birmingham inpatient drug treatment service · we rated birmingham inpatient treatment drug...

This report describes our judgement of the quality of care at this location. It is based on a combination of what wefound when we inspected and a review of all information available to CQC including information given to us frompatients, the public and other organisations

Ratings

Overall rating for this location Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive? Good –––

Are services well-led? Good –––

Overall summary

We rated Birmingham inpatient treatment drug treatmentservice as good because:

• Staff knew how to protect people from harm andcould identify when clients were at risk of significant

harm. Staff knew what incidents to report and theprocedures to follow when reporting. The servicediscussed and learnt from incidents andimplemented changes to improve working practices.

BirminghamBirmingham InpInpatientatient DrugDrugTTrreeatmentatment SerServicviceeQuality Report

Park House15 Park Road SouthHockleyBirminghamB18 5QLTel:0121 523 5940Website:www.cahngegrowlive.org

Date of inspection visit: 29 April 2019Date of publication: 12/07/2019

1 Birmingham Inpatient Drug Treatment Service Quality Report 12/07/2019

• There was clear learning from incidents the servicedeveloped an open learning culture that all staffcontributed to and supported.

• Staff were aware of the service vison and values andfelt respected and supported by the managers. Staffhad opportunities to improve their working practicesthrough supervision, training and team buildingdays.

• Staff completed and updated clients’ riskassessments and risk management plans whichincluded early exit from the service. All risksidentified throughout the assessment phase weretransferred through to the clients care records andregularly monitored.

• Recovery plans were individual and met the client’sneeds, they included pathways to other services andagencies that could also support the client.

• Staff followed best practice when storing, recordingand administering medicines. There were goodsystems and processes in place for controlledmedicines. Staff had access to guidelines policies andprocedures for managing medicines.

• Staff communicated with patients with compassionand kindness and clients spoke highly of staff and theirknowledge, skills and professionalism.

• Staff understood the individual needs of clients andinvolved and supported clients in understanding theircare and treatment.

• Managers had the skills, knowledge and experiencerequired to effectively perform and lead in their roles.They had a good understanding of the service andwere visible and approachable for staff and clients.

However:

• Although the service allowed children to visit clients atPark House and had a procedure to follow, to keepthem safe they did not have child visiting policy.

Summary of findings


Our judgements about each of the main services

Service Rating Summary of each main service

Residentialsubstancemisuseservices

Good –––

Summary of findings


Contents

PageSummary of this inspectionBackground to Birmingham Inpatient Drug Treatment Service 6

Our inspection team 6

Why we carried out this inspection 6

How we carried out this inspection 7

What people who use the service say 7

The five questions we ask about services and what we found 8

Detailed findings from this inspectionMental Capacity Act and Deprivation of Liberty Safeguards 11

Outstanding practice 22

Areas for improvement 22

Summary of findings


Birmingham inpatient drugtreatment service.

Services we looked at Residential substance misuse servicesBirminghaminpatientdrugtreatmentservice.

Good –––


Background to Birmingham Inpatient Drug Treatment Service

Change Grow Live is a social care and health charity inEngland and Wales. Park House is a purpose built 18bedded residential detoxification and stabilisation unitfor substance misuse. They provide services for men andwomen over the age of 18 years. Birmingham City Councilcommissions nine of the beds and the remaining bedsare used for out of area placements. The unit acceptsprofessional and self-referrals.

Park House is a consultant led service which is staffed 24hours a day, seven days a week. It is supported by clinicaland operational on-call systems. A client’s average lengthof stay at Park House is two weeks but the stay is basedon clients’ individual needs.

Park House is not suitable for clients who have a primarymental or physical health issue that requireshospitalisation.

Park House registered with the Care Quality Commissionin 2015 to deliver the following regulated activities:

• Accommodation for person who require treatment forsubstance misuse.

The service has a registered manager.

The service had been inspected in August 2016 with afocused inspection in August 2017.

When the service was inspected in August 2016 therewere two breaches of the Health and Social Care Act 2008(Regulated Activities) regulations 2014.

Dignity and respect, regulation 10 (2) (a).

We informed the provider that they must ensure thatsame sex accommodation is provided at Park House.Toilets must be identified for male or female use. Wefound that the provider did not provide privacy for theclients from those using the communal areas during theassessment phase of the clients’ admission. This was dueto the proximity of the smoking shelter.

The focused inspection in August 2017 found the servicehad addressed the requirement notices issued at the lastinspection in August 2016. They received requirementnotices in the following areas; Person Centred Care,regulation 9 (3) (a) (b) (e):

Care plans must be provided for the service. They mustensure that all physical health care needs aredocumented in care plans. The provider must ensure allclients are involved in their own care and that care plansare person centred.

Dignity and Respect, regulation 10 (1)(a):

The provider must follow same sex guidance and providea permanent female lounge.

Safe care and treatment, regulation 12 (2) (a)(b):

We told the provider that they must ensure that whenassessing clients all risks identified must be correctly andaccurately documented in risk management plans.

Our recent visit to the service found the provider had metall requirement notices.

