This was an unannounced focused inspection relating to issues identified at a previous inspection in August 2016 following which we served warning notices. We do not currently rate independent standalone substance misuse services.
Following a comprehensive inspection in August 2016 we issued a warning notice under regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection we assessed whether the service provider had put right issues identified in the warning notice. We found some improvements had been made. However not all areas had been addressed.
We found the following issues that the service provider needs to improve:
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The service was not administering medication safely. Medication administration records were not always completed properly. There were gaps in signatures to confirm administration. Prescription charts were not always signed by a doctor. We found some prescription charts were duplicated. Staff administering medication had not been signed off as competent to do so.
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Physical health and withdrawal symptoms were not being monitored effectively. Physical health observations requested by the doctor were not always being completed. Staff completed Clinical Institute Withdrawal Assessment for alcohol scales on admission. However these were not repeated consistently.
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Staff had not completed medication management training at the time of the inspection. However evidence was provided to show that staff had been booked onto training.
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Staff were monitoring fridge temperatures. However the thermometer did not allow them to record minimum and maximum temperatures.
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There were gaps in medication management. There was a system for auditing medication stock levels. However clients’ own medication was being recorded on a separate sheet. This meant that the provider’s policy was not being followed. Controlled drugs were being managed in accordance with legislation. A new medicines policy had been developed. However there was no date of issue on the policy.
However, we also found the following areas of good practice:
Following the comprehensive inspection in August 2016 we issued a warning notice under regulation 17 of the Health and Social Care Act 2008 (regulated activities).
At this inspection we assessed whether the service provider had put right issues identified in the warning notice. We found some improvements had been made. However not all areas had been addressed.
We found the following issues that the service provider needs to improve:
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Robust systems There was a lack of audits in place. Staff told us that a care record audit was completed monthly. However, the provider shared results verbally with staff and there was no documentation to evidence this. The provider’s quality assurance programme requires the service to complete at least two different audits each year.
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Risk assessments were completed. We found some evidence of risk management plans. However there were risks that had been identified that were not addressed in risk management or care plans.
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There was a ligature audit. This identified the level of access clients had to rooms with ligature points. There was no additional assessment or mitigation in place. However mental health was part of the pre-admission assessment for clients. The service did not admit individuals at risk of suicide.
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Not all policies and procedures had been reviewed. Several policies were overdue for review. There was a box on the front page to evidence that review had taken place.
However, we also found the following areas of good practice:
Following the comprehensive inspection in August 2016 we issued a warning notice under regulation 18 of the Health and Social Care Act 2008 (regulated activities).
At this inspection we assessed whether the service provider had put right issues identified in the warning notice. We found some improvements had been made. However not all areas had been addressed.
We found the following issues that the service provider needs to improve:
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Data on compliance with mandatory training was not available during the inspection. Staff we spoke with told us that training had been discussed in team meetings and that they had training dates booked in.
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Staff appraisal rates remained low. However staff we spoke with were able to tell us the dates of their planned appraisal. They had been given a pre-appraisal assessment to complete as part of the process.
However, we also found the following areas of good practice:
Following the inspection we held a management review meeting to discuss the findings. We issued a letter of intent to the provider, requesting further information and assurance. It also laid out the regulatory and enforcement actions available to the CQC if regulations were not met.