Parkland Place Lancashire

We rated CAIS at Salus as good overall because:

• The findings of this inspection mean the service is being removed from special measures.
• The service had implemented an action plan following our last inspection that addressed all of our previous concerns. There was clear evidence that the service had improved.
• The service provided safe detoxification from illicit substances and alcohol. The environment was safe, clean and supported recovery. The service had enough staff. Staff assessed and managed risks associated with detoxification 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. Clients had access to different detoxification programmes amd supporting interventions.
• The teams included or had access to the full range of specialists required to meet the needs of clients and deliver detoxification programmes. Managers ensured that these staff received relevant 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 around their detoxification.
• 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 the governance processes ensured that its procedures ran smoothly.

However:

• The rationale for the length of a clients’ detoxification programme was not always recorded in care records.

• Although staff could provide a rationale for storing emergency medications securely there was no documented risk assessment to support this.

We rated CAIS at Salus as inadequate because:

• The provider was not following the policy that set out the pre-admission process. Not all clients had had a comprehensive assessment of their risks and needs. We identified two clients whose previous history indicated that they would be at risk during withdrawal or detoxification. On both occasions, the provider had failed to adequately assess or mitigate these risks.

• Care plans did not fully reflect all clients’ needs and the rationale for the choice of detoxification regime was not always clear.

• Staff did not keep complete records of the care provided. They failed to record important information about the medical management of detoxification. Staff were not consistent in reviewing the effects of medication on clients’ physical health regularly and in line with national guidance.
• The provider did not manage medicines safely. The provider did not have effective policies, procedures and training related to medication and medicines management; including prescribing, detoxification or assessing people’s tolerance to medication.
• Staff were not supported appropriately. They did not receive regular supervision. No staff had had an appraisal of their performance in the last 12 months. Staff did not receive any training that was specific to detoxification. Not all staff had a clear understanding of the Mental Capacity Act 2005 and the implications for their practice.

• The communal shower facilities compromised clients’ privacy and dignity.
• The provider’s approach to improving the quality of its services and standards of care was not effective. Systems to assess, monitor and mitigate risks to clients’ health, safety and welfare were not effective. The clinical audit for care records had no actions recorded when improvements were identified. It was not clear how data was analysed, managed and used to support activities.

However:

• Staff helped clients to understand the risks of continued substance misuse.
• Discharge plans included pathways to enable clients to access other supporting services.

• The provider gave clients opportunities to provide feedback and the service had made improvements as a result. It was also responsive to feedback from clients, staff and external agencies. There was learning from incidents and the service had been proactive in responding to clients’ concerns.
• Recovery staff were supported to attain qualifications in line with national occupational standards. There was a peer mentor arrangement with the partner organisation.