Nest Healthcare

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good. We assessed eight quality statements. Staff comprehensively assessed people, so the care and treatment provided met their needs, this included their mental and physical health. Staff continued to monitor progression through detox with recognised ratings scales. However, the providers discharge policy was not fully embedded, and due to the low number of admissions since our last inspection, we could not confirm that the discharge policy was being followed.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they offered a person-centred approach to treatment, staff said that clients engaged in activities they chose, and that staff could update or amend care plans to reflect client’s preferences. Managers told us they assessed clients pre admission. The service contracted a consultant psychiatrist who completed a further clinical assessment and prescribed any medication required. This was conducted virtually but the manager told us the consultant psychiatrist was available to support through telephone and video conference when required.

A comprehensive pre-admission assessment had been completed for the one client admission since our last inspection, which included medical history, psychiatric history, detox history and nutrition requirements. SADQ (severity of alcohol dependence audit questionnaire) and Clinical Institute Withdrawal Assessment for Alcohol, (CIWA-Ar), a ten-item scale used in the assessment and management of alcohol withdrawal had been used to assess and record the severity of client’s conditions. We reviewed a care plan for one client, and found that the care plan was thorough, included an ‘all about me’ section, and demonstrated client involvement in developing their care plans.

Staff told us they assisted clients to purchase their own food and supported with cooking. Staff described a varied daily physical and mental wellbeing routine for clients, that was centred around clients wishes and interests. Managers told us that clinical reviews were carried out virtually and the consultant was available for telephone and video conference when needed.

Staff provided interventions suitable for the client group, including reiki, acupuncture, individual therapy sessions, walks and yoga. They ensured that clients had access to physical healthcare. All staff were engaged in delivering therapeutic activities. Due to the low number of referrals since our last inspection, managers had not carried out regular clinical audits, benchmarking, or quality improvement initiatives. However, a medicines management audit was carried out for the last client in treatment. The provider described how they would complete audits once they had clients in treatment. Other than an infection control audit, no other audits such as care plan audits or risk assessment audits were taking place.

Managers told us how they collaborated closely with the local community substance misuse service. However, as referrals can come from outside of the local area it was unclear how they would collaborate with other community substance misuse providers from client’s local areas.

We received feedback from one of the external agencies who have previously referred to Nest Healthcare. They said their collaboration with Nest Healthcare ensured that clients received appropriate support completing their treatment, complemented by the referring agencies aftercare services.

The provider had developed a discharge policy following our last inspection, which stated that prior to discharge clients will undergo a comprehensive assessment to evaluate their readiness for transition, including relapse prevention skills and support network, and that clients will receive a personalised discharge plan outlining recommendations for continued care, including follow up appointments, therapy or support group participation, medication management and lifestyle recommendations. We reviewed one discharge plan which was detailed and completed with client involvement. However, due to the low number of admissions since our last inspection, we could not confirm that the discharge policy was fully embedded.

We reviewed feedback from two patients. Patients commended the range of activities available for them to engage in and said that therapy was useful in supporting them break the cycle of addiction.

Staff told us they provided a range of care and treatment suitable for the clients in the service. External therapists carried out regular sessions with clients, and staff told us they included opportunities to engage in yoga, group walks, individual sessions with staff, mindfulness, reiki, and life coaching.

The provider had process in place to support people to live healthier lives. This included a weekly timetable, focussing on physical and emotional wellbeing. The service had its own transport in place to support with taking clients to various external services, such as the local acute hospital, community substance misuse services, dental appointments, and mutual aid groups.

Managers told us they were monitoring client outcomes using SADQ (severity of alcohol dependence audit questionnaire) and Clinical Institute Withdrawal Assessment for Alcohol, (CIWA-Ar). However, these had only been used with one client since our last inspection, so had not been embedded into treatment.

The service had no examples of how they were collecting or analysing data about outcomes and performance or engaging in local and national quality improvement activities. The service did not use outcome measures to record outcomes or performance post discharge. The provider told us they followed up with clients post discharge and the care record we reviewed confirmed this. However, outcomes from these phone calls were not recorded anywhere, so we could not be assured that the service was recording outcomes.

Mangers told us that unwillingness to engage in treatment was part of the exclusion criteria and through the pre-admission assessment they would identify if someone did not consent to treatment or had been coerced by family members to engage in treatment.

With consent, relevant information was shared with other healthcare providers involved in clients' care. The pre admission assessment included consent to engage in treatment and agreement with Nest Healthcare terms and conditions.