Nest Healthcare

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated safe as requires improvement. We assessed eight quality statements. We found improvements to the safety of the service following our last inspection. There was a positive learning culture where events were investigated. However, practise had not yet been embedded into the service and Duty of Candour had not been considered. The environment was safe and met peoples needs. However, the ligature risk assessment needed updating. Staff had received training appropriate to their role and medicines management processes had been improved. However, staff had not had the opportunity to put learning and new systems into practise, team meetings and supervision were not taking place to ensure staff learning and understanding of the service was up to date. Client files were thorough but did not include individualised early exit plans.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Mangers told us improvements had been made to the service following the last inspection, including reviewing the breaches from the last inspection using external auditors to gather and collate information to improve services. Following our last inspection the provider carried out an internal investigation into all patient records for clients in treatment at the time of the inspection. The investigation included concerns around poor auditing, medication administration record (MAR) sheets not being present, and care plans lacking information. Following the investigation a team meeting was held and the local authority were contacted. Learning identified included staff training and daily audits of MAR sheets.

The service had a duty of candour policy in place, which staff were aware of. However, following an internal investigation taking place, the duty of candour policy was not followed. The service did not have a speak up champion in place. The service had a process for investigation complaints. However, they had no complaints within the 6 months leading up to inspection.

The provider told us they had worked closely with local organisations to improve safety and patient care. Following our last inspection, the provider told us that referrals from external organisations had been halted due to the rating provided by CQC.

We reviewed feedback from a referring agency commending Nest Healthcare on their client-centred approach, and the therapeutic and holistic treatments, provided in a homely setting.

The service had agreements in place with local organisations, including mutual aid groups, local community substance misuse services and the local authority. However, there were no protocols in place and agreements were not formalised. Due to the low number of admissions since our last inspections these relationships had not been embedded.

The provider told us they had improved safeguarding processes and procedures following concerns raised at the last inspection. Staff told us they had received training on how to recognise and report abuse, appropriate for their role. Staff knew how to make a safeguarding referral and who to inform if they had concerns. Staff liaised with the local authority safeguarding board with any concerns or queries.

Overall, 100% of staff had received safeguarding training. The provider had a policy relating to the Mental Capacity Act which staff were aware of and had access to. The manager discussed and checked capacity to consent to treatment with clients as part of the admissions assessment. Overall, 100% of bank staff and permanently employed staff had completed their Mental Capacity Act training.

The provider told us they had processes in place to manage medical emergencies and had access to a car to transport clients to medical appointments. Staff we spoke with said that the manager was on call 24/7 and they had access to out of hours medical support when needed.

The service managed risk and client safety where there was mixed sex accommodation. The service had separate bathroom facilities and clients could lock their bedroom doors. The service had developed a new ligature risk assessment and ligature risk management plan since our last inspection. The ligature risk assessment was thorough. However, the service used a generic ligature risk assessment template but had not amended parts of the ligature risk assessment to suit the building or grounds. The ligature risk assessment did not include radiator covers as part of the assessment. The service had a vital monitoring and escalation policy in place to manage clinical risk, that staff adhered to. The client risk assessment we reviewed included risks to self and others. It had a review date and was personalised. However, there was no early exit from treatment plan located within the client file.

Staff told us they ensured cleaning records were up to date. Support workers completed daily cleaning tasks, cleaning records were up to date and all areas were visibly clean. Staff told us followed infection control policy, including handwashing.

All areas were clean, well maintained, well-furnished and fit for purpose. Gas, electrical and fire safety certificates were in place and located in an easy to access folder. All equipment had been PAT (portable appliance testing) tested to ensure it was safe to use.

Contingency plans were in place, for who to contact should there be a failure or breakdown of equipment, including gas, electricity, water, flood, plumbing and drainage and appliance breakdown. The services business continuity plan included emergency evacuation plan.

Managers told us that following the last inspection, due to the restrictions placed on Nest Healthcare, there had been one new admission, which meant most staff had resigned. At the time of inspection there were two permanent members of staff, including the manager, and three other staff members had been taken on with bank contracts. Managers told us that since our last inspection, there had been a focus on learning, development, and competency, with a focus on enhancing substance misuse skills. Since our last inspection, all permanent and bank staff had received training in alcohol misuse training, drug misuse training, medication administration training and substance misuse rehabilitation.

We reviewed supervision notes for one permanent staff member. However, these were all dated for 2023 and no supervision had been carried out since our last inspection. There were no team meeting minutes available for us to view as no team meetings had taken place within the last three months. However, we reviewed minutes from a full staff meeting that had been held in October 2023 following our last inspection.

The provider had a training database in place to monitor training and development. Recruitment information was kept centrally with the providers central human resources team. The provider did not have a supervision or appraisal database in place to highlight when staff were due supervision.

Managers told us that staff carried out daily cleaning tasks, which due to there being no clients in treatment were not always being carried out at the time of inspection. During inspection, we noted the the facilities were clean and tidy. Staff told us that when clients were in treatment, clients were able to purchase their own food for their individual needs and preferences and that staff and clients cooked meals together.

We reviewed daily cleaning logs and schedules, which were complete for the period that the last client admission took place. The service had a daily disinfecting schedule in place, which was completed when clients were in treatment. All permanent and bank staff had received mandatory training in food hygiene, infection control and health and safety.

Leaders told us following the last inspection they had received external support to improve their medicines management systems and processes. This included enlisting support from a pharmacist and other local substance misuse providers. The providers admission and exclusion policy was clear that clients deemed as high risk would not be accepted for treatment.

The provider had safe systems and processes in place to prescribe and administer medicines safely, all equipment to support detox was well maintained, calibrated, and stored in a clinical bag located within the manager’s office. Medicine regimes were in place for staff to continually review, these were supported by using SADQ (severity of alcohol dependence audit questionnaire) and Clinical Institute Withdrawal Assessment for Alcohol, (CIWA-Ar) scales. Medicines were stored in a locked cupboard in the manager’s office. The controlled drug book was well maintained. The service had naloxone in place to reverse the effects of an opiate overdose.