Archived: Cherry Tree Cottage

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• During our recent inspection, we found that the service had addressed the issues that led to the previous requirement notices.

• In December 2015, we had found that the environmental risk assessment had not identified potential ligature points and that ligature cutters were not available to staff. When we visited in December 2016, we found a comprehensive environmental risk assessment, which had identified potential ligature points, along with an action plan to reduce these risks. Staff were aware of these and had access to ligature cutters. This meant that they were able to manage potential risks more effectively.

• In December 2015, we found that there was no Naloxone policy. On this inspection, we found a policy in place and staff had received training in the use of naloxone. This meant staff were aware of the procedures in place to follow safe naloxone use.

• During the most recent inspection, we found that the service had addressed all the ‘shoulds’ we had recommended from the December 2015 inspection.

• We found the service had made the environment safer by fitting window restrictors on the first and second floor windows and implementing an alarm system for staff and clients to use to summon assistance. They had also fitted two-way locks so clients could lock their bedroom door if they wished.

• Staff had received training in the prevention and management of violence as well as training on the Mental Capacity Act and Deprivation of Liberty Safeguards. This was a recommendation from the inspection in December 2015. In addition to, all staff had completed further training in line with drug and alcohol national standards (DANOS). DANOS provides standards of performance that people in the drug and alcohol field should be working to. Additional training completed including professional boundaries and risk management.

• The registered manager had reviewed and updated all policies and procedures in October 2016, in line with moving to a new location.

• The service had enough staff to care for the number of clients and their level of need. Staff knew and put into practice the service’s values, and they knew and felt supported by each other and the registered manager.

• There were good procedures in place for administration of medicines. Staff carried out and recorded appropriate physical observations, and ensured the clients dignity and privacy whilst doing so.

• The staff team met weekly to review client care and discuss governance systems implemented. These included feedback from clients and carers, supervision and support and reviews of policies and procedures. Staff also reviewed any incidents and complaints at these meetings. Staff were able to share examples of learning from incidents and feedback from clients.

• We observed staff to be very caring and knowledgeable about their clients individual needs and all clients we spoke with were overwhelmingly positive about the service

However, we also found the following issues that the service provider needs to improve:

• Staff did not record the temperature of the clinic room or clinic fridge, therefore were unable to assure us that the medications were being stored within the correct temperature range.

• It is normal practice in many rehabilitation programmes for the client not to leave the premises during the first week of detoxification. During this week, if the client had no money with them, clients agreed to share their bank personal identification number (PIN) with the service. Even though, we saw signed contracts between the client and service to do this, they were not formal third party mandates as required by the banking services. This did not safeguard the clients or staff.

• Staff were able to talk about their clients’ needs in detail and had a good understanding of the recovery focus, However, this was not always reflected in the written risk assessments and care plans. We found one instance of risk identified by the prescribing doctors assessment which had not been transferred the care plan support staff used.

• Staff did not always contact the clients GP at the beginning of a treatment intervention if the client had not consented. This meant that the client was exposed to potential double prescribing or the service did not have a complete medical history of the client.

• Although staff told us that, they were open and transparent with clients and carers, and that they understood the importance of doing so. There was no Duty of candour policy in place to support and guide staff.