Archived: PCP Clapham

Updated 27 November 2019

PCP (Clapham) is a service provided by PCP (Clapham) Limited. The service provides a substance misuse day service, following the 12 step model of abstinence, for clients with substance misuse problems. The majority of clients require alcohol/opiate detoxification treatment when they start in the service. Clients sleep at the provider ’ s facility in Medwin Road whilst receiving their detoxification treatment and therapy at PCP Clapham. Medwin Road is a separately registered location provided by PCP (Clapham) Limited.

Following detoxification treatment, clients continue their day programme at the service and transfer to step down accommodation provided by PCP (Clapham) Limited.

The treatment lasts between two and 12 weeks. During our inspection, five clients were using the service and paid for this themselves. The service could provide treatment for up to nine clients. Occasionally clients’ treatment was funded by statutory agencies.

PCP Clapham is registered to provide: Treatment of disease, disorder or injury. Since our last inspection the manager of the service had become the registered manager at the service.

We have inspected PCP (Clapham) eight times since 2013. At the last inspection in June 2019, we found that the provider was breaching the following regulations:

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Regulation 12 – safe care and treatment

Regulation 11 - need for consent

Regulation 17 – good governance

We issued the provider with a warning notice in respect of Regulation 12 and requirement notice s in respect of Regulation 11 and Regulation 17 .

During the September 2019 inspection we found that , although the provider had made many improvements to the service , they had not met all the requirements of the warning notice. However, progress had been sufficient to downgrade this to a requirement notice.

Updated 27 November 2019

This is the first time we have rated PCP (Clapham).

We rated PCP (Clapham) as requires improvement because:

• The provider had not addressed all the issues CQC highlighted in its 2017 briefing which was circulated to all providers of substance misuse services and remains on our website:

• Following this inspection, we issued a letter of intent to the provider informing it that we proposed to impose conditions on the provider’s registration in accordance with section 31 of the Health and Social Care Act 2008 because of the serious concerns we had about the safety of the care being delivered to clients. We asked the provider to take immediate actions to address the issues. The provider responded quickly describing actions it was taking to minimise risks to clients in the service. We subsequently decided not to impose conditions on the provider. Instead we issued a Warning Notice which required the provider to make improvements to the medical and nursing assessments of clients and ensure it obtained information on clients’ medical history from healthcare professionals prior to detoxification treatment.

• At the last inspection in April 2018, we told the provider that it must develop an effective system to manage the risks to clients’ physical health and that it must have governance systems in place to ensure the quality and safety of the service.. At this inspection, we found that the provider had not made sufficient improvement in these areas and the risks to clients having detoxifcation treatment had not been reduced.

• Clients’ medical and mental health history was not always obtained from other healthcare professionals prior to detoxification treatment. This meant important information concerning clients’ health was not always known. There was no record that staff considered whether it remained appropriate to provide treatment without this information; this could place clients at risk.

• Medical and nursing assessments of clients, prior to detoxification treatment, contained only limited detail. A full history of clients’ substance misuse, physical and mental health problems, and social circumstances, was absent and did not follow best practice guidance from the National Institute for Health and Care Excellence and Department of Health. Clients’ detoxification treatment plans did not always include clear reasons for the plan, including the choice of medicines and dose.

• Clients’ risk management plans did not clearly describe how staff should manage the clients risks from detoxification treatment, including potential physical and mental health risks. When a client experienced physical health problems shortly after commencing treatment, the service did not ensure appropriate investigations were undertaken and as a result placed the client at risk of serious harm. As the service did not identify the risk, staff did not follow the duty of candour requirements of informing and apologising to the client.

• Clients were not offered testing for blood borne viruses, as recommended in best practice guidance from the Department of Health.

• The governance system did not provide effective oversight of the medical and nursing assessment and decision-making at the point of clients’ admission. There was a general lack of understanding by staff and managers of the importance of obtaining clients physical and mental health history before deciding it was safe to provide treatment at the service. There was a general lack of clinical leadership.