Our inspection team

The team that inspected the service comprised two CQCinspectors, medicines inspector and assistant inspector.

Why we carried out this inspection

We inspected this service as part of our ongoingcomprehensive mental health inspection programme.

Summaryofthisinspection

Summary of this inspection


How we carried out this inspection

To fully understand the experience of people who useservices, we always ask the following five questions ofevery service and provider:

• Is it safe?• Is it effective?• Is it caring?• Is it responsive to people’s needs?• Is it well-led?

Before the inspection visit, we reviewed information thatwe held about the location, and sought feedback fromstaff at two focus groups.

During the inspection visit, the inspection team:

• visited the location and looked at the quality of theenvironment and observed how staff were caring forpatients

• spoke with seven patients who were using or had usedthe service

• spoke with the registered manager• spoke with six other staff members; including doctors,

nurses, admin, health care support workers and peersupport mentors

• held one focus group for staff• attended and observed one group activity

• looked at six care and treatment records of patients• carried out a specific check of the medication

management• looked at a range of policies, procedures and other

documents relating to the running of the service.

What people who use the service say

People who had used the service were verycomplimentary about the service and the staff. They feltempowered to change and felt staff supported them toachieve their outcomes.




The five questions we ask about services and what we found

We always ask the following five questions of services.

Are services safe?We rated safe as Good because:

• The service had secure access to the building through a videointercom system operated by staff. The service had a safeenvironment. Clients staff and visitors were provided withportable alarms. All areas accessed by clients were clean andwell maintained. Furniture and décor were in good condition.

• All clients received a weekly fire safety briefing to ensure theywere aware of procedures to follow in the event of a fire.

• The service had ensuite rooms and provided male and femaleonly sleeping corridors. Prior to admission, clients were offereda choice of whether they wished to access same sex onlysleeping corridors or mixed area.

• Staff completed and updated clients’ risk assessments and riskmanagement plans which included early exit from the service.All risks identified throughout the assessment phase weretransferred through to the clients care records and regularlymonitored.

• Staff knew how to protect people from harm and could identifywhen clients were at risk of significant harm. Staff knew whatincidents to report and the procedures to follow whenreporting. The service discussed and learnt from incidents andimplemented changes to improve working practices.

• There was clear learning from incidents the service developedan open learning culture that all staff contributed to andsupported.

• Staff followed best practice when storing, recording andadministering medicines. There were good systems andprocesses in place for controlled medicines. Staff had access toguidelines policies and procedures for managing medicines.

However:• The service did not have a policy to follow to support children

when visiting Park House.

Good –––

Are services effective?We rated effective as Good because:

• The service invited clients to a preadmission visit where staffbegan the process of assessment. Staff completed care recordswhich showed a seamless transfer and continuity of care fromthe community team to the inpatient services.

Good –––




• Recovery plans were individual and met the clients’ needs, theyincluded pathways to other services and agencies that couldalso support the client.

• Staff provided clients with a range of care and treatmentinterventions suitable for the client group. The interventionswere those recommended for substance misuse services.

• Staff had opportunities to improve their working practicesthrough supervision, training and team building days.

Are services caring?We rated well-led as Good because:

• Staff communicated with patients with compassion andkindness and clients spoke highly of staff and their knowledge,skills and professionalism.

• Staff understood the individual needs of clients and involvedand supported clients in understanding their care andtreatment.

• Care plans were personalised and holistic. Clients told us thatstaff listened to them and that their treatment wasindividualised and included their goals and needs.

• The service encouraged clients to provide feedback duringweekly service user meetings and by completing aquestionnaire on completion of treatment.

Good –––

Are services responsive?• There were good facilities that promoted comfort dignity and

privacy. Clients had their own ensuite rooms. There was accessto a range of rooms for various groups and activities.

• Recovery plans met the diverse needs of clients using theservice. Staff ensured clients were referred to other agencies forsupport prior to discharge and involved key workers.

• The service had disabled access for those who required it thisincluded rooms adapted to support their needs.

• The service monitored all clients on the admission list and keptin contact with referrers and care co-ordinators. They wereaware of any changes to those requiring admission.

Good –––

Are services well-led?We rated well-led as good because:

• Managers had the skills, knowledge and experience required toeffectively perform and lead in their roles. They had a goodunderstanding of the service and were visible andapproachable for staff and clients.

Good –––




• Staff applied the services vision and values and felt respectedand supported by the managers.

• The service had a clear governance structure and frameworksthat were embedded throughout the organisation. There weregood reporting tools to capture the performance of the service

• The service had good processes to manage staff well being andprovided weekly wellbeing hours. Staff could use the hour tomanage and support their mental health and physicalwellbeing.




Mental Capacity Act and Deprivation of Liberty Safeguards

Staff were aware of their roles and responsibilities underthe Mental Capacity Act 2005 and knew how to supportpeople who lacked capacity. Staff ensured clientsconsent to care and treatment was assesseddocumented and reviewed.

The service provided staff with for the Mental Capacity Act2005, 88% of staff had completed module one and 94%had completed module two. Staff said mental capacitywas assessed as part of the multi-disciplinary team. Staffknew where to seek advice if required concerningcapacity.

