Cassiobury Court

Updated 28 January 2019

Cassiobury Court is a 20 bedded residential service providing drug and alcohol detoxification and rehabilitation, based in Watford. The service supports clients to achieve abstinence.

Staff and external professionals provide treatment groups on a sessional basis including drama therapy, yoga, acupuncture, photo therapy, mindfulness, recovery groups and harm minimisation groups. Clients are supported to access external mutual aid groups.

The service offers aftercare support for one year following discharge for clients who have completed their treatment programme. These weekly sessions run on a Saturday.

Clients are self-funded and most clients accessed treatment at the service for 28 days.

The service is registered to provide accommodation for adults who require treatment for substance misuse, and treatment of disease, disorder or injury. At the time of inspection Cassiobury Court had a registered manager and nominated individual.

The service accepts male and female clients. On the day of the inspection, there were 19 clients admitted of mixed gender.

Clients with mobility issues are provided with en-suite bedrooms on the ground floor. Clients have a key to their own room, and sign a contract covering a code of conduct and boundaries during their stay.

The Care Quality Commission last inspected the service on 09 October 2017. During the last inspection the Care Quality Commission issued the following requirement notices under Regulation 18: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing:

• The provider did not ensure that all staff had received an appraisal.
• The provider did not ensure that all staff received regular management supervision in line with policy.
• The provider did not ensure that all staff had completed Mental Capacity Act training and safeguarding vulnerable adults training.

And Regulation 15: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Premises and Equipment:

• The provider did not ensure that the clinic room was of a size that was fit for purpose.

The provider sent their action plans to the Care Quality Commission following the last inspection to address this. We saw during the inspection that all the improvements required by the Care Quality Commission had been achieved.

Updated 28 January 2019

We rated Cassiobury Court as requires improvement because:

• The ligature risk assessment did not include risks in corridors and did not capture all other ligature risks. The mitigation was not adequate so we were not assured of clients safety.
• The alcometer and oxymeter had not been calibrated.
• The qualified nurse received regular managerial supervision but was not having clinical supervision as appropriate to their role.
• Cassiobury Court had a small number of clients who had self-harmed within the last 12 months. The service had an admissions criteria and the admissions policy highlighted a range of high risk issues that were considered to be unsuitable for acceptance into the service. The service was accepting admissions who were identified as unsuitable in the admissions criteria.
• At the time of the inspection, the mixed sex accommodation was not split into male and female areas, although the manager said that if this was requested by a client then they would accommodate this. The current arrangement meant that clients may have their privacy or dignity compromised. The potential risk was not mitigated by risk assessments. The service did not have a lone working policy, there was no alarm system and we were not assured that staff and clients could summon help quickly in an emergency.
• The pre-admissions assessment was shared with managers and staff via a social media application on personal mobile phones. The service did not have processes in place to monitor the security of the information.

However:

• Staff had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff that we spoke with gave examples of how they would support clients who lacked capacity.
• Staff provided a range of psychological therapies recommended by The National Institute for Health and Care Excellence. These included cognitive behavioural therapy and group therapy. Some of the topics covered in group therapy were mindfulness, meditation, reflection and relapse prevention, phototherapy, tai chi and yoga. Clients were given some choice about which therapies they accessed.
• We observed that staff spoke to clients with patience, kindness and respect. Clients that we spoke with told us consistently that staff were empathic and respectful and treated them with dignity and kindness. There was always a staff member available to speak to and they provided clients with practical and emotional support.
• Managers had the skills knowledge and experience to carry out their role effectively. They had a good understanding of the organisation that they managed and were clear and committed to achieving high quality care and treatment.

Updated 28 January 2019

Updated 22 December 2017

See overall summary.