Archived: St Stephens

Updated 1 January 2020

St Stephens is a location registered with the Care Quality Commission as the accommodation for Perry Clayman Project (PCP) Leicester, which is an independent residential substance misuse service for clients with an alcohol or substance addiction. St Stephens provides accommodation for up to seven clients undergoing alcohol and substance detoxification. There are further properties providing shared accommodation for clients who have moved on from the detoxification phase of treatment, but these are accommodation only and therefore did not fall under the remit of this inspection.

St Stephens was registered with the CQC in March 2018. The service has a registered manager and a nominated individual. PCP (Clapham) Limited is the registered provider.

The regulated activities at St Stephen’s are accommodation for persons who require treatment for substance misuse. Individual and group therapy treatments are offered to clients at the nearby treatment centre, known as PCP Leicester. There is a separate inspection report relating to PCP Leicester that should be read alongside this report.

We inspected St Stephens in July 2018. At the time of that inspection we did not rate substance misuse services, therefore the service was not rated. We issued requirement notices for breaches of the following regulations:

Regulation 12 Safe care and treatment

• The provider had not ensured a safe and clean environment for clients. The provider had not completed a ligature assessment for the property. There were no ligature cutters on the premises. The property was not clean on the day of our visit. The kitchen cupboards were dirty, we found a dirty chopping board, there was mould around the bath in the ground floor bathroom and a build-up of lime scale around some of the taps. Not all clients were aware of fire safety procedures. Clients had not participated in a fire drill.
• There were infection control issues at the accommodation. There was only one mop in the property for cleaning kitchens, bathrooms and bodily spills. The worktop had been covered in a badly fitted laminate, the trim was coming away and tiles in the kitchen around plug sockets and switches had rough edges, which created areas which were difficult to keep clean. There were wooden utensils in the kitchen, these were visibly unclean.
• Clients had no means of summoning help from their bedrooms. There was no procedure in place for the observation of clients undergoing detoxification at the property. Staff told us they would check on clients as and when they thought it necessary. This posed a risk to clients not receiving emergency care if they were to suffer side effects from the detoxification treatment, for example, seizures.
• The stairs in the property were not safe. Two stair treads were loose, and one carpet gripper was exposed. The carpet was loose in places. This posed a risk to clients tripping and falling whilst using the stairs.

Regulation 17 Good governance

• Governance of the service was poor. The provider did not have monitoring systems in place to ensure processes were being followed or key performance indicators to gauge the performance of the team. For example, the provider did not know that the new cleaning schedules were not being followed, that there were maintenance issues at the property and some staff were not being supervised.
• Recruitment procedures were not robust. Staff had been appointed to specialist roles with no previous experience or skills and had not received an induction or training to enable them to fulfil the role.
• Staff did not receive regular supervision. The provider’s policy stated that staff should receive supervision quarterly. We reviewed staff files of two staff who worked at St Stephen’s. One staff had received one supervision in the last year and the other had received none.

We told the provider to take the following action:

• The provider must ensure a safe and clean environment for clients.
• The provider must ensure clients safety is maintained throughout their stay at the accommodation.
• The provider must ensure effective governance of the service.
• The provider must ensure the correct recruitment procedures are in place to ensure a competent and skilled workforce.
• The provider must ensure all staff receive supervision in line with their policy.
• The provider should review client’s access to a doctor during the initial stages of their detoxification treatment.
• The provider should regularly review the use of blanket restrictions.
• The provider should review staff working patterns to ensure hours worked are not excessive.
• The provider should review facilities at St Stephens to ensure the comfort and dignity of clients.
• The provider should ensure the registered manager is able to fulfil their responsibilities.

We found that the provider had addressed most of the issues. We have identified the issues which remain later in this report.

At the time of our inspection, seven people were accessing the service for treatment. The service provides care and treatment for male and female clients, all of whom were self-funded.

To be noted: Since writing this report the provider has deregistered this service with the Care Quality Commission. This means that the service has closed and no longer exists.

Updated 1 January 2020

We rated PCP St Stephens as requires improvement because:

• The facilities did not promote dignity, recovery and comfort of clients. There were no quiet areas in the accommodation, other than in client’s own bedrooms. There were not enough seats in the lounge area for all clients. There was no dining table and only three clients could sit at the small breakfast bar at any one time. The service had not provided adequate cooking facilities for clients who were expected to be self catering. Clients told us they had to wait a long time to cook their evening meal. The lighting in the property was dim, especially in bedrooms. The provider had not supplied any additional lighting to improve this.
• Supervision had not always taken place as required by the provider’s policy. The provider’s policy stated that staff should receive supervision quarterly. We reviewed the files for five staff who worked at St Stephens and only one had received regular supervision. In addition, mangers did not formally supervise new starters they had been post for three months, the impact of this could be that new staff may encounter skills deficits or develop poor practice before they were formally picked up through the supervision process.
• The provider only had one dose of Naloxone available at the house. Naloxone is an emergency medication used to reverse the effects of an opiate overdose. National guidance suggests that it is good practice to have at least two doses available.

However:

• The service provided safe care. The accommodation where clients stayed during the evening and weekends was safe and clean. The service had enough staff to keep clients safe. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• We heard positive examples of staff providing exceptional care and support to clients. Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.

Updated 6 September 2018

Inspected but not rated

Updated 1 January 2020

Residential substance misuse service