Detailed findings from this inspection


Safe Good –––

Effective Good –––

Caring Good –––

Responsive Good –––

Well-led Good –––

Are residential substance misuse servicessafe?

Good –––

Safe and clean environment

Safety of the facility layout

The service provided a safe and clean environment forclients. The entrance to the service was locked, access wasvia a video intercom system. Staff opened the door topeople once they had introduced themselves, and in thecase of professionals, provided identification. Once in thereception area all visitors were required to sign the registeron entering and leaving the building. The service hadclosed circuit television in operation in corridors,communal areas and outside at the entrance to thebuilding and in the garden.

Staff provided all clients with a group fire safety inductiononce a week to ensure they were aware and familiarisedwith the procedures in the event of a fire.

All bedrooms had ensuite facilities, clients were providedwith a key fob that was programmed to open theirallocated room only. The service also provided clients withsafety alarms that they could use on the premises. Visitorswere also issued with alarms. Staff could pinpoint thelocation of the alarm from the alarm panel. Staff regularlytested alarms.

Corridors were separated in to male and female corridors.Three bedrooms located at the centre leading to both thefemale and male corridors could be rotated in to eithermale of female only rooms depending on the demand at

the time. It could also be mixed gender. Clients were askedprior to admission if they had any preferences to a male orfemale only space. Rooms had anti ligature furniture andstaff completed environmental assessments whichincluded up to date anti ligature reports and fire riskassessments.

Staff had access to pin point personal alarms. All clientsand visitors were issued with alarms whilst on thepremises.

At our last inspection of the service, we identified that therewas no permanent female only lounge. The service usedthe large lounge to partition an area to create a female onlylounge. During our recent visit we found the service hadcreated a designated female only lounge. This was apermanent space available to female clients whenever theyrequired.

Maintenance, cleanliness and infection control

The service had accessible rooms where clients were seen.Areas that clients had access to were clean and wellmaintained, furnishings were comfortable and in goodcondition. This included, the clinic and consultation room,lounge area and conservatory. The large lounge could bedivided in to three sections using partitions therefore itprovided space for other uses for clients.

Staff adhered to infection control principles. Sharps boxes/clinical waste were collected weekly.

Clinic room and equipment

Clinic rooms were fully equipped with accessibleresuscitation equipment and emergency drugs that staffchecked regularly. Staff maintained equipment well andkept it clean.


Residential substance misuseservices

Good –––


Safe staffing

The service had adequate numbers of skilled staff tosupport the needs of the clients accessing treatment andcare. Staffing included a clinical service manager, leadnurse, registered general nurses, registered mental nurses,doctor, eight health care support workers which included arecent recruitment, administration staff, chef, volunteersand peer support mentors.

The service reported three staff on long term sick leave andsix staff leavers within the last 12 months leading toNovember 2018.

The service reported that in the months leading up toNovember 2018, 238 shifts had been filled by bank oragency staff to cover vacant posts, sickness or absences.Permanent staff working for the service worked bank shiftswhen they were short staffed. The service also recentlyrecruited to three vacant nurse posts with one morevacancy to fulfil. They also recruited 12 bank staff. Themanager explained they had three regular bank staff andthree regular agency staff that they used. This ensured thatstaff were familiar with the service’s procedures andprocesses and the client group.

We viewed the staff rota which matched the number andtypes of staff on all shifts at weekends, weekdays and nightshifts.

The staff rota was completed in advance. Managersreviewed it daily therefore they could plan to ensure safestaffing levels were available for each shift.

Mandatory training

The service ensured all staff including seasonal, bank andagency staff received mandatory training. This included anintroduction to health and safety. Training was deliveredthrough e-learning or video. The manager receivedmonthly reports which identified how many staff hadcompleted mandatory training. As of April 2019, the servicetraining matrix showed that between 93% to 100% of staffhad completed mandatory training except for dataprotection. The completion rates for the this subject wasbelow 65%. The service provided staff with an hour perweek to complete any outstanding mandatory training.

Assessing and managing risk to patients and staff

In August 2017 we carried out a focused inspection to lookat the requirement notices issued at the previous

inspection of 2016. We had issued the service with arequirement notice to ensure that all clients’ identified risksmust be correctly and accurately documented on riskmanagement plans. We found the service did not havebespoke care plans, they used risk assessment tools tocapture care planning information. The document did notrecord or address the clients’ physical health needs.

On this inspection, April 2019, we found that the servicehad addressed the issues raised previously. We looked atsix sets of client care records which staff had completed toa good standard. We found all clients had a risk assessmentwith risk management plan that staff regularly reviewed. Allrisk assessments were up to date. The service had alsobegun to complete joint initial assessments with doctorsand nurses to ensure all risks were captured.

Clients had a service user plan. This documented amongstother information client goals, risk indicators, physical andmental health and safeguarding. All information capturedduring the admission process was pulled through on to theservice user plan ensuring updated continuity ofinformation and risks.

