We rated Broadway Lodge as good because:

• Staff treated clients with kindness, dignity and respect. Staff demonstrated an understanding of the individual needs of clients.
• The provider had addressed the issues we raised at our last inspection. Records were accessible to all staff. The provider held records in paper and electronic format. The provider was in the process of moving to an electronic record keeping system with a completion date of end of this year.

• At our comprehensive inspection in 2016 we found that records were not accessible to authorised people as necessary to deliver clients care and treatment in a way that met their needs and kept them safe. During our focused inspection on 4 April 2018, we found that staff did not have access to records contain all relevant information that need to be aware of risk and in order to deliver clients care and treatment in a way that meets their needs and keeps them safe. This was a breach of regulation 17 (2)(c). At this inspection we found this requirement had been met; staff told us and we saw that records were accessible to all staff. The provider held records in paper formats and these records were also stored on computers. We were told the provider was in the process of moving to electronic record keeping system with a completion date of the end of this year.

• Staff screened clients prior to admission to ensure the service could meet their needs; they completed care plans with clients upon admission. Staff enabled clients to access physical healthcare including GPs, dentists and hospital appointments.
• All clients had a risk assessment. There was an initial risk assessment followed by a further ongoing one. The initial risk assessment was robust and comprehensive. The ongoing risk assessment was more standard with less details.
• The service was fully staffed. Staff received regular supervision and they attended team meetings and handovers. Staff told us morale was very good, they worked well as a team and supported each other.
• Staff ran a weekly house meeting for clients to raise concerns and complaints informally. Clients knew how to complain. Staff actively sought the opinions of clients. There were systems to record, review and discuss complaints and incidents in place and there was evidence of change in response to these.
• The service had a range of facilities for clients including an art room, a chapel, extensive grounds, table tennis and yoga equipment. There were a range of activities for clients to take part in including art, gardening, games, meditation, reiki, acupuncture and shopping trips. The provider supported clients to access community based substance misuse support groups.
• The provider followed national best practice guidelines treatment such as National Institute for Health and Care Excellence guidelines (NICE). Staff we spoke with told us they used the Department of Health drug misuse and dependence UK guidelines on clinical management (also known as the ‘Orange Book’).

• The provider had established systems and processes to monitor and improve the safety of the environment. The provider completed regular risk assessments of the environment and action plans were developed based on the risks identified.

• The provider had effective systems and processes in place to ensure its workforce were equipped to deliver treatment. Staff had an annual appraisal and six-monthly reviews.

• The service had a dedicated registered manager. The registered manager had been working in this role for several years. Leaders and managers were visible and experienced in working in substance misuse.

However:

• Not all clients had a discharge plan and were involved in the planning of their discharge.
• Staff did not monitor the temperature of the clinic room environment where they stored medicines to ensure they were kept within the correct range.

We do not currently rate independent standalone substance misuse services. Our last comprehensive inspection of Broadway Lodge was in April 2016. At that inspection, we issued five requirement notices. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards. On 4 April 2018 we undertook an unannounced, focused inspection to see whether the provider had made the required improvements.

• At the last inspection in 2016 we asked the provider to ensure clients admitted for detoxification from opiates have individual care plans and risk assessments to ensure staff can appropriately manage risks. In April 2018, we found clients had care plans and risk assessments in place including ones that related to detoxification from opiates. Staff involved clients in developing their care plans and risk management plans. Further work was needed to ensure risk assessments addressed previous risks for each client such as where they had previously had seizures.

• At the last inspection in 2016 we said the provider must ensure staff reviewed and thoroughly investigated incidents and acted to prevent incidents re-occurring. At this inspection we found the management team reviewed incidents and told staff about any lessons learnt from them. However, further work was needed to collate all the incidents so that themes and trends could be found. The staff team had completed environmental risk assessments that were up to date.

• At the last inspection in 2016 we said the provider must ensure policies and procedures allow anyone to raise concerns about their care and treatment or the care and treatment of people they represent.

• At the last inspection in 2016 we said the provider must ensure staff receive regular appraisals and any training, learning and development needs should be identified and supported.

• At the last inspection in 2016 we said the provider must ensure records are accessible to authorised people to deliver clients care and treatment in a way that meets their needs and keeps them safe.

We carried out this inspection to follow up a compliance action made at an inspection which took place on 11 February 2013.

During this inspection we did not speak with people who used the service. We spoke with three staff members about the procedures that had been put in place to protect people from risks associated with medicines.

We found the receipt, storage and administration of medication was managed safely. This meant the systems in place protected people from the risks associated with medicines.

Staff spoken with told us they had made changes to the way medication was administered. This included a separate room in the main house which meant people were seen individually when medication was administered.

The clients we met were positive in their views of the treatment they are getting and how they are supported by the staff, examples of the comments made to us included, "it's a very welcoming place ,very welcoming and friendly everyone is very considerate" and “they have brilliant staff, out of everywhere that I've been it's the only place that ever worked for me", and "it's brilliant here ,they give you the tools and they tell you what you

should do ,I can’t fault the place the strength of this place is that they treat clients like human beings".

Clients told us that they feel that Broadway Lodge is a supportive place to stay. One person told us, "the support staff are good and they are really strong on boundaries here".

Clients also told us they are well supported by the staff to regain independence in their daily lives when they leave Broadway Lodge after completing treatment there. Clients said staff spend time with them and listen to them and talking to them in a way that is respectful and sensitive to their needs. As one client explained, "it's the empathy between

staff and clients here, everyone is listened to".

We do not currently rate independent standalone substance misuse services.

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

• Care records did not contain detailed information that addressed the needs of each individual and had limited space for clients to identify their own strengths and resources. This meant staff did not design care or treatment with a view to achieving the client’s preferences and ensuring that staff met the client’s needs.

• All clients have an electronic client data management system record. Staff regularly updated this for therapeutic interventions. Staff maintained medical records separately for all clients. All members of the medical team have access to the client data management system records. All counsellors can access the medical records by visiting the medical offices. Some staff told us they did not always check the records and relied on staff handovers to keep up-to-date with care and treatment.

• The provider did not assess the environmental risks to the health and safety of clients who received care and treatment. This meant that staff could not use the environmental risk assessment to make required adjustments, for example, to the premises or equipment, which could affect aspects of care and treatment.

• The provider had not thoroughly reviewed all incidents reported to make sure that staff took action to remedy the situation. This meant staff could not prevent further occurrences and make sure that staff made improvements as a result.

• The provider had an appraisal system. However, this was not robust. The manager had not identified staff development, set goals or followed up on disciplinary actions. This meant that the manager could not monitor staff competence.

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

• Clients described feeling supported by staff; clients said staff treated them in a dignified and respectful manner.

• Clients receiving treatment at Broadway Lodge felt safe. The provider had an understanding of client clinical risks. Procedures were in place to ensure safe administration of medication.

• The provider complied with the guidance of the National Institute of Health and Care Excellence (NICE) and Public Health England. They offered a range of therapeutic activities that included Cognitive Behavioural Therapy.

• Staff provided individualised methods of supporting clients’ recovery, for example, information provision for non-English speakers. There was a complaints management policy within the organisation and staff understood and worked within the duty of candour.