Our rating of this service stayed the same. We rated it as good because:
The service provided safe care. The environment was safe and clean. The service had enough staff. The service used sessional staff, or community staff from the same organisation, who were known to the service so they did not have to use agency staff. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. Staff adopted a very person-centred approach to safeguarding and asked residents how they wanted to proceed. Staff empowered residents to make the safeguarding referral themselves where appropriate.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the residents and in line with national guidance about best practice. The provider had developed a treatment program called Recovery and Aftercare from Formative Trauma (RAFT) that was independently validated by the University of Bath. RAFT provided clients with a bespoke treatment plan that aimed to treat trauma underlying addiction. Staff engaged in clinical audit to evaluate the quality of care they provided.
Teams included, or had access, to the full range of specialists required to meet the needs of residents. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with those outside the service who would have a role in providing aftercare. Staff had good working relationships with the community team from the same organisation who provided aftercare to residents leaving the service.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff treated residents with compassion and kindness, respected their privacy and dignity and understood the individual needs of residents. They actively involved residents and families and carers in care decisions. To encourage dog owners to attend rehabilitation, the service had heated kennels for residents’ dogs so they could bring their dog with them. Residents said that staff were approachable and that they were treated with respect, care and understanding. Residents said most of the staff went above and beyond to equip them with the tools they needed for their recovery.
The service managed beds well so that a bed was always available locally to a person who would benefit from admission and residents were discharged promptly once their condition warranted this. Staff made sure residents understood their discharge care plan which included harm minimisation and a departure risk assessment. Discharge plans were discussed in team meetings. Post discharge, community workers took residents onto their caseload and followed up with their recovery support.
The service was well led, and the governance processes ensured that service procedures ran smoothly. Staff reported their job satisfaction as high. Staff said they felt their roles were empowering to others and that they had a positive working relationship with their peers. Staff said they felt proud to work for the organisation. Managers recognised that their staff team experienced fatigue and stress during the pandemic. They invested in a full subscription for each staff member to a wellbeing app. Staff could also access the organisation’s employee assistance programme. The service had an effective governance structure and performed well in their audits. The provider’s risk register formed part of a shared regional risk register which fed into a national risk register. Managers completed a separate review of their local risk register in relation to the pandemic
However:
Staff did not always follow the provider’s policies and procedures when they needed to search residents or their bedrooms to keep them safe from harm. The service had a draft standard operating procedure for searching residents’ bedrooms but not all staff were aware of it and how to keep themselves safe.
Staff did not give carers information on how to access a carers’ assessment.