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Inspection Summary


Overall summary & rating

Good

Updated 20 May 2019

We rated Hay Farm as good because:

  • Hay Farm had made improvements to the service since our last inspection. This included adding a new clinic room, ensuring bedrooms contained call alarms and the introduction of an admissions officer post that had resulted in strengthening the admissions process. The admissions officer streamlined the admissions process and ensured the service didn’t take clients it was not able to care for them effectively or that didn’t meet its criteria for admission.
  • Staff were skilled and competent to provide safe care and treatment. Staff were aware of their responsibilities and dedicated to providing safe, high quality care for clients. We observed staff treating and discussing clients with respect, dignity and compassion. Clients feedback about their care and treatment was positive.
  • There was a comprehensive assessment process for clients accessing the service. Risk assessments were detailed, regularly reviewed and contained a risk management plan. Staff collaboratively completed care and recovery plans with clients. Recovery plans were holistic and individual to each client.
  • Staff provided a range of care and treatment interventions that were in line with guidance from the National Institute for Health and Care Excellence.
  • There was fortnightly group clinical supervision for staff. Supervision was arranged so that staff could attend at least one session a month.
  • There were a range of multidisciplinary meetings to ensure staff shared information appropriately. There was a system for reporting, reviewing and learning from incidents.
  • There was a range of rooms to meet client needs. Regular activities both on site and away from the service were offered to clients.
  • All clients received a welcome pack which contained information about how to make a complaint.
  • Senior managers showed a good understanding of the service and could clearly describe how staff were working to provide high quality care.
  • Staff were aware of the vision and aims of the service. A recent staff survey showed that 83% of staff felt satisfied working at the service.
  • There were clear systems to support good governance. Senior managers continually explored ways to improve and develop the service.

However

  • Clients were unable to lock their bedroom doors and there was no CCTV or security at the service. Clients told us they were concerned about the lack of security and that other clients were able to enter their bedrooms.
  • Fire extinguishers had not been checked by a qualified engineer in line with legislation.
  • Staff stored clients’ own medicines separately and administered medicines from stock. Staff only used client’s own medicines if the service did not have them in stock. During the inspection we saw that mediciness had been transcribed onto prescription charts for five clients. However, not all of these transcriptions had been authorised for administration by the doctor. Legislation requires authorisation from a prescriber before staff can administer medicines. Staff did not seek to obtain dispensed medicines from the pharmacy when clients’ leave was planned. There wasa risk that staff could dispense and supply medicines to clients without them being prescribed.
  • Some staff had not updated their mandatory training for several years. The prescribing doctor had not completed any of the mandatory training specific to their role.
  • The process to monitor staff competency during their induction did not demonstrate clear oversight and record keeping. Information including the signature of staff signing off competence was missing on some records.
  • The prescribing doctor had little involvement in the clinical audits, including those that related to medicines management and prescribing practice.
Inspection areas

Safe

Requires improvement

Updated 20 May 2019

W

e rated safe as requires improvement because

:

  • Some clients told us they were concerned they were unable to lock their bedroom doors and that other clients may come into their rooms. There had been five recent incidents that involved one client entering other clients’ bedrooms There was no CCTV and people could access and leave the site at any time. Clients said they were concerned about the lack of security on site.
  • There was little signage across the site and none of the buildings or rooms were named or numbered. This meant that there was a risk that clients, especially those receiving a medicated detox who may be disorientated or confused, may inadvertently enter another clients’ bedroom.
  • Fire extinguishers had not been checked by a qualified engineer in line with legislation. The last certificate for testing of fire extinguishers by an external agency was dated July 2016.
  • The prescribing doctor did not always work from the service. Staff stored clients’ own medicines separately and administered medicines from stock. Staff only used client’s own medicines if the service did not have them in stock. During the inspection we saw that medicines had been transcribed onto prescription charts for five clients. However, not all of these transcriptions had been authorised for administration by the doctor. Legislation requires authorisation from a prescriber before staff can administer. Despite the contracted pharmacist and staff raising this with the prescribing doctor, charts remained unsigned.
  • Staff did not seek to obtain dispensed medicines from the pharmacy when clients’ leave was planned. There was a risk that staff could dispense and supply medicines to clients without them being prescribed due to the amount of transcribing without the doctor signing to authorise.
  • Training data provided by the service showed that some staff had not completed refresher training since 2015. The prescribing doctor had not completed any of the mandatory training specific to their role.

However:

  • All bedrooms contained a call alarm for clients to alert staff. There was a nominated member of staff each day, who was responsible for responding to alarms. All bedrooms contained a credit sized laminate card which contained telephone contact details for staff.
  • There was a clean well-equipped clinic room that contained the necessary equipment to carry out physical examinations. Staff had access to the emergency equipment in the clinic room. An external pharmacist completed a fortnightly audit of the clinic room and fed-back any learning to the senior management team.
  • Registered nurses were available 24 hours a day. Nurses were skilled and experienced to deliver the care required to meet the needs of clients. Nursing qualifications included mental health, wound care and counselling.
  • Risk assessments were detailed and up to date. All three risk assessments reviewed contained a risk management plan.
  • Medicines were stored safely and securely in temperature monitored areas. The service kept emergency medicines, including oxygen. Staff checked these regularly to ensure they were safe to use. Medicines were administered by registered nurses and clinical therapists who had received training in the safe administration of medicines.
  • Staff monitored clients’ physical health and completed withdrawal assessment scales.

...

