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Inspection Summary


Overall summary & rating

Good

Updated 4 April 2019

We rated Nelson Trust as good because:

  • Staff were proactive at identifying and managing risk. There were effective systems in place to ensure the management of clients’ risks. Risk assessments and recovery plans were personalised, thorough, and understood by all staff. All staff understood how to report incidents and near misses. Managers reviewed incidents in governance meetings and involved staff in discussing the learning from incidents and implementing change. Incidents were also reviewed by the risk and assurance team.

  • The premises were safe for the clients. The managers had completed ligature and environmental risk assessments on the premises in 2018. These were reviewed every six months.
  • Care plans and crisis plans were up to date or comprehensive to assist the teams to deliver safe care and treatment to clients. They were holistic, personalised and promoted recovery and met the individual needs of each client. They included physical health care checks from clients’ GPs.

  • Clients and their families were encouraged to work together. Families were offered weekend workshops to assist and understand their relative’s recovery. Family members spoken with were very positive about this.
  • The service ensured clients were integrated into the local social networks, employment and education opportunities. Many clients remained in the local area after completing their treatment and became part of the community.
  • The service ensured there was a wide choice of treatments and clients’ individual needs and preferences were central to the planning and delivery of tailored services. There was an education academy where clients completed educational courses in conjunction with the local college. There was also a maintenance team in the service where clients could learn new skills.

  • Senior managers in the service demonstrated clear, effective and inclusive leadership with a strong sense of direction and objectives. All staff spoken with were aware of the developments and direction of the service.
  • The board of trustees, the senior management team and the Chief Executive Officer were visible across all sites. They visited the houses and attended community meetings. Clients and staff were confident they could raise concerns with any of the senior management team and they would be acted upon.

However:

  • Staff members did not ensure clients had access to advocacy services.
Inspection areas

Safe

Good

Updated 4 April 2019

We rated safe as good because:

  • Staff were proactive at identifying and managing risk. There were effective systems in place to ensure the management of clients’ risks. Risk assessments and recovery plans were personalised, thorough, and understood by all staff.

  • Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • There were systems in place to check the competence of staff to administer medicines safely and to ensure all clients received physical health checks.

  • All staff understood how to report incidents and near misses. Managers reviewed incidents in governance meetings and involved staff in discussing the learning from incidents and implementing change. Incidents were also reviewed by the risk and assurance team.
  • Staff members ensured that the premises were safe for the clients. The managers had completed ligature and environmental risk assessment on the premises in 2018. These were reviewed every six months.

Effective

Good

Updated 4 April 2019

We rated effective as good because:

  • Staff completed a thorough, high quality assessment of needs with all clients prior to the start of treatment.

  • Care plans and crisis plans were up to date or comprehensive so supported the teams to deliver safe care and treatment to clients. They were holistic, personalised and promoted recovery and met the individual needs of each client and included physical health care checks from clients’ GPs.

  • Clients could choose their treatment form a wide range of different psychosocial interventions. All treatments available were in line the relevant National Institute for Health and Care Excellence (NICE) guidelines.

  • Staff received regular supervision and had annual appraisals of their work performance.

  • Staff regularly monitored and reviewed the effectiveness of treatment. Clients had regular reviews of their mental and physical health.
  • Staff had a good understanding of the Mental Capacity Act 2005. This included consideration of fluctuating or deteriorating mental capacity. Staff could respond appropriately if clients lacked capacity to make a decision whilst under the influence of alcohol or drugs.

Caring

Good

Updated 4 April 2019

We rated caring as good because:

  • Staff treated clients with compassion. Feedback from clients confirmed that staff treated them well and with kindness.
  • Staff involved clients in decisions about their care and treatment.
  • All clients spoken with told us staff members described treatment options and gave them choices.
  • Staff ensured clients were involved in the recruitment of staff.
  • Clients and their families were encouraged to work together. Families were offered weekend workshops to assist and understand their relative’s recovery. Family members spoken with were very positive about this.
  • The service ensured clients were integrated into the local social networks, employment and education opportunities. Many clients remained in the local area after completing their treatment and became part of the community.

However:

  • Staff members did not ensure all clients had access to advocacy services.

Responsive

Good

Updated 4 April 2019

We rated responsive as good because:

  • The service ensured there was a wide choice of treatments. Clients’ individual needs and preferences were central to the planning and delivery of tailored services. There was a Hub academy and Hub maintenance division in the trust where clients completed educational courses in conjunction with the local college.

  • Each client had both a named recovery /support worker and an allocated counsellor on admission to the programme with identified skills, knowledge and experience to meet their individual assessed needs.

  • Female clients could choose to live in an all-female house supported by female staff. They could also choose to stay in a quieter house.
  • All staff treated concerns and complaints seriously, investigated them and learnt lessons from the results.

Well-led

Good

Updated 4 April 2019

We rated well-led as good because:

  • Senior managers in the service demonstrated clear, effective and inclusive leadership with a strong sense of direction and objectives. All staff spoken with were aware of the developments and direction of the service.

  • Senior managers in the service promoted a positive culture that supported and valued staff. There was a clear statement of vision and values which staff knew, understood and emulated in each of the houses.

  • The board of trustees, the senior management team and the CEO had oversight of the service through robust and consistent governance and assurance procedures. The governance team who monitored risk and assurance implemented effective systems across all teams. Governance and performance management arrangements were proactively reviewed and reflected best practice.

  • The board of trustees and the senior management team and the CEO were visible across all sites. They visited the houses and attended community meetings. Clients and staff were confident they could raise concerns with any of the senior management team and they would be acted upon.

  • Staff spoke very positively about the supportive and innovative teamwork within their teams. They were positive about the culture, valued the support from the managers and morale was high. Staff reported that supervision received from their managers was supportive and meaningful. They were aware of the whistleblowing policy and were confident they would use it if needed.
  • All staff were proud about the innovative work they did in relation to trauma informed treatment, the women only residential service and the enabling environment. 
Checks on specific services

Substance misuse services

Good

Updated 4 April 2019

Nelson Trust is a residential rehabilitation service for substance misuse.

Other CQC inspections of services

Community & mental health inspection reports for Covington House can be found at The Nelson Trust.