We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The provider had addressed concerns identified at previous inspections.
• The building was clean and well maintained, and there were appropriate infection control measures in place.
• There were adequate staff to provide the service. All clients had weekly one-to-ones with a member of staff as part of their recovery programme.
• Records were stored safely and securely. Records for former clients were archived or destroyed appropriately.
• Food was stored safely and hygienically.
• Staff and the fire services could quickly identify which area of the building a fire alarm had been activated.
• Clients were informed how to complain about the service. There were expected timescales for responding to and dealing with complaints, and these were monitored by the provider.

This was a focused inspection relating to issues identified at a previous inspection.

We issued a warning notice following a comprehensive inspection in July 2016 relating to two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were for regulation 12 (safe care and treatment) and regulation 15 (premises and environment).

At this inspection, we assessed whether the service provider had put right issues identified in the warning notice. We found improvements in terms of safe care and treatment and that the provider had met the requirements of the warning notice. We found improvements in terms of premises and the environment, but there were still areas that the provider had not addressed, so we have issued a requirement notice for a breach of regulation 15 (premises and environment).

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

• Cleaning and maintenance of the showers had not thoroughly addressed the problems, and there remained dirt, ingrained mould, and decaying sealant.

• Dry foods, such as cereals, were not stored in sealed containers.

• The appliances in the kitchenette in the dining and group room were in need of cleaning or repair.

• There were no hand towel or toilet roll dispensers in some of the toilets, so they were placed on the top of general waste and sanitary product bins.

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

• The provider had implemented effective food hygiene procedures, which included the safe monitoring, preparation and storage of food.

• The provider had implemented cleaning schedules and guidance, and the provision of employed cleaning staff to work alongside clients.

• First aid boxes were new, and their contents complete and in date.

• Action had been taken to address an ongoing damp problem in the building, and the area affected was not accessible to clients.

• The provider had an ongoing programme of work, which had started at Unity House’s sister service. This included the replacement or refurbishment of all the showers and bathrooms. New chairs were on order for the dining and group room, to replace the existing chairs which were dirty and stained.

• The provider had implemented colour-coded mops, to reduce the risk of cross contamination.

We do not currently rate independent standalone substance misuse services.

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

• Areas of the building were not clean and properly maintained. There was no means of ensuring that the building was properly cleaned, and that appropriate infection control measures were in place. First aid boxes contained out of date items, and effective food hygiene practices were not in place.
• A key component of the service was to provide a weekly one-to-one session with clients. However, the service had a practice of same-gender only keyworking and there were not enough male staff to provide regular one-to-ones with male clients. There were staff vacancies for managers and keyworkers. Agency staff temporarily filled these posts whilst recruitment took place.
• The records of former clients were not stored securely. Confidential information was accessible to unauthorised people, and the paper records were at risk of physical damage. There was no process for ensuring that records were archived correctly, and stored and securely destroyed when necessary.
• The service had a complaints policy, which staff and clients were aware of, but this was not always implemented effectively.

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

• There was a programme of environmental checks, which included testing and monitoring of fire equipment, water and legionella testing, gas and electricity. Staff were aware of and knew how to report and escalate incidents. Medication was managed and administered correctly.
• All staff had the necessary pre-employment checks carried out. Permanent staff had completed their mandatory training, and received regular supervision and an annual appraisal and had completed their mandatory training.
• Clients had a clear care pathway. Clients understood the 12-step programme, and signed a contract which affirmed their commitment to abstaining from alcohol and drugs, compulsory attendance in the group programme, and carrying out activities such as cooking and cleaning as part of the community. Clients were registered with a local GP for their physical healthcare needs. Discharge planning was initiated while clients worked through the 12-step programme. Clients were positive about the staff, and told us they felt safe in the service. Men and women had separate bedroom and bathroom areas, and their own lounges.
• Clients were involved in decisions about their care. Clients attended a weekly community meeting, where they raised concerns and complaints. Clients valued the peer support workers. These were volunteers who had been through the 12-step programme themselves.
• An extensive audit of the service had been carried out. Where gaps were identified, an action plan had been implemented to address this.