A drug and alcohol detoxification and rehabilitation service in Liverpool, has been rated inadequate again by the Care Quality Commission (CQC) and has been placed in special measures, following an inspection carried out in January.
A focused inspection was carried out to follow up on safety issues identified at a previous inspection in November, when CQC suspended the provider’s registration.
At the January inspection, improvements had not been made and the suspension was extended. CQC carried out a further inspection in February, following which the provider’s suspension was extended again, it was then lifted on 17 March, although the service remains in special measures. The report for the February inspection will publish once the usual quality assurance process has completed.
We Can Recover CIC is a private company which provides inpatient care and detoxification for up to 24 people with addictions such as alcohol or drugs.
As well as being rated inadequate overall following January’s inspection, it was rated inadequate for being safe and well-led. Effective, caring and responsive have not been inspected, therefore remain unrated. CQC are currently considering if further enforcement action needs to be taken to keep people safe.
Karen Knapton, CQC deputy director of operations in the north, said:
“When we inspected We Can Recover CIC, we found leaders didn’t have the experience to run the service safely and hadn’t actioned the concerns we identified at the November inspection, which led to the service being suspended.
“The service didn’t have enough experienced and accessible nursing and medical staff to deliver high quality, safe care to people. Three out of four nurses, including the newly appointed clinical lead, had no previous substance misuse experience. Also, it wasn’t obvious what arrangements were in place to cover gaps in staffing levels and there wasn’t a clear process for staff to escalate concerns out of hours.
“Leaders still weren’t supporting staff to follow good practice with respect to safeguarding, or even have a policy for staff to follow. Staff didn’t have appropriate training on how to recognise and report abuse despite us telling leaders they needed to do this at the previous inspection. It was also concerning that managers didn’t complete all appropriate employment checks for new staff which could put people at risk of harm.
“Following the January inspection, we were so concerned with what we found that we visited again in February and extended their suspension, which was eventually lifted in March. Although some improvements had been made, more work needs to be done to keep people safe.
“We have fed back our further concerns to the provider and will continue to monitor the service closely and inspect where we expect to see improvements as people deserve a much higher and safer standard of care.
“We are currently considering if we need to take further enforcement action to keep people safe.”
Findings from the inspection included:
- Clinic rooms were not fully equipped, and staff did not check and maintain equipment in line with manufacturer guidance. There was no emergency equipment or emergency medicines available or risk assessment to assess which emergency medicines staff may or may not need in this service
- Staff were not provided with the skills needed to safely deliver care to people. Training records were inaccurate, and the mandatory training programme was not comprehensive. Relevant training, indicated on the suspension notice, had not been arranged. Role specific training had not been completed by staff and the rationale for the allocation of training was not clear. Rotas did not ensure that staff working on all shifts had the necessary experience to safely care for people
- Staff that screened people’s admission and risks had not completed all of the role specific training required to fulfil their role. The service was unable to describe effective systems and processes to review risk prior to admission and it was unclear what the review process was and who this involved
- The service had not established systems and processes to safely prescribe, administer, record and store medicines. Staff who were to administer medicines were not all suitably qualified and competent to administer medicines safely. The policy which support worker medicines training was based upon, was contradictory and of poor quality
- Leaders had not implemented safe systems and processes to provide safe and good quality care to people. Information returned was not timely and accurate. Managers struggled to return basic information that was associated with the day to day running of the service. Policies, protocols and documentation did not accurately reflect how care was to be provided or how the service was run.