This unannounced focussed inspection inspected aspects of the key questions of safe, effective and well led.

We do not currently rate standalone substance misuse services.

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

• BAC O’Connor Rehabilitation centre senior managers had not ensured the regular supervision of clinical staff or their completion of mandatory training in safeguarding, manual handling and infection control. This meant that staff lacked essential support to do their job safely.

• We found that staffs knowledge of how to report incidents was inconsistent. Staff missed opportunities to learn fully from incidents because the learning process was not clear to all staff.

• The storage of medication, in one of two areas, was inadequate meaning that there was no guarantee of the security of drugs. The BAC O’Connor centre did not have established links with a local pharmacist to support staff training in medication management and assistance in medicines audit.
• At the time of inspection the service was not able to provide treatment for a brain disorder, Wernicke’s Encephalopathy, sometimes found in alcohol dependent clients. Managers had suspended treatment until the nursing staff had received training in managing anaphylactic shock, a possible side effect of the injection used. This training was booked but had not been completed at the time of inspection.
• Records of staff supervision and training were incomplete and data provided shortly after the inspection showed significant non-compliance in meeting acceptable standards for the provision of clinical supervision and mandatory training.

• We found client care records were not securely stored meaning sensitive client information was vulnerable to misuse or loss.

• Senior staff had not always taken action in response to significant incidents involving client self-harm and personal injury.

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

• Staff were aware of safeguarding issues, could identify forms of abuse and knew to report them to senior management if they occurred. Comprehensive risk assessments also helped staff to manage client risk to themselves or others.

• Both the residential and detoxification sides of the centre had safe staffing levels and all staff had the standards of experience and qualification for their job roles.

• The GP had attended specialist training and received regular supervision for their work at the centre. The GP followed all national guidance for the treatment of substance misuse problems except in the one incidence above.

• All staff could describe the recovery agenda for the centre, were skilled in supporting clients through detoxification, and in supporting the resettlement of clients in the community. All clients we spoke to expressed positive opinions about their experiences, as residents.

We do not currently rate substance misuse services.

We found:

• The unit had 24 hours a day, seven days a week staffing with 24-hour qualified nursing cover on the detoxification unit.
• All staff had completed mandatory training. Electronic records demonstrated this, alongside recording in personnel files.
• The detoxification unit had an observation room for use by clients considered at increased risk of complications during assisted withdrawal. This provided additional monitoring and support for clients and was an example of good practice.
• We found appropriate arrangements were in place to ensure that medicines were stored and managed safely.
• There was evidence of reporting and effective learning from incidents. There had been no serious incidents in the service from December 2014 to December 2015.
• Thorough client assessments took place prior to admission, including a weekly pre-rehabilitation group, allowing regular monitoring of clients prior to admission.
• Client’s treatment records contained recovery plans that were up to date, personalised, holistic and recovery orientated.
• Information was stored securely, some information was stored electronically but the majority of treatment records were paper based. These were stored securely and all appropriate staff had access to them.
• Clients signed a written treatment contract that included consent to bag searches, urine screening and breathalyser testing, reduced access to the telephone escorted leave only.
• There was a weekly family/carer group.
• Therapies on offer included relapse prevention, relaxation, anger and stress management, cycle of addiction, life story work and one-to-one therapy sessions tailored to individual needs.
• The provider had a two-year aftercare programme in order to continue to support clients in their recovery journey after completing the residential programme.
• A clear structure was in place for reporting complaints with timescales for response.
• Staff knew and spoke confidently about and with passion for the organisation’s recovery-focused values.
• Both the chief executive officer and senior managers had a visible presence and staff told us they were approachable and were often on site.
• The provider had developed two tearooms and a radio station within the county. This provided clients who had completed the programme with volunteering and paid employment opportunities alongside recognised qualifications in catering.
• The provider was in the process of developing an electronic care records system that clients would use. This would allow active participation in the electronic planning of their care and their recovery journey. This system was in development and the provider was planning to be active by April 2016.

