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Inspection Summary


Overall summary & rating

Good

Updated 10 June 2019

We rated The Equilibrium Project as good because:

  • There were enough staff to provide safe care and they carried out risk assessments to check the suitability of clients for a community detoxification programme. Medication was adjusted to make sure it met the client’s needs. There were policies in place to report and learn from incidents.
  • The clients’ physical and mental health was assessed to make sure they were suitable for treatment. Staff followed National Institute for Health and Care Excellence (NICE) guidance when providing treatment. The registered managers had appropriate experience and received clinical supervision from an appropriate professional.
  • The staff referred clients on to appropriate services, when needed, and gave clients information about local services. Clients, and when appropriate families, were involved in planning their care and recovery plans. The service actively asked for feedback from clients.
  • The service had a clear inclusion and exclusion criteria and meet with clients within 48 hours. The team offered ongoing telephone support free of charge to clients following treatment. Information was provided in a way the clients would understand. Nurses used reflective practice to review care.
  • The registered managers had leadership experience and were committed to improving the service. There were governance processes in place and these were being built into the electronic record system.

However:

  • The independent prescriber did not contact the client’s GP before starting treatment. Nurses dispensed medication into a compliance aid for clients on a daily basis when altering the dose of the detoxification medicines, this practice is known as secondary dispensing and increases the risk of a medicines error. There was no policy on reporting accidents.
Inspection areas

Safe

Requires improvement

Updated 10 June 2019

We rated safe as requires improvement because:

  • Staff had dispensed medicines in a compliance aid for clients on a daily basis, known as secondary dispensing, which increased the risk of a medicines error.

  • Staff had not requested clients’ medical information from GPs before commencing the detoxification programme.

  • There was no procedure for reporting accidents or notifying the Care Quality Commission of notifiable incidents.

However:

  • There was adequate staffing to provide safe care and the service had plans to increase staffing as needed.

  • Staff completed a risk assessment to identify if a client was suitable for community detoxification. There were appropriate risk management plans in place for the client during their treatment and if they chose to stop treatment.

  • Staff kept client records safe and secure and could access them as needed.

  • There was an independent prescriber present during the detoxification to review and adjust medication as needed.

  • There were processes in place to report and learn from incidents relating to clients and staff knew them.

Effective

Good

Updated 10 June 2019

We rated effective as good because:

  • Staff assessed clients’ physical and mental health using recognised tools recommended by the National Institute for Health and Care Excellence (NICE).

  • Staff prescribed medicines that followed the guidance recommended by NICE.

  • The service was developing links with other care providers and offered advice about alternative options to the client.

  • The registered managers were continually developing their skills and knowledge.

  • The registered managers were experienced in substance misuse treatment and were receiving clinical supervision from other professionals.

Caring

Good

Updated 10 June 2019

We rated caring as good because:

  • Staff referred clients to appropriate services if they did not meet the criteria for community detoxification.

  • Staff gave information to clients about local services that could support them after detoxification.

  • Nurses encouraged clients to be involved in planning their care and encouraged them to involve family members where appropriate.

  • Staff developed personalised recovery plans with clients.

  • The service encouraged clients to give feedback to help improve the service.

Responsive

Good

Updated 10 June 2019

We rated responsive as good because:

  • There was a clear criteria for inclusion and exclusion for treatment which meant they only offered a service to clients that were suitable for community detoxification.

  • The service began assessing clients within 48 hours of referral to the service.

  • The service offered telephone support to the client following their treatment.

  • Staff could provide information in an appropriate format for the clients.

  • Nurses had used reflective practice to review concerns.

Well-led

Good

Updated 10 June 2019

We rated well-led as good because:

  • The service was well led, and the registered managers had the necessary experience for their roles.

  • There was a commitment towards continual improvement and learning from incidents.

  • The registered managers had a clear vision for the service.

  • The service had been proactive in seeking the views of clients.

  • The provider was building governance systems into its health record system.

However:

  • There was no policy around staff accidents and learning from them.

Checks on specific services

Community-based substance misuse services

Good

Updated 10 June 2019