Acquiesce Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as good. At this assessment the rating has stayed the same Good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service maintained a strong, proactive, and positive culture of safety, based on openness and complete honesty. Leaders embedded, maintained and sought to continuously improve a culture of openness and collaboration and safety was everyone’s top priority.

There had been no serious incidents in the last 12 months. There had been no adverse events specific to this service. People felt supported to raise concerns and reported that staff treated them with compassion and understanding.

People and staff including bank staff were actively encouraged to raise concerns about safety and encouraged to share ideas to improve the service, and the value of learning was continually demonstrated and reinforced by leaders. They had processes in place for staff to report incidents, near misses, and safety events. A system was used to record and investigate complaints. When things went wrong, staff apologised and offered support. Learning from incidents and complaints led to changes that improved care for others.

All staff knew what incidents to report and how to report them. Incident reporting was included in safeguarding training. A staff member was on call 24 hours a day. Anything reported to the on-call staff member was logged and shared with the team. For example, when a person left the location during programme sessions, this was discussed with all staff and used as an opportunity to reflect on how the situation could have been better managed. Staff consistently reported all incidents that required reporting.

Staff understood the duty of candour. They were open and transparent and provided people and families with full explanations when things went wrong. A duty of candour policy was in place.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the team discussed and learnt from concerns and incidents. Staff described an open culture where safety was a top priority. Feedback from incident investigations, both internal and external, was shared with staff. Staff met to discuss this feedback, and there was evidence that changes had been made as a result. Incidents were documented and discussed during team meetings, including reflection on alternative actions that could have been taken. This supported shared learning and gave staff the opportunity to contribute to improvements.

Lessons were consistently learnt to identify and embed good practice. Where necessary, information was shared with external agencies. For example, safeguarding concerns were shared with the local authority. Information was shared with staff during team meetings to identify and discuss any concerns. One example of this was where a client had left the onsite programme. Discussions were held as to what they could have done better in the response to their return. Good practice was also shared with staff and staff received positive written feedback on their delivery of the care and treatment programme.

Staff were debriefed and received support following incidents when needed. Staff had access to an employee assistance programme that provided support and counselling. For instance, when a person developed psychosis during treatment, staff who had worked closely with them and may have experienced distress were provided with a debrief.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

The evidence showed an exceptional standard. The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety that involved the person themselves, staff and other partners in their care. This included referrals, admissions and discharge, and where people move between services. There was a strong awareness of the risks to people across their care journeys. The approach to identifying and managing risks was proactive and effective. The effectiveness of these processes was appropriately monitored and managed to keep people safe. Positive risk taking was also encouraged.

The service had shared care protocols in place. Staff understood and followed these. They ensured that referral and admission processes captured all essential information to determine whether people’s needs could be safely met. Admission coordinators completed online, telephone, and face-to-face consultations.

Where they were unable to meet a person’s needs, they were signposted to other services. Alternative care pathways and referral systems were in place for people whose needs could not be met. Admission coordinators triaged referrals, consulted with external agencies, and referred people on where appropriate. Referral into the service was initiated through an online request, although people could also contact them directly by telephone or email. They offered flexible call-back arrangements to suit people and their families or carer’s needs.

Staff consulted with detoxification services to obtain updated information when a person was transferring between services. Each person allocated a place was assigned a practitioner who maintained in contact prior to admission to help reduce any anxiety or concerns.

They involved relevant healthcare and social care services to ensure continuity of safe care, both during admission and post-discharge. Where consent had been provided, GPs were contacted to confirm medical history and obtain an up-to-date prescription list.

Discharge planning was well managed and began on admission and was a real focus 2 weeks before the end of treatment. People told us this took place during their stay, prior to discharge. Staff maintained weekly contact with people and their families or carers, offering psychosocial support by telephone. This was intended to continue for 3 months, although we found that support was extended where needed.

They ensured continuity of care when people moved between services. Staff supported people to find accommodation and access local support.

At the time of inspection, there were 4 people on the waiting list. Managers told us the expected wait was around 2 weeks. Generally, they were able to offer immediate availability, and the waiting period had not exceeded 4 weeks. They operated a self-referral process, with phone lines open 7 days a week, Monday to Sunday, 9am to 9pm. People or referral parties (e.g. GPs, other agencies) could speak with an admission coordinator who completed a telephone consultation.

There were no prescription interventions. Where prescriptions were needed, GP appointments were arranged, as all people were temporarily registered with a GP.

Shared care protocols were in place and staff understood and followed these where applicable.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding and knew how to raise a safeguarding alert when appropriate. One safeguarding referral had been submitted to the local authority in the last 12 months.

Staff gave examples of how they protected people from harassment and discrimination, including those with protected characteristics under the Equality Act. Policies and procedures were in place covering harassment, bullying, safeguarding, discrimination, equality, dignity and respect, diversity, and social inclusion. Where a person reported bullying or harassment, they provided support and mediated with relevant services on their behalf.

