• Residential substance misuse service

No 11

Overall: Good read more about inspection ratings

2 Kendrick Mews, London, SW7 3HG (01304) 841700

Provided and run by:
Aissa Limited

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about No 11 on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about No 11, you can give feedback on this service.

28 January and 4 February 2020

During a routine inspection

At a previous inspection in May 2019, we identified concerns about safety and quality of the service which put clients at risk of harm. The service was rated as inadequate overall and was placed into special measures. Following the inspection in May 2019, the service made the decision to not admit any clients for alcohol detoxification who had a history of alcohol withdrawal seizures and delirium tremens.

During this inspection our rating of the service improved. We rated each domain as good and the service overall as good. As a result of this inspection, the service was removed from special measures.

We rated No 11 as good because:

  • The service provided safe care. The clinical premises where clients were seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
  • Staff treated clients with compassion and kindness, and understood the individual needs of clients. They actively involved clients in decisions and care planning.
  • The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
  • The service was well-led and leaders had the skills, knowledge and experience to perform their roles.

However:

  • Forty-five percent of clients using the service did not give permission for the provider to obtain or share information from their GP. Whilst the service had measures in place to mitigate the risks associated with this, they recognised that to improve the overall safety of the service further work was needed.
  • The provider did not have a system in place for staff to raise an alarm from within the clinic room in an emergency.
  • Further work was needed to strengthen the providers audit programme to ensure that outcomes were consistently rated across the range of measures used and that the sample included clients who had completed each of the various treatment pathways.
  • The provider had recently strengthened its governance systems. Further work was needed to ensure that these were embedded and sufficiently robust to drive quality, safety and improvement in the service.

1 and 2 May 2019

During a routine inspection

We rated the service inadequate overall because:

  • The service provided medically monitored residential substance misuse detoxification treatment and psycho-social rehabilitation services. The service did not provide safe care for clients undergoing alcohol detoxification. The provider accepted clients for alcohol detoxification who had a history of alcohol withdrawal seizures and delirium tremens. This carried a level of medical risk that was not fully assessed prior to admission.

  • We were concerned that the provider had not full taken account of a CQC briefing (supported by Public Health England) on the quality and safety of detoxification in residential substance misuse services. This was circulated to providers of all relevant services in 2017 and it remains on our website: https://www.cqc.org.uk/sites/default/files/20171130_briefing_sms_residential_detox.pdf

  • Clients did not have a comprehensive assessment before commencing alcohol detoxification treatment. There was no record that clients had a physical examination, including for clients with a reported physical health problem. This included clients with possible or actual liver disease.

  • Clients did not have a cognitive assessment. This meant clients were not screened for Wernicke’s encephalopathy. Wernicke’s encephalopathy can result in irreversible brain damage if left untreated.

  • Clients were not asked about, or offered, screening for blood borne viruses, such as hepatitis and HIV.

  • Clients’ medical and mental health history was not always obtained from other healthcare professionals prior to detoxification treatment. This meant important information concerning clients’ health was not always known. When clients refused to consent for the service to contact their GP, there was no record to show a clinician had reviewed the decision to make sure it was safe to provide treatment without this information.

  • Environmental and health and safety risks were not managed. Actions recommended in a fire risk assessment dated March 2017 had not been actioned. Due to our concerns we requested an urgent visit from the fire safety officer from the London Fire Brigade. They carried out a visit on the 3 May 2019. They have told us they are taking further action.

  • The service did not have effective systems for the appropriate and safe use of medicines, this put people at risk of receiving unsafe care and treatment. The service’s medicine policy did not address all relevant areas. There were no prescribing protocols in place, doctors prescribed on an individual basis.

  • One of the GPs prescribing for clients undergoing alcohol detoxification treatment had not had any specific training in treatment for substance misuse.

  • Some staff had not completed, or updated, all of their mandatory training.

  • At our last inspection, we recommended that the provider ensured that staff supervision continued for all staff and was recorded. At this inspection staff reported that they had regular supervision. However, staff supervision records were not available to confirm the frequency, quality and content of staff supervision.

  • Staff team meeting minutes for 2018 were not available. Team meetings did not include any standing agenda items concerning safeguarding, referrals, incidents or complaints.

  • The governance systems and processes in the service were not effective and did not keep people safe. They were not sufficient to assess, monitor and improve the safety and quality of the service. Risks were not appropriately identified, monitored and minimised.

  • Managers lacked a clear understanding of regulatory requirements. Auditing processes were not robust and concerns were not always identified and acted upon. There was no system to ensure that best practice and national guidance was consistently followed.

  • The provider did not have a proper process to make robust assessments to meet the fit and proper persons regulation (FPPR) (Regulation 5 of the Health and Social Care Act 2008).

