Care service inspection report

Care service inspection report Follow-up inspection Glasgow Drug Crisis Centre (Turning Point) Care Home Service 123 West Street Glasgow Inspection completed on 23 March 2016

Service provided by: Turning Point Scotland Service provider number: SP2003002813 Care service number: CS2003000942 Inspection Visit Type: Unannounced Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and set out improvements that must be made. We also investigate complaints about care services and take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect page 2 of 15

1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at www.careinspectorate.com. This care service was previously registered with the care commission and transferred its registration to the care inspectorate on to 1 April 2011. The service is aimed at people who are no longer coping in the community and may be at risk due to their chaotic drug use. Admission is based on self referrals and on the basis of priority and need. This is a short-term service of twenty-one days with the average length of stay seventeen days after which people are supported back into the community or to other drug and alcohol services which offer longer term services. There are a number of related services such as a needle exchange and performance and image enhancing drug clinic based in the same building. Clients can access these as and when they wish. The service aims to offer "a safe, confidential service which will support and encourage people to find ways of making their drug use less problematic and achieve a better quality of life". Inspection report 2 How we inspected this service The inspection was undertaken by one inspector on the 18th March 2016 07:45am-17:50pm We concluded the inspection and feedback was given to the service manager and Operational manager on 23 March 2016. During the course of the inspection we spoke to: - The Manager - One service coordinator - Two registered nurses - Eight people who use the service - One Support worker - One Student on placement (from Scottish Drugs Forum) - One Practitioner. Advice was also sought from the Care Inspectorate's pharmacy advisor. page 3 of 15

We observed the morning staff handover, the service users forum and interactions between staff and people who use the service. We spent time talking to nursing staff looking at and talking about medication procedures and practices within the unit. We sent care standards questionnaires to the manager to distribute to staff and service users. We received completed questionnaires from six members of staff and eight people using the service. We looked at: - Insurance and registration certificates - Staff questionnaires - Five health/medication files - Medication records and audits - Minutes of staff meetings - Minutes of nurse meetings - Minutes of clinical governance meetings - Supervision and appraisal records for five staff - New supervision format - Records of staff receiving codes of conduct - Notifications made to the Care Inspectorate - Adult Support and Protection policy and operational guidelines - Medication operational guidelines and policy - Guidance on proposed changes to groupwork structure and daily timetable - Action plans for service to address issues raised at inspection. 3 Taking the views of people using the service into account We spoke to eight of the ten people using the service at the time of inspection. A further eight people completed care standard questions. The feedback from service users was very positive about the staff and the service provided. It was clear that service users were very grateful for their place in the service and many stated it had saved their life and for several of them it had done so on a number of occasions. People told us that staff were approachable and treated them with respect and were on hand to support them at any time they needed. page 4 of 15

"This is the first time I have used this service and I have been treated with respect and dignity from all staff" "My experience of GDCC (Glasgow Drug Crisis Centre) is probably the place that has saved my life in more ways than one and if it wasn't here there would be more drug overdoses and deaths" "All the times I've been here I've been treated with respect. As I was one of the first people since it opened 21 years ago it's saved my life on many occasions and also being really treated well with the staff and key workers" "If it was not for the Crisis Centre I would be dead by now" "I found turning point only service gave the support I needed. Happy how I have been treated". The only negative issue that was raised both in the questionnaires we received and speaking to people was the issue of shared rooms. People were not happy about having to share a room and did not feel they were told this may be the case when they agreed to come into the service. See quality theme 2, statement one for more information. 4 Taking carers' views into account N/A page 5 of 15

