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STARS Southend Requires improvement Also known as Change, Grow, Live

Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 September 2019

We rated STARS Southend as requires improvement because:

  • Managers did not have sufficiently robust and effective governance systems in place to effectively monitor and have oversight to manage the service, including: a lack of ligature and environmental assessments, maintenance issues and repairs, completion of physical health monitoring and safeguarding practices.
  • Staff informed us that nurses monitored detoxing clients’ physical health. However, we found in six out of nine records, staff did not record physical health monitoring for clients going through an alcohol detox.
  • Staff did not keep an accessible record of safeguarding concerns that did not meet the safeguarding threshold.
  • Staff did not always document safeguarding risks in risk management plans.
  • Some members of staff could not recall any incidents or evidence any learning. Managers did not invite recovery champions to meetings where staff and managers discussed lessons learned.
  • Staff did not report all incidents on the provider’s electronic reporting system, for example finding drugs or alcohol on the premises.
  • The service leaders did not adequately assess the premises or mitigate risks within the environment to ensure client safety. Staff had not completed a risk assessment to identify ligature points and staff failed to identify sash windows on the upper floor that opened fully, as a potential risk of falls.
  • Staff did not check the fridge and freezer temperature where they stored donated food, including meat, for clients’ meals. This increased the risk of food poisoning to clients and staff.

However:

  • Staff took a holistic and collaborative approach to assessing, planning and delivering care and treatment to clients.
  • The service had strong leadership and positive regard for staff wellbeing. Staff felt valued and fully supported by managers within the service and spoke highly of the culture.
  • Despite National Institute of Health and Care and Excellence guidelines stating that clients should have their ECG monitored when being prescribed over 100mg of methadone, nurses demonstrated person-centred and safe practice by lowering this threshold to 80mg of methadone.
  • The service psychiatrist monitored additional health needs and diagnosed disorders to clients that hadn’t received a diagnosis. Commissioners, GPs and external organisations commended the work of the doctor particularly with mental health.
  • The service offered free, hot meals to clients using donated food from restaurants and supermarkets. The service also operated an open-door policy for clients to socialise with their peers even if they were not attending a group.
Inspection areas

Safe

Requires improvement

Updated 10 September 2019

We rated safe as requires improvement because:

  • The service leaders did not effectively assess the premises or mitigate risks within the environment. Staff had not completed a risk assessment to identify ligature points which could pose a risk to clients. This was despite working with some clients who had a risk of self-harm or attempted suicide.
  • The provider had a system in place for identifying and managing repairs. However, we found stains on some ceiling tiles and carpet tiles were peeling off in places. Staff had identified issues with floor but had not identified any actions or timeframes for the repair of these issues. Staff did not identify stains on the ceiling tiles. Some rooms in the building appeared visibly dated and the service did not have a decorating schedule.
  • Staff had not completed a thorough environmental risk assessment of the location and failed to identify sash windows on the upper floor that opened fully, as a potential risk of falls. Staff had not identified actions or timeframes to remedy peeling carpet tiles and stains on ceilings within the environmental risk assessment.
  • Staff did not report all incidents on the provider’s electronic reporting system, for example finding drugs or drug paraphernalia or alcohol cans on the premises. This posed a risk to client safety and increased risk of reoccurrence, as managers did not fully investigate these incidents or introduce actions to reduce the risk of this happening again.
  • Staff identified safeguarding risks in initial assessments, however staff did not always document safeguarding risks in risk management plans.
  • Staff did not keep an accessible record of safeguarding concerns raised that did not meet the safeguarding threshold.
  • Staff did not check the fridge and freezer temperature where they stored donated food for clients’ meals. This increased the risk of food poisoning to clients and staff.

However, we found the following areas of good practice:

  • There the service had enough skilled staff to deliver safe care and treatment and conducted robust recruitment checks. The service only worked with agencies that conducted appropriate checks such as: right to work, disclosure and barring service certificates and training. In addition, managers interviewed all agency staff prior to them working with clients.
  • Client records showed that staff tried to follow-up and re-engage clients if they missed an appointment or did not engage with the service.
  • The provider had robust processes for medication management. They had an administration officer for prescriptions to ensure written logs were correct and updated regularly.

Effective

Requires improvement

Updated 10 September 2019

We rated effective as requires improvement because:

  • Staff informed us that nurses monitored detoxing clients’ physical health and recorded monitoring on the electronic system for each client. However, we found in six out of nine records, staff did not record physical health monitoring for clients detoxing from alcohol.
  • Though managers shared lessons learned for incidents that staff reported, these did not include incidents that staff did not report such as finding drugs or alcohol on the premises.
  • Some members of staff could not recall any incidents or evidence any learning from incidents. In addition, managers did not invite recovery champions to meetings where staff and managers discussed lessons learned.

