Archived: Cranstoun - City Road

Updated 29 October 2018

Cranstoun City Road provides care and treatment to men and women who require a medically monitored detoxification from drug and alcohol misuse. The service has 24 beds available for treatment, 10 of which were occupied at the time of our inspection. Clients are admitted for between 10 and 14 days on average, dependent upon their individual treatment plan. Following detoxification, the majority of clients are discharged to a rehabilitation setting or a supported living service.

Cranstoun City Road is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury.

There was a registered manager in place at the time of inspection.

The service received referrals from London and nationally from various organisations.

The service was last inspected in June 2017. We found concerns about the quality and safety of the service. We issued the provider with three requirement notices. At this inspection we found the provider had made improvements.

Updated 29 October 2018

We rated Cranstoun City Road as good because:

• The service had made improvements since the last inspection. All staff received appropriate training to safely meet the care and treatment needs of clients. Regular environmental checks including fire safety, were carried out regularly and recorded. Robust arrangements to recruit and train a planned future intake of volunteers were being implemented. All clients had early exit plans in place.

• The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Incidents were appropriately investigated and shared lessons learned with the whole team. When things went wrong, staff apologised and gave clients, or their families, honest information and suitable support.

• The service had enough staff with the right qualifications, skills, training and experience to keep clients safe from avoidable harm and abuse and to provide the right care and treatment. Robust recruitment procedures and high staff take up of mandatory training meant that clients were protected from the risks of receiving unsafe care or treatment.

• Managers appraised staffs’ work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service. A programme of specialist training was planned for all staff over the coming 12 months.

• Client records were clear, up-to-date and available to all staff providing care. The service ensured that all clients were comprehensively assessed before starting their treatment, including their physical and mental health needs. The prescribing professional always met with clients face-to-face before prescribing any medicines.

• Personalised, holistic care plans were in place for each client. The service assessed and managed the risks associated with clients care and treatment. Only clients whose care and treatment needs could be safely met were admitted to the service for detoxification. Where client risk changed, assessments and management plans were updated to reflect this.

• The service provided care and treatment based on Department of Health Drug misuse and dependence: UK guidelines on clinical management and evidence of its effectiveness. Clients detoxification medication regimes followed best practice guidance. Physical health monitoring recommended by national guidance was carried out by staff.

• Staff understood their roles and responsibilities under the Mental Capacity Act 2005. They knew how to support clients with dual diagnosis and those who lacked the capacity to make decisions about their care. The service prescribed, gave, recorded and stored medicines well. Clients received the right medication at the right dose at the right time.

• Staff of different professions worked together as a team to benefit clients. The staff team liaised with other stakeholders, including the clients’ GPs, the referring agency and secondary services the client would be receiving support from post discharge. Clients’ housing, money and employment needs were assessed and staff supported clients to access other agencies to help support them. There were links with local debt management and advocacy services.

• The service had robust systems to assess and review referrals which meant that clients could access the service when they needed it. The service worked well with other stakeholders and providers to facilitate transfers of care. Staff routinely followed up clients four weeks after discharge to check on their progress.

• Staff cared for clients with compassion. Feedback from clients confirmed that staff treated them with compassion and respect. Staff provided emotional support to patients to minimise their distress. Staff involved clients in decisions about their care and treatment.

• The service had suitable premises and equipment and looked after them well. The premises had a range of private and communal spaces to facilitate individual and group work programmes.

• The service took account of patients’ individual needs. Staff demonstrated an in-depth knowledge and understanding of clients’ protected characteristics and potential vulnerabilities. The service had arrangements in place to support transgender clients including a bedroom of single occupancy on the same floor as their self-identified gender. One bedroom on the premises had been adapted to allow wheelchair access.

• The service ensured that clients received regular, varied and nutritious meals to meet their needs and improve their health. The service made adjustments for clients’ religious, cultural and other preferences.

• The service had leaders at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Leaders were visible and approachable to staff and clients. Leaders promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service had robust governance systems that collected, analysed and used appropriate information to monitor the performance of the service and drive improvement. The service had effective systems for identifying risks, planning to eliminate or reduce them. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. The service was committed to improving services by learning from when things go well and when they go wrong.

However:

• Whilst the service had made communication devices available to staff so they could stay in contact whilst working in different parts of the building, on the day of our inspection one temporary member of staff was not aware of this and was not using the device, which could compromise their safety and the safety of clients.

Updated 29 October 2018