The Care Quality Commission
  • Residential substance misuse service

Archived: Cranstoun - City Road

Overall: Good read more about inspection ratings

352-358 City Road, Islington, London, EC1V 2PY (020) 7843 1640

Provided and run by:
Cranstoun

All Inspections

29 August 2018

During a routine inspection

We rated Cranstoun City Road as good because:

  • The service had made improvements since the last inspection. All staff received appropriate training to safely meet the care and treatment needs of clients. Regular environmental checks including fire safety, were carried out regularly and recorded. Robust arrangements to recruit and train a planned future intake of volunteers were being implemented. All clients had early exit plans in place.

  • The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Incidents were appropriately investigated and shared lessons learned with the whole team. When things went wrong, staff apologised and gave clients, or their families, honest information and suitable support.

  • The service had enough staff with the right qualifications, skills, training and experience to keep clients safe from avoidable harm and abuse and to provide the right care and treatment. Robust recruitment procedures and high staff take up of mandatory training meant that clients were protected from the risks of receiving unsafe care or treatment.

  • Managers appraised staffs’ work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service. A programme of specialist training was planned for all staff over the coming 12 months.

  • Client records were clear, up-to-date and available to all staff providing care. The service ensured that all clients were comprehensively assessed before starting their treatment, including their physical and mental health needs. The prescribing professional always met with clients face-to-face before prescribing any medicines.

  • Personalised, holistic care plans were in place for each client. The service assessed and managed the risks associated with clients care and treatment. Only clients whose care and treatment needs could be safely met were admitted to the service for detoxification. Where client risk changed, assessments and management plans were updated to reflect this.

  • The service provided care and treatment based on Department of Health Drug misuse and dependence: UK guidelines on clinical management and evidence of its effectiveness. Clients detoxification medication regimes followed best practice guidance. Physical health monitoring recommended by national guidance was carried out by staff.

  • Staff understood their roles and responsibilities under the Mental Capacity Act 2005. They knew how to support clients with dual diagnosis and those who lacked the capacity to make decisions about their care. The service prescribed, gave, recorded and stored medicines well. Clients received the right medication at the right dose at the right time.

  • Staff of different professions worked together as a team to benefit clients. The staff team liaised with other stakeholders, including the clients’ GPs, the referring agency and secondary services the client would be receiving support from post discharge. Clients’ housing, money and employment needs were assessed and staff supported clients to access other agencies to help support them. There were links with local debt management and advocacy services.

  • The service had robust systems to assess and review referrals which meant that clients could access the service when they needed it. The service worked well with other stakeholders and providers to facilitate transfers of care. Staff routinely followed up clients four weeks after discharge to check on their progress.

  • Staff cared for clients with compassion. Feedback from clients confirmed that staff treated them with compassion and respect. Staff provided emotional support to patients to minimise their distress. Staff involved clients in decisions about their care and treatment.

  • The service had suitable premises and equipment and looked after them well. The premises had a range of private and communal spaces to facilitate individual and group work programmes.

  • The service took account of patients’ individual needs. Staff demonstrated an in-depth knowledge and understanding of clients’ protected characteristics and potential vulnerabilities. The service had arrangements in place to support transgender clients including a bedroom of single occupancy on the same floor as their self-identified gender. One bedroom on the premises had been adapted to allow wheelchair access.

  • The service ensured that clients received regular, varied and nutritious meals to meet their needs and improve their health. The service made adjustments for clients’ religious, cultural and other preferences.

  • The service had leaders at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Leaders were visible and approachable to staff and clients. Leaders promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service had robust governance systems that collected, analysed and used appropriate information to monitor the performance of the service and drive improvement. The service had effective systems for identifying risks, planning to eliminate or reduce them. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. The service was committed to improving services by learning from when things go well and when they go wrong.

However:

  • Whilst the service had made communication devices available to staff so they could stay in contact whilst working in different parts of the building, on the day of our inspection one temporary member of staff was not aware of this and was not using the device, which could compromise their safety and the safety of clients.

20 June 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

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

  • At the inspection in November 2015, we found that the provider did not have sufficient panic alarms for the staff that were on duty. At the June 2017 inspection, we found that the provider had purchased more alarms and now had six. Staff said that the alarms had been tested but there were no records of how often staff had tested the alarms.
  • When the service was inspected in November 2015, we found that staff were not undertaking security checks of the building in line with the provider’s policy. During this inspection, we found that the safety and security checks were still not taking place in line with the provider’s policy. There were no assurances that the environment and service was safe for both staff and patients at all times due to gaps in the records.
  • At the inspection in November 2015, we found there was no written procedure or risk assessment for the security of medicines in transit to and from the service. During this inspection, we found that the provider was in the process of reviewing their policy regarding the secure transportation of medicines. The service manager had issued staff with interim guidance regarding the transportation of medicines. However, staff were not adhering to this guidance. This meant staff were compromising their personal safety when collecting medicines from the pharmacy.
  •  Staff had not undertaken fire alarm checks and fire evacuation drills in line with the provider’s policy.
  • The provider was unable to provide training completion rates for the volunteers at the service. The provider did not offer training to the sessional workers. There was a risk that this group of staff did not have sufficient knowledge and skills to undertake their duties.
  • The service was not routinely developing early exit plans with clients. Staff were not giving clients a plan on how to minimise the risk of overdose or physical health complications should they decide to leave treatment early. All clients had a discharge plan, but the plans were brief and lacked detail. The plans did not contain any details for clients on how they could consolidate their progress once they had been discharged.

