We carried out this focused inspection of Grosvenor House to review remedial actions taken by the provider in relation to a regulatory breach. The inspection was announced two weeks before the inspection took place.

When we inspected the service in September 2016, we found the provider was in breach of Regulation 12 (Safe Care and Treatment), Health and Social Care Act (Regulated Activities) Regulations 2014. This regulation was not being met, as we found that:

• Risk was not always assessed and managed effectively, including risks to children.

• Risk assessments and risk management plans were not in all records reviewed.

• There was insufficient or incomplete information in the child safeguarding information, risk assessments and risk management plans.

• The information in the risk assessments and risk management plans did not match the notes in the contemporaneous records.

During this focused inspection, we reviewed the actions taken by the provider to address the issues raised in the previous inspection in September 2016.

At this inspection, we found that:

• Comprehensive risk assessments were in place in all records we reviewed. These included information on risks to children of service users.

• Detailed risk management plans were in place in all but one of the records we reviewed.

• Staff had completed additional training in safeguarding and risk management.

• Staff had a very good understanding of the safeguarding policies and procedures and had good links with other local professionals.

• Staff recorded information relating to risk and risk management within contemporaneous notes in service user care and treatment records. This was in line with information within risk assessment and risk management plans.

We found evidence which showed how the service involved patients in decisions regarding their care and found that the service had systems in place to ensure feedback from patients, regarding the service, was received. Both patients and staff spoke to us in positive ways about the respectfulness of the service and care provided. One patient, for instance, told us that "[staff] don't judge" whilst a staff member said "the ethos of care provided was respectful". We learnt how the service worked on a proactive basis to ensure people who found it difficult to access help could still be provided with care and support.

We saw processes were in place to ensure both children and adults were safeguarded. There was evidence which showed that staff had received safeguarding training and we saw examples of how the service had discussed, internally, a range of safeguarding matters; these discussions included a reflective appraisal of how safeguarding incidents had been dealt with by the service and led to recommendations being made to help improve future practise.

We reviewed a sample of patient records and, with patient consent, observed several clinic appointments. We saw a range of care needs assessments were undertaken by the service, along with care plans being devised to meet patient's identified needs.

We received positive comments from patients regarding the service. One patient, as an example, told us there was "nothing [the service] could do better". Another patient said: "All I can do is praise them".

We found that a range of staff with diverse skills and experiences was employed by the service. Patients we spoke with gave us positive feedback regarding the staff; patients we spoke with also told us about how easy it was to access the service as there was always staff available to help them.

The sample of electronic care records which we reviewed were up to date and kept securely. Staff appeared to be competent in using the electronic records system and care related information could be quickly located by staff.

We asked four people if they would like to speak to us in order to provide feedback on the service. Two people did not wish to do so. The two people we spoke with said that staff treated them with dignity and respect. One person said; “The staff are really friendly, positive and non-judgemental.” The other person told us that the staff were “sound."

Both people said that the service tried to fit around them to accommodate appointment requests. People said their treatment was explained to them and they had the opportunity to ask questions. They also said staff checked they had agreed to and were happy with the treatment provided.

People told us they would speak to the manager or contact the NHS if they wished to make a complaint about the service.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Spectrum employed a range of multidisciplinary professionals to deliver treatment and care to clients in the Inspiring Recovery service. They all demonstrated a good understanding of the Spectrum mission, vision and values. Staff received a comprehensive induction, and appropriate training for the role, as well as managerial and clinical supervision and appraisal. They were supported by senior managers, who were visible and actively involved in the operational delivery of the service.

• Clients, relatives and carers we spoke with told us that Spectrum staff, including the doctors, nurses and recovery workers, were kind, polite and respectful to them. We observed recovery workers and nurses maintaining the clients’ privacy and dignity in their approach with clients and treating them with empathy and encouraging them to achieve their goals.

• All treatment was underpinned by national guidance and staff had a good understanding of the best practice guidance that was appropriate with regard to prescribing, physical health care, detoxification and access to psychosocial interventions. There was a regular audit programme for medication and record keeping.

• Clinic rooms were clean and tidy and had the necessary equipment. Staff followed procedures to manage and prevent the spread of infections. All staff knew how to report incidents and could describe what types of occurrences they would report. Staff could escalate their concerns to the local risk register and these were reviewed at the joint clinical governance meetings. Feedback from all incidents was shared in team meetings and in other communications.

• Clients did not have to wait to access clinical treatment and staff were proactive in their approach towards supporting clients in discharging from substance misuse services. All transitions were seamless between the stages of recovery. Clients saw the service as one seamless system that delivered their care and treatment as the Inspiring Recovery service.

• All clients knew how to complain. The service responded to complaints in a timely manner, investigated where appropriate and any identified learning was cascaded to the teams. Spectrum gathered individual and joint feedback on the care and treatment provided in the Inspiring Recovery services and used this feedback, along with the complaints and compliments information, to inform the service delivery and design.

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

• Whilst Spectrum had a number of audits and health checks to monitor the safety and effectiveness of the service, we identified issues relating to the assessment and management of risk, including risks relating to safeguarding children.

• Documentation was not completed consistently and staff did not always follow policies and procedures. Where clients did not attend for their appointment in shared care, the positive-engagement procedure was not always followed. This procedure supported the recovery workers in managing the risks associated with the client not attending the service, for example the risk of overdose.

• The care plan documentation and recording in the shared care practices was inconsistent, the recovery goals agreed with clients were not always specific and time bound and there was not always evidence that the client had been offered a copy. The recovery workers had to input information on to two client information systems and duplicate their work. It was in these shared care services where the majority of these concerns were identified.

• All clients were not aware of the late night and early morning treatment provision available across the service. Clients told us that  Also, the complaints information leaflet did not contain information on how to complain to the Parliamentary and Health Service Ombudsman.