In December 2018, the service introduced enhanced carepathways as part of the standard operating procedures.This provided individualised risk assessment for clients’specific risks such as falls or seizure management, suicideprevention or pregnancy. Once completed managers couldidentify whether extra staff would be required to supportthe client such as one to one support or observations.

Staff recognised and responded to a deterioration in theclients’ physical health, which was recorded in the carerecords. We saw evidence of actions taken by staff whenmanaging situations with the clients’ physical health. Staffalso gave examples of situations when they reacted toclients requiring support from the emergency services.

Staff explained that at times they had clients with a mentalhealth diagnosis and they would like to be able to supportthem better. Staff had also requested de-escalationtraining. It appeared that some staff had experience ofusing de-escalation techniques from previous employmentbut could not use it as other staff had not been trained inthis area.

Management of service user risk

As part of the admission process, the service invited clientsto attend the unit prior to their admission. Managers and



Good –––


staff felt this was important so that clients understood theprocesses and procedures and the expectations duringtheir admission. It also supported staff to assess andminimise risks.

Clients completed recovery plans in the community withtheir named worker. This included discussions concerningharm reduction and consequences of continued use ofsubstances. Unexpected exit for the service was alsodiscussed. The recovery plan formed an integral part ofstaffs ongoing risk assessments of clients at the service. Onadmission staff completed the severity of alcoholdependence questionnaire with the client. They discussedthe recovery plan and looked at protective factors of whatkept the client safe.

The minutes of staff meetings described and discussedstaff responses to risks posed by clients, such as smoking inbedrooms or clients who had fallen. Staff also gaveexamples of how they responded to changes of a client’sphysical health. We saw information relating to this inminutes of staff meetings. Managers feedback from theinvestigation of the incident and stated staff had followedthe falls pathway and updated the enhanced care plan toincrease observations.

The service had access to a doctor through on call systemsand face to face contact. Staff contacted them for supportand advice when required on the physical health of a client.Staff responded to client’s sudden deterioration in theirhealth. We saw in the care records where staff documentedevents leading to an emergency admission to hospital.There was documentation showing staff prompt responseswhen managing physical health care issues for clients intheir care.

Clients were required to adhere to the services communityagreement which set out guidelines and prohibited itemsand behaviour for Park House. Staff searched clients andtheir belongings on admission, they also searched thepremises and the grounds of the unit. Visitors may havealso been subject to bag searches to support buildingsecurity and safety. Clients were informed of the reason forstaff to carry out searches in the service user guide.

Clients were able to have visits at weekends. Visitors wereonly allowed in communal areas of the unit. The service did

not have a child visiting policy however managersexplained that children could visit but could not be presentin communal areas. The group rooms had a dual functionand were also used as family rooms when children visited.

There was evidence in the clients’ care records that prior toattending the service, clients had attended a communitygroup once a week that looked at reducing their use ofsubstances.

Safeguarding

Staff knew how to protect clients from abuse. We observedstaff discussing safeguarding with clients on admission.Care records showed staff considered safeguarding, theyhad appropriate links to agencies. The service supportedthose who were subject to safeguarding. Information wasshared between the community hubs, other agencies andthe inpatient service.

Staff could identify adults and children at risk of abuse orsignificant harm. They were aware of reporting systemswithin the service and explained how they would informtheir manager with any safeguarding concerns. Thesafeguarding lead also liaised with staff at the service andprovided support where required. All staff receivedsafeguarding training via eLearning for adults and children.Policies and procedures were available on the service’sintranet and staff knew where and how to access it.

Staff access to essential information

The service used electronic records; the system was usedthroughout the organisation therefore all staff could accessclient notes. Staff scanned any paper records on to theelectronic system.

Doctors had remote access to client care records whenaway from the unit. Staff had access to computers andlaptops throughout the service and could updateinformation in care records as and when required. Carerecords we viewed were accurate and up to date.

Medicines management

The service had effective guidelines, policies andprocedures for staff to follow on the management ofmedicines. Staff had access to detoxification, withdrawaland stabilisation policies on the provider’s intranet. Staffunderstood and followed the policies.

Staff followed best practice when storing, administeringand recording medicines, this included medicines



Good –––


reconciliation. The service had systems and processes inplace for the storage of controlled drugs and there wasevidence of daily stock checks. Staff managed medicineerrors appropriately. There were facilities for staff todispose of controlled drugs which staff stated was alwayswitnessed. The pharmacist completed audits of controlleddrugs and other medicines kept at the service. Anyfeedback from the pharmacist or lessons learnt wasdiscussed at the information governance team meetingsand in clinical supervision.

Patients own medication was clearly identifiable and staffchecked them prior to use. Staff clearly labelled medicationthat had an increased expiry date once opened with thedate when it was first used.

Staff monitored and reviewed the side effects ofmedication and used the Clinical Institute WithdrawalAssessment and Clinical Opiate Withdrawal Scale sideeffect scales.

Prescriptions were kept in a safe in the nurses’ office; onlynurses had access to the safe.

