We rated Gladstones Cotswolds Clinic as good because:

• Staff had imbedded protocols to ensure safe management of medicines at the clinic since our last inspection. This included reviewing their protocol and developing more tools for staff to ensure they followed best practice and national guidance. We saw that staff were knowledgeable about national guidance in prescribing medicines and sought advice on managing medicines from their pharmacy appropriately.

• Staff helped to ensure the safety of patients by assessing their risk prior to admission, as well as during their treatment. They also assessed and checked the environment of the clinic to keep clients safe. This included an environmental risk assessment, as well as checking the water temperatures (to help prevention of legionella), completing gas safety checks and holding fire drills.

• Clients were involved in assessing their needs during their treatment, and in designing their treatment plans. We saw that staff sought consent from them appropriately when considering sharing information. While in treatment, clients benefited from group and individual therapy using therapies recommended by the National Institute for Health and Social Care Excellence.

• Staff received supervision in line with their professional guidance, and discussed clients risk and presentations in twice daily handovers, as well as a multidisciplinary team weekly. These meetings used a set structure to ensure that important factors were not overlooked.

• There was a culture of acceptance and respect in the service. Clients said staff treated them with dignity and that discrimination against people was not tolerated in the service. They were involved in their care and staff gave them opportunities to feedback on their care during their treatment in weekly meetings, and after their treatment. Client views were used as part of the recruitment process for new staff.

• The clinic had no waiting list at the time of inspection, but they worked with patients to ensure they were admitted and discharged at appropriate times. While patients were there, they had access to a range of facilities so they could have group and one to one therapy. Clients could also personalise their rooms during their stay. The clinic had adaptations for clients with disabilities, and staff worked with clients with mobility issues to make adaptations to the service to make it accessible for them.

However:

• There were still steps for the service to take to improve their governance procedures. For example, implementing systems to speed up the collection of data to show the services progress against its key performance indicators, and ensuring that their website displayed accurate information about the services they provided.

• The service had no set of defined values for staff to work with, and there was no strategic vision for the service. This had been added to their action plan after our visit.

• Staff were in the process of completing their appraisals and so none of them had an up to date appraisal.

• Clients felt the admission process could be better, and that they should get their induction pack as soon as they were admitted instead of potentially waiting three days

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service had well-furnished facilities. Staff completed audits to ensure the environment was clean and safe. For example, checks of water temperature to ensure reduced risk of legionella and gas and electric safety checks.

• Staff completed in depth assessments with clients. These assessments, along with further discussions with clients led to a holistic recovery plan as well as regularly updated risk assessments. Staff used recommended assessment tools to measure withdrawal to ensure that clients were kept safe. Testing for blood borne viruses was also offered.

• Clients had access to therapies recommended by the National Institute for Health and Care Excellence (NICE) in one-to-one sessions as well as a structured group therapy program. These therapies were provided by experienced and qualified staff. Clients could access aftercare if they continued being abstinent from alcohol and illicit substances.

• We saw that staff had sought consent to treatment and had checked that clients had the mental capacity to make decisions throughout their treatment. This included consent to blanket restrictions that were in place for client’s safety and recovery.

• Clients told us that the staff treated them with respect. We saw this in an assessment we observed. Staff were caring and motivated to help clients recover. This included ensuring they had access to information, external charities and advocacy services. Clients had information about how to raise a complaint in their welcome pack, and if they wished their family to be involved in their treatment, their family received an information pack as well.

• Chefs cooked meals to meet clients’ dietary needs and staff had made adjustments to the timetable in the past to allow time for clients to pray.

• There was clinical and managerial leadership for staff. The service had hired more professionals to ensure staff could be professionally supported. Staff told us they had good morale and that they felt comfortable raising concerns.

• The service wanted to improve and had hired a contractor to conduct a mock CQC type inspection and had developed an action plan following this to improve the service.

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

• Staff only recorded the actual temperature of the fridge. They did not record maximum and minimum temperatures for the medicines fridge over a 24 hour period which could have meant that medicines were being stored outside of the recommended guidelines. This could impact on the effectiveness of the medicines.

• Staff did not have access to guidance on 'as required' medicines or a general medicines management procedure which meant they had to rely on the on call nurse if they had any concerns. Staff received training on administering medicines but their competency to do that was not tested.

• The service had identified a gap in its governance systems and had put in place actions to begin to address these gaps. These systems were very new. We saw evidence that some changes had been made but the systems were not fully embedded at the time of inspection.