However:

  • At our last inspection, we identified that physical health monitoring equipment had not been regularly serviced and staff were not aware of their duty of candour. At this inspection, these matters had been resolved.
  • People were cared for in a clean and comfortable environment and there were enough staff to meet the needs of the client group. Clients were supported and treated with dignity and respect and were involved as partners in their care. Clients were supported to understand and manage their care and treatment. The service offered family interventions and post discharge support groups.
  • Clients were supported with their recovery journey. There was an extensive programme of individual and group activities that reflected patients’ individual needs and preferences. Clients had clear and detailed plans in place in the event of their unexpected exit from treatment.
  • Clients knew how to complain or raise concerns. Clients were able to give feedback on the quality of their experience. This was reviewed by the management team to make improvements to the service.
  • Staff felt respected, supported, valued and were positive about working for the provider and their team.

We informed the provider of our serious concerns during and immediately after this inspection. We sent a letter of intent (notice of CQC’s intention to take urgent action) to the provider about our concerns in relation to how assessment and treatment for clients’ detoxification was being managed. The provider decided to stop providing alcohol detoxification treatment to clients with a history of alcohol withdrawal seizures or delirium tremens. The provider also sent an action plan to address our other immediate serious concerns. We have also taken other enforcement action concerning breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. The details are found at the end of this report.

1 October 2019

During an inspection looking at part of the service

This was an unannounced focused inspection looking at progress the provider had made in addressing breaches found at our last inspection in May 2019. We did not rate the service as a result of this inspection.

We found areas of practice that require improvement.

  • The service’s governance processes were not yet fully embedded. It was not clear where responsibility for assurance lay. For example, what level of meeting issues were discussed and actioned at.
  • Some of the provider’s quality and safety data, for example data on staffing and admissions, was not shared or used locally and was only reviewed at the organisational level governance meeting held twice a year.
  • The provider had not updated all policies and procedures to reflect changes in practice at the service. Some policies and procedures contradicted each other.
  • The service did not yet have a fully comprehensive risk register that allowed staff to identify risk and manage it.
  • The service did not have an updated fire risk assessment in place.

However:

  • All clients undergoing detoxification had a comprehensive medical assessment.
  • All clients’ medical assessments were consistent and standardised.
  • All clients had a comprehensive risk assessment and risk management plan in place before starting treatment.
  • The provider’s storage and administration of medicines had improved.
  • The provider had installed new heat and fire detection systems and done remedial works to comply with the local fire service’s enforcement.
  • The provider had taken action to ensure that environmental risks were appropriately identified, managed and mitigated.

We did not review the breaches identified under Regulation 5, Fit and Proper Persons and Regulation 18, Safe Staffing during this inspection. These breaches are carried forward in this inspection report and will be reviewed at our next inspection.

The service voluntarily agreed to continue not to admit any clients for alcohol detoxification who had a history of alcohol withdrawal seizures and delirium tremens until the service is comprehensively inspected.

26 June 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

We carried out this inspection to assess whether the provider had met the requirement notice that we served following our inspection in January 2017 related to regulation 18 (staffing). This was a short notice announced inspection.

We found the following areas of improvement since the last inspection

  • At our last inspection in January 2017, we found that the provider did not always ensure there were safe levels of staff. This was because there had been shifts where no nurse had been on site. We also found that one member of night staff had worked five nights consecutively. During this inspection, we spoke with staff and checked staff rotas. We saw that shifts were always covered with a registered nurse. We checked night shift rotas and saw that no member of staff worked for more than 5 nights in a row. Where permanent staff were unavailable, the service had increased the pool of bank staff. This meant that there had been an improvement since the last inspection.

  • At our last inspection in January 2017, we found that nurses did not receive clinical supervision. At this inspection, we saw that the service manager had appointed a head nurse in the unit who had the role to undertake supervision with all nurses. There had been some changes in personnel and we saw that these supervision sessions had taken place for the month prior to the inspection and were planned ahead. Staff told us that they had had received recent supervision, but supervision over the previous year had been sporadic. The service manager also received regular supervision. This meant that we saw there had been an improvement in nurses’ access to supervision, although this new supervision schedule had not yet had time to embed fully in the new staffing structure. There was a risk that supervision may not be maintained.

24 January 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

We carried out this inspection to assess whether the provider had met the requirement notices that were served following our inspection in August 2016 which related to regulation 12 (safe care and treatment) and regulation 18 (staffing). We also followed up on concerns that were raised with us about the safety of the service since the previous inspection.

We found the following areas of improvement:

  • Staff had received specialist training that related to the needs of the client group. At this inspection, all staff had completed specialist drug and alcohol awareness training and eating disorders training.
  • Since our last inspection in August 2016, the provider had improved health and safety with sanitary waste disposal facilities available in all toilets.

