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East Sussex STAR Service Good

Inspection Summary


Overall summary & rating

Good

Updated 24 December 2019

We rated East Sussex STAR as good because:

  • The areas where clients were seen were safe and clean. The service provided safe care. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • The service provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
  • Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.

However:

  • Staff did not always submit notifications to the Care Quality Commission about incidents that were reported to the police.

  • Caseloads were high. The average caseload for staff was approximately 70 clients. Staff said that the high caseloads meant that they could not always give clients the time they needed.

  • Vacancies and high sickness absence in Hastings meant the service was often short staffed. The number of changes to service delivery and management during the previous 12 months had affected staff morale. Staff said they were stressed and under pressure because of the staffing levels.
  • Staff were unable to locate the cleaning logs to demonstrate that medical equipment was cleaned regularly.
  • The boilers in both services did not work properly and some areas of the environment were tired and in need of repair.
  • Care plans were mixed across Eastbourne and Hastings. In Hastings, staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Care plans were less personalised in Eastbourne.
  • There were no recognised scales to measure opiate withdrawal in any of the 14 care records reviewed.
Inspection areas

Safe

Good

Updated 24 December 2019

We rated safe as good because:

  • All areas where clients received care were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

  • Staff knew the clients and received basic training to keep them safe from avoidable harm.

  • Staff assessed and managed risks to clients and themselves well. They responded promptly to sudden deterioration in clients’ physical and mental health. Staff made clients aware of harm minimisation and the risks of continued substance misuse. Safety planning was an integral part of recovery plans.

  • Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • Staff kept detailed records of clients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • The service used systems and processes to safely prescribe, administer and record medicines. Staff regularly reviewed the effects of medicines on each client’s physical health. In addition to consultants, the service had non-medical prescribers in post.

  • The service had a good track record on safety. The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave clients honest information and suitable support

    However:

  • The service reported individual caseloads ranged between 30 and 70 clients, dependent upon complexity. Staff said that caseloads had increased because of covering long term sickness absence and vacancies. They said that high caseloads affected time available for clients and stress levels. Data provided by the service said that in October, the average caseload was 48.

  • Vacancies and high sickness absence in Hastings meant the service was often short staffed. Staff said they were stressed and under pressure because of the staffing levels.

  • Staff reported cleaning the medical equipment after each use. However, they were unable to locate the cleaning logs to evidence this.

  • The boilers in both services did not work properly. Staff used electric heaters as an interim measure whilst waiting for repairs.

Effective

Good

Updated 24 December 2019

We rated effective as good because:

  • Staff completed comprehensive assessments with clients on accessing the service. They worked with clients to develop individual care plans and updated them as needed. Care plans in Hastings reflected the assessed needs, were personalised, holistic and recovery-oriented. Care plans in Eastbourne were less personalised.

  • Staff provided a range of care and treatment interventions suitable for the client group and consistent with national guidance on best practice. They ensured that clients had good access to physical healthcare and supported clients to live healthier lives.

  • Staff used recognised rating scales to assess and record severity and outcomes for alcohol dependence. They also participated in clinical audit, benchmarking and quality improvement initiatives.

  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers made sure that staff had the range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.

  • Staff from different disciplines worked together as a team to benefit clients. They supported each other to make sure clients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.

  • Staff supported clients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and knew what to do if a client’s capacity to make decisions about their care might be impaired.

    However:

  • The detail in care plans was mixed. In Hastings, staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Care plans were less personalised in Eastbourne.

  • There were no recognised withdrawal scales such as the clinical opiate withdrawal scale (COWS) or clinical institute withdrawal assessment of alcohol scale (CIWA-r) in any of the records reviewed.

  • Staff said that some opportunities for face to face training was discouraged because of staff shortages in Hastings.

Caring

Good

Updated 24 December 2019

We rated caring as good because:

  • Staff treated clients with compassion and kindness. They understood the individual needs of clients and supported clients to understand and manage their care and treatment.

  • Staff involved clients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that clients had easy access to additional support.

  • Staff informed and involved families and carers appropriately.

Responsive

Good

Updated 24 December 2019

We rated responsive as good because:

  • The service was easy to access. Staff planned and managed discharge well. The service had alternative care pathways and referral systems for people whose needs it could not meet.

  • The design, layout, and furnishings of treatment rooms supported clients’ treatment, privacy and dignity.

  • The service met the needs of all clients, including those with a protected characteristic or with communication support needs.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Requires improvement

Updated 24 December 2019

We rated well-led as requires improvement because:

  • The number of changes to service delivery and management during the previous 12 months had affected staff morale. There was high vacancy and sickness absence. Staff said they were stressed and under pressure because of the staffing levels.

  • Staff were not always able to attend face to face training because of staffing numbers and change of venue for classroom training.

  • Staff did not always submit notifications to the Care Quality Commission about incidents that were reported to the police.

However:

  • Leaders had the skills, knowledge and experience to perform their roles and had a good understanding of the services they managed. A new service manager had recently been appointed, and they were visible in the service and approachable for clients and staff.

  • A recent change to the provider’s vision and values meant that staff did not all know and understood them. However, staff understood their role within a client’s recovery.

  • Most staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated that governance processes operated effectively and that performance and risk were managed well.

  • Teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff collected and analysed data about outcomes and performance.

Checks on specific services

Community-based substance misuse services

Good

Updated 24 December 2019