Hay Farm

Updated 20 May 2019

Hay Farm is registered to provide mixed gender residential rehabilitation and detoxification for up to 12 clients over the age of 18 who require treatment for substance misuse and associated problems relating to alcohol or drug dependency. Hay Farm offers treatment to people with eating disorders and other addictive or compulsive behaviours.

Clients at Hay Farm are mostly self-funding although they do accept professional referrals. Hay Farm does not accept referrals for people detained under the Mental Health Act.

Hay Farm is registered to provide the following regulated activities:

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

There is a registered manager at the service although they do not attend the service daily.

This is the first time the service has been inspected using the ratings methodology for substance misuse services.

Hay Farm was inspected in June 2016, where it was found in breach of the following regulations of the Health and Social Care Act 2014:

Regulation 12 Safe care and treatment

Regulation 17 Good governance

Inspectors also found the service had breached regulation 12 of the CQC Registration Regulations 2009 because its statement of purpose (SOP) contained inaccurate information about the activities and service user bands the service was registered to provide.

We told the provider to take the following actions:

• The provider must have an accurate statement of purpose
• The provider must have a comprehensive admission or exclusion criteria to safeguard clients
• The provider must ensure that call alarms re available in client’s bedrooms and that staff have alarms and carry these at all times
• The provider must obtain GP summaries for clients prior to admission
• The provider must ensure that clients risk assessments are comprehensive and contain risk management plans and crisis contingency plans

During an unannounced focussed inspection in October 2017, inspectors found that the provider had taken some action in response to the concerns, but that further improvements were required. Inspectors found that although call alarms had been installed, they worked intermittently due to power surges and the SOP still contained inaccuracies. After the inspection, the provider confirmed that issues with call alarms had been resolved and that following a discussion with inspectors, the SOP would be amended and submitted to CQC.

Updated 20 May 2019

We rated Hay Farm as good because:

• Hay Farm had made improvements to the service since our last inspection. This included adding a new clinic room, ensuring bedrooms contained call alarms and the introduction of an admissions officer post that had resulted in strengthening the admissions process. The admissions officer streamlined the admissions process and ensured the service didn’t take clients it was not able to care for them effectively or that didn’t meet its criteria for admission.
• Staff were skilled and competent to provide safe care and treatment. Staff were aware of their responsibilities and dedicated to providing safe, high quality care for clients. We observed staff treating and discussing clients with respect, dignity and compassion. Clients feedback about their care and treatment was positive.
• There was a comprehensive assessment process for clients accessing the service. Risk assessments were detailed, regularly reviewed and contained a risk management plan. Staff collaboratively completed care and recovery plans with clients. Recovery plans were holistic and individual to each client.
• Staff provided a range of care and treatment interventions that were in line with guidance from the National Institute for Health and Care Excellence.
• There was fortnightly group clinical supervision for staff. Supervision was arranged so that staff could attend at least one session a month.
• There were a range of multidisciplinary meetings to ensure staff shared information appropriately. There was a system for reporting, reviewing and learning from incidents.
• There was a range of rooms to meet client needs. Regular activities both on site and away from the service were offered to clients.
• All clients received a welcome pack which contained information about how to make a complaint.
• Senior managers showed a good understanding of the service and could clearly describe how staff were working to provide high quality care.
• Staff were aware of the vision and aims of the service. A recent staff survey showed that 83% of staff felt satisfied working at the service.
• There were clear systems to support good governance. Senior managers continually explored ways to improve and develop the service.

However

• Clients were unable to lock their bedroom doors and there was no CCTV or security at the service. Clients told us they were concerned about the lack of security and that other clients were able to enter their bedrooms.
• Fire extinguishers had not been checked by a qualified engineer in line with legislation.
• Staff stored clients’ own medicines separately and administered medicines from stock. Staff only used client’s own medicines if the service did not have them in stock. During the inspection we saw that mediciness had been transcribed onto prescription charts for five clients. However, not all of these transcriptions had been authorised for administration by the doctor. Legislation requires authorisation from a prescriber before staff can administer medicines. Staff did not seek to obtain dispensed medicines from the pharmacy when clients’ leave was planned. There wasa risk that staff could dispense and supply medicines to clients without them being prescribed.
• Some staff had not updated their mandatory training for several years. The prescribing doctor had not completed any of the mandatory training specific to their role.
• The process to monitor staff competency during their induction did not demonstrate clear oversight and record keeping. Information including the signature of staff signing off competence was missing on some records.
• The prescribing doctor had little involvement in the clinical audits, including those that related to medicines management and prescribing practice.

Updated 20 May 2019