In clinical areas where medicines were kept we sawevidence of daily room and fridge temperature checks. Staffchecked the emergency medication bag daily to ensure itwould be ready for use if needed. The emergency bag wasnot tamper proof however it was locked away. The bagincluded three prefilled naloxone containers, with extrastock stored in a locked cabinet. Naloxone is a medicationused to block the effects of opioids especially in the case ofan overdose. Staff trained all clients in the use of naloxoneprior to discharge to reduce harm.

Track record on safety

There were no serious incidents reported at this service inthe last 12 months.

Reporting incidents and learning from when things gowrong

All staff knew what incidents to report and could accessand use the service reporting systems. Managersinvestigated incidents and shared lessons learnt with allstaff via local information governance team meetings andweekly team meetings. The service operated a learningculture and ensured all staff knew that incidents were anopportunity to learn and not to blame. Staff told us theyapologised to clients when things went wrong and gavehonest feedback and support.

Staff were able to give examples of lessons learnt followingincidents and improvements that had occurred as a result.We saw example of this in the minutes of the weekly teammeeting and in the information governance team meeting.

Are residential substance misuse serviceseffective?(for example, treatment is effective)

Good –––

Assessment of needs and planning of care

We reviewed six client care records. It was clear that clientshad contributed to their care plans. The records were clientcentred, holistic and recovery focussed. They included afull history of the client such as mental health, physicalhealth, safeguarding and substance misuse.

Staff began the assessment process with clients when theywere referred to the service. Clients were invited to attendthe service prior to their admission, therefore assessmentswere ongoing.

Clients completed recovery and discharge plans with theirkey worker in the community. On admission staff discussedthe plans with clients which included risk assessments andrisk management plans. This ensured both staff and clientswere aware of the goals clients wished to achieveprotective and risk factors. It also highlighted the processfor an unplanned discharge from the service.

Best practice in treatment and care

Staff provided a range of care and treatment interventionssuitable for the patient group. The interventions were thoserecommended by, and were delivered in line with,guidance from the National Institute for Health and CareExcellence.

Medication was prescribed in line with guidance from theNational Institute of Health and Care Excellence. Staffadministered test doses of medication that requiredphysical health care monitoring prior to commencingdetoxification. Staff completed a physical health check onadmission which were ongoing throughout the client’sadmission.



Good –––


Prescription charts displayed documented evidence thatstaff adhered to strict regulations regarding withdrawalmedication.

Staff and external agencies facilitated therapy groups suchas mindfulness, motivational groups, alcoholicsanonymous and narcotics anonymous. The managerstated staff had received specific training for some of thegroups.

Staff completed weekly Malnutrition Universal ScreeningTool assessments to identify clients who were eithermalnourished or are at risk of malnutrition. Staff providedclients with information on healthy eating. We sawinformation on notice boards regarding specific types ofdiets and nutrition to support various physical healthconditions. On admission staff offered encouragement andsupport to help clients who smoked to stop.

Skilled staff to deliver care

All staff received an induction and as part of this wereexpected to complete mandatory training. The serviceprovided all staff with a range of training suitable for theirroles. Managers monitored staff completion of mandatorytraining through monthly reports.

However, staff told us they would like to have training inmental health or for the service to employ more staff withmental health experience. Staff had approached managersto ask for this training as they felt this was an area ofknowledge required to further develop their roles and skills.Managers stated they were currently waiting for dates forstaff to commence face to face de-escalation training. Alsotraining dates for dual diagnosis for mental health andsubstance misuse had become available. Managers told usstaff would be attending the course in July 2019.

Managers implemented team building days where staffreceived training which included hepatitis C andsafeguarding.

Staff sought external training which they fundedthemselves, managers provided shifts that supported theirattendance at training and completion of assignments.

The service followed robust recruitment processes. Theyensured all staff working for the service received checksthat confirmed they were suitable to work with the client

group. The service recruited and trained volunteers whohad previously used the service. They went through theappropriate recruitment process and staff supported themwith their new roles.

All staff had a supervisor that provided regular supervisionand yearly appraisals. The service reported supervisionrates of 89% for April 2019. Staff we spoke with said theyreceived regular supervision and their appraisals had alsobeen completed. The service reported 100% completionrates for appraisals up to April 2019. We viewed supervisiondocumentation between staff and their supervisors. Staffdiscussed a range of e-learning and face to face training,shadowing opportunities and observations they requiredor had already completed.

The service addressed staff poor performance byincreasing support. This was through a combination offormal and informal supervision and involvement from thehuman resources team. Staff were provided with a supportplan with detailed information on how staff would besupported to improve their performance. This could bethrough shadowing or observation.

All volunteers were subject to the appropriate recruitmentselection process and had received support and trainingfrom the service to develop their roles. Volunteers we spokewith explained as they were in recovery they felt theyreceived good support from staff and their progressionwithin the service was good.

Multidisciplinary and interagency team work

The service had the right staff with the skills and knowledgeto support the client group.

The team consisted of registered general nurses, registeredmental health nurses, health care assistants, doctors,pharmacist, volunteers and peer support mentors. Theservice had good continuity of care with keyworkers withinCGL community services. Their links with other agencieswas also prevalent, this included housing, employment,education, GPs, hospitals, community mental health andsafeguarding teams. Comprehensive assessmentsincorporated a multidisciplinary input individualised forthe client. The service liaised with external agencies as andwhen required.

