We rated Broadreach as requires improvement overall because:

• The service’s medicines management was not robust. The medical officer was signing prescription charts for alcohol detoxification prior to assessing clients. Without a full face to face assessment an incorrect detoxification regime could be started resulting in incorrect medication, dose or frequency being administered. Staff received a client’s summary record from their local GP up to four weeks before the client arrived at the service. This meant that clients may not receive up to date medication.

• The service had a number of blanket restrictions in place. These restrictions were not assessed on an individual basis. The provider did not have a blanket restriction log that justified the use of the restrictions. The provider did not routinely review these restrictions and the provider did not seek client feedback on the restrictions. Clients had no access to mobile phones throughout treatment including when on community leave in the local area but were able to take mobile telephones on home leave and when travelling distances. Clients were not allowed to bring food or drink, including water into groups, and clients were unable to leave the service unescorted until week eight of treatment. Clients had to seek approval from staff for their visitors and visitors with current substance misuse would not be approved. Clients were asked to sign a contract agreeing to these restrictions. Staff witnessed client’s giving a urine sample on admission. However, at the time of inspection the service’s policy relating to urine testing did not state it should be witnessed. There was also a bench in the service’s car park that only staff were allowed to use.

• There was a lack of crisis plans in place for clients. This means that staff and clients may not know what their support needs were during a time of crisis. Crisis plans should include relapse prevention strategies personalised to the client’s support needs and treatment goals. Crisis plans and relapse prevention strategies should be written with clients to ensure staff know how to support a

  client if their mental health deteriorated or if they relapsed. Clients did not have a person-centred unplanned discharge plan. Client records contained a basic unplanned discharge form, but risk management plans did not identify those at risk of unplanned discharge from treatment.

• Staff were not adhering to infection control principles in the clinic room. We found plastic cups, a syringe and a beaker with residual methadone liquid inside. The syringe had not been cleaned between uses and the beaker was left on top of the medication cabinet. Methadone is an opiate medication prescribed for the treatment of heroin addiction and is a controlled drug. Staff were also transporting urine samples from a toilet at the front of the building to the clinic room at the back for testing, which could result in a spillage.
• The provider did not have robust and comprehensive governance and quality assurance processes in place to ensure sufficient oversight, quality assurance and risk management of the service. For example, the service did not audit or review service provision and outcomes of client’s care to ensure the therapeutic programme offered was effective.

However:

• All seven of the client care and treatment records reviewed contained a current risk management plan and person-centred recovery plans.
• Staff provided a range of care and treatment interventions suitable for the client group. These included medication, psychological therapies, complementary therapies, and activities. The service had enough skilled staff to meet the needs of clients. The majority of staff had completed mandatory training. Staff were provided with a comprehensive induction and had relevant qualifications to provide clients with effective care and treatment. Managers had appropriate qualifications to perform their role. Counsellors were qualified to deliver the therapeutic programme.
• Clients told us that staff attitudes and behaviours were kind, respectful and showed an interest in their wellbeing. Clients said that staff understood them and that they felt safe in the service.
• Clients had lockable safes in their bedrooms to securely store personal possessions. This was an improvement from the previous inspection.

We do not currently rate independent standalone substance misuse services.

Broadreach has been inspected twice previously, in 2013 and 2016. The comprehensive inspection in September 2016 did not fully comply with CQC policy and guidelines for inspection activity. Consequently the report was not published.

We will undertake a further comprehensive inspection in the near future.

In July 2017 we carried out an unannounced, focussed inspection of this location to check on a number of issues that had come to our attention through the information we hold about the provider.

At this inspection we found the following areas of good practice:

• All medicines were stored safely and administered by staff apart from those required for immediate relief of symptoms such as asthma inhalers.

• There were systems in place to ensure the repair of faulty equipment in a timely manner; there was a schedule for safety testing of equipment and staff now carried personal alarms.

• Medication risk management plans were in place to give staff permission to manage and administer medicines. This included some disease specific risk assessments. For example, diabetes plans which detailed triggers and symptoms and what actions to take if the client’s health deteriorated.

• The provider had reviewed its policy on locking bedroom doors. Bedroom doors did not lock but this was for the safety and wellbeing of clients. We talked to clients about this policy and they were in agreement with it.

• Physical health checks were carried out on admission and clearly documented.

• Risk assessments were clearly documented in client’s files.

• There was a programme of audits in place to ensure required improvements in the services were identified and actioned in a timely manner and the vision and values of the provider were clearly displayed on a noticeboard.

We met and spoke with most of the 14 people who used services and spoke to people about the care and support they had received at Broadreach. We talked with most of the staff on duty and checked the provider's records.

Comments from people who were staying in the Broadreach included, "Would recommend the place to anyone” and “They have really helped me”.

We saw that people's records described people's care and treatment programme and how these would be met. We saw that people consented to the care and treatment they would be receiving.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a professional way that demonstrated a good understanding of people's individual needs and preferences.

We looked at care records for six people; this included two new admissions on the day of the inspection. We spoke with staff about the care and treatment given to some of these people, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their planned treatment how those treatments would be arranged and met.

There were effective systems in place for safeguarding people from abuse. All the staff we spoke with were clear about the actions they would take should they have any concerns about people's safety.

We spoke with many of the staff working during our visit. Comments included “Great team work” and “Plenty of support.” Staff said they were supported to deliver care and treatment safely and received appraisals and supervision to promote good practice.

We saw that Broadreach House held all records securely to protect people’s confidentiality.