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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.}\par
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.}\par
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We looked at ten sets of clinical records. We found they all had a self assessment document and individual short, medium and long term goals were planned and documented.  We spoke to people who were attending a group meeting during our visit. They all said that they had received a very good service. They told us that the service was very friendly and open and that they were always able to contribute at meetings. They said they felt that their opinions about their care mattered.}\line \line {\f0\fs24\cf1 Staff told us about their referral links with "front of house staff" in place in local accident and emergency departments. They said this enabled them to approach people who had come to actual harm as a direct result of their alcohol use. One person we spoke with during our visit told us that they had been referred to Action for Change by staff at a local accident and emergency department.}\line \line {\f0\fs24\cf1 Staff told us they were trained in first aid and knew how to summon support should emergency services be required and gave examples of having done so, when people at clinic had become very unwell.}\line \line {\f0\fs24\cf1 Nursing staff told us how they worked closely with GP's, district nurses and hospitals to ensure that people had the right care. There was evidence of referral to GP services for blood tests and results and in relation to "detox" in some of the records we reviewed.}\line \line {\f0\fs24\cf1 The manager told us that although referrals can come from GPs and/or probation services, the key ingredient to achieving personal goals relating to alcohol use was self motivation. All the people we spoke to who had used the service echoed this and said that although it had been hard at times (and remained hard) that the continued support offered by Action for Change kept that motivation going.}\line \line {\f0\fs24\cf1 Staff told us about specialist services for younger people and we saw information leaflets specifically aimed at young people.}\par
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We saw a Quality assurance policy that described measurable monitored standards.   For example that all staff receive diversity training and that the risk strategy was up to date. We saw that diversity training was in place and that staff had attended. We saw an up to date risk strategy.}\line \line {\f0\fs24\cf1 People told us they were involved in assessing their own care by setting individual short, medium and long term goals which were reviewed at clinic appointments. People told us they were encouraged to provide feedback. Staff told us that they invited people to complete a feedback form on discharge from the service. For example people were asked  "would they return to the service should they need to and if not why not". There was also scope for general comments.}\line \line {\f0\fs24\cf1 The manager told us that comparative data from self assessments completed before and after treatment provided individual quality assurance and overall performance data.  We saw self assessments in the all the records we reviewed. These included assessment of depression and anxiety, general well being and alcohol use. }\line \line {\f0\fs24\cf1 Staff told us that people were asked to feed back using a questionnaire and we saw some of these completed questionnaires. We saw that this feedback was monitored regularly. The manager told us that feedback was generally positive. We saw that the number of people who did not complete treatment/achieve personal goals was also monitored. }\line \line {\f0\fs24\cf1 We saw that the self assessments in records had been checked by senior staff and that management guidance and clinical supervision was in place to support staff with the care they gave and was documented in staff records. }\line \line {\f0\fs24\cf1 Managers told us there were a number of key performance indicators that were reported. For example: the number of people that used services, the number of people that did not complete treatment and the time between referral and treatment. We saw annual reports reflecting this. }\line \line {\f0\fs24\cf1 Staff told us that because of the high risk of relapse, the relapse prevention service was essential. Staff told us that this part of the service was expanding and was now run by service users. The people we spoke to who had used this service confirmed this and said it helped build their self confidence and reduced their dependence on the service.}\par
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\pard\itap0\sl0\sb300\lin114\rin108 {\f0\fs24\cf1 We are the regulator of health and social care in England.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as \u8220?government standards\u8221?.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of dentists and other services at least once every two years. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service\u8217?s records and check whether the right systems and processes are in place.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 You can tell us about your experience of this provider on our website.}\par
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\pard\itap0\sl0\sb300\lin114\rin108 {\f0\fs24\cf1 The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.}\par
\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We reach one of the following judgements for each essential standard inspected.}\par
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\pard\intbl\sl0\lin6\rin90 {\f0\fs24\cf1 This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.}\cell
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\pard\intbl\sl0\lin6\rin90 {\f0\fs24\cf1 This means that the standard was not being met in that the provider was non-compliant with the regulation. }{\f0\fs24\cf1\par}
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\pard\intbl\sl0\lin6\rin90 {\f0\fs24\cf1 If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.}\cell
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\pard\intbl\sl0\lin284\rin266\keepn {\f0\fs26\b\cf4 How we define our judgements (continued)}\cell
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\pard\itap0\sl0\sb300\lin114\rin108 {\f0\fs24\cf1 Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. This could be a minor, moderate or major impact.}\par
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.}\par
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\pard\intbl\sl0\lin284\rin266\keepn {\*\bkmkstart _Ref327949238}{\f0\fs26\b\cf4 Glossary of terms we use in this report}{\*\bkmkend _Ref327949238}\cell
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\pard\intbl\qr\sl0\lin9 {\pict\pngblip\picscalex24\picscaley24\picwgoal615\pichgoal615
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\pard\intbl\sl0\rin90 {\f0\fs24\b\cf1 Essential standard}\cell
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 The essential standards of quality and safety are described in our }{\f0\fs24\i\cf1 Guidance about compliance: Essential standards of quality and safety}{\f0\fs24\cf1 . They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the }{\f0\fs24\i\cf1 Guidance about compliance}{\f0\fs24\cf1 . The 16 essential standards are:}\par
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\pard\intbl\sl0\lin85\rin67 {\f0\fs24\cf1 Respecting and involving people who use services - Outcome 1 (Regulation 17)}\cell
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\pard\intbl\sl0\lin85\rin67 {\f0\fs24\cf1 Consent to care and treatment - Outcome 2 (Regulation 18)}\cell
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\pard\intbl\sl0\lin85\rin67 {\f0\fs24\cf1 Staffing - Outcome 13 (Regulation 22)}\cell
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\pard\intbl\sl0\lin85\rin67 {\f0\fs24\cf1 Complaints - Outcome 17 (Regulation 19)}\cell
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\pard\itap0\sl0\sb200\lin114\rin108 {\f0\fs24\cf1 These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.}\par
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\pard\intbl\sl0\lin13 {\f0\fs24\cf1 Copyright Copyright \u169? (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified.}\cell
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