The service had regular weekly multi-disciplinary teammeetings. They invited other professionals to attend asnecessary. All clients were discussed within morning



Good –––


handover with the multi-disciplinary team. Notes from themeeting were typed on to the electronic system so it couldbe viewed by all staff. The doctor received a daily hand overof all clients and high-risk clients were seen daily. Weeklyward rounds were held every Friday by the lead consultantas part of the multi-disciplinary team.

We saw evidence of multidisciplinary input within the clientcare records and recovery plans, which were initiated in thecommunity and continued through to the inpatientservices.

Staff told us that they liaised with external services tosupport clients in their recovery and upon discharge. Anexample of this is where staff extended a client’s admissionto facilitate a social care assessment prior to the clientleaving the service.

The service discharged clients when their treatment wascompleted. The discharge plan was completed prior to theclient attending the service with their community worker.As both in patient and community services used the samesystems, information was available to support with theclient’s discharge. Clients from out of the area were mostlyfrom CGL services, managers were given access to carerecords via CGL care records system.

Good practice in applying the Mental Health Act

The service was not registered to have clients that weredetained under the Mental Health Act 1983. Staffcompleted Mental Health Act training via e-learning.

Good practice in applying the Mental Capacity Act

All staff were required to complete the introduction to theMental capacity Act 2005 via e-learning modules one andtwo. The service reported completion rates of 88% formodule one and 94% for module two. Staff who had notcompleted the training were booked on to future trainingsessions. The manager explained that the doctorcompleted checks for capacity for clients arriving at theservice. Staff were aware of their roles and responsibilitiesunder the Act. The service provided a pathway for staff tofollow regarding Mental capacity. This was available at ParkHouse and on the service intranet. Staff were aware ofwhere to access the information.

Are residential substance misuse servicescaring?

Good –––

Kindness, privacy, dignity, respect, compassion andsupport

We observed good interactions between staff and clientsaround the unit and within therapy groups. Clients and thefamily member we spoke with all reported that staff treatedthem with compassion, dignity and respect. Staff offeredpractical and emotional support while maintainingprofessional standards. Staff built relationships with clientson trust and had a good understanding of clients’ concernsand life experiences.

Staff felt able to raise concerns about disrespectful,discriminatory or abusive behaviour towards clients. Staffsaid they could raise concerns at any time as the managerwas approachable and had an open-door policy.

Staff and clients reviewed care plans at the weeklymultidisciplinary review meetings. Staff went through thiswith them regularly throughout their stay.

CGL had clear polices on confidentiality. This was explainedto clients coming in to the service which we observed thison the day of our visit during an admission.

Involvement in care

Staff communicated well with clients so that theyunderstood their care and treatment. Clients told us thatthere was always someone available to talk to them. Weobserved in the minutes of staff meetings discussions onhow staff planned to support a client with visualimpairment by using visual aids to communicate.

All clients using the service had a recovery plan and riskmanagement plan that demonstrated their preferencesand recovery goals. Staff supported clients to understandand manage their care; clients told us that they were fullyinvolved in all aspects of their care and treatment. Clientscomplete a “My Stay at Park House Assessment Map” whichinformed staff in the clients voice their holistic needs, goalsand the support they required whilst at Park House.

The service sort feedback from local service user forumsand had developed service user feedback questionnairesfor clients to complete upon discharge. We viewed a someof the questionnaires which were all positive about theservice they had received. Staff listened and responded to



Good –––


service user feedback to improve overall experience and asa result introduced weekly movie nights and ongoingweekly health and safety sessions. Clients were involved inproducing a ‘frequently asked questions’ booklet for newclients. They shared their questions and concerns fromwhen they arrived in the service. The service documentedresponses to the ‘frequently asked questions so clientscould also view them.

Involvement of families and carers

Staff provided information on how to access carers’support and there was information on notice boardsthroughout the unit. Carers and relatives could givefeedback on the service through online reporting tools onthe service website or through meetings.

Are residential substance misuse servicesresponsive to people’s needs?(for example, to feedback?)

Good –––

Access and discharge

Park House was staffed 24 hours a day seven days a week.Staff adhered to the referral criteria and assessed eachclient’s risk to determine the persons suitability to accessthe service. Referrals were received by professionals andother agencies; clients could also self-refer. The service had18 beds, nine were commissioned by the local authorityand the other nine were reserved for out of area referrals.Clients who’s needs could not be met by the service weresupported to access alternative care pathways such ascommunity services or admission to local hospitaldetoxification facilities.

The manager explained the service had seven days fromthe date the referral was received to reply to the referrerwith an outcome. The service also responded to referrers ofcomplex cases within seven days. This would be to requestfurther medical information or a face to face review withthe assessment team. The service had met these targets.

The service had an eligibility criteria for people whowanted to access the service. They did not accept clientsunder 18 years of age or clients whose primary need was a

mental or physical health problem that required treatmentin hospital. This information was clearly documented onCGL website and in other documentation about accessingthe service.

