We rated Longreach as requires improvement because:

• There was insufficient attention to safeguarding children and adults. The service did not adhere to safeguarding principles. Staff did not consistently recognise or identify safeguarding concerns. Staff were not trained in child safeguarding. Staff did not update the safeguarding log and information was not shared between staff about safeguarding concerns. Staff told us that if they identified a safeguarding concern, they informed their manager who made a referral to the local authority. Staff identifying the concern should be confident and competent to make the referral themselves.
• The service had blanket restrictions in place that impacted on client’s freedom. Clients told us that the environment was too restrictive. For example; 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 were unable to have unsupervised access to the community until week four of treatment. Clients had to seek approval from staff for their visitors and visitors with a current of substance use would not be approved. The provider did not have a blanket restrictions policy in place and a log of their use was not kept. The provider did not consider restrictions on an individual basis or regularly review the use of blanket restrictions.

• The medicines reconciliation process put people at risk of harm. Community staff were provided with a GP summary, including list of medication, up to four weeks prior to admission. Clients brought in 28 days of medication with them and this was checked against the GP list. There was no process in place to ensure this was the most up to date and accurate list of medication.
• The provider did not have governance processes in place to ensure sufficient oversight, quality assurance and risk management of the service. Managers did not ensure that staff supervision considered the quality of safeguarding practices within the staff team nor did they offer staff training in child safeguarding. The organisation did not hold a risk register for the service to ensure that all service risks are identified and managed. The provider did not have systems in place to monitor the effectiveness of their therapeutic program or have sufficient quality assurance processes in place. The provider did not have systems in place to ensure that client feedback was always acted upon.
• The service also did not audit the program against the National Institute for Health and Care Excellence (NICE) guidelines or have a quality assurance process. The service did not monitor the efficacy of the therapy program. This meant the programme was not evidence based.
• Staff did not follow infection control principles. Staff carried contaminated clinical waste, following urine drug testing, across the house for disposal in the clinic room. There was no hand washing sink available in the clinic room for staff to use.
• At the time of inspection, the location of the clinic room compromised safety, privacy, dignity and confidentiality of clients. The clinic room formed the walkway into the dining room. Confidential information was on display in the clinic room that was visible when clients accessed the dining room. The door to the clinic room was left unlocked. Clients could access sharps bins and medical equipment which could be used to cause harm to themselves or others. Following the inspection, the provider informed us they had moved the clinic room.

• There was no evidence of crisis plans or unplanned discharge plans for clients. Crisis plans should contain personalised information on what support is available during a deterioration of mental health and a relapse prevention plan. Staff were not assessing whether clients were at risk of unplanned discharge or creating robust unplanned discharge care plans with clients.
• The service did not routinely act on client feedback. Clients raised issues regularly through house meetings and evaluation forms but these were not addressed by the provider.
• The service did not routinely supply take home naloxone to all clients and carers following treatment for opiate rehabilitation.

However:

• Staff completed high quality, collaborative and individualised care plans.
• 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.

• Staff treated clients with kindness, dignity and respect. We observed staff interacting with clients in a respectful, caring and appropriate manner.
• The service had clear referral criteria and referrals were screened and assessed to check for suitability. Admissions were agreed at a weekly multidisciplinary team meeting.
• Clients had access to a local community project for women in recovery from addiction. The project provided counselling, housing support, outreach, a therapeutic group program and parenting support.

We do not currently rate independent standalone substance misuse services.

Longreach 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 reports were 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.
• The provider had good medicines management practices in place that included ensuring that missed doses of medicine were explained and when necessary followed up with the GP or specialist nurse for advice and guidance. However, it did need to ensure that when patients transferred from other services there was a clear record of the reasons why their medication was prescribed.
• The provider had a system to ensure they reported incidents. Staff had clear guidelines on what constituted an incident and how to report. The registered manager knew which incidents to report to CQC.
• Mental Capacity Act training was in place and all staff were up to date with it.
• The provider had recently reviewed their policy on locking bedroom doors. Bedroom doors did not lock but this was for the safety and wellbeing of clients in case staff wanted to gain access in an emergency. We talked to clients about this policy and they were in agreement with it.

On this inspection we met nine of the women currently using the service and spoke with four women about the care and support they had received from Longreach. We also spoke with four staff employed at the home. We checked the provider's records and spoke with the registered manager.

We looked in detail at the care and treatment four women currently staying in Longreach received. We spoke to staff about the care and treatment given to people. We looked at the records related to the four women we met and observed staff interacting with the women staying in the home. We saw that the staff had a good understanding of the women’s individual needs and we observed that they were kind and respectful.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

There were enough staff on duty to meet the needs of the women receiving care and treatment at the home and a member of the management team was available on call in case of emergencies.

Staff personnel records contain all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the women receiving care and treatment in the home.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS apply to care homes and hospitals. No application had needed to be submitted at Longreach House.

Is the service effective?

The women told us that they were happy with the care and treatment that had been delivered and their needs had been met. One person who was due to leave the home told us that the home had met the planned treatment programme agreed on admission. It was clear from our observations and from speaking with staff that they had a good understanding of the women’s care and support needs and that they knew them well. One woman told us. "They really listen to me as a person” and another person said “I was asked about my care and treatment”. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

The women we spoke to told us they were supported by kind and attentive staff. We saw that the staff showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One woman told us “I don’t always want to participate in group sessions yet but the staff encourage me but don’t force me”.

Is the service responsive?

People’s needs had been assessed before they moved into Longreach for their continued rehabilitation. The women told us they met with their support counsellor regularly and when needed to discuss what was important to them. Records confirmed individual’s aspirations and diverse needs had been recorded and care and treatment had been provided in accordance with individual’s needs. The women had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Women told us they had been asked to complete “Got an Idea” forms to make suggestions on how to improve the home. We saw records that told us that the women had been listened to as a result of the completed forms. As an example we saw that suggested equipment had been purchased and an outing had been arranged.

Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the running of the home and their views had been taken into consideration. Women currently staying in the home and the staff all spoke well of the registered manager.