5 What the service has done to meet any requirements we made at our last inspection Previous requirements 1. The provider must ensure that there is clear and detailed recording of any medical assessments and any subsequent treatments prescribed as part of the support planning process. This is to ensure that all those supporting the person are aware of any relevant medical history and the planned course of treatment whilst in the service. This is in order to comply with: The Social Care and Social Work improvement Scotland (requirements for Care Services) SSI 2011 No 210. Regulations 4(1) (a) - Welfare of users Timescale - Three months. This requirement was made on 16 November 2015 Since the last inspection the service has developed a database for the Visiting Medical Officers (VMO's) to input their medical assessments directly onto the computer where they can be accessed by the nursing staff. A printer has been purchased for the medical room so that the medical assessments can now be completed and printed immediately making them legible and accessible. Each service user now has a health/medical file kept in the medication room for all relevant health and medical information including their medical assessments. We looked at a sample of these and found that except one, all had printed, legible medical assessments. The content of the assessments we saw were better than previously seen with more information about the person's current state of health and any previous health issues. Although it was good to see that these assessments were now more comprehensive and legible, we advised the manager that it would be good practice for the doctor completing these to sign them once printed off. At present there is a printed name in the signature box which could be complemented with an actual signature. page 6 of 15

Staff told us that at times they still struggled with reading the VMO's writing on the Kardex (medications, instructions for administration and dosages). We saw that it had been raised at one of the nurses meetings that this is still an issue and if there was a way that these could be printed. The operational manager told us this is something they are aware of and continues to be raised in the clinical governance meetings with the VMO's. It was good to see that audits were being undertaken to identify and address issues with the medical assessments around the issues raised in the last inspection and that these audits were raising issues and identifying where improvements still need to be made to the process. This is a positive addition to the quality assurance of the service especially during the period where everyone is getting used to using new processes and standards for completion. There is space on the medical assessment for identifying who has confirmed the medication that the person is currently taking. Some of these boxes were blank indicating that no check had been made, one we saw referred to GDCC nursing staff making these checks. We discussed the process for this with one of the nurses and the manager who explained that the Nurse completing the initial assessment (usually completed in the one stop clinic attached to the service) verifies the medication the service user is on over the phone with their GP and also verifies with the pharmacist when the medication was last dispensed. We advised that when verifying this information over the phone, it is good practice for a second member of staff to actually hear the information being given by the other party (GP/Pharmacist) for example by listening into the conversation on another line or using the speakerphone function if appropriate. Good practice would also be to request that information given by the GP in relation to medication is followed up in writing (for example via email or fax). We discussed this with the manager and operations manager and suggested it would be good for these practices to be included as part of the standard operating procedures for medication. This requirement has not been fully met but we saw that progress has been made towards meeting this. Not Met Inspection report 2. The provider must ensure that all staff are acting in accordance with legislation and best practice guidance in relation to the administration of medication. page 7 of 15

This is in order to comply with: SSI 2011 No 210. Regulations 4(1) (a) - Welfare of users Timescale - Three months. This requirement was made on 16 November 2015 Since the last inspection, staff told us that there have been a number of changes made to medication processes and systems which have improved the processes and made them 'tighter'. The organisation has commissioned a nurse consultant to support nursing staff with the process of revalidation (the process required to maintain their registration to enable them to practice as a nurse) and to also look at some of the practices and systems being used in the service. We saw that the organisation has continued to have clinical governance meetings to address some of the issues around medication and ensure that they are operating in line with legislation and best practice guidance. Nurses meetings are also being held quarterly so that the nurses are able to get together and discuss practice issues. We saw in the minutes of these we sampled that discussions had taken place around changes to medication processes and the medication errors that had occurred. We were made aware of an on-going issue around the safe storage of a controlled drug but we are confident that the service is taking the appropriate steps to deal with and resolve this issue as quickly as possible. During the course of the inspection we noted that the medication keys (door to the medication room, medication cupboard and controlled drugs cupboard) are all kept together in one bunch. We advised the manager to look at the guidance around this as it is not good practice to keep all the keys together and it can increase the risks of medication being accessed for misuse. This requirement remains ongoing and we hope to see that positive changes we saw at this inspection have been cemented into practice and these changes have been sustained. Not Met page 8 of 15

