Our last inspection of Haywain Barn was in April 2018 which was an unannounced, focused inspection to check that the provider had made all the improvements we required it to make following the comprehensive inspection in August 2017.

During the inspection in April 2018, we found the provider was not meeting the required standard of care set out in Regulation 12, safe care and treatment, of the Health and Social Care Act, 2008. We took enforcement action and issued a warning notice in May 2018.

We told the provider they must comply with the requirements of the regulation by 2 July 2018.

We carried out an unannounced, focused inspection on 26 July 2018 to check whether the provider had made the required improvements. We found that the provider had met the requirements of the warning notice and was now delivering safe care and treatment as required by Regulation 12.

We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Haywain Barn was in August 2017. At that inspection, we issued seven 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.

We inspected Haywain Barn in April 2018 to review the work the provider had told us they had undertaken to address the requirement notices.

We found that the provider had not met the requirements for regulation 9 person-centred care, regulation 12 safe care and treatment, regulation 17 good governance and regulation 18 staffing.

However:

We found that the provider had met the requirements for regulation 13 safeguarding service users from abuse and improper treatment, regulation 16 receiving and acting on complaints and regulation 11 need for consent.

We rated Haywain Barn as good overall because:

• Staff managed alcohol detoxification safely in line with national guidance. Staff used and completed nationally recognised assessment tools. Clients had the necessary blood tests taken prior to commencing a detoxification regime. The doctor assessed all patients prior to the start of their detoxification regime and during the detoxification. Staff used the clinical institute withdrawal assessment of alcohol scale (CIWA-Ar) to identify and monitor withdrawal symptoms. Staff acted promptly by monitoring and administrating medication as required in such instances.
• The service was completing relevant health and safety checks and had records in place to demonstrate this. The service had completed comprehensive environmental risk assessments. The provider had employed an external company to conduct a ligature audit of the service and planned to use the findings to improve the service’s ligature risk assessment. Although the service did not take clients who were at high risk of ligaturing, the management team recognised that client risk levels can change during treatment.
• Staff completed risk assessments for all clients. These were completed at pre-admission, on admission and reviewed weekly with clients.
• Client records contained a comprehensive assessment. Staff developed recovery plans that met the needs identified during assessment. Therapy staff completed person-centred treatment plans with all clients shortly after admission. Treatment and recovery plans contained client’s goals and aims for treatment and were reviewed weekly with clients.
• There were very few blanket restrictions place on clients and those in place were clearly justified and understood by the clients. Staff supported clients to maintain contact with their families. Clients had access to their mobile phones and were not restricted in their use so they could maintain contact with families and friends. The service encouraged family to engage with the service and held weekend family days for family to get to know the service.
• Staff, together with clients, developed discharge plans that included a crisis plan and an unplanned discharge plan. Clients were provided with information on the risks of leaving detoxification early. Clients discussed discharge in weekly sessions and those nearing discharge had a final discharge plan detailing where they were going and what aftercare they would receive from the service. The service provided clients with an aftercare programme following discharge. Clients typically received four follow-up calls to ensure the treatment the client received remained effective and staff provided support to clients when needed.
• There was a positive and supportive culture within the organisation. Staff told us that senior members of the organisation were approachable and supportive. Staff told us that the manager was passionate about the service and felt supported by the service nurse.

However:

• There were no formal arrangements in place to cover the service if the nurse and service GP went on leave. The nurse was not receiving formal clinical or peer supervision.
• The provider did not use recognised outcome tools to determine the effectiveness of treatment. For example, by using the Treatment outcomes profile (TOP) or the Alcohol outcomes record (AOR).