Archived: Orchard

Updated 11 June 2019

Addiction Recovery Centre Portsmouth (ARC) is a residential drug and alcohol rehabilitation service, which also provides alcohol and drug detoxification treatment. There is a treatment centre, which all clients attend Monday to Saturday, for individual and group sessions.

Accommodation for clients is provided in one of their four houses. One house is for female clients and the other three houses, for males. Clients are transported by minibus between the locations at set times. Local authorities refer into the service. Clients can also refer themselves.

The accommodation is registered with the Care Quality Commission to provide the regulated activity of accommodation for persons who require treatment for substance misuse and the treatment centre is registered to provide treatment of disease, disorder or injury. There is a Registered Manager in place.

Treatment provided is abstinence based and the programme consists of an induction procedure, group treatment, key working and counselling. There is also community-based engagement in the form of self-help groups and meetings, weekend activities, aftercare packages and drug and alcohol testing.

The service has undergone an extensive review since September 2018 when the Care Quality Commission raised concerns about the safety of clients using the service following an inspection. After the September 2018 inspection we issued warning notices to the provider and required them to make significant improvements to the overall safety of the service. At that time, we placed the provider into special measures. We told the provider they must improve staff training, employment checks, the management of complaints and incidents, risk assessment, the standard of initial assessments, systems used to monitor the effectiveness and safety of the service, medicines management, record keeping, and processes they used when detoxifying new clients.

In November 2018, and January 2019 we completed two further unannounced focused inspections. At these inspections we found that the provider had made enough improvement to meet the requirements of the warning notices served.

At this inspection we found that the provider had implemented substantial changes that have resulted in significant improvement to the quality and safety of care.

Updated 11 June 2019

Following this inspection, we have removed this provider from special measures.

Our rating of this service improved. We rated it as good because:

• The services had undergone significant improvement since our last inspection in September 2018.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients cared for in a residential detoxification and substance misuse service. Treatment was clearly aligned with national best practice guidance and staff used clinical audit to evaluate the quality of care they provided.
• Clients had access to the full range of specialists required to meet their needs. Staff worked well together as a multi-disciplinary team and with those outside the service who would have a role in providing aftercare. The provider had improved the mandatory training programme it offered to staff to support them to provide good quality and safe care. Managers ensured that staff received training, supervision and appraisal.
• Staff completed detailed and meaningful risk assessments and risk management plans with clients following their initial assessment. The provider had reviewed and minimised the use of restrictive practices. They managed medicines safely and followed good practice with respect to safeguarding. The treatment and accommodation environments were safe and clean.

• Staff treated clients with compassion and kindness, respected their privacy and dignity and understood the individual needs of clients. The provider had reviewed records and leaflets to ensure use of appropriate language.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed other than for a clinical reason. The service offered free aftercare, allowing clients to access groups and support at the centre following discharge, and used a clear protocol for managing clients unplanned exits from treatment.
• Staff understood and discharged their roles and responsibilities under the Mental Capacity Act 2005. The provider had updated its policies, processes and training requirements to promote compliance with the requirements of the Mental Capacity Act 2005.
• All staff worked to nationally recognised best practice for substance misuse treatment. Leaders had the skills, knowledge and experience to perform their roles, were visible in the service and approachable for clients and staff. Leaders had undertaken additional training and development, and new comprehensive governance processes had been implemented which ensured that service procedures ran smoothly.

However:

• The service did not deliver a smoking cessation programme. One client told us they would have liked to have accessed smoking cessation support.

• The service did not have a specific programme for engaging families and carers and did not actively seek feedback from them.
• The service had no specific arrangements in place for accessing translation or foreign language support should clients need it.
• Clients could not lock their bedroom doors.