Effective

Good

Updated 20 May 2019

W

e rated effective as good because

:

  • Clients received a comprehensive assessment on admission. The assessment process included a pre admission assessment with the nurse, a comprehensive medical assessment with the specialist medical prescriber and a psychiatric assessment with the psychiatrist.
  • Hay Farm employed a multidisciplinary team which included a specialist medical practitioner, nurses, therapists and support workers. Some staff had additional lead roles including safeguarding and diet and nutrition.
  • Hay Farm had created the post of admissions officer to strengthen the admissions process and ensure that it didn’t take clients it was not able to care for effectively or met its criteria for admission.
  • Care plans were holistic and recovery oriented. Care plans demonstrated staff working collaboratively with clients.
  • Staff followed the National Institute for Health and Care excellence (NICE) guidance in the prescribing of medicines to support alcohol and opiate detoxification.
  • Therapists provided a range of psychosocial interventions and activities to meet client needs in line with NICE quality statement 23.
  • Staff used recognised rating scales to assess and record symptom severity and outcomes of opiate and alcohol detoxification. We saw evidence of staff completing regular physical health observations including blood pressure and pulse in accordance with NICE guidance
  • Staff received regular clinical supervision with an external supervisor. Meetings were arranged so that staff could attend at least one session per month.

However:

  • There was missing information on the staff induction and competency spreadsheet and there was no way of identifying who had recorded the information, formal oversight or dates reviewed.

  • The group clinical director said that they held monthly line management meetings with senior staff. However, they were unable to provide evidence of these meetings during the inspection, so we could not be assured these had taken place.
  • Although staff met with their line manager once or twice a year to review their performance development review, and could meet with their managers when required, they did not receive regular formal one to one meetings with their line manager.

The service employed staff who had lived experience of using substances but there was no additional assessment or support in place for staff who were in recovery. 

Caring

Good

Updated 20 May 2019

W

e rated caring as good because

:

  • Staff spoke with respect and compassion when discussing clients. They displayed a good understanding of individual need and a desire to provide high quality care. Clients told us staff were polite and respectful.
  • Clients said that staff were compassionate and responsive to their needs. They said that staff had provided information about accessing additional support, where required.
  • Staff supported clients to attend mutual aid groups by driving them to meetings
  • Clients were involved in completing their recovery plans, which were holistic, and person centred. Clients completed a continued recovery plan which contained information how they could maintain their recovery following discharge.
  • Clients said they felt listened to and able to raise concerns directly with staff or during the weekly community group meeting.
  • Hay Farm actively encouraged family and carer involvement. Staff regularly kept in contact with families and carers where consent had been obtained. Families and carers could eat dinner with their relative on Sundays and could attend individual and joint sessions with therapists. Staff used this as an opportunity to gather feedback from families and carers.
  • Clients completed a satisfaction questionnaire prior to discharge. The questionnaire was in the process of being reviewed so that feedback was more meaningful to improve and develop the service.

Responsive

Good

Updated 20 May 2019

W

e rated responsive as good because

:

  • The provider had introduced the post of admissions officer to strengthen the referral process and ensure that Hay Farm’s exclusion criteria was adhered to.
  • Although staff did not formally record plans for an unplanned exit, all clients completed a continued recovery plan (CRP) which contained details how they would continue their recovery in the community.
  • Hay Farm was in the process of introducing a discharge appointment system so that all clients had a dedicated appointment to ensure robust discharge planning.
  • There was a range of rooms and equipment to support treatment. There was a comfortable client lounge with games, books and a television. The main lounge was used for group therapy and there were individual consulting rooms. Clients had access to a well maintained outside area, where they could smoke.
  • Hay Farm offered a range of activities to meet a range of individual needs and interests. These included equine therapy, drumming, massage, yoga and art therapy. Clients could choose from a range of external activities twice weekly, that were weather dependent. Staff support clients attend mutual aid meetings.
  • Clients were complimentary of the food and that staff responded to their dietary requirements.
  • All clients were given a welcome pack which included information about what to expect from treatment and how to make a complaint. Complaints information included details about external agencies including CQC.
  • Hay Farm offered a choice of food to meet clients’ dietary requirements due to personal needs, allergies, religious or ethnic needs. Staff provided advice and support with healthy eating. A member of staff was the lead for diet and nutrition.

However:

The standard of decoration in the bedrooms varied. Clients told us that some rooms were not as nice as others and staff had been slow to respond to a client’s request to change rooms.

Well-led

Good

Updated 20 May 2019

W

e rated well led as good because

:

  • The group clinical director and clinical manager were both visible in the service and approachable for clients and staff. They showed a good understanding of the service and could clearly describe how staff were working to provide high quality care for clients.
  • There was a commitment towards continual improvement and innovation. The service had recently introduced the role of an admissions officer to strengthen the admissions process and ensure the service was able to meet the needs of the client. The service had completed an audit looking at the number of clients who were prescribed psychotropic medicines on admission and to see if physical health monitoring was taking place in line with guidelines.
  • There was a clear system to report, review and learn from incidents.
  • Staff were aware of the visions and aims of the service. There were regular meetings where staff discussed the strategy and plans to develop the service. Managers cascaded information to staff during team meetings and training days.
  • Senior managers had arranged a day to review results of the staff survey to encourage staff engagement.
  • Staff morale was good. Staff we talked to spoke positively about their job and providing the best service for clients.
  • There were good internal processes to discuss and review the care being provided such as handovers, clinical meetings, team meetings, clinical governance meetings and heads of department meetings.
  • Staff were involved in the clinical audits. The results of the audits were discussed during the four monthly clinical governance meeting held to oversee audits and review governance.

However:

  • The process to monitor staff competence during their induction did not demonstrate clear oversight and record keeping.
  • The service did not have any key performance indicators and only used client feedback to monitor the effectiveness of the service.
  • The prescribing doctor had little involvement in the clinical audits, including those that related to medicines management and prescribing practice.

.

Checks on specific services

Substance misuse services

Good

Updated 20 May 2019

Residential substance misuse services

Good

Updated 20 May 2019

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