8 January 2019
During a routine inspection
We rated Allington House good because:
- Staff treated clients with dignity, respect, compassion and kindness. Clients told us that staff were empathic, caring and approachable. Staff involved clients and carers in decisions about their care, treatment and changes to the service. Staff supported clients to maintain contact with their families and carers and provided a space for them to meet. The service encouraged dog owners to attend rehabilitation by enabling them to bring their dog with them.
- Clients who used service were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each person. The service had a strong recovery ethos with staff devoted to ensuring that clients had excellent outcomes. Clients praised the staff in helping them open-up and talk about areas of their life they had previously kept to themselves.
- All clients we spoke with said they felt safe. Clients described Allington House as a quiet, calm and homely environment. Clients told us that the service had a community spirit, and that everyone looked out for each other. They felt that the staff were very interested in their welfare and that they “went the extra mile” to ensure they were happy and able to succeed in their recovery. Clients described the service as having ‘saved their lives’ and felt that the skills staff taught them would enable them to move back into the community safely.
- Managers and staff shared a clear definition and vision of recovery for clients that was embedded throughout the service. Staff understood their roles in supporting clients in their recovery journey and treated them as partners in their care. Staff said they felt respected, supported and valued, and were proud of the work they did.
- The provider actively worked to reduce barriers to treatment for their clients. For example, the service had admitted clients with their pets, purchased support from domiciliary care agencies for clients requiring personal care and employed a driver who collected clients when public transport was a barrier to treatment.
- Staff were very motivated and inspired to offer care that was kind and promoted clients’ dignity. Staffing levels were safe and there were plans in place to cover vacancies, sickness and annual leave. There was a positive culture within the house, staff felt respected and valued as members of the team and there was support from the registered manager. Staff received the specialist training needed to carry out their work effectively. Through safeguarding training and information, staff understood how to protect clients. Staff had two monthly supervision and yearly appraisal.
- Staff had good knowledge of safeguarding procedures that helped them protect vulnerable adults from abuse. Staff reported incidents as they arose and learnt from accidents and incidents in the house.
- The service was clean, well equipped, well-furnished and had good facilities. The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity and there were adaptations for people with disabilities. The manager completed environment health and safety checks, this included an assessment of ligature points. A ligature point is anything which could be used to attach a cord, rope or other material for hanging or strangulation.
- The service provided care based on National Institute for Health and Care Excellence guidance. Allington House provided one to one time and group work to clients. Staff monitored and addressed physical health of clients in the house. Staff received mandatory and specialist training and they had a good understanding of the Mental Capacity Act.
- There was no waiting list for the service. In the event of clients relapsing, staff tried to work around triggers for relapse. The service had a range of rooms for clients, including living rooms, a large dining room and a multi-faith room. There was wheelchair access and access to outside space. Staff provided care according to ethnic, cultural differences and personal preferences. Staff supported clients to access and attend external support groups.
- Clients knew how to complain. There were policies in place to guide staff within their work. The provider maintained and discussed the organisational risk register. Clients had regular opportunities to give feedback about the service, including; house meetings, evaluation forms, suggestion box and a feedback book.
However:
- Staff did not complete comprehensive risk assessments for clients admitted to the service and there was no evidence of crisis planning. Staff did not complete individualised care plans for clients accessing the service. Staff did not document discharge plans. Staff kept a lot of information in their heads and this was not translated into the documentation. There were blanket restrictions in place.
- Medicines were not always prescribed safely due to staff not using medicines reconciliation processes as routine. This means that staff did not routinely check that the medicines they were giving were the ones prescribed by the GP.
- The service did not have sufficient governance systems in place to ensure sufficient oversight and risk management of incidents and safeguarding. Managers therefore did not monitor to look for trends, this meant that if the same incident kept on occurring then there was no oversight to look at the reasons why or for example, if there was a gap in staff training.