Staff were able to identify adults and children at risk of, or experiencing, significant harm. This was discussed and documented on the pre assessment and on admission. This included working in partnership with other agencies. Children were not permitted to visit the service.

All staff had completed training in the Mental Capacity Act and demonstrated a good understanding of its five statutory principles. Staff were able to identify when a person’s capacity to consent to treatment might be impaired and took all practical steps to support decision-making.

Where mental capacity was a concern, staff assessed and recorded capacity appropriately. Assessments were decision-specific and focused on significant decisions. When people lacked capacity, staff made decisions in their best interests, taking into account the person’s wishes, feelings, culture, and history.

People signed consent to treatment forms, which were accessible to all staff involved in their care and treatment. Confidentiality agreements were also signed, specifying which parties’ staff could share personal information with. These were available to all relevant staff.

Staff supported clients in preparing reports for court and arranged weekly visits to a children’s centre to support contact with children.

There were multiple channels for clients to recognise and report any safeguarding concerns, including daily diaries, via a 1-1 session or calling the on-call number.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a transparent and open culture which encouraged creative thinking in relation to people’s individual safety.

People were enabled to take positive risks to maximise their control over their care and support. They were also actively involved in managing their own risks along with their relatives, friends and other carers. Clients were encouraged to take positive risks to build their independence, confidence and resilience. For example, when clients attend external venues such as the gym, cafes, outdoor areas for walks they may experience triggers and cravings, but these risks were taken in a control planned way which allowed the client to manage their own risks in line with their personal goals.

Staff showed empathy and had an enabling attitude that encouraged people to challenge themselves, while recognising and respecting their lifestyle choices.

The service consistently applied person centred care with a positive culture which supported recovery, engendered trust between people and staff, and protected the safety and wellbeing of all people using services.  The service proactively sought out new and creative solutions and best practice.

We reviewed 6 risk assessments, risk management plans, and discharge plans. These were comprehensive, regularly reviewed, and up to date. People were involved in their risk assessments during admission and throughout treatment, and contingency planning was included.

Staff routinely provided harm minimisation advice related to the risks of ongoing drug and alcohol misuse. Safety planning formed an integral part of recovery plans.

Re-engagement plans were in place for all people, outlining steps to take if someone unexpectedly disengaged from treatment.

They had clear processes for responding to suspicions or evidence of substance use during treatment. Staff monitored changes in behaviour and personality. Random drug and alcohol tests were carried out, and urine samples could be sent to a laboratory for screening on admission. Where substance use was suspected, room checks were completed weekly and at random.

A list of banned items was available to all people and aligned with expectations for a substance misuse service (e.g. bladed articles, weapons, drugs, alcohol). Items brought in were confiscated, logged, and returned upon discharge.

Staff involved people in care planning, risk assessment, and relapse prevention planning, as evidenced in care records. People completed daily diaries to reflect on irrational thinking and problem behaviours, which were reviewed by their allocated practitioner. Morning grounding sessions were held with all people, and one-to-one sessions were offered at least weekly, or more frequently if needed. People had access to copies of their care plans and related documents.

They supported people to access advocacy services and provided assistance where needed.

They ensured safe and appropriate accommodation. People with recent or known risks of suicide or self-harm were not admitted, as accommodation was not staffed. Triage assessments included evaluation of suicide and self-harm risk, and managers had authority to refuse admission where needs could not be safely met. If clients during their stay became suicidal, they supported them to access emergency mental health services. They also had staff available 24 hours to support clients.

Staff supported one vulnerable older person by assisting with applications for supported accommodation, completing relevant forms, meeting with housing officers, and helping the person relocate from unsafe housing. Staff also visited the person to ensure they had settled in well.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Facilities, premises and equipment were designed and used to meet the needs of a range of all people who used the service.

There was a comprehensive system to proactively manage the safety, maintenance and repair of facilities, premises and equipment.

Staff completed and regularly updated thorough risk assessments across all areas and took action to remove or reduce identified risks.

All staff carried personal alarms, which they wore at all times while on site. Staff were available to respond when needed.

There were no clinic rooms, as they did not prescribe medication. People had access to lockable storage lockers for medication prescribed outside the service, both at their accommodation and at the treatment centre.

All areas were very clean and tidy, well maintained, well furnished, and fit for purpose. Cleaning records were up to date, and the premises were visibly clean.

Accommodation was provided within a large residential property, with bedrooms located on the ground and upper floors. People were responsible for cleaning their own bedrooms and shared areas. A cleaner attended at weekends to deep clean the kitchen and communal spaces.

Staff followed infection control guidelines, including handwashing. A designated manager oversaw infection control responsibilities.

Equipment was well maintained, clean, and in working order. Annual environmental risk assessments were completed, including ligature risk assessments, fire risk assessments, and appliance testing. All certificates reviewed were in date. A business continuity plan was in place. The service had a dedicated director of facilities and a staff member responsible for health and safety checks, including fire safety, gas safety, legionella, and portable appliance testing.