During our inspection we saw that people’s consent to care and treatment was gained. People had a copy of their recovery plan which detailed the support they had consented to.

We saw that people received the care and treatment they required to meet their individual needs. This care and treatment was delivered in a professional manner and people told us they were happy with the support provided. One person told us, “The best day of my life was when I walked in here. I can’t believe how fortunate I was and I’m pleased I decided to come.”

We saw that there was enough skilled staff on duty at all times. This ensured that people received the care and treatment they required.

We saw that there was an effective system to respond to any comments or complaints. People were confident that they could talk with staff and their concerns would be addressed. One person told us, “I wouldn’t hesitate talking to any of the staff here. They always listen and are interested in what we have to say.”

We carried out this inspection to check on the care and welfare of people using the service. The inspection was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with two people using the service and six members of staff. We spoke with social care professionals prior to our inspection who told us they did not have any concerns about the service.

We only inspected the accommodation where people were receiving care and treatment for rehabilitation, as the accommodation that people used as part of the detoxification programme was unoccupied.

People knew all the details about the rehabilitation programme and had agreed to how the treatment would be carried out. People received group and individual therapy to support them during the agreed treatment.

We saw that staff treated people with respect and dignity and people told us that they were well looked after. People told us the staff were always available for them and they also received support from their peers. They said if they had any concerns they would discuss them with members of staff or the manager.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The centre offered a clean, pleasant and homely environment and a range of facilities conducive to recovery.
• The centre offered a holistic recovery pathway that included detoxification, rehabilitation and aftercare services. The centre adopted a psychosocial approach to understanding clients’ addiction with access to a range of therapies, mutual aid, and other support services.
• Staff followed evidence-based practice and guidelines when treating and monitoring clients during their detoxification and rehabilitation. This included consideration of Wernicke's encephalopathy.
• The centre had a dedicated staff team that showed passion and genuine commitment to their work and their clients’ progress. The centre had a strong, qualified therapy team that provided a range of evidence-based therapies that they tailored to meet individual clients’ needs.
• Staff received the appropriate mandatory and specialist training for their roles, and had access to a range of training and development opportunities. Staff received supervision regularly and managers kept detailed, good quality supervision records.
• The centre had a strong person-centred focus with good client and family involvement. Staff held a graduation ceremony to celebrate a client’s successful completion of their recovery programme. The service supported clients with protected characteristics appropriately. The centre also responded to requests from the local community for help to set up support groups, for example, the lesbian, gay, bisexual and trans community, and the Muslim and Polish communities.
• Staff spoke highly of the new registered manager and said he was visible, proactive and supportive. Staff described an improvement in staff morale and operational management since he joined the organisation.
• Staff kept clients’ records up-to-date and in good order. Staff stored confidential records securely. The centre had robust incident reporting processes and shared lessons learnt with staff.

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

• Staff did not always store medicines at the correct temperature, which affected the usefulness of the medicines. Staff recorded fridge temperatures daily but took no action when they were outside the accepted range. The provider had no protocol on how to deal with affected medicines.
• Staff did not destroy controlled drugs on the premises as required by legislation, and there was no reference to this in the controlled drugs policy. Staff did not check clients’ prescribed medicines before giving homely remedies, which presented the risk that staff might administer an incorrect dose. The provider did not stock an emergency medicine for rapidly reversing opioid overdose, for example, naloxone.
• Some clinical and medicines-related policies lacked standard operating procedures and protocols to help staff carry out clinical tasks. Some clinical and medicines-based audit tools and checklists were not sufficient for their purpose of ensuring compliance and highlighting issues.
• The centre did not have integrated care records along its care pathway. Each part of the service kept separate client records. The service did not have an integrated multidisciplinary team approach to reviewing clients’ care. Each part of the service conducted its own reviews.
• Some Disclosure and Barring Service (known as DBS) checks were more than three years old. Some of the provider’s policies were out-of-date.