However, we found the following areas of good practice:

  • Despite National Institute of Care and Excellence guidelines stating that clients should have their ECG monitored when using 100mg methadone, nurses demonstrated person-centred and safe practice by lowering this threshold to 80mg of methadone.
  • Staff reviewed and updated individual care plans regularly. All ten care plans reviewed were personalised, recovery orientated, and holistic. Staff ensured that care plans had clear care pathways and involved supporting services including housing charities and mental health support.
  • Counsellors offered therapy sessions to all clients, carers and family members. The Psychologist conducted numerous family therapy sessions together with the client and client alone.
  • The service had a skilled multidisciplinary team including community outreach workers and a hospital liaison worker.

Caring

Good

Updated 10 September 2019

We rated caring as good because:

  • Staff treated clients with kindness and compassion. We spoke with eight clients who felt empowered in their treatment and found staff to be caring, respectful and sensitive to their needs.
  • Clients informed us they were always involved in devising and reviewing their care plans and staff would offer a copy if they requested it.
  • Managers and staff involved clients in redecorating the premises. Staff consulted with clients on what colour schemes they wanted and gave clients ownership of naming a part of the building.
  • The service had systems and processes in place for client and family feedback. The service had an anonymous feedback system called ‘Care Opinion’ where clients could feedback on the service they received. We checked five pieces of feedback and 98% of feedback was positive.

However, we found the following areas the service needs to improve:

  • Staff had not documented carer involvement in the clients’ care plans or why it was not appropriate for their involvement.
  • Clients did not know what the groups/clinics involved as staff did not provide information on what they entailed.

Responsive

Good

Updated 10 September 2019

We rated responsive as good because:

  • The provider had a clear admission and discharge criteria for the service. Recovery coordinators supported clients to develop their plans leading up to discharge. We saw robust evidence of staff checking on clients who did not engage or attend appointments. Staff also supported clients to obtain housing and get back into education or employment.
  • Staff supported clients with accessing employment, voluntary work and education. The service also provided a career pathway for clients who had made it through the recovery process and had recovery champion roles within the service. The service had permanent staff in post who had gone through the recovery journey.
  • The service had a range of rooms to carry out group work, individual therapy sessions and physical health checks. The building split into two areas, one area was for clinical staff and hosted multiple rooms for one-to-one sessions and group work.
  • The service manager facilitated external mutual aid groups, such as Alcoholics Anonymous and Narcotics Anonymous to take place within the building after hours. Staff encouraged and supported clients to engage with this if they chose to do so.
  • Staff looked at the clients’ holistic needs throughout their recovery journey. We saw evidence in client care notes of staff working with clients to meet needs, such as housing, benefits, abuse and mental health. The service had good links with local organisations and charities such as homeless charities, sexual health clinics, mental health charities and domestic abuse charities.
  • The service ran daily groups and hosted ‘PODS’ gender specific for men and women. The PODS were meetings whereby individuals would have physical health checks, mental health checks and advice from key agencies such as domestic violence charities or healthy eating organisations.

However, we found the following areas the service needs to improve:

  • Despite staff following up clients who did not engage or attend appointments, in the records we sampled discharge planning did not always include unexpected exit from treatment.
  • The provider had not ensured that all areas of the building promoted recovery as parts were visibly dated. One therapy session room did not have privacy glass which compromised the confidentiality and dignity of clients having therapy sessions within that room.
  • The service held regular community meetings where clients raised issues for discussion. However, staff did not minute these meetings and did not keep a log of concerns raised and actions taken.

Well-led

Requires improvement

Updated 10 September 2019

We rated well-led as requires improvement because:

  • Managers did not have sufficient oversight of environmental risks in the building such as the windows, general wear and tear and lack of ligature risk assessment.

  • Managers did not have sufficient oversight of incident recording and did not understand why some incidents needed to be reported such as finding drugs, drug paraphernalia or alcohol on the premises.

  • Managers did not ensure that staff kept an accessible record of safeguarding concerns that did not meet the safeguarding threshold.

  • Managers did not have sufficient insight into whether physical health monitoring for clients detoxing from alcohol was taking place.

However, we found the following areas as good practice:

  • The service had strong leadership and regard for staff wellbeing and staff felt valued and fully supported by managers.

  • Managers and staff embedded governance policies, procedures and protocols into practice and regularly reviewed them at integrated governance team meetings.

  • The service manager had access to information to support them with their management role. This included information on the performance of the service, staffing and client’s care.

Checks on specific services

Substance misuse services

Requires improvement

Updated 10 September 2019