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Inspection Summary


Overall summary & rating

Good

Updated 21 August 2019

We rated Providence Project 6 as good because:

The building was clean, well equipped, well-furnished and fit for purpose.

The service had enough staff and had plans in place to adjust staffing levels when client numbers increased. Staff assessed and managed risks well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate client recovery.

Staff assessed the physical and mental health of all clients on admission. They developed care plans which staff reviewed regularly and updated as needed. Staff involved clients in care planning and risk assessment and actively sought their feedback on the quality of care provided.

Staff provided a range of treatment and care for clients based on national guidance and best practice for substance misuse services from the National Institute for Health and Care Excellence (NICE).

The service treated incidents, concerns and complaints seriously. They investigated them, learned lessons from the results, and shared these with the whole team and wider service to improve practice.

Systems and processes around prescribing, administering, recording and storage of medicines were robust. The service had an agreement with the local GP practise for a responsible clinician to prescribe all medicines, including detoxification medication.

Staff training compliance levels was 100% for mandatory training such as safeguarding, first aid and medicine management as well as some substance misuse specialist training courses. Staff were confident with their safeguarding responsibilities and made referrals to the local authority as appropriate to ensure that people were safe from abuse.

Staff treated clients with compassion, kindness and respected their privacy and dignity. The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity. Clients we spoke with spoke highly of the staff and the standard of care they delivered.

Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of substance misuse and the service they managed. Leaders were visible in the service and approachable for clients and staff. Staff felt respected, supported and valued, and morale was good. Staff received regular internal and external supervision, and all staff had been appraised.

Inspection areas

Safe

Good

Updated 21 August 2019

We rated safe as good because:

  • The service was clean, well equipped, well furnished, and fit for purpose. Staff ensured they assessed and acted upon environmental risks.

  • The service had a well-established staff team, who knew the clients well. The service had no vacancies and had an out of hours emergency protocol to help keep clients safe. Although the service did not have any medical staff, there were sufficient skilled staff to provide safe care. Detoxification medication was prescribed by a doctor at a local GP practice. Staffing at the clinic could be adjusted to meet the needs of their clients. The service provided mandatory training in key skills for all staff, including core substance misuse specialist training. Compliance levels for all training was 100% for all staff at the time of this inspection.

  • As part of the admission process, staff comprehensively assessed clients’ risks, including past substance misuse, history of blood borne viruses and mental health history. Staff responded promptly to deterioration in a client’s health and wellbeing. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate client recovery. Staff kept detailed records of clients’ care. Records were clear, up-to-date and easily available to all staff providing care.

  • Systems and processes around prescribing, administering, recording and storage of medicines were robust. All medicines were prescribed by a GP at a local surgery the service had an agreement with. Administration of medicines was the responsibility of one staff member per shift to promote accountability and minimise errors.

  • Staff were aware of their responsibility to safeguard clients from abuse and we saw examples of staff making appropriate safeguarding referrals.

  • The service managed safety incidents well. Staff recognised incidents and reported them. Managers investigated incidents and shared lessons learned with the staff team.

However:

  • Some medication administration record (MAR) charts had been hand written but the provider did not specify within their policy how this was to be carried out safely. MAR charts records did not specify times for administration of medicines and there was no system in place to monitor medication being supplied to clients who were self-medicating.

Effective

Good

Updated 21 August 2019

We rated effective as good because:

  • Staff assessed the physical and mental health of all clients on admission. They developed care plans which were reviewed regularly and updated as needed.

  • Staff provided a range of treatment and care for patients based on national guidance and best practice. Staff used recognised rating scales to assess and record severity and outcomes. These included use of the clinical institute withdrawal assessment for alcohol (CIWA-AR) to identify common signs and symptoms of alcohol withdrawal. They also participated in clinical audit and quality improvement initiatives.

  • Managers supported staff with supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.

  • Staff understood the provider policy on the Mental Capacity Act 2005 and were aware of the fluctuating nature of capacity and the potential impact of substance misuse on the ability to make a decision.

However:

  • Care plans were generic and not personalised for each client. Care plans did not reflect clients’ individual needs and recovery goals.

Caring

Good

Updated 21 August 2019

We rated caring as good because:

  • Staff treated clients with compassion and kindness. Staff had an understanding of the impact peoples' care and treatment could have on their emotional and social well-being. They respected clients’ privacy and dignity. They understood the individual needs of clients and supported them to understand and manage their care, treatment or condition.

  • Staff involved clients in care planning and risk assessment and actively sought their feedback on the quality of care provided.

  • Staff informed and involved families and carers appropriately, including holding awareness events for families.

Responsive

Good

Updated 21 August 2019

We rated responsive as good because:

  • The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity. Clients had their own bedrooms and could keep their personal belongings safe.

  • There were admission criteria to ensure that only clients who could safely receive a service were admitted to the service. For example, not admitting clients with a medium to high risk of self-harm as the service could not meet their needs.

  • Staff assessed and treated clients who required care promptly and clients did not wait too long to start treatment. There were no waiting lists at the time of this inspection.

  • There were a range of rooms to allow one to one therapy, and group therapy and clients could decorate their rooms during their treatment.

  • The service was welcoming to clients of different races, genders, religious beliefs and sexual orientation.

  • Clients knew how to complain and felt comfortable that staff would act on their concerns. The service treated concerns and complaints seriously. We saw that complaints were reviewed by senior leaders and learning was acted upon.

Well-led

Good

Updated 21 August 2019

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible and approachable for clients and staff.

  • Staff knew and understood the provider’s vision and values and how they applied to the work of their team.

  • Staff received regular supervision and yearly appraisals which were meaningful and had objectives focused on improvement and learning.

  • Staff felt respected, supported and valued, and morale was very good amongst the team. Staff felt comfortable raising concerns in the service without fear of reprisal and were aware of the whistle blowing procedures.

  • The service had facilitated a research project on the efficacy of yoga in recovery from substance misuse.

Checks on specific services

Substance misuse services

Good

Updated 21 August 2019