We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Environmental risk assessments were completed and up to date and there was a ligature risk audit in place which provided adequate mitigation. The provider had undertaken internal building works to fill in open beams which had previously been identified as ligature risks.

• We reviewed five care records. All clients had a pre admission assessment and an up to date risk assessment. All risk assessments were detailed and records contained a plan for unexpected exit from treatment.

• Staff provided a holistic, bespoke service and treatment plans were written to support all areas of the client’s life. Staff encouraged clients to establish links with support services in the community. Prior to discharge staff made referrals to services which were local to the clients home area.

• All of the staff responsible for the administration of medication had received medication management training. The psychiatrist followed National Institute for Health and Care Excellence guidelines in prescribing and reviewing medication.

• All of the clients that we spoke with told us staff were compassionate, kind and supportive and they felt very safe within the service.

• The doctor attended the service on the day of admission and weekly thereafter. There were additional skype meetings and telephone calls as required.

• There was access to groups throughout the day and during the evenings on week days, and there were activities and some groups held at the weekend

• An aftercare group was provided for clients who had completed their treatment and they could also phone for support.

• There was an up to date risk register and the manager accessed this to submit and update risks. Environmental risk assessments, including ligature risk audits had been introduced and were up to date.

• The service used key performance indicators to measure performance against a range of objectives. These included food standards, room standards, staff numbers and medication audits.

• Staff knew where to access the whistle blowing policy and how to use it. There had been no whistle blowing cases in the last twelve months prior to inspection. Staff told us that they enjoyed working at the service and that morale was high.

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

• The sharps bin was stored in the clinic room and was full at the time of inspection.

We rated Charterhouse Clinic as Requires Improvement because:

• The service did not robustly manage the risks associated with detoxification from drugs and alcohol. Staff did not regularly review client’s physical health observations during detoxification in line with national guidance. The provider did not use dependency scales on admission or consistently use withdrawal scales such as the opioid withdrawal scale to monitor the severity of the client’s withdrawal symptoms in line with national guidance.
• Governance systems were not robust. The service did not have a system to monitor areas for improvement identified through self-auditing and leaders did not maintain a robust risk register.
• Staff did not robustly mitigate the risks associated with mix gender accommodation by conducting risk assessments.
• The service did not hold regular staff team meetings. The last team meeting was held in August 2018.
• The training matrix was not up to date and did not accurately reflect the dates staff had completed their annual training.

However:

• Staff spoken with, reported good team morale and said they were proud to work for the provider.
• Staff provided a range of psychological therapies recommended by The National Institute for Health and Care Excellence. These included cognitive behavioural therapy and group therapy. Some of the topics covered in group therapy were mindfulness, meditation, reflection and relapse prevention.
• The provider had a whistle blowing policy in place. Staff were aware of the policy and told us they were confident in raising a whistle blowing.
• We observed staff interacting with clients in a kind and respectful manner throughout the inspection.
• Clients told us they felt safe whilst in treatment and that staff were kind and caring. All clients had a named key worker who met with their client weekly.
• We saw evidence that clients were involved in developing and setting their own care plan and goals.