We rated Haynes Clinic as requires improvement because:

• The provider’s arrangements of governance oversight were not robust. We found policies were not detailed and did not include current national guidance for staff on how to deliver care. Including the safe guarding policy, infection control, fire, medicines management, duty of candour, supervision, Mental Capacity Act, Equality Act, mandatory training, emergency and business continuity, the control of substances hazardous to health and the complaints policy.

• There was no evidence of learning from incidents. For example, we found an unreported Care Quality Commission notifiable incident were a client drank half a bottle of bleach and was taken to hospital by paramedics. During the inspection we found cleaning chemicals including bleach in the bathrooms and kitchens.

• Ligature risks were not adequately mitigated. We found the ligature risk assessment was generic for all locations and did not identify specific risks. Fire risk assessments were not updated annually. We noted fire risk assessments were completed in 2013 and 2016.

• Client risk assessments did not include risk management strategies.

• There were blanket restrictions in place. Clients were not able to lock their bedroom doors and did not have anywhere secure to store their valuables in their bedroom.

• The provider did not store emergency medications in line with guidance such as Naloxone which is used to reverse the effects of an opioid overdose or an Epi Pen which is used to reverse an allergic reaction.

• We were not assured staff knew and understood the vision and values of the service. We reviewed the vision and values which were honesty, integrity and caring. There was no description detailing what the values meant and how the provider ensured staff applied them in their daily working.

• Maintenance issues were not identified at the at the residential houses. We found splits in the laminate flooring in the hallways and broken kitchen floor tiles.

• Cleaning chemicals were not stored in accordance with the Control of Substances Hazardous to Health Regulations 2002. We found cleaning chemicals including bleach in and disinfectants in the kitchen and bathrooms.

However

• The treatment centre had adequate space for staff to meet with clients. There was a small room where clients were seen on admission and received a physical health check. The service had access to emergency defibrillation equipment which was stored in the staff office and was calibrated and checked regularly. The three accommodation houses and treatment centre were visibly clean.

• Staff had access to individual alarms. Staff told us they were aware of personal safety procedures.

• Mixed gender accommodation at the three houses was managed appropriately.

• The registered manager had established the number of support workers and therapists required to meet the needs of the clients. At the time of inspection there were no staffing vacancies.

• Staff screened client’s physical health observations on admission and regularly reviewed the client’s vital observations during detoxification in line with best practice guidance.

• Clients were given information regarding the service and the detoxification programme and the risks involved in the process. Clients spoken with confirmed this. We saw clients were involved in planning their care. Care and treatment records were recovery focused and based on smart goals. Clients completed life stories and a 12-step recovery booklet that included preparation for discharge.

• We observed staff interacting in a kind and respectful manner throughout the day. Clients told us that staff at the service were supportive. Generally, the staff knew their clients and were aware of their needs. Clients told us they felt supported through the admission process and reported the pre-assessment was thorough.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Effective and regular staff handovers were taking place. Staff had access to regular team meetings.

• The Clinic and the houses were spacious, visibly clean and tidy.

• The service had sufficient staff in post with the necessary skills and experience to deliver the treatment programme.

• Support workers transported client medication between The Clinic and the houses in safe locked boxes.

• Overall, 100% of staff were trained in safeguarding. Compliance with supervision and appraisal was 100%.

• Staff recorded incidents and were aware of lessons learnt.

• We reviewed six care and treatment records, five had an initial risk assessment in place.

• Doctors assessed all clients on admission. Prescribed medication was in line with the Department of Health guidance. Support workers completed physical health checks upon admission and routinely thereafter.

• Staff completed personalised recovery care plans for clients and updated them regularly.

• The service offered daily therapy, group work and access to mutual aid groups.

• The service offered twelve months post discharge support to all clients.

• Staff were observed to be passionate and caring and had a good understanding of clients individual needs.

• Staff provided clients with information about the service and treatment upon admission; clients were supported to visit The Clinic prior to admission.

• Clients knew how to complain and staff described how they supported clients to raise concerns.

• Managers completed risk assessments for staff with previous criminal convictions.

However, we also found the following issues that the service provider needs to improve:

• Communal bathrooms were not designated for males or females.

• No emergency equipment was available on site.

• Compliance with some elements of mandatory training was low.

• Clients did not have anywhere safe to store their valuables in their bedrooms and could not lock their bedroom doors.

• The service was not fully accessible to disabled clients. In the houses bathrooms were located on the first floor.

• There were gaps in staff recruitment files and training records were not up to date.

• Policies were not always comprehensive. They did not provide guidance to staff of how to respond in certain situations.

When we inspected The Haynes Clinic Limited on 11 November 2013, we spoke with five of the nine people who were on the treatment programme at the time, and looked at the care records for three people. People said they felt safe, and spoke positively about the care and treatment they received and the staff that supported them. One person said, "I couldn't fault the staff; they're amazing, always approachable." Another person said, "It's brilliant, I couldn't have hoped for more."

