treatment. The electronic record system had been improved. This meant client information was readily available to relevant staff.

  • Systems and processes to manage incidents and risks were being appropriately implemented. The risk register had been updated and all incidents were being reported. There was a process in place to escalate incidents and risks via a governance structure.

Staff were now receiving regular supervision in line with the providers policy. Staff had received specific training in the Mental Capacity Act and were aware of how to implement a mental capacity assessment and best interest’s decision.

Inspection carried out on 18 October to 19 October 2017

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:

  • Client records including assessments, risk assessments, and recovery plans were poorly documented. Information was missing and records were not updated regularly. The electronic record system was not effective in supporting staff to record or locate client information. Information was difficult and time consuming to find. This meant that vital information to implement client care was not available.

  • Client records had been transferred from the previous provider in April 2017. However, staff were unable to locate them within the electronic record. This meant that staff had to repeat assessments and plans unnecessarily. Staff were not able to complete this in a timely way. This had not been reported as an incident and therefore any future prevention was not clear.

  • Staff managerial and clinical supervision figures were low and did not meet the provider’s target of every six to eight weeks. This meant that staff were not appropriately supervised in their roles.

  • Staff did not understand the Mental Capacity Act, code of practice and best interest checklist procedure. Staff were unaware of how to assess capacity or how to act on the findings.

However, we also found the following areas of good practice:

  • Access to keyworkers, doctors and other disciplines was good. Staff were able to prioritise urgent needs and see clients the same day if necessary. There was also a psychologist newly in post who could provide therapy to clients with complex psychological issues.

  • Clients gave excellent feedback on the attitude of staff and the service they receive. Clients stated that staff were flexible to meet their needs and caring. Clients felt the service had positively transformed their lives.

  • Managers were visible within the service. Staff felt supported by them and that they could seek informal support at any time. Staff described managers as approachable and able to recognise caseload limitations.