Archived: Clouds House

We rated Clouds House as good because:

• Staff provided safe detox and treatment for clients based on national guidance and best practice. Pre-admission assessments used by the service were high quality and included questions which assessed current substance use, risk of blood borne viruses and physical health needs. Staff used the pre-admission assessment to develop risk assessments, on admission, to guide development of individually tailored detox medication regimes. Staff regularly reviewed the effects of medication on each client’s physical health and used nationally recognised tools, including the Clinical Institute Withdrawal Assessment for alcohol scale and the Subjective Opiate Withdrawal Scale.

• Recovery treatment was provided based on the 12 step model. The environment was fit for purpose and there were adequate rooms to provide psychosocial therapies, activities, and safe detox. All areas were safe, clean, well-equipped, well furnished and well maintained. The design, layout, and furnishings of the service supported clients’ privacy and dignity.
• Staff were skilled, competent and knowledgable in meeting the needs of people who used the service. The service provided training in key skills to all staff and made sure everyone completed it. The service had ensured all registered nursing staff had completed part 1 of the Royal College of General Practitioners certificate in the management of drug misuse and the clinical lead had completed part 2. Psychosocial therapies were provided by qualified counsellors and psychotherapists. Staff had completed monthly topical training on substance misuse subjects. Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
• Clients were positive about the service and staff treated clients with compassion and kindness. They respected privacy and dignity, and supported their individual needs. Staff involved clients in decisions about their care, treatment and changes to the service.
• Staff supported clients to make decisions on their care for themselves. They understood the service policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly when appropriate.
• The service treated concerns and complaints, and client safety incidents seriously. The service provided a variety of forums for clients and staff to give feedback on the service and raise any concerns or complaints. There were systems in place to record, review and discuss complaints and incidents and there was evidence of improvement in response to this. The service monitored service risk through a local and corporate risk register which staff could contribute to. Changes to the service were discussed with clients and staff.
• Leaders within the service were visible and approachable for both clients and staff. Staff morale was high and the staff team felt respected and valued. The nursing team and counselling team worked well together and were supported by their managers.

However:

• Staff did not always complete all sections of risk management and care plans. Staff did not regularly review risks and progress within care plans. Six out of seven care records did not have risk assessments completed for the ‘aftercare’ section of the management plans. Risk assessments and care plans had only been reviewed in one care record of the seven reviewed.
• Although staff were managing the risks, documentation of the ligature point risks and plans to mitigate the risks were incomplete (a ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation). The checklists database for care records, which staff were expected to complete, was not up to date. Although clinical care record audits were being completed monthly, these had highlighted issues with reviews of care plans for three consecutive months without significant improvement or an action plan being developed.
• Some of the blanket restrictions used did not include a clear rationale for their use in the consent paperwork. This included, restricted times to watch television, and set bedtimes without access to other areas of the building. The service did not have a plan or policy in place for reducing restrictive practice.

We undertook this inspection to find out whether Clouds House had made improvements to the residential substance misuse service following the last comprehensive inspection of the service in October 2016. We published our report in early February 2017, and told the provider to take the following actions:

• The provider must ensure that all care plans, including those that detail physical health needs are reflective of individual needs and that they are client centred, holistic and created in partnership with clients.
• The provider must ensure that where processes are in place to allow nurses to administer certain medicines without a prescription when clients first arrive at the service, that the framework that allows this practice to happen lawfully is signed by a qualified pharmacist.
• The provider must ensure that it reports all relevant incidents and safeguarding events to the CQC as is their statutory responsibility.

At this inspection, we found that they had met all the requirements stated above. The service now completed detailed assessments and care plans for each new client when they were admitted. They had also put Patient Group Directions in place so they could administer medicines to clients who had just been admitted to the service. They were also correctly notifying the CQC of any incidents and safeguarding events when needed.