Fleming House

We rated Fleming House good because:

• The service had enough staff to safely meet client’s needs. Staff at all levels of the organisation had appropriate skills, knowledge, and experience to provide the right care and treatment.

• The service had clearly defined and embedded processes to keep people safe. Staff understood their responsibility to report incidents and managers took actions to improve safety.

• The service had clear and robust policies in place for safeguarding adults and children. Staff received safeguarding training. Staff identified safeguarding concerns and took steps to prevent abuse from occurring. Management had established links with the local authorities safeguarding team and reported concerns.

• Staff received training in the Mental Capacity Act 2005 and applied this in practice.

• The service took a holistic approach to assessing, planning and delivering care. Clients received a comprehensive assessment before entering treatment. Clients personal preferences, strengths and goals were reflected in care plans. Clients were involved in developing their own risk assessment and crisis plans. Staff supported clients to develop timely, holistic and personalised discharge plans. Clients records were clear, up to date and were accessible for staff.

• The service provided care and treatment in line with national guidance. The service provided treatment for clients, which included medication, psychological therapies, and occupational activities intended to help patients acquire living skills. There were a range of activities for patients to take part in including gardening, games, acupuncture, bowling, and classes in computer skills and digital photography.

• The service monitored and reported client treatment outcomes. Staff used structured assessment tools to regularly review client’s recovery and needs.

• The service sought to work collaboratively with other providers and agencies to promote high quality care and positive treatment outcomes. The service exchanged knowledge and skills with other providers. The service worked in collaboration with other providers to develop a ‘treatment loop’ which allowed clients to continue their recovery at another centre after breaching specific treatment requirements.

• Staff displayed positive attitudes and behaviours when interacting with clients. Clients described staff as approachable and helpful. The service sought to accommodate client’s preferences and needs, such as dietary, cultural, religious, communication, and needs arising from disability.

• The service sought feedback from people using its service and had a clear policy for managing complaints. Managers promptly investigated complaints, apologising and acting on them where required. Management involved clients in resolving complaints.

• The service had suitable premises and equipment and looked after them well. The premises provided separate floors of accommodation for male and female clients. The premises provided a range of private and communal areas for socialising, individual and group therapies. Clients had access to a garden and spaces to meet visitors.

• The service had a manager in post with the right skills, knowledge and experience who was approachable and visible for staff and clients.

• The service had governance systems that collected, analysed and used information to monitor and improve care. The service had effective systems for identifying and managing risk.

However:

• The service maintained thorough cleaning records for the environment but held no cleaning records for medical equipment, such as sphygmomanometer, also known as a blood pressure meter. This is posed a potential infection control risk. However, on visible inspection these devices appeared clean and staff told us they cleaned them regularly.

• The service was not using disposable breathalyser mouthpieces. However, the service was sterilising breathalyser mouthpieces between use.

• The services ligature risk assessments identified areas of concern but did not adequately document how risks were mitigated or removed.

• The service did not have a written procedure for managing bathing safety for clients undergoing detox. Clients who are detoxing from alcohol can be at higher risk of experiencing seizures.

• The service did not maintain records of whether clients had been offered copies of their care plans.

We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Fleming House was in December 2016. At that inspection, we issued three requirement notices. Issuing a requirement notice notifies a provider that they are in breach of legal requirements and must take steps to improve care standards.

On 10 May 2018 we undertook an unannounced, focused inspection to see whether the provider had made the required changes and found the following improvements had taken place:.

• Following the last inspection in 2016, we told the provider they must ensure they assess clients referred for alcohol detoxification to ensure they are suitable for the service. At this inspection, we found that the provider had clear admissions criteria and only admitted clients suitable for the services and treatment provided.
• Following the last inspection in 2016, we told the provider that they must ensure clients had access to emergency medication and that medication to manage seizures was prescribed for clients who required it. At this inspection, we found that clients did have access to emergency medication. The service only admitted clients with epilepsy only when their condition was stabilised with medication. The service does not admit any clients with a history of alcohol withdrawal seizures at all.
• Following the last inspection in 2016, we told the provider they must ensure staff maintain the kitchen to an appropriate standard of hygiene. Staff working in the kitchen must have the appropriate training and supervision. At this inspection, we found that the kitchen was clean and tidy and there were plans in place to ensure all staff were trained with the appropriate skills required.
• Following the last inspection in 2016, we told the provider they must ensure all actions they have identified in risk assessments to mitigate risk to clients are completed. At this inspection, we found that there was a comprehensive environmental risk assessment in place, which was updated and reviewed regularly.
• Following the last inspection in 2016, we told the provider they must report all safeguarding issues to the appropriate safeguarding team as soon as they became aware of them and to notify the Care Quality Commission of incidents as required. At this inspection, we found that the provider had an effective safeguarding policy in place and that referrals were being made to the local safeguarding authorities and the Care Quality Commission.
• Following the last inspection in 2016, we told the provider they must ensure they report all incidents in line with their incident policy and that they monitor incidents and disseminate any lessons learnt to the wider team. The provider must ensure all relevant information is reported to the fortnightly management team meeting. At this inspection, we found the provider had a good incident reporting policy in place and this was being followed by staff. There was an incident log, and learning and feedback was disseminated through staff meetings and handovers.