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Inspection carried out on 12 March 2019

During a routine inspection

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 carried out on 17 October 2017

During an inspection to make sure that the improvements required had been made

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • Although the service had fitted call alarms in all bedrooms, they were not working during our inspection. This was an ongoing issue due to the service experiencing dips in power. Staff had acted to rectify this and expected the alarms to be working by the end of October 2017.

  • Staff told us they had received training in incident reporting. However, this had not been recorded on the training matrix.

  • Staff told us they discussed incidents during the weekly clinical management meeting. However, records from these meetings did not capture this information.

  • Staff completed regular visual and physical observations, although they were inconsistent in their recording of these.

  • Three pre-admission assessments recorded client consent for staff to contact their GP. However, only one record contained a GP summary.

  • Although the service had added exclusion criteria to their admissions policy, it lacked detail to support the screening of inappropriate referrals at the earliest opportunity.

  • The service had not updated the statement of purpose since our inspection in July 2016, when it was found to contain incorrect information.

However, we also found the following areas of good practice:

  • Risk assessments contained appropriate information and were reviewed regularly.

  • The service had introduced an incident book since our inspection in July 2016.

  • Care plans were detailed and staff linked care plans to risk assessments.

  • We saw evidence of staff liaison with various health professionals to ensure safe care and treatment of a client.

Inspection carried out on 5 July to 6 July 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • Staff knew and put into practice the service’s values. Staff knew and had contact with managers at all levels. The service had a very stable staff team and had enough trained and experienced staff to care for the number of clients and their level of need.

  • Staff were caring, supportive and showed real compassion in their work. Staff treated people as individuals. Staff were very person centred. Clients told us that they felt their individual needs were responded to and their care plans demonstrated this.

  • Staff were well supported and encouraged by the management to further develop their skills through training.

  • After care and follow up service and supportwas offered to clients and their families and carers. There were support groups for carers and a top up return service for clients who had previously completed their programme. Clients and ex-clients also told us that they felt they could and have contacted Hay Farm at any time for support. Clients, ex-clients and some of their carers told us that they really benefitted from Hay Farm’s follow up support when they left the service.

However;

  • Although staff could recognise incidents and reported them, there was not a full robust procedure in place to record these. We saw an accident book but not an incident book. Staff acknowledged this during the inspection and were going to introduce an incident book.

  • We were told GP summaries could be requested following agreement from the client. However we saw no evidence of this during the inspection in clients records. This could lead to a lack of full information on a client’s full physical and mental health history.

  • There were no call alarms in bedrooms or communal areas and clients had to rely on their own mobile phones to call staff. However, staff tried to mitigate any risks by ensuring there were two central phones held by staff on duty and regular observations  conducted day and night on clients.

  • The service did not have a written admission or exclusion criteria.Whilst the provider gave verbal evidence on Clients they could not accept and why. The service did not have a written exclusion criteria.This meant there was no point of reference for inappropriate referrals.

  • There were up to date risk assessments. However, these were not in-depth and did not have a crisis contingency plan.

Inspection carried out on 29 January 2014

During a routine inspection

We spoke with patients, the registered manager, health care assistants and support staff. We looked at patients' care plans, staff files and the service's policies and procedures.

We found that patients' views and experiences were taken into account in the way the service was provided .

We found that patients' needs were assessed and care and treatment was planned and delivered in line with their individual therapeutic plan. One person told us,"They are so caring. It�s truly amazing. I have so many nice things to say.�

We saw that patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Staff received appropriate professional development. We spoke with staff who told us they received sufficient training to meet the needs of the patients they supported. One member of staff told us �We try to foster a 1:1, eclectic approach which includes the 12 step programme. This is a rich and evolving field and each person's programme is tailored around them.�

Patients', their representatives and staff were asked for their views about their care and treatment and they were acted on. Patients told us they were given the opportunity to express their views about every aspect of their care, treatment and support.