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

  • Since our last inspection the provider had not improved their systems for ensuring that nursing staff received regular supervision. This was an ongoing breach of regulation.
  • The service had not ensured there were sufficient staff on all shifts. It did not have nursing staff available for two shifts between December 2016 and January 2017.

2 August, 3 August and 10 August 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas where the service needs to improve:

  • While staff had undertaken mandatory training, there was no specific training which reflected the specialist needs of clients available for all nurses, health care assistants and therapists including the enquiries team who were based off site and took referral information. For example, training specifically reflecting substance misuse, alcohol misuse, eating disorders and mental health. However, after our inspection, we were told that the service had booked all health care assistants and nursing staff onto face to face training for alcohol misuse and eating disorders.
  • Staff told us they had been given little information about clients prior to them being told by the enquiries team to present at the service for an assessment.
  • Nurses were not receiving regular clinical supervision, although there were plans to implement peer supervision these had not been actioned at the time of our inspection. The service manager's management supervision was not documented.
  • Clients and staff shared toilet facilities. None of the toilets had specialist sanitary waste bins.

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

  • Clients who had used the service were very positive about the support and care which they had received.
  • The service ensured that clients were assessed by a nurse on admission and doctor soon after admission.
  • Staff undertook physical health monitoring of patients.
  • Staff in the service had referred clients to specialist physical and mental health services when their health had deteriorated.
  • There had been significant improvements in the service since our previous inspection in October and November 2016 including adopting more robust policies in physical health management and monitoring. There had also been significant improvements in the medicines management procedures and staffing levels.
  • Staff were enthusiastic and committed to providing a good quality of care to clients. They were supportive of the service manager.

27 October 2015 and 24 November 2015

During an inspection looking at part of the service

Aissa limited is registered to provide the following regulated activity:

  • Treatment of disease, disorder or injury
  • Accommodation for persons who require treatment for substance misuse

The service has a registered manager in place.

Aissa limited provided treatment and accommodation for people with substance misuse problems, including rehabilitation and alcohol and opiate detoxification.

This inspection consisted of two visits, one on the 27 October and one on 24 November 2015.

During the inspection visit on the 27 October 2015 serious concerns were identified about the care and treatment of patients going through alcohol and opiate detoxification. There were a lack of staff that held the appropriate qualifications, competence, skills and experience to provide care, treatment and support patients safely. Staff were not trained in completing physical health checks and monitoring deteriorating health. Staff had not completed mandatory training courses, this included safeguarding vulnerable adults and children at risk, assessing needs and the Mental Capacity Act.

Medicines management was poor and unsafe. Medication was being written on medicine administration charts and was not being signed by the prescribing doctor. There were no systems in place to check this was being completed safely. A patient was prescribed medication via email without a medical assessment. Medicines prescribed as required had no maximum daily doses recorded in the records. Patients could potentially be administered more than the maximum permitted daily dose.

Risk assessments and risk management plans were limited in length and not comprehensive. For patients who were suicidal, the risk was not documented in detail for how this would be managed during the admission. None of the care plans included regular monitoring of physical health using a recognised tool. The only physical health monitoring being completed was on admission which included blood pressure, pulse and weight. Staff had no training to carry out physical health observations.

As a result of the serious safety concerns identified we issued the provider with a letter of intent to use Section 31 of the Health and Social Care Act 2008 notice, on 9 November 2015. In response to this, the provider voluntarily stopped admitting patients to the service.

During the second inspection visit on 24 November 2015, Aissa limited had made improvements and changes in response to our concerns. Comprehensive risk assessments and risk management plans had been reviewed. The management of medicines had significantly improved and an external company employed to regularly check and audit medicines. All staff had completed required mandatory training for their roles and responsibilities. A detox policy and procedure had been implemented to describe responsibilities of staff. The policy included care during detox and the requirements of tele prescribing. However, the policy was not comprehensive and required further improvements.

Following the second inspection the decision was taken to allow Aissa limited to start readmitting patients again. The provider understood the areas that required further improvements.

26 July 2013

During a routine inspection

People who used the service gave their consent to any care or treatment before they were accepted onto the treatment programme. They told us this was reviewed with them on a regular basis. People understood the care and treatment choices available to them and told us that their choices had been respected and listened to. They said they could suggest and make changes to the service as long as they were appropriate and would not jeopardise the treatment programme or people's safety.

People described the staff as "really helpful". They said they felt safe and that staff were always available.

Staff were able to develop their skills and training and support was available to all members of staff. Staff received regular supervision and were able to attend relevant training courses.

People who used the service were asked for their views and the provider took their comments into consideration in trying to improve the service.