Archived: Osbrooks Also known as Moving Forward

This was the first inspection of the service. We rated it as inadequate because:

• The provider failed to ensure that information on client risk was centrally located in the client file.
• Care plans did not include all risks identified at the initial assessment. The client files did not include the risk assessments; nor did they contain records of risk reviews or risk management plans. This meant that not all client records contained consistent information regarding risk - including assessment documentation and prescribing information. As a result, this important information was not easily accessible to staff to inform the care that they provided.
• The provider failed to ensure that staff always responded to warning signs and deterioration in people’s heath or changing risks.
• The provider failed to ensure that all staff were properly trained in using detoxification or withdrawal management tools and could therefore manage detoxification safely.
• The provider failed to ensure that all re-accreditations, such as the managers nursing registration, were completed in time and all staff had up to date DBS checks completed.
• The provider had failed to ensure that out of date fire safety equipment had been replaced.
• Not all staff were aware of the admission criteria, nor did they always follow them.
• We were not assured that the records were an accurate record of the medicines prescribed and administered or declined, nor a full reconciliation of the client’s medicines on admission.

• Up-to-date care plans were not always present or complete in the client files. We found the care plans to contain pre-populated generic information and whilst short- and long-term goals were identified there were limited steps on how to achieve them.
• Whilst staff used recognised rating scales to assess and record severity and outcomes, not all staff were trained in using them.
• The provider failed to ensure that effective records were kept in order to ensure the safe management of the service, included staffing rotas, documents about the running of the service and client records including medication charts.
• Governance policies, procedures and protocols were not regularly reviewed and often out of date or had passed their renewal date.

However:

• The full-time staff had completed their mandatory training, including safeguarding, and all staff received an induction when they joined the service, which included the completion of the Care Certificate.
• Staff completed some comprehensive assessments with clients on admission to the service, including consent to treatment, client details, breathalyser reading, medical and social background, alcohol dependence questionnaire and basic physical observations.
• Staff provided a range of care and treatment interventions suitable for the client group. These included medication, activities, counselling and therapy. A structured timetable of therapy and activities was offered to clients Monday to Saturday.

• Clients told us that the staff treated them with compassion and kindness and that the staff understood the individual needs of clients and supported clients to understand and manage their care or treatment.
• The service held monthly quality and innovation meetings for staff and had evidence of initiatives to improve the service, such as an improvement log.
• Clients were made aware of the risks of continued substance misuse and harm minimisation.

The inspection team identified concerns that were placing, or could place, the clients at Osbrooks at risk. CQC sent a Section 31 Letter of Intent to the provider following the inspection. A letter of intent describes these concerns to the provider and asks that the provider responds to CQC with plans to rectify the issues immediately otherwise further enforcement action could be taken. The areas which CQC asked the provider to address were:

1. The provider must ensure that Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA-Ar) assessments scores are appropriately responded to and provide evidence that all staff understand the intervention required according to the CIWA-Ar score.
2. The provider must ensure that the correct tools are used when assessing client’s withdrawal and that all staff are aware of which tool to use depending on which substance treatment plan the client is on.
3. The provider must ensure that the GP assessments for each client are contained in the client files and accessible to all staff working with the client.
4. The provider must ensure that all known risks and identified risks are recorded, and appropriate action is taken to mitigate the risk and that this is recorded in the risk plan for all clients.

The provider responded in a timely manner describing the adequate and immediate actions taken to ensure the safety of clients at the service in relation to these four areas of concern. Details of the concerns and the provider’s response are contained within the report findings.