We do not currently rate independent standalone substance misuse services.

We carried out this inspection to assess whether the provider had met the requirement notice that we served following our inspection in January 2017 related to regulation 18 (staffing). This was a short notice announced inspection.

We found the following area of improvement since the last inspection:

• At our last inspection in January 2017, we found that the provider did not always ensure there were safe levels of staffing. This was because there had been shifts where no nurse had been on site. We also found that one member of night staff had worked five nights consecutively. During this inspection, we spoke with staff and checked staff rotas. We saw that shifts were always covered with a registered nurse. We checked night shift rotas and saw that no member of staff worked for more than 5 nights in a row. Where permanent staff were unavailable, the service had increased the pool of bank staff. This meant that there had been an improvement since the last inspection.

• At our last inspection in January 2017, we found that nurses did not receive clinical supervision. At this inspection, we saw that the service manager had appointed a head nurse in the unit who had the role to undertake supervision with all nurses. There had been some changes in personnel and we saw that these supervision sessions had taken place for the month prior to the inspection and were planned ahead. Staff told us that they had had recent supervision but supervision over the previous year had been sporadic. The service manager also received regular supervision. This meant that we saw there had been an improvement in nurses’ access to supervision, although this new supervision schedule had not yet had time to embed fully in the new staffing structure. There was a risk that supervision may not be maintained.

We do not currently rate independent standalone substance misuse services.

We carried out this inspection to assess whether the provider had met the requirement notices that were served following our inspection in August 2016 which related to regulation 12 (safe care and treatment) and regulation 18 (staffing). We also followed up on concerns that were raised with us about the safety of the service since the previous inspection.

We found the following areas of improvement:

• Staff had received specialist training that related to the needs of the client group. At this inspection, all staff had completed specialist drug and alcohol awareness training and eating disorders training.

• Since our last inspection in August 2016, the provider had improved health and safety with sanitary waste disposal facilities available in all toilets.

  We found the following issues that the service provider needs to improve:

• Since our last inspection the provider had not improved their systems for ensuring that nursing staff received regular supervision. This was an ongoing breach of regulation.

• The service had not ensured there were sufficient staff on all shifts. It did not have nursing staff available for two shifts between December 2016 and January 2017.

People who used the service gave their consent to any care or treatment before they were accepted onto the treatment programme. They told us this was reviewed with them on a regular basis. People understood the care and treatment choices available to them and told us that their choices had been respected and listened to. They said they could suggest and make changes to the service as long as they were appropriate and would not jeopardise the treatment programme or people's safety.

People described the staff as "really helpful". They said they felt safe and that staff were always available.

Staff were able to develop their skills and training and support was available to all members of staff. Staff received regular supervision and were able to attend relevant training courses.

People who used the service were asked for their views and the provider took their comments into consideration in trying to improve the service.

We do not currently rate independent standalone substance misuse services.

We found the following areas where the service needs to improve:

• While staff had undertaken mandatory training, there was no specific training which reflected the specialist needs of clients available for all nurses, health care assistants and therapists including the enquiries team who were based off site. For example, training specifically reflecting substance misuse, alcohol misuse, eating disorders and mental health. However, after our inspection, we were told that the service had booked all health care assistants and nursing staff onto face to face training for alcohol misuse and eating disorders.
• Staff told us that sometimes they had been given little information about clients prior to them being told by the enquiries team to present to the service for an assessment.
• Nurses were not receiving regular clinical supervision, although there were plans to implement peer supervision these had not been actioned at the time of our inspection. The service manager's management supervision was not documented.
• Clients and staff shared toilet facilities. None of the toilets had specialist sanitary waste bins.

However, we also found the following areas of good practice:

• Clients  who used the service were very positive about the support and care which they had received.
• The service ensured that clients were assessed by a nurse and doctor soon after admission.
• Staff undertook physical health monitoring of clients.
• Staff in the service had referred people to specialist physical and mental health services when their health had deteriorated.
• There had been significant improvements in the service since our previous inspection in October and November 2016 including adopting more robust policies in physical health management and monitoring. There had also been significant improvements in the medicines management procedures and staffing levels.
• Staff were enthusiastic and committed to providing a good quality of care to clients. They were supportive of the service manager.