The Care Quality Commission
  • Residential substance misuse service

Bank House

Overall: Good read more about inspection ratings

Church Street, Sutton In Ashfield, Nottinghamshire, NG17 1EX 07976 227503

Provided and run by:
Steps Together Rehab Limited

Important: The provider of this service changed. See old profile

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Bank House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Bank House, you can give feedback on this service.

22 - 23 March 2022

During a routine inspection

Bank House is a 17-bedded, mixed gender, residential substance misuse service providing detoxification and rehabilitation interventions.

Our rating of this location improved. We rated it as good because:

  • The service provided safe care. The clinical premises where clients were seen were safe and clean.
  • The service had enough staff, including nursing staff for safe detox.
  • Staff assessed and managed risk well and followed good practice with respect to safeguarding. Staff now had access to alarms, and clients had access to call alarms in their rooms.
  • Staff developed holistic, recovery-oriented care plans informed by a face to face comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice.
  • Staff engaged in clinical audit to evaluate the quality of care they provided. Clinical audits now ensured care records were holistic and well ordered.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
  • Staff treated clients with compassion and kindness, and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service was easy to access. Staff planned and managed discharge well.
  • The service was well led, and the governance processes ensured that its procedures ran smoothly. This included the management of medical stationary which was an improvement since our previous inspection.

11 & 12 October 2018

During a routine inspection

We rated Bank House as requires improvement because:

  • The provider had not sufficiently addressed all concerns from the previous CQC inspection in January 2018. Concerns remained around medicines management, particularly practices in relation to controlled drugs.

  • Clinical leadership at the service had not been consistent. Governance processes, including clinical audit, did not ensure that omissions in clinical practice were identified and acted upon. The service did not have clear frameworks about what should be discussed at all levels of the organisation.

  • Staff did not always use recognised rating scales correctly to assess and record severity and outcomes with clients. Staff did always fully complete rating scales, and did not always complete withdrawal rating scales to the frequency directed by the admitting psychiatrist.

  • Staff did not always record client physical observations to the frequency directed by the admitting psychiatrist and did not always record them correctly to ensure that monitoring of physical health during detoxification was effective.

  • Staff used a standardised approach to care planning that did not always meet all client need, and did not support clinical practice in the service. We also found that staff did not keep care and treatment records in good order. We found information without complete client identifiable information, without the name and position of the recorder, and incorrectly filed.
  • Staff did not always report all incidents that affected the health, safety and welfare of clients using the service. Agendas for staff and clinical meetings did not include feedback and learning from incident investigations as something that would always be discussed.

  • The service did not make personal alarms available to staff, or have an effective system in place for clients to summon assistance to their rooms in an emergency.

However:

  • The provider had acted to make improvements to address many of the concerns raised by the previous CQC inspection in January 2018. We saw that psychiatrists now made a physical examination of clients entering the service, and medicines reconciliation practices had been established. The service had purchased an automated external defibrillator and medicines fridge.

  • The service used a clear model of recovery. The therapy programme provided clients with psychological therapies recommended by the National Institute for Health and Care. Staff and clients contributed to the development of recovery plans that were personalised, recovery focussed and addressed a range of needs.

  • Clients using the service spoke positively about their experiences. Clients felt involved in their care and could provide feedback on the service they received.

  • All areas of Bank House were maintained and provided a good standard of accommodation. Clients could choose single or shared rooms, and the service complied with good practice guidance on gender separation. Clients reported the quality of food was good.

29th January to 30th January 2018

During an inspection looking at part of the service

We do not currently rate standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • We did not see evidence of risk mitigation or the documenting of decisions made regarding communication with other health care professionals in relation to medicines reconciliation and medical histories.

  • The provider had not completed competency checks for support workers trained to administer medicines and the medicines management policy was not specific to the activities of the service.

  • The provider had not acted on an action point arising from an environmental fire risk assessment.

  • The service did not have any resuscitation equipment and we did not see a risk assessment or a record of a discussion to explain how the provider had reached this decision.

  • Staff did not receive training in safeguarding children and the safeguarding policy incorrectly identified when the CQC should be notified of a safeguarding concern.

  • The detail and completeness of clients’ assessments varied, including the recording of physical health assessments. Care and treatment records did not always contain a complete and up to date record of assessments, clinical discussions and decisions made by staff.

  • The service did not have a regular formalised process for staff from all disciplines to meet to discuss and record the progress of clients.

  • Staff recruitment processes and staff employment files did not meet practices described in the service’s policies.

  • Staff did not routinely record discussions with clients prior to admission and there was no policy or procedure to guide staff through the referral, admission and discharge process.

  • Governance systems at Bank House were not fully established and embedded. There was not a full range of policies to support practice and guide staff.

However, we also found the following areas of good practice:

  • All areas of Bank House were well maintained and provided a good standard of furnishings.

  • Registered staff knew what to report as an incident and how to report it. Systems were in place to feedback learning from incidents to staff and we saw an example of service change following an incident.

  • Staff and clients contributed to the development of recovery plans that were personalised, recovery focussed and addressed a range of needs.

  • Staff were caring, respectful, polite and shared care plans with clients. We saw staff promoting participation in group therapies and celebrating clients’ completion of treatment at graduation ceremonies.

  • Clients were able to give feedback on the service they received at community meetings and through an exit questionnaire on discharge.

  • Bank House provided clients with a structured therapy programme and access to activities.

  • Staff spoke positively about their jobs and passionately about working with clients experiencing substance misuse. Staff described Bank House’s manager as approachable, supportive and open to feedback.