They described a strict contract and timetable of treatment and support, but said they recognised this was an important part of their treatment. People said they were given choices; however they understood that the ethos of the programme involved some restriction on choices for the treatment to be effective.

They confirmed they had received good information about the service either on, or prior to admission, and said that it had been helpful to them and their families when making decisions about the treatment programme they should join.

The provider had systems in place, to manage risks and assess and monitor the quality of service they provided.

We received positive feedback from the three people we spoke with who received treatment from The Haynes Clinic. One person told us, “It’s nice to be around people who understand what I’ve been going through and I feel safe to talk about things I wouldn’t normally [talk about].”

People said that they felt their rights were respected by the staff. One person told us, “I feel my rights are extremely well respected. I had legal issues to deal with that was a big worry, I didn’t feel able to cope with them and the staff have been really helpful.”

People told us that they were able to make choices within the structure of the programme. For instance, people said there was choice about how they spent their spare time and the food that was prepared for meals.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their care and treatment plans. Staff were knowledgeable about people's needs. All three people told us that they felt safe at the service and had good relationships with the staff and the other people receiving a service.

Staff told us, and records verified, that staff had received training to carry out their roles within the Haynes Clinic.

People made positive comments about the environment which we found to be safe. They said there was sufficient space and a designated area outside to smoke.

People we spoke with told us that, overall, they were happy with the service provided. One person said, “It’s brilliant”. Another person said, “I would like to thank all the staff for helping me with my recovery”.

However, people also commented that their dignity, diversity and physical needs were not always met or respected. They did not always have sufficient choices and did not receive sufficient information about the service.

Each person had a care plan in place. However, these were not personalised and did not give staff sufficient guidance on the specific care each person needed. For some people, risks had been identified but there was no guidance in place for staff on how to manage the risks.

People told us they received the medicines they had been prescribed. We found that medicines were not being managed correctly. Fire safety checks were not satisfactory so put people at risk. The provider’s recruitment process was not robust enough to ensure staff employed were suitable to work with people using the service.

People told us they did not know who to speak with if they wanted to comment or complain. They said there was no complaint information displayed in the service.

We do not currently rate independent standalone substance misuse services.

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

• There was no designated clinic area. Medicines were administered from the main office. Client’s privacy and dignity could not be assured during examination or interview, the room used for these purposes was not soundproofed. Urine testing was carried out in the disabled toilet located in a public part of the clinic.

• Staff had not switched on the fridge intended for clinical use. Weighing scales and blood pressure monitors had not been calibrated. Doctors did not record in detail physical medical examinations. Doctors handwriting was not legible.

• Data provided at the time of inspection showed 71% of care staff had completed mandatory training. 

• While risk management plans identified current risk and suitability for treatment at The Haynes Clinic, they did not identify ongoing risk assessment and management.

• Staff were unclear about what incidents should be reported. Local governance arrangements were not robust; there were no robust systems in place for tracking and monitoring invesitgations, incidents, notifications, or safeguarding alerts. Therefore we could not be assured the provider was upholding their responsibilities under the duty of candour.

• The provider did not have any key performance tracking or monitoring systems in place to monitor the quality of their service. Policies, procedures, and protocols did not include quality impact assessments.

• The provider did not use recognised outcome measures to monitor the quality of their service. Neither management nor staff could clearly identify relevant National Institute for Health and Care Excellence (NICE) guidelines for substance misuse.

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

• Clinical and residential areas were clean, tidy, and well maintained. Cleaning audits were in place, there were effective infection control measures in place. Appropriate emergency equipment was present and maintained.

• Accommodation was based on the principles of therapeutic community in large shared houses, set in mature and private grounds. Clients were involved in running the houses and could cater for their dietary requirements and preferences.

• There were effective policies and procedures in place relating to medication management. A consultant psychiatrist was available 24 hours a day. All staff understood their responsibilities in relation to the Mental Capacity Act.

• The provider was a member of the Federation of Drug and Alcohol Professionals (FDAP). Therapy counsellors were members of the British Association of Psychotherapists (BACP). Doctors had been revalidated in the previous 12 months, and 91% of staff had up to date supervision and 100% of staff had in date annual appraisal.

• The consultant psychiatrist verified assessments before any detoxification regime was implemented. Staff had received appropriate specialist training to carry out health checks, monitor, and advice on side effects of medication and detoxification withdrawal symptoms.

• Clients had recovery orientated care plans. Clients formulated their own leaving plans. Staff offered telephone and aftercare support when clients had completed treatment. Staff handovers were effective. Clients told us they felt respected and valued by staff, and staff told us they felt respected and valued by the provider.

• Staff understood and supported the provider’s vision and values. Staff spoke positively about the leadership at The Haynes Clinic. Staff were proud of the culture and quality of service they helped to develop.