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

  • At our inspection in November 2015, we found that the provider did not train staff in safeguarding children and young people. During this inspection, we found that the provider had trained staff in safeguarding children and young people.
  • At our inspection in November 2015, we found that the provider did not have systems in place to monitor staff suitability to work with the client group throughout the period of employment. When we re-inspected the service in June 2017, we found that the provider now had systems in place to ensure that staff remained suitable to work with the client group. The provider requested an updated criminal records check every three years.
  • At our inspection of the service in November 2015, we identified that the provider expected staff to undertake capacity assessments but they did not provide staff with training. When we inspected the service in June 2017, we found that the provider had trained staff in the Mental Capacity Act (MCA), although the level of understanding of the MCA varied between staff.
  • The service gathered feedback from clients and used it to improve the service.

10, 11 & 27 November 2015

During a routine inspection

  • Cranstoun City Road provides a residential detoxification, crisis intervention and stabilisation service for up to 21 people with drug and alcohol dependency.
  • The environment was clean. A number of rooms for therapy were available, but the building was not accessible by wheelchairs. The provider had used capital funding to make the ground floor bedrooms more accessible to disabled people.
  • People received holistic assessments, and had a medical assessment within 24 hours of being admitted to the service. There were good examples of staff working together, within the service and in the community to ensure people who use services needs were fully met. The service had a clear policy around access, discharge, and unplanned exits from treatment.
  • Staff considered guidance around best practice when prescribing medication.
  • Staffing levels were sufficient for the needs of people who use services. The provider had a mix of counsellors, nurses and doctors.
  • There was a wide range of training and staff could request specialist training. The provider regularly provided staff with supervision and appraisals.
  • Staff treated people who used services with kindness and respect. We saw that staff understood individual needs and were aware of individual’s preferences. People who used services said they felt safe when using the services.
  • Staff reported that morale was low and they noticed levels of stress amongst their colleagues.

29 August 2013

During an inspection looking at part of the service

The service was discreetly located with no signs to draw attention to its purpose. People received a two to three week detoxification programme before going home or moving on. A range of compulsory and optional activities were available to assist people to cope with their detox.

We spoke to three people who used the service and one person who formerly used the service and they were positive about the staff team. One person said, 'the staff are impeccable.' The other three confirmed that the staff were 'non-judgemental'. People who used the service had to abide by the strict house rules. Two people who currently used the service said they had been told about them prior to admission; one person said they had not realised they would be strip searched when they moved in.

Staff described good support and we were told there was plenty of experience within the staff team. We noted that many staff members had worked in the service for a long time. The staff team was made up of nurses and social care workers and a doctor was in attendance for several hours six days each week and on call at other times.

We saw that, with the help of people who used the service, the building was kept clean and tidy and infection prevention and control was taken seriously. One person who used the service told us this was 'reassuring'. Medication was prescribed and administered in line with the service's policy and procedures and senior staff demonstrated their knowledge of best practice.

4 December 2012

During a routine inspection

On the day of our inspection eight people were using the service. We spoke with four people who were at different stages in their admission, with one nurse and one social care staff. We also spoke with the social care manager and with the registered manager.

People who use the service told us that 'the service is really great, they explain everything to you'. They also commented 'staff are generally really good, they try and make time to speak with you', and 'they really understand what you are going through'.

The service appropriately assessed and consulted with people using the service. However, individual care plans had not been developed for each person using the service. This meant that we could not be sure that all aspects of each person's care had been appropriately considered.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Overall, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

15 March 2012

During a routine inspection

One inspector visited the service over the course of an afternoon and evening on 15th March 2012. We spoke with people who use the service, with staff and examined a range of records.

People who use the service were able to refer themselves. They told us that that their care and treatment options had been clearly explained to them, and that they received an induction to the service on admission. During their admission people using the service had their health needs assessed and were supported to obtain appropriate healthcare services.

During their admission people who use the service attended a structured group work programme. Their individual needs were assessed and care plans and risk assessments were developed.

People who use the service were protected from abuse. The provider responded appropriately when safeguarding concerns were identified.

People who use services had their treatment options explained to them, and received their medicines at the times they needed them. However, there was no clear record of what had happened to controlled drugs prescribed, but not administered to one patient.

The provider employed a range of social and nursing staff and had a large volunteer group. Appropriate pre employment checks were carried out on staff and volunteers. An in house training programme for staff and volunteers had been developed.

The provider had developed systems to monitor and improve the quality of service provided. However, some records relating to complaints and fire alarm testing had not been fully completed.