Closed-circuit television (CCTV) was used to monitor external grounds and entrance/exit areas. CCTV was also in place at the entrances to the treatment and accommodation services. Signage was displayed to indicate CCTV use, and people were informed of this prior to admission.

Shared reception areas were managed safely, with adequate space and secure access via keypad and fob entry. Risk assessments were in place to mitigate associated risks.

They complied with Department of Health guidance on same-sex accommodation. Mixed-sex accommodation was well managed and appropriately risk assessed.

People had their own bedrooms, each with a double bed, seating area, storage space, and lockable doors.

Description: We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The continuing development of the staff skills, competence and knowledge were recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. Bank staff were proactively supported in their role.

They employed 12 whole-time equivalent staff, including a registered manager, team manager, director of facilities, recovery practitioners, admissions coordinators, support coordinators, and a housekeeper/shopper. There were no vacancies at the time of inspection. They operated continuous open recruitment for bank support workers.

There was no current sickness absence. Over the last 12 months, 106 shifts had been covered by bank staff. The average sickness absence rate over the same period was 5.5%. Managers supported staff who required time off due to ill health. The staff turnover rate over the last 12 months was 0%.

Managers completed observations of staff during sessions they delivered to clients and provided written feedback. They looked at professional boundaries, teamwork and presentation, safeguarding, communication and information governance and organisational and prioritisation skills.

All staff had completed mandatory training, with 100% compliance. Training was appropriate for the client group and included safeguarding adults and children, the Mental Capacity Act, fire safety awareness and warden duties, first aid awareness, manual handling, health and safety awareness, handling violence and aggression, lone working, person-centred care, infection control, and training in internal systems and human resource tools. All staff had completed the Care Certificate standards. New learning disability and autism training had a completion deadline of 31 August 2025.

Additional training was also provided, including counselling, Level 3 Substance Misuse Practitioners Award, Self-Management and Recovery Training (SMART), Level 3 Motivational Interviewing, sharps in care, 5-step family training, and fluid and nutrition.

Staff received monthly supervision and annual appraisals. Staff told us managers were very supportive and accessible. Managers operated an open-door policy.

They had sufficient staffing levels to keep people safe, and support arrangements were in place. Managers ensured staff working with people had up-to-date Disclosure and Barring Service (DBS) certificates. Risk assessments were completed for staff where required. Identity checks and references were obtained prior to employment.

All bank staff received a full induction and were familiarised with the service before starting shifts. A safer recruitment policy was in place, which addressed the elimination of unlawful discrimination, promotion of equality of opportunity, and fostering good relations between people of diverse groups, in line with the Equality Act (2010).

Staff turnover was low, and many staff had been employed by the service for a long time. They had also employed staff who had themselves gone through their own rehabilitation. People we spoke with said this was positive and they felt able to discuss issues because some staff themselves had been in rehabilitation services and they understood.

Daily flash meetings were held to hand over information from the night duty staff. These meetings included rota planning, programme cover, and arrangements to support people with appointments.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to assessing and managing the risk of infection, which is in line with current relevant national guidance and standards.

People were protected as much as possible from the risk of infection because premises and equipment were kept appropriately clean and hygienic.

Staff had received appropriate training and there were clear roles and responsibilities around infection prevention and control.

Staff maintained equipment to a high standard and ensured it was clean. All areas were clean, well furnished, and well maintained. Cleaning records were up to date and showed that areas were cleaned regularly. People were responsible for keeping their living spaces clean, tidy, and organised. A designated staff member completed a weekly deep clean of the accommodation.

An infection prevention and control lead was in place. Staff adhered to infection control principles, including handwashing and the safe disposal of clinical waste. Monthly infection control audits were completed, and improvements were made as a result. For example, following an audit, additional clinical waste bins were introduced for people experiencing bladder damage due to ketamine use. These bins were placed in bedrooms when needed and they supported safe disposal of adult incontinence products.

Personal protective equipment (PPE) was used appropriately. Staff conducting urine drug screening wore visors as part of standard PPE.

All staff had completed infection prevention and control training, with 100% compliance.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff did not administer medicines. People were responsible for managing their own medicines, which were stored in locked boxes within their bedrooms. Lockable lockers were also available during the day for secure storage.

Staff ensured an up-to-date prescription summary was obtained from each person’s GP. On admission, staff checked medicines to confirm they matched the prescription. All people admitted to the service were self-medicating, and a medication log was maintained for each person. Risk assessments were completed in relation to patients who were self-medicating.

People told us that where medication required refrigeration, a small fridge was provided in their bedroom.

If medication was needed during treatment, staff supported people to make appointments with the temporary GP they were registered with or contacted NHS 111 for advice.

Staff took proactive steps to safeguard people from harm, including liaising with GPs to review and, where appropriate, adjust prescriptions for medicines with addictive potential.