Brookdell House

On this page

• 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

The building was well maintained. All areas were visibly clean and tidy. However, the bedrooms were ready for refurbishment.

Staff assessed and managed risks to clients and themselves well. They understood how to support clients being abstinent and the service worked well with other agencies to do so.

Staff responded promptly to any unexpected discharges and made clients aware of harm minimisation and the risks of continued substance misuse. The service used systems and processes to safely administer, record and store medicines.

The service had low client safety incidents; however, staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team.

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.

All staff knew what incidents to report and how to report them.

There had been one serious incident within the service in the last 12 months. This was a medication error in which a client self-administered a diabetic pen that was out of date. We reviewed the incident and found it had been investigated, and appropriate actions had been taken as well as lessons learned noted for sharing with staff.

Staff understood their responsibilities under the duty of candour. They knew this included the need to be open and transparent, give clients and families a full explanation and apologise when things went wrong. We saw the provider had sent a duty of candour letter following the medication incident. The service had followed the process correctly.

Staff received feedback from the investigation, and this feedback was discussed in team meetings and daily handovers.

The service had a waiting list of six to eight weeks and on the day of our assessment 21 out of 22 beds were occupied.

The provider carried out a pre-admission assessment for all clients, which considered physical and mental health needs and risks such as history of substance misuse or self-harm. All clients followed the 12-step recovery programme. The programme was adapted to meet individual need by including, for example, additional one to one time or changing the timescale for completing step work.

As they progressed through the recovery programme, clients completed individual pieces of work and alongside it, with staff, they set their own individual goals to develop their identified strengths and meet their needs. They looked at what they wanted to achieve and how to do that, including considering issues that might block their progress, things that might be helpful, and how to build on their strengths. Staff and clients updated the goals at least monthly or when needed.

Clients understood where they were in their recovery plan and many had discharge plans that included further support from the provider in the form of housing and day care support elsewhere.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff could give examples of how to protect clients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff worked effectively with other agencies to promote safety including systems and practices in information sharing.

Staff implemented statutory guidance around vulnerable adults and children. There was a safeguarding policy for staff to follow. The policy included timescales for actions and contact names and telephone numbers for local authority safeguarding teams and internal safeguarding leads. All staff were aware of where and how to refer to safeguarding. There was a safeguarding lead who staff could seek advice and guidance from. The service had one incident in the last 12 months that involved safeguarding concerns.

Compliance for safeguarding adults training was at 100%. There was evidence in care records of staff working closely with other agencies to promote safety and good evidence of information sharing where appropriate.

However, the provider did not have children’s safeguarding as part of its mandatory training for staff. Managers told us that children only visited under supervision of the adults responsible for them, but they had planned to introduce such training for staff, and the safeguarding lead was due to complete a higher level of children’s safeguarding training.

We reviewed eight clients’ records. Staff completed a full risk assessment for each client and updated it should the risk change or after an incident. The service still had paper records for each client, but we saw staff had completed assessments ensuring any risks were identified.

Staff monitored clients for any deterioration in their physical or mental health. There were good links with the local drug and alcohol service, mental health services and G.P. with the practice nurse visiting weekly.

As part of the 12-week residential programme, clients were given advice on harm reduction including reduced tolerance and reducing the risk of overdose. There was a clear process for staff to follow to reduce the risk of harm following an unexpected discharge. Out of the 135 clients who used the service in the last twelve months, 15 were unexpectedly discharged.

Clients with a history of opioid abuse were offered naloxone. The early use of naloxone, a non-addictive, life-saving drug, can reverse the effects of an opioid overdose. Drug and alcohol testing protocols were in place. There was a breathalyser test and mouth swab test, which were conducted via an intelligence led approach. Any client found to be using drugs and/or alcohol was supported individually.

Incidents of substance misuse were assessed in the best interests and safety of the client and the other residents. Where it was not possible for the person to stay, they were discharged and supported to access community services.

Quality Statement Score: 3

Brookdell House was a large house in its own grounds, which could provide accommodation for 22 clients. All the bedrooms were en-suite. Some rooms had double occupancy and there was an annexe that provided accommodation for three clients. There was a ground floor bedroom that could be used for a client with mobility needs.

The building was well maintained. All areas were visibly clean and tidy. However, the bedrooms were ready for refurbishment. A cleaning rota was in place and clients cleaned the communal areas daily and prepared all meals as part of the recovery programme.

The service kept records of all general areas including, cleaning, kitchen, toilets and other health and safety issues such as water-borne bacteria testing. The service recorded daily environmental checks in all rooms. Staff adhered to infection control principles and cleaning materials and equipment were stored separately from other equipment.

The service had up-to-date health and safety and fire risk assessments. There was an up-to-date fire evacuation plan with fire warden information displayed throughout the building. There was evidence of weekly fire alarms testing and full fire evacuation drills taking place. There were safety certificates to cover the maintenance and operation of the building, including a business management continuity plan.

There was emergency medication such as naloxone available. Staff carried out temperature checks of the fridges used to store medication and these checks were audited. Records seen on inspection were completed and up to date. Clients we spoke with on inspection told us they felt safe when attending the service.

Quality Statement Score: 3

The service had enough staff, who knew the clients and received basic training to keep them safe from avoidable harm. All staff had completed mandatory training.

The provider had determined the safe staffing levels; the service had 15 staff. This included the service manager, who also worked a therapist, another self-employed therapist, recovery support workers, group facilitators and support staff. During the daytime and evening clients would be supported by three staff members. One staff members would be present at the service overnight.

The group work, which was supported by the group facilitators, took place in a large conservatory.

While turnover of staff was small, two had left in the last 12 months. The service had an induction programme that included training and shadowing of staff. While the service did have volunteers previously, at the time of the assessment they did not.

The service had one member of bank staff who filled in for shifts not covered due to illness or holidays. They were experienced in the service and had completed an induction. The service also used agency staff.

The service had low levels of staff sickness, with less than 1% sickness in the last 12 months.

Mandatory training compliance was at 100% and all staff had Disclosure and Barring Service checks in place.

All areas were clean, well maintained, well-furnished and fit for purpose.

Staff made sure cleaning records were up-to-date, and the premises were clean. We observed that identified maintenance issues were reported and logged appropriately. Staff adhered to infection control principles, including handwashing.

The service used systems and processes to safely store medicines. Before admission, clients were asked to bring two weeks of medication with them. On admission clients are asked to sign the "Administration of Medication Declaration of Wishes Form" to delegate the administration of all or part of their medication to the manager and staff.

Clients were risk assessed and supported to self-administer their own medication which was stored in a locked safe in their bedrooms. The MAR chart were checked daily, and balances weekly.

Each client is risk assessed and those who have not self-administered are encouraged to do so by week six to begin their preparation for discharge. Those who feel they did not wish to self-administer can choose to have their medicines stored and administration supported by staff.

Clients were registered with a local GP to ensure monitoring of physical health took place. The service offered blood borne virus testing through a local community substance misuse service. All staff were trained in the use of naloxone. The early use of naloxone, a non-addictive, life-saving drug, can reverse the effects of an opioid overdose.