We rated Closereach as good because:

• Staff provided safe treatment for clients based on national guidance and best practice. Pre-admission assessments used by the service were high quality and included questions which assessed current substance use, risk of blood borne viruses and physical health needs. Staff used the pre-admission assessment to develop risk assessments and guide the completion of individually tailored treatment plans. 
• Recovery treatment was provided based on the cognitive behavioural therapy programme. There were adequate rooms to provide psychosocial therapies and activities. All areas were safe, clean, well-equipped, well-furnished and well maintained. The design, layout, and furnishings of the service supported clients’ privacy and dignity.
• Staff were skilled, competent and knowledgeable in meeting the needs of people who used the service. The service provided training in key skills to all staff and made sure everyone completed it. Qualified counsellors provided psychosocial therapies. The manager of Closereach had the right skills and abilities to run a service providing a good quality of care.

• Clients spoke highly of the staff, and said they felt safe in the comfortable environment and found the treatment was positively impacting their lives. Clients told us they were treated with respect, compassion and kindness.
• Staff spent extensive time with clients through various activities to provide exceptional person-centred care. Staff were passionate about providing extra opportunities to clients that would be individually meaningful for them during their recovery and after discharge. 
• Staff supported clients to make decisions on their care for themselves. They understood the service policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly when appropriate. 
• There were systems in place to record, review and discuss complaints, compliments and incidents. Improvements had been made in response to this.
• Leaders within the service were visible and approachable for both clients and staff. The staff team felt respected and valued, worked well together and were supported by their managers.
• Leaders had effective systems in place to regularly support their staff and improve the quality of care they provide. This was achieved by regular managerial and clinical supervision, appraisals and staff meetings.

However:

• Although there was a sink in the clinic room, there was no sink dedicated to handwashing and the collection of urine samples did not ensure good infection control. 
• The service had sought medical histories and medication information from clients GP’s up to four weeks prior to admission. This meant clients medication could have changed before they arrived at the service. However, the manager had ensured that clients were registered with a local GP within 48 hours and medicines reconciliation was completed with the local GP at registration. 
• Although there were procedures in place to respond to an overnight emergency, there was no provision of staff at the premises overnight.
• The provider had some blanket restrictions which did not have a clear rationale. However, the manager allowed clients to make ‘special requests’ to allow them temporary alleviation from these restrictions.

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We do not currently rate independent standalone substance misuse services.

Closereach has been inspected twice previously, in 2013 and 2016. The comprehensive inspection in September 2016 did not fully comply with CQC policy and guidelines for inspection activity; consequently the report was not published.

We will undertake a further comprehensive inspection in the near future.

In July 2017 we carried out an unannounced, focussed inspection of this location to check on a number of issues that had come to our attention through the information we hold about the provider.

At this inspection we found the following areas of good practice:

• Mental Capacity Act training was in place and all staff were up to date with it.

• Clients told us that staff always knocked before entering and that they were made aware their bedrooms would not have locks on the doors before they entered the service. The provider had updated their privacy and dignity policy and all new staff were required to read this during their induction.

• Clients told us that they were happy with the activities provided at the service and meaningful activities were being provided. Clients could request specific activities. Staff and clients recorded activities on a board in the communal corridor.

However,

• The showers were dirty and mouldy and you could see over and underneath the shower cubicle door. The environment was generally untidy and not well-maintained.

• Although risks for clients were identified there were not always associated risk management plans for staff to follow when caring for and supporting clients and no records of actions to be taken in the event of either planned or unplanned discharge. The provider had not checked that staff were completing and updating the required risk assessments, risk management plans, care plans and medication files which would ensure the safe care and treatment of clients.

• Clients physical health needs were not being supported or monitored appropriately throughout their stay.

• The mission statement for the service was displayed on a communal notice board. However, when we spoke to clients and staff, they did not know what the service’s shared vision and values were.

• Some medication management processes were not robust. We found that the staff team, including the manager, did not have a thorough understanding of medication systems and processes. However, medicines were stored safety and a new fridge had been purchased to store medication when needed.

We met and spoke with five people who used services and spoke to people about the care and support they had received at Closereach. We talked with most of the staff on duty and checked the provider's records.

Comments from people who were staying in Closereach included, "They have saved my life” and “I don’t think I would be here if it was not for them”.

We saw that people's records described their individual care and treatment programmes and how these would be met. We saw that people consented to the care and treatment they would be receiving.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a professional way that demonstrated a good understanding of people's individual needs and preferences.

We looked at care records for four people. This included one fairly new admission and one person who was due to be discharged. We spoke with staff about the care and treatment given to people currently staying in Closereach. We looked at records relating to some of the people we met and observed staff working and interacting with people.

We saw that medicines were administered by suitably trained staff. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to administer and record medicines.

All the staff spoken with said that they felt well supported by their colleagues and management. We saw staff received the training they required to carry out their roles. One staff member said, “X (the registered manager) door is always open- very hands on”.

We saw that Closereach had a complaints procedure available and documentation of complaints dealt with.

We met most of the people who staying at Closereach and spoke with four people about the care and support they had received at Closereach. We also spoke with staff employed at the home. We checked the provider’s records and spoke with the registered manager.

We saw people's privacy and dignity were respected and staff were helpful when assisting people. Comments from people who were staying in the centre included, “They are helpful and supportive, listen to me and I am involved in the planning of my care and treatment”.

All the staff we spoke with were clear about the actions they would take should they have any concerns about people's safety.

We saw and heard staff speak to people in a professional way that demonstrated a good understanding of people's individual needs. We looked in detail at the care and treatment four people received. We spoke to staff about the care and treatment given, looked at records related to them, met with them, and observed staff working with some of them. We saw that the staff had a good understanding of people's individual needs and that they were kind and respectful.

We saw that people's records described people’s care and treatment programme and how these would be met. We saw that people consented to all areas of their lives including consent to the care and treatment they would be receiving.

The men staying at Closereach said, “They (Closereach) have got my life back on track”.