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Inspection Summary


Overall summary & rating

Good

Updated 7 June 2019

We rated Livingstone House Good overall because:

  • The service provided safe care. The environment was safe and clean. The service had enough staff and they assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the client group and in line with national guidance and best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • Managers ensured that staff received training, supervision and appraisal. The staff worked well together as a multidisciplinary team and with those outside the service who would have a role in providing aftercare.
  • Staff truly respected and valued people using the service as individuals and empowered them to understand and manage their care. They treated clients with dignity, compassion and kindness. They understood the individual needs of clients and supported them to understand and manage their condition.

  • Staff actively involved clients and families and carers in care decisions. Staff involved families and carers and provided them with exceptional levels of support. Staff actively worked with clients and their families to rebuild broken relationships caused by addiction.
  • The service provided a range of treatment options including detoxification, day care, aftercare, resettlement, peer support and volunteering. Staff planned and managed discharge well and liaised well with community services.
  • The service was well led. Staff were undertaking a programme of improvement and updating governance processes to ensure the service ran smoothly.
Inspection areas

Safe

Good

Updated 7 June 2019

  • All areas were safe and clean. The environment was well furnished, well maintained and fit for purpose.
  • The service had enough nursing and medical staff, who knew the clients and received basic training to keep clients safe from avoidable harm.
  • Staff assessed and managed risks to clients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment to enable clients’ recovery.
  • 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 had easy access to clinical information and it was easy for them to maintain high quality clinical records – whether paper-based or electronic.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each client’s physical health.
  • The service had a good track record on safety. The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. There was a culture of learning lessons embedded in practice.  
  • 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. 

Effective

Good

Updated 7 June 2019

  • Staff assessed the physical and mental health of all clients on admission. They developed individual care plans, which they reviewed regularly. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.
  • Staff provided a range of care and treatment interventions suitable for the client group and consistent with national guidance and best practice. This included psychosocial interventions, group therapies and support for self-care and the development of everyday living skills. Staff 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. They also participated in clinical audit and quality improvement initiatives.
  • Staff had a range of skills needed to provide high quality care. Staff had 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 service had effective working relationships with other staff from services that would provide aftercare following the client’s discharge.
  • Staff understood their roles and responsibilities underthe Mental Health Act Code of Practice. Staff ensured clients knew their rights while in treatment and routinely revisited these. Staff supported clients to make decisions on their care for themselves.

Caring

Outstanding

Updated 7 June 2019

  • Staff truly respected and valued people using the service as individuals and empowered them to understand and manage their care. They treated clients with dignity, compassion and kindness. They understood the individual needs of clients and supported them to understand and manage their condition.
  • Many staff  were themselves  in recovery and this gave them additional insight and empathy with clients.Clients were enthused and motivated by the examples they saw of staff and volunteers who were on the same recovery journey.
  • Feedback from clients and families was overwhelmingly positive about staff and the service provided. All clients and carers, past and present, had nothing but praise for the service and staff and the dedication they had shown in helping turn their lives around.
  • Group therapy sessions demonstrated how the values of kindness, compassion, respect and support were thoroughly embedded into the service and all those involved in it. 
  • Staff actively involved clients and families and carers in care decisions. Staff involved families and carers and provided them with exceptional levels of support. Staff actively worked with clients and their families to rebuild broken relationships caused by addiction.
  • 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 independent advocates.

Responsive

Good

Updated 7 June 2019

  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway.
  • The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity. There were quiet areas for privacy and reflection.
  • The food was of a good quality and prepared by employed catering staff. Clients could make hot drinks and snacks at any time.
  • The service met the needs of all clients who used the service – including those with a protected characteristic. Staff helped clients with communication, advocacy and cultural and spiritual support.
  • The service treated concerns and complaints seriously, investigated them and learning lessons from the results was embedded in practice. Lessons were shared with the whole team.

Well-led

Good

Updated 7 June 2019

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for clients and staff.
  • The manager promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff modelled compassionate and person-centred care and demonstrated services vision and values in their work.
  • Staff felt respected, supported and valued. They reported that the service provided opportunities for development. They felt able to raise concerns without fear of reprisal.
  • Our findings from the rest of the inspection demonstrated that governance processes operated effectively and were managed well.
  • There was a strong culture and focus on continuous learning and improvement at all levels of the service that was embedded within the practice.  
Checks on specific services

Substance misuse services

Good

Updated 7 June 2019