• The responses to complaints were brief, and did not always address each point of complaint. Complainants were not informed in the response that they could appeal against the decision or the way the investigation was undertaken. The providers’ complaints policy required complainant’s to contact the service again to find out how to appeal.

• There had been no registered manager for the service since 5 November 2018 and an application had not been submitted to CQC. After the inspection, the manager submitted an application to become the registered manager.

However:

• Clients had early exit plans if they left detoxification treatment early. Clients were given information about the risks of leaving treatment early and actions to take to minimise these risks.

• At our previous inspection in April 2018, we found the provider did not effectively addresspotential safeguarding concerns, particularly regarding children. At this inspection, there was a clear process and procedure in place for safeguarding vulnerable adults and children. There was a safeguarding lead in the service and referrals to the local authority safeguarding team were made when required.

• Staff knew what incidents to report and how to report them. Learning from incidents was shared with the staff team in team meetings and during staff handover.

• Staff demonstrated compassion, dignity and respect for clients and provided emotional and practical support. Staff dealt effectively with disrespectful, discriminatory or abusive behaviour or attitudes without fear of the consequences.

• The provider had made improvements to the governance system since our inspection in April 2018 although still needed to be embeded.

• A new manager had started in the service six months before the inspection. They had already had a positive impact on the quality of the service and were a capable and effective leader. They also had an understanding of how a governance system can provide assurance on the quality of care clients receive. The new manager was visible and accessible to clients and staff.

Updated 24 March 2017

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Updated 17 September 2015

The service was not safe. There were no detailed written protocols in place in respect of assisted alcohol or opiate withdrawal to enable staff to provide safe and appropriate care and treatment to a patient withdrawing from alcohol or from opiates. Staff did not carry out regular physical health checks on patients undergoing alcohol detoxification in order to identify withdrawal symptoms and any physical health concerns. Most staff did not have sufficient training to be able to provide safe care to patients undergoing assisted alcohol withdrawal or opiate detoxification. Patient risk assessments did not always identify risks associated with patients’ mental health. The provider had not conducted proper checks on staff before they were employed to ensure that suitable people were working in the service and patients were not put at risk. The training requirements for different staff roles in the service had not been assessed. Mandatory training was limited to two areas and did not cover all basic responsibilities staff undertook. There were no set timescales for refreshing or updating training to ensure it remained current. There were no proper systems in place to monitor the safety of the environment. The service had not had a fire risk assessment since 2012. Fire drills had not been carried out at the premises. The service had not conducted an infection control risk assessment or audit in the last 12 months. Staff had not always acted promptly when they had identified potential risks to the safety and potential abuse of children.

Staff had not received an annual appraisal of their work performance and did not receive regular managerial supervision. There was no system in place to check the competence of staff to administer medicines safely or carry out physical health checks on patients going through assisted withdrawal from alcohol or opiates. Staff did not always follow medicines management policies. Patient records were not always complete or accurate. There were no care plans in place to support staff to care for patients going through alcohol detoxification. Patient care plans did not always address the potential risks to people of early exit from the programme. Most staff had not received training in safeguarding children.

Staff were caring and committed to patients using the service. Most patients were positive about the service, particularly the therapeutic groups and individual counselling provided. Patients felt involved in planning their care and treatment and were aware of their care plan. Patients gave feedback about the service at regular community meetings and by completing a satisfaction survey.

Staff were aware of the needs of different patients and considered whether the service was failing to attract different groups of people. The service did not provide direct access to an interpreting service but encouraged and supported patients to obtain their own interpreter if needed. There was a system in place for managing complaints. However, patients did not routinely receive written responses to their complaints.

There were no proper systems or processes in place to ensure the quality and safety of service was assessed, monitored and/or improved. There was no robust information collection and management system in place. No meaningful information was collected about the service which made it difficult to identify where improvements were needed or could be made. Clinical audits did not take place or when they did they were not recorded. There was little oversight of quality and safety from the provider.