Once referrals had been accepted waiting timescales foradmission were on average two to five weeks from the datewhen the referral was approved. Managers explained thatthis varied from month to month. At the time of our visitmanagers said the waiting period was from two and a halfweeks.

They explained that staff communicated withcare-coordinators/keyworkers in the community for aplanned discharge from the service. All clients weredischarged back to the community discharge plans for keyworkers/care co-ordinators to follow up. Recovery and riskmanagement plans reflected the diverse and complexneeds of the client. Clear pathways for accessing otherservices such as housing, education, debt managementand mental health services were on-going between CGLcommunity teams and inpatient services.

Staff gave examples of when they had liaised with otherservices or agencies to ensure safe discharge from service.The longest delayed discharge the service hadencountered was a week due to other services delay incompleting an assessment of needs for the client.

The facilities promote recovery, comfort, dignity andconfidentiality

All clients had their own ensuite rooms which supporteddignity and privacy.

The service had disabled access to the building. Theground floor bedroom was designed with adaptations tosupport clients who required support for disabled access,this included a hoist. The service also had a lift available foruse to reach rooms on the first floor.

There was a range of rooms and equipment to supportclient’s treatment and care, for example consultation, clinicand therapy rooms. Clients had use of the outside spaceand there was a smoking shelter available away from thebuilding.

Clients were restricted from using their mobile phones atthe service. Prior to admission clients were informed of thisand agreed to it. Phones were stored in a safe. Clients who



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wished to remain in contact with family and friendsbrought phone cards to access the pay phone. Individualcare plans provided a client’s authorised list of people whostaff could share information with.

The service identified clients’ dietary requirements prior toadmission. The chef catered for cultural and religiousrequirements, dietary preferences and for clients who hadfood allergies. Healthy eating options were included tosupport the client’s recovery. Clients had access to snacksand drinks 24 hours a day.

Patients’ engagement with the wider community

As part of their admission clients identified family andcarers they wanted to maintain contact with during theirstay. Staff monitored this weekly with clients. Staffsupported clients to access services they would requireonce they were discharged and to maintain relationshipswith agencies and services they were involved with. Thisincluded services such as education, employment andhousing.

Clients with religious cultural beliefs were supported toaccess places of worship within the community. Staff wouldarrange to accompany clients to and from the venue.

The service had access to advocacy support and thereforeif required staff supported clients to seek advocacy supportand for carers and family members.

Meeting the needs of all people who use the service

CGL had a transgender equality policy that set out howthey intended to meet the needs of transgender staff,volunteers and service users. Their aim was to provide awelcoming environment in all their services. They were alsoseeking to recruit a diversity lead at the service.

The service used interpreters when required either inperson or through a telephone service.

Managers explained that the multi-disciplinary teammonitored clients on the waiting list through contact withkey workers and care co-ordinators. Clients scheduled foradmission could be admitted earlier than expected if therewere cancellations or early exits from the service.

Listening to and learning from concerns andcomplaints

The service reported 14 compliments and sevencomplaints from clients up to November 2018.

The service treated concerns and complaints seriously. Theservice encouraged clients’ family and carers to makecomplaints and shared the lessons learnt from outcomes ofinvestigations with staff.

Service user representatives encouraged complaints togain feedback to contribute towards and supportimprovements to local service delivery. The serviceexplained they advertised their complaints and feedbackprocesses in service user accessible areas on the “You said,we said board” The service also had a lead service userrepresentative model whereby the service userrepresentatives’ feeds into regional and national meetings.

An example of a change that was made came from acomplaint about the engagement and responsiveness ofCGL. This supported the organisation to develop a newproject to look at producing interactive ways of engagingwith CGL through the website.

Are residential substance misuse serviceswell-led?

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Leadership

Managers had the right knowledge and experience to carryout their roles and responsibilities. They had the necessaryskills to support and work with the client group andprovide clinical leadership for other staff.

All staff knew the service’s clear definition of recovery. Staffunderstood the issues facing some of the clients who usedthe service. The service strived to enable and equip clientsto use their inner strength and resources to support changein their lives. Their mission was to ‘help people change thedirection of their lives, grow as a person and live their livesto its full potential’.

Managers clearly demonstrated their understanding of theservices they provided and managed. They discussedwhere the service was currently at and how they wereworking to provide high quality care. They had clear visionsfor future developments to improve the service userexperience.

Managers were visible in the service and approachable forstaff and clients alike to provide support, guidance andadvice.



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Vision and strategy

Change Grow Live visions and values were ‘focus,empowerment, passion, respect, vocation and socialjustice’. Staff knew their roles and responsibilities inachieving this. Staff worked with clients who experiencedsubstance misuse, homelessness, poverty, unemployment.They understood the visions and values and how they wereinstrumental in supporting the clients to make a change.CGL began the visions and values process at therecruitment stage. All potential staff received a competencyvalues-based interview. This supported the recruitmentpanel to make decisions on getting the right person for therole.

All staff had job descriptions and knew what their roles andremits were within the organisation and the margins oftheir role when working with clients.

