Archived: Tower Hamlets Community Alcohol Team

Updated 28 October 2016

Tower Hamlets Community Alcohol Team (THCAT) provides services ranging from education and brief intervention for non-problematic drinkers, to community detoxification and pathways into residential rehabilitation for dependent drinkers. This service is provided by Rehabilitation for Addicted Prisoners Trust (RAPt)

This service is registered with the CQC to provide the following regulated activities:

• Treatment of disease, disorder or injury.

At the time of the inspection the service was commissioned by the London Borough of Tower Hamlets. However, the service is to be decommissioned and the provider reported that the contract was due to end on 30 September 2016. On the same day the lease expires for the premises. The London Borough of Tower Hamlets have since extended the contract until 31 October 2016 so the provider will be providing regulated activity from another premises during this time. The new location will be in the same borough but using a local NHS trust's premises whilst the provider carries out their regulated activity. 

There was a registered manager for this service but the provider informed us that they had left the service in 2014. However, there was a service manager in post who had day to day oversight of the service and had applied to become the registered manager.

We last inspected this service in 2013. At that time the service was meeting essential standards, now known as fundamental standards.

Updated 28 October 2016

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• The home detoxification programme was unsafe. Clients detox for alcohol at home and come to the community base for therapy and activity. We subsequently asked the provider to cease admitting clients to the home detoxification programme due to the concerns we had which included, little clinical oversight of the home detoxification programme, the service did not have effective arrangements in place to assess, monitor and improve the quality of the community alcohol detoxification programme and ensure that this was carried out safely and in line with national guidance.
• The provider has provided CQC with an action plan to improve the safety and quality of the home alcohol detoxification programme in the future.
• The service had not completed an infection control risk assessment of the service or conducted an audit of infection control arrangements.
• The premises were not secure to keep clients and staff safe. Once a client or visitor was buzzed into the building, clients and visitors were able to roam free. Therefore, if someone was intoxicated then it was difficult to manage them and escort them off the premises.
• Letters to the client’s general practitioner were not sent out after a home detoxification was completed.
• Care records of clients who had undergone home detoxification were stored on paper and in two different electronic records systems. Some staff did not have access to all the available information to be able to carry out detoxification safely. Alcohol detoxification regimes were left blank in client’s care records.
• There was little management or clinical oversight of the way the detoxification was carried out to make sure it was safe. The nurse in the service had only received clinical supervision twice and no management supervision since April 2015.
• The provider had not carried out checks with the disclosure and barring service in relation to the manager at the service before they started work in the service.
• Staff had not received training in the duty of candour and the service did not provide a policy or guidance for staff on what the duty meant.
• The service did not risk assess their rationale for not keeping emergency equipment on site.

Please see end of this report for requirement notices that have been issued to the provider.

However, we also found the following areas of good practice:

• Staff had a good understanding and knowledge of safeguarding adults and children. Staff were able to identify the risks that the clients faced and the people in their networks.
• Staff were very passionate about the work they did and this was reflected in client feedback about the service.
• Staff were happy working at the service and felt supported by their manager.