We rated Bosence Farm as good because:

• Clients felt safe and well cared for. The clients we spoke with were confident in the abilities of staff and felt that they worked with clients’ best interests at heart.
• The environment was clean, welcoming and fit for purpose.
• Medicines were managed safely. At our previous inspection we found not all staff administering medicines had received training. At this inspection we found that all staff involved in medicines administration had received suitable training. Medicines policies and procedures had been reviewed by the clinical lead and updated. Medicines were stored and administered safely.
• All treatment at the service followed National Institute for Health and Care Excellence (NICE) guidelines in both the prescription of medicines and the delivery of psychosocial interventions  including drug misuse in over 16s: opioid detoxification clinical guideline [CG52] Published date: July 2007 and Drug misuse in over 16s: psychosocial interventions. Clinical guideline [CG51] Published date: July 2007.
• Clients risk and treatment needs in relation to their recovery were assessed prior to admission and care was planned and delivered in line with this assessment. Specific assessments for blood born viruses were undertaken at point of admission.
• The provider recorded incidents and could demonstrate learning from these. Staff we spoke with understood safeguarding and referrals had been made to the safeguarding team.
• Clients in Bosence and the young Persons unit had a full activity program, including evenings and weekends. The key workers worked with clients to complete a comprehensive assessment of their individual needs and compiled a plan to maintain independence.
• The service was recovery focussed with discharge planning being built in to client plans from the outset. Early exit from treatment plans were also put in place early in clients stay to ensure those unexpectedly leaving the service were as safe as possible. These plans involved carers and relatives where appropriate. Links formed with local community support groups to enable clients to continue with support on discharge.

• •Staff demonstrated an understanding of the impact care being provided can have on a clients’ wellbeing. Clients were provided with emotional support at all stages of their treatment through group work, one to one work and peer support.

• The service used the same electronic note keeping system as the local community substance misuse service. This ensured that the service had immediate access to all previous assessments and care plans.

However:

• Some staff felt that there was a lack of positive leadership which was leading to low morale among. clients who were too high risk were being admitted to the service with the potential to lead to poorer outcomes However, this was not supported by evidence from outside referring agencies.

Sleeping areas in Bosence and a 3 bed corridor in Boswyns were not segregated into male and female. This potentially placed people at risk in terms of their sexual safe

Clients in Boswyns did not have a private space in which to have a telephone conversation. Summary of findin

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The environment was clean, welcoming and fit for purpose. Clients felt safe and well cared for.
• Medicines were managed safely. At our previous inspection we found not all staff administering medicines had received training. At this inspection we found that all staff involved in medicines administration had received suitable training. Medicines policies and procedures had been reviewed by the clinical lead and updated. Medicines were stored and administered safely.
• All treatment at the service followed National Institute for Health and Care Excellence (NICE) guidelines in both the prescription of medicines and the delivery of psychological therapies.
• Clients risk and treatment needs were assessed prior to admission and care was planned and delivered in line with this assessment.
• The provider recorded incidents and was able to demonstrate learning from these. Staff we spoke with understood safeguarding and we saw that relevant referrals had been made to the safeguarding team.

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

• Staff had not always completed mandatory training.
• The dates of opening of liquid medicines had not been recorded.

At this inspection we focussed the inspection at the Bosence Farm residential service. We inspected the Boswyns detoxification service in March 2013 and judged it at that time fully compliant with the regulations we inspected.

On the day of the inspection, we spoke in private and on a one to one basis with six of the eight people who were resident at the service. People were very positive about the care and support they received. Comments we received included “It has been a life changing experience…..I am very positive about my stay here,” and “It has been great. Exactly what I needed.” Care and support were provided in a homely, comfortable and safe physical environment.

We judged the programme offered to the people during their stay to be developed and managed to a good standard. People told us they were supported by staff with respect and dignity. People said they felt “very cared for” during their stay. Care planning documentation was maintained to a good standard.

We checked if there were satisfactory numbers of staff to support people, staff recruitment and training, and we judged these all to be to a good standard.

Bosence Farm was made up of two separate services; Boswyns and Bosence Farm. Boswyns provided comprehensive assessment, residential detoxification and stabilisation for up to sixteen people. Bosence provided structured residential rehabilitation for up to fourteen people.

The majority of our inspection time was spent at Boswyns. We did spend an hour and a half speaking with staff and people who used the service at Bosence Farm, and the people we spoke with were extremely positive about the service which was provided. This inspection report focuses on the service at Boswyns.

On the day of the inspection, we spoke with sixteen people who were staying at either Boswyns or Bosence Farm. People were very positive about the care and support they received. For example typical comments included “Being here has provided me with the ability to sit down and be at peace with myself,” “I cannot fault it….staff are great, they are so kind and caring,” and “the staff teach us responsibility…I am pretty confident we will achieve our goal of abstinence.” People said the food was to a good standard, the home was always warm, clean and they felt safe there.

The services were maintained, furnished and decorated to a good standard. Health and safety standards were to a good standard. When we inspected the home was clean and odour free. Staff recruitment checks and staffing levels were to a satisfactory standard. Quality assurance systems were also satisfactory.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Risk had been assessed on admission for all nine of the clients whose records we looked at. All nine had thorough, up-to-date risk assessments and risk management plans in line with national treatment agency guidelines for good practice. Risk and risk management plans were discussed in multi-disciplinary team meetings and plans were made for observation of clients when needed. Clients who chose to leave before the end of their treatment were provided with overdose awareness advice before leaving the service.

• Staff demonstrated a good awareness of safeguarding, including the need to be aware of safeguarding issues for the children of clients. Staff were able to give us examples of safeguarding concerns that they had referred to the local authority. Electronic records showed that staff involved the local authority safeguarding team appropriately.

• Medicines at Boswyns were stored securely in locked cupboards in the clinic room that was also locked when unattended. Staff managed stock levels well and carried out appropriate checks when administering medicines to make sure they were in date and safe to use.

• There was a robust assessment and monitoring system in place to ensure that clients at Bosence Farm rehabilitation could self-medicate safely. All clients at Bosence Farm rehabilitation had lockable storage boxes in their bedrooms.

• Care plans were up to date, personalised, holistic and recovery-oriented. The standard of assessment and care planning was very high. Ongoing monitoring of physical health took place and referrals were made to specialist healthcare if needed. Staff used a range of National Institute for health and Care Excellence approved tools to assess and monitor clients’ symptoms. Every client had an “exit plan” which included details of contacts and the place that the client would go to when they left. Information about relapse prevention and overdose was provided to clients who wanted to leave early and could not be persuaded to stay.

• Staff were experienced and motivated and told us they enjoyed their work. Sickness, absence rates and us they enjoyed their work. Sickness, absence rates and use of bank and agency staff were low.

• Supervision and appraisals for staff at Bosence Farm rehabilitation occurred regularly and was of good quality.

• The Boswyns building, which was completed in 2010, was light, spacious and well designed.

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

• Mandatory training rates were low. Although the provider was aware of this and had plans to improve training rates, the provider had not ensured that all staff were booked on to relevant mandatory training sessions.

• Staff at Boswyns who administered, or witnessed the administration of medication had not had an assessment of their competency to do so.

• Fridge temperatures at Boswyns were monitored regularly but we found that appropriate action had not been taken when temperatures were outside those recommended for safe storage of medication. The provider kept a limited supply of emergency medicines on site but had not reviewed this to ensure that the limited holdings were adequate.

• Staff at Boswyns were not receiving regular supervision that was in line with the provider’s policy.