Staff had opportunities to contribute to discussions aboutthe service and could speak to managers on improvementsthat could be made to services. Staff could give examplesof changes that had been implemented throughdiscussions with managers. We could also see examples ofcontributions to discussions within the team meetingsabout improving services.

Staff had regional workers forums with a staffrepresentative who fed back issues to local managersmeetings and the regional staff worker forums chaired bythe area director.

The manager told us they created a service qualityimprovement plan. They felt supported and empowered bysenior managers to request what was required to improvethe service.

Culture

Staff told us they felt respected valued and supported, theyfelt empowered by the manager to achieve their fullpotential. Staff reported good morale with their colleagues.However, recently the staff group had experienced a highturnover of staff. This was felt to be due to the change inmanager and people’s anxieties around adapting to thatchange. There were some levels of stress during this timeas staff were unsettled and experienced staff shortages.

Where performance concerns were raised, staff weresupported through formal and informal supervision,shadowing and observation. Managers explained ifconcerns continued a six-week formal action plan would beimplemented and following that human resources support.

Staff felt proud and supported working for the organisationand felt part of the future direction.

The service had a whistle blowing policy, staff were awareof how to access it. Any issues reported to the managerwere recorded as incidents. The manager explained theyhad an open-door policy and staff could speak at them atany time.

The service provided staff with access to support foremotional and physical health needs.

Staff had daily wellbeing hours. The service hadimplemented this in recognition of how at times the natureof the work could be stressful and the need for staff tomaintain their wellbeing.

Governance

The governance structure within the service was good, theyhad up to date clinical governance policies which was theframework followed throughout the organisation.Managers and staff completed regular health and safetyreviews and audits. This included daily audits, medicinemanagement and clinical audits. Information from auditswere fed in to the information governance team meetingsand weekly staff meetings to be shared with staff anddevelop action plans.

Managers attended fortnightly senior management teammeetings and Board meetings to effectively communicateany issues or keep informed with developments within CGLand their community partners.

Staff knew what incidents to report. The service hadreporting systems and processes to monitor andinvestigate incidents and complaints. The service operateda learning culture. They used incidents and outcomes fromcomplaints as a learning opportunity to improve workingpractices and the clients experience. Information wasshared with all staff at team meetings and through emails.

All staff completed mandatory training and were providedopportunities to attend other training pertinent to theirroles and as identified in their supervision and appraisals.The service had introduced protected continued



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professional development and revalidation for staff withprofessional qualification to ensure registrations were keptup to date. Staff had good knowledge and understandingof safeguarding and adhered to the principles of the MentalCapacity Act.

The service refreshed their leadership and developmentprogramme to include a model on inclusive leadership. Allparticipants on the development programme wouldbecome mentors. This would be part of the mentoringprogrammes for women, black Asian and minority ethnic,disabled and lesbian gay bisexual and transgender staff.The service also stated they had also deliveredunconscious bias workshops to the board of trustees. Thissupported the service to meet the requirements of thecharity governance code for diversity. The charitygovernance code was a resource used by community,voluntary and charity organisations to develop overallcapacity in terms of how the ran their organisation.

Management of risk, issues and performance

CGL had quality assurance management and performanceframeworks embedded throughout the organisation’spolicies and procedures. The service had reporting toolsand audits that provided information about the service ona weekly and monthly basis. Risk issues were alsodiscussed and documented within a range of forums.

The service met regularly with the commissioners tomeasure both performance and financial performance.

Park house managed their own budgets. Their forwardplanning ensured they continued to provide good qualityservice for the clients whilst they made cost improvements.

Managers said they were the only ones who had access tothe risk register. However, staff could escalate any concernswith managers at any time to add to the register.

Information management

All information required to support and deliver client carewas available to relevant staff and stored securely on theservice database. Staff had access to equipment andinformation technology to support them in their roles. Theyhad access to essential information as required accessiblethrough laptops and computers. Remote access to clientinformation was available to doctors who were on call tosupport with providing advice and information for staff.

Information pertaining to client prescriptions were on asafe and secure prescribing system. Prescriptions werekept in a large safe, only designated staff had access to thesafe.

The service developed good joint working relationshipsand information sharing protocols with externalorganisations. This included, local authority, NHSproviders, GPs, mental health teams, housing providers andeducation services. Staff understood the importance ofdeveloping these relationships to support the client inachieving positive outcomes.

Engagement

Clients and carers were provided with opportunities to givefeedback on the care they received from the service.Information was gathered through surveys and feedbackforms were available.

Information on the service was available on the servicewebsite. Clients, carers, staff and other professionals andagencies could sign up to receive the service newsletter.There was a list of information such as job vacancies, harmreduction information, news, recovery and support advice,research and reports.



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Areas for improvement

Action the provider SHOULD take to improve

• The provider should have a child visiting policy toensure all staff, visitors and clients are aware of theservices policies and procedures.

Outstandingpracticeandareasforimprovement

Outstanding practice and areasfor improvement


birmingham inpatient drug treatment service · we rated birmingham inpatient treatment drug...

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