We do not currently rate independent standalone substance misuse services.

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

• The service had not addressed one of seven issues that we identified in our last inspection in September 2016, for which we took enforcement action. Staff still provided clients with one days’ worth of medication in the morning and signed medicines charts without witnessing clients taking all their medicines. As clients admitted to the service were assessed to be able to administer their own medicines, the service planned to support clients with the self-administration of medicines, rather than staff administer this daily. The medicines management policy was not up to date to reflect safe practice.

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

• The service had successfully addressed the six other issues identified at the last inspection. Staff now disposed of clinical waste appropriately, carried out infection control audits and stored medicines appropriately.

We spoke with two people currently using service and one person who had moved on to a shared house following his stay at the service. They described how the 12 week rehabilitation programme changed the way they thought about themselves and their addiction. One of them said, “It’s a life saver.”

People said they talked to staff or the other people using the service, called peers, if they had any concerns or worries. Volunteers, who had used the service in the past, came regularly to the house. We were told that when people first arrived someone would accompany them when they went to other services. Support was also provided when they moved on from the residential programme. The service liaised with other organisations to make sure people had access to the services they needed.

The housekeeper worked with the people using the service to make sure the house was kept clean. When things in the house needed fixing this was done promptly. There were regular checks so that people were protected from the risks of unsafe premises. Records were well ordered and fit for purpose.

People and staff contributed to maintaining the standards of the service.

The people using the service told us they were given information before they arrived so that they could make an informed choice. One person said they received telephone calls from staff to talk about the service and what it could offer and they said "this made me feel really at ease".

The people we spoke with said that staff were always available if they had any concerns or worries. They talked about the tools they had been given to develop new behaviour and set boundaries that would prevent them returning to misusing drugs or alcohol. Support was also provided when they moved on from the residential programme. One person commented, “I know they wouldn’t just leave me".

There was a house meeting every day when information was shared and people had the opportunity to make suggestions, such as the food on the menu and to raise any concerns relating to the running of the house.

Other evidence corroborated the views of the people using the service that Kairos provided care and treatment that met people's needs. Staff were well supported and had access to training and professional development. There were processes in place to place to assure the quality of the treatment programme.

We do not currently rate standalone substance misuse services.

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

• The service did not keep clients safe from avoidable harm by managing medication effectively. It did not allow the use of certain medication used to treat alcohol dependency. Staff withheld it from clients to whom it had been prescribed without the necessary skills or authority, potentially causing harm to clients. Staff removed prescribed tablets of medicine from their original packaging and placed the tablets in a dossette box each week. This meant that the tablet could become ineffective or harmful when taken, putting clients at risk.
• Staff gave clients their prescribed controlled drugs but the storage, administration procedures and record-keeping were unsafe. A client’s insulin was kept in an unlocked food fridge instead of a separate locked medication fridge. There was a risk that anyone could access the insulin.
• The service did not have clear protocols and procedures to minimise the risks of infection. Procedures for disposing of clinical waste were not robust.
• The service did not have up to date, comprehensive risk assessments or records of clients’ needs and treatment. There was a lack of crisis planning or clear arrangements for clients who may have exited the service early. Clients’ care plans were not regularly updated and clients’ progress was not recorded during their stay.
• The system for safeguarding children from abuse was not robust. The service did not assess risks to children visiting the premises adequately. The service did not have a lone working policy to protect staff who worked alone at night.
• The provider did not offer specialist training relevant to the needs of the client group. The service did not provide all staff with training in substance misuse. These issues regularly presented themselves in the service. Staff had not received training in safeguarding children. Staff were not trained in how to respond to violent and aggressive behaviour even though the provider’s policy on violence and aggression stated that all staff should be trained in this area.

• Rates of managerial supervision were below the providers supervision policy stated. The correct pre-employment checks were not completed on all staff at the service.

• The service did not have effective governance systems in place to assess, monitor and improve the service.
• As a result of the serious concerns we identified in respect of the way medicines were managed in the service we served a warning notice under section 29 of the Health and Social Care Act 2008 on the provider and the registered manager. This stated that significant improvements needed to be made by 28 November 2016.

However, we found the following areas of good practice:

• The service had an aftercare programme clients could use after their treatment had finished and for as long as they needed it. The service also offered free places to clients if they could not fund themselves.
• Clients all felt supported by the staff and that the treatment was helping them. The clients had access to a garden area with table and chairs. Staff supported clients to paint a mural on the wall in the garden.
• The service had a 24 hour emergency telephone service that both staff and clients could ring in an emergency.
• Staff had a good understanding of the client’s housing and financial needs whilst in recovery.
• The service offered a comprehensive range of one-to-one and group therapies for all clients.
• Staff had worked at the service for years because they believed in the organisation’s ethos.