We rated Oldfield Farm as requires improvement because:

• Staff did not always report all incidents that affected the health, safety and welfare of clients using the service. Governance processes and records did not demonstrate how essential information, including learning from incidents, was shared and discussed at senior levels of the organisation.

• The service did not always demonstrate how its directors held the necessary qualifications, skills and experience for their role. This did not support fit and proper person requirements.

• The service did not demonstrate what baseline of training was used to ensure the learning and competencies of all staff remained consistent.

• Staff did not make and record all the necessary checks at the service to ensure that it remained safe. This included not regularly checking the service’s one personal alarm to ensure it remained in good working order, not measuring the temperature of the room where medicines were routinely stored, and not ensuring cleaning rotas demonstrated completion of tasks.
• Although the service used blanket restrictions, there was no policy in place to guide staff practice in the use of blanket restrictions, or provide a framework for review.

However:

• Staff practices around risk assessment and planning care with clients was good. Care records contained completed risk documentation, and recovery plans that were personalised and addressed the recovery needs of clients. Staff and clients met regularly to review care.

• The structured recovery programme provided clients with interventions recommended by the National Institute for Health and Care Excellence, support to live healthier lives, and a range of outdoor activities and work skills. Staff delivered interventions to clients individually or as part of a group.

• Clients described staff as caring, respectful, and polite. Staff interactions with clients were delivered warmly. Staff participated in activities with clients as part of the recovery programme delivered.

• The service had a range of policies and documents in place that were relevant to the service and to guide staff practices. This included a service vision, risk register, sharing information, and practices around managing referrals, assessment and discharge.

We do not currently rate independent standalone substance misuse services.

We carried out this unannounced focused inspection to assess whether the provider had met the requirement notice we served following our inspection in September 2016 related to regulation 12 (safe care and treatment) Health and Social Care Act 2008 (regulated activities) regulations 2014 and whether action had been taken over our concerns.

During this inspection we looked at four key questions, safe, effective, caring, and well-led where we had previously identified concerns. We did not inspect responsive.

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

• The service now had a comprehensive ligature risk assessment, which highlighted ligature points in each room. The assessment included an action plan to either remove or reduce any identified risk.

• Staff now received regular supervision. The manager documented this in staff records.

• All staff had the right training to care for clients. The manager had ensured this included Mental Capacity Act training.

• Clients now had individualised early exit plans. Staff knew who to inform if clients chose to leave the service before their treatment ended. These were included in each client’s care notes.

• The provider had contact details of advocacy services on a noticeboard and in the resident’s handbook. The manager knew about changes to services and kept the information up to date.

• Staff and clients now held residents house meetings. Staff recorded feedback in minutes, including when changes had been made as a result of the meeting.

• The manager had improved the quality assessment of the service. Staff could now see where improvements to care had been made.

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

• The building had numerous ligature points and the service had not adequately risk assessed them.

• Supervision was not regular for all staff.

• Clients did not have individualised early exit from treatment care plans. This meant that clients could have been at risk if they left the service early, as staff had not planned for this.

• The provider did not have any key performance tracking or monitoring systems in place to monitor the quality of their service.

• There was no specific Mental Capacity Act training.

However, we found the following areas of good practice:

• Staff were experienced in substance misuse work and had access to specialist training. All staff had completed mandatory training.

• Volunteer staff had access to the same training and supervision as permanent staff.

• Staff had good levels of job satisfaction and enjoyed their roles.

• Clients were involved in the development of their care plans. Staff helped clients identify what their individual aims were and reviewed risk assessments and progress as part of their weekly one to one sessions.

• Clients had access to activities and therapy seven days a week.

• The team worked well together with the common goal of providing an excellent service to clients.