We do not currently rate independent standalone substance misuse services.

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

• The provider did not ensure that staff were always available on site to safely observe clients when clients were undergoing detoxification treatment. The service did not have a policy or procedure in place for staff to follow regarding the frequency that observations of clients should take place.
• As a consequence, we asked the provider to to stop the admissions of new clients, whilst it took action to ensure the safe care and treatment of clients undergoing detoxification treatment. The provider agreed and stopped admissions until the 5th February 2018 when the provider told us that it had taken necessary actions to ensure it was able to deliver a safe service to clients.
• We went back to inspect the service on 13 February 2018 to ensure that these actions had been carried out. We found that staffing levels had increased. However, whilst the provider had introduced observation sheets for staff to record observations on there was still no clear guidance in place for what staff should be observing and what action that they should take if there were concerns noted.

• The provider did not adequately mitigate risks to the health and safety of people using the service. Risk assessments did not provide information about how to safely manage or mitigate potential risks. There was not enough information available to clients about the risks associated with exiting detoxification treatment early.

• The provider did not have a clear policy or procedure in place detailing the local arrangements for identifying and referring adult safeguarding incidents to the local authority. Staff had a poor working knowledge of safeguarding.

• Clients did not have care plans in place. Although staff and clients told us that a holistic approach to treatment and recovery was taken during their time with the service, there was no framework in place to ensure that the full range of individual needs were identified and appropriately managed.

• Improvements were needed to the premises and equipment. The environment was not maintained and adequate infection control measures were not being taken to ensure the hygiene and cleanliness of the environment. Physical health monitoring equipment was not routinely calibrated to ensure that observations were accurate. The first aid kit was not fully equipped.

• A robust plan detailing when and how actions identified in a recent fire risk assessment to make the premises fire safe was yet to be developed. Records demonstrating the frequency of cleaning were not maintained.

• There was a lack of effective governance systems to ensure that safe, effective care was being delivered. For example, the provider did not use key performance indicators to monitor the ongoing performance of the staff team. There was no formalised clinical audit process to detect areas for improvement in care records, for example. The provider was not aware of the hours that staff were working above their contracted hours. A business continuity plan that outlined how the service would be provided in an emergency, for example if the premises were not able to be used, was not in place.The provider was in the process of developing thir vision and values.

• The provider did not have a serch policy in place for staff to follow if they needed to search clients rooms.

• Further improvements were needed to ensure that staff were suitably skilled and competent to provide safe care and treatment. Not all staff had received training to meet the needs of the client group. Whilst all staff were able to access regular group supervision, evening support workers were expected to attend this within their own time.
• Robust arrangements to ensure the safety of staff and clients when staff were lone working on site were not in place. The provider did not have an on call system in place to ensure that staff could contact a manager for support if needed.

However:

• Clients gave positive feedback about the support they had been given by staff working at the service.

• The service followed good practice in medicines management. Policies and procedures were in place for staff to follow.