Walmer

We rated Addiction Recovery Centre as Inadequate because:

• Following its inspection, the Care Quality Commission issued two warning notices due to immediate concerns about the safety of clients using the service. We required the provider to make significant improvements to the safety of the service by 9 November 2018 and to the governance of the service by 21 November 2018. In response to our concerns the provider agreed voluntarily not to take any further admissions until it had made the improvements to address the safety concerns.
• Addiction Recovery Centre did not provide safe residential detoxification for clients that was in line with national guidance and best practice. There were no clinical staff employed by the provider to oversee detoxification and the staff who were supporting clients through detoxifications were not trained or assessed as competent to support them safely. Staff did not use and were not trained to use drug or alcohol detoxification monitoring tools. The only clinical involvement was from the GP who prescribed the initial detoxification regime and had no further involvement unless there was a problem.

• Pre-admission assessments were not robust and staff sought either no or limited health-related information from the clients’ GP. Staff did not undertake sufficiently detailed or thorough individual risk assessments of clients. Risk assessments did not indicate what actions staff should take in situations that endangered the clients’ health or wellbeing. For a number of clients, the assessments did not include relevant health concerns that should have been considered when planning care.

• Staff did not manage medicines safely. Clients’ had no way of keeping their medicines safely in the accommodation. Staff had not undertaken risk assessments of clients who were self-administering medicines. Medicines were not sufficiently labelled on dosage boxes. Two staff members who held keys to the medicines cabinet and administered medicines were not up-to-date with their medicines administration training.
• Staff were not trained to the required standard to help them carry out their role. Staff did not receive training in safeguarding or the Mental Capacity Act. Staff did not consider clients’ capacity to make decisions whilst under the influence of alcohol or drugs. Clients told us they could not remember signing consent forms at the start of treatment because they were under the influence of drugs or alcohol. This also included signing for consent to payment. The mental capacity policy did not direct staff to reassess capacity at a more suitable time if clients were under the influence. Policies were not written in line with the Mental Capacity Act.
• Staff had not received up-to-date training in basic life support and were not trained in safeguarding adults at risk or in child protection. Staff had not completed all the training requirements of the provider’s induction policy. Not all staff had commenced the diploma level 2 in health and social care or a number of health and safety topics that the policy detailed that they should have completed.
• The provider told us that there had been no serious incidents in the last 12 months. However, we discovered that a serious incident had occurred but this had not been reported to the local safeguarding team or CQC, as required by regulations. It is unclear whether any additional incidents had occurred as staff did not always record or investigate adverse incidents. There was no evidence that staff learned from and changed practice as a result of incidents
• Leaders lacked an understanding of what constituted a safe, good quality residential detoxification and therapy service. They lacked an understanding of what was required to meet CQC regulations in delivering the service.
• The governance arrangements were unclear and did not enable the provider to manage or monitor the quality of the service it delivered. Key information was not discussed at staff meetings and there was no process in place to review key items including; incidents, complaints, safeguarding, training and supervision. There was no framework for reviewing and updating policies and procedures or any record that staff had read and understood policies and procedures the provider did not monitor outcomes or have any indicators to monitor the performance of the service.
• The provider had not made adequate employment checks on staff working for the service. They did not undertake risk assessments for staff who had positive disclosures on their Disclosure and Barring Service certificates. Staff employment files were not well maintained. Contracts, roles, job descriptions and hours of work were not up-to-date.
• The provider was misrepresenting what treatment interventions it was delivering in its documentation and on its website. The provider advertised that it delivered therapies such as cognitive behavioural therapy, dialectical behavioural therapy and transactional analysis. The majority of staff were not trained to deliver such therapies and told us they did not deliver these but they used an approach based on cognitive behaviour therapy.
• The terminology used in one of the client’s records was derogatory and offensive. There were inappropriate statements in the service user guide which had caused offence to clients. Staff did not respect clients’ privacy. They had looked through client’s phones and did not see a problem with doing this. Clients told us they were concerned about having to let staff see their personal mobile phones.

• Complaints were not always recorded and were not responded to with empathy and compassion. We reviewed responses to complaints and found that the language used was judgemental and accusatory.
• The provider had not carried out legionella testing and was not aware of the requirement to do so.

However:

• The environment was clean and tidy and the furnishings were in good order and there were adequate counselling and group therapy rooms. Clients’ accommodation was comfortable.
• Leaders of the service and staff described a passion for supporting people to recover. The service had a full complement of staff and no vacancies and staff received regular supervisions and appraisals
• Clients were positive about the interactions they had with staff and their keyworkers. Clients felt involved in their care. Clients felt they could raise concerns if they had any. Staff at the service had recently collected and analysed feedback from clients. Small changes had been made to the service as a result.
• Immediately following the inspection, the provider took the following actions:

sourced and booked staff onto training in the Mental Capacity Act for staff

ordered lockable storage for medicines as soon as we identified concerns about clients not being able to keep their medicines safe

We returned to the provider on 01 November 2018 as the provider informed us that it was going to start admitting clients again. We wanted to check that the provider had made improvements and was able to provide a safe service to clients. We undertook a focused inspection and found a number of improvements. These are summarised in a separate report.