6 What the service has done to meet any recommendations we made at our last inspection Previous recommendations 1. The manager should ensure that there is an effective groupwork programme operating in the service to support people manage their addictions and gain information about harm reduction. National Care Standards: Care Homes for People with Drug and Alcohol Misuse Problems: Standard 5 - Support arrangements. This recommendation was made on 16 November 2015 Inspection report The service is currently recruiting a groupwork facilitator to fill a part time vacancy they have. We saw that some new sessions have been introduced into the groupwork programme to refocus the content in order to better support people gain knowledge and understanding around addictions and harm reduction. The timetable for how the sessions fit into the daily routine of the service has been reviewed and the timings of sessions amended in order to allow appropriate breaks before meals and time for key working and individual activities such as reviews to fit in with 'office hours' (when other professionals are available) without the person having to miss out on a groupwork session. The manager is currently holding regular service user forums to gain feedback on all areas of the service. Feedback is also being asked for after each groupwork session using evaluation forms in order to review which sessions are working well and where any changes need to be made. Staff and service users that we spoke to appeared happy with the changes that are being proposed and that have been made. This is an area that still needs some work in order for the recommendation to be fully met but we could see that there had been good progress in this area and there were plans in place to continue taking this forward. 2. The manager should ensure that the use of shared rooms is reviewed to ensure that the service adheres to best practice guidance and the underpinning principles of the National Care Standards. page 9 of 15

National Care Standards Care Homes for People with Drug and Alcohol Misuse, Standard : 3 - Your environment. This recommendation was made on 16 November 2015 We saw that the service has gained quotes to look at the potential for separating the current shared rooms and making them single rooms. The organisation has yet to decide if this is an option they wish to pursue and if they can support the costs involved in this. Service users we spoke to continued to voice their concerns over the sharing of rooms, especially when people are at different stages of their stays or have specific mental health or medical issues. Although service users told us they were not told they would have to share a room, and one person told us they would not have agreed to come in of they knew they would have to share, we did not find any evidence to suggest that the information is not available to them. We have seen that the information forms part of the welcome information and service user agreement. Staff told us they try to accommodate people's needs for single rooms as best they can and offer those in shared rooms the chance to move to a single one when it becomes available. This recommendation remains unmet. 3. To ensure that the service is acting in line with best practice guidance in relation to Adult Support and Protection legislation, the organisation's policy needs further development. This is to ensure that there was a clear link to the relevant interagency and /or local council guidance and that the process for raising concerns and making a referral (including the use of AP1 forms) are clearly documented within the policy. National Care Standards Care Homes for People with Drug and Alcohol Misuse, Standard : 4 - Management and. This recommendation was made on 16 November 2015 We saw that there are now operational procedures to accompany the adult support and protection policy which include links to relevant multi agency procedures and the use of AP1 forms for formerly reporting concerns. The procedures, policy and list of contacts is available to staff in the office of the residential service. This recommendation has been met. page 10 of 15

4. The manager should ensure that professional codes of practice and conduct are adhered to by all staff and appropriate action is taken where staff have not acted in accordance with these codes. This is to ensure that staff behave in a professional manner and maintain their professional registration. National Care Standards Care Homes for People with Drug and Alcohol Misuse, Standard : 4 - Management and. This recommendation was made on 16 November 2015 Inspection report We found during our visit that there had been some improvement to staff morale in the service and feedback from staff was things were moving forward in a positive way. Staff have all been given a copy of their relevant codes of practice and been asked to sign to confirm they have been given this. More work needs to be done to ensure staff understand the link between the codes of practice and their conduct and the implications for not acting in accordance with these codes. We saw that there is a new supervision template in place which should support supervisors cover all relevant areas and improve recording of issues raised and actions take forward to deal with those issues. This template is only just starting to be used so we will look more closely at this during the next inspection. The manager has been meeting on a one to one basis with staff to try and identify any issues and ways to resolve them, this has also been supported by the development of a questionnaire based on some of the issues raised at the last inspection. We thought that the questionnaire was a good idea as it was designed to help the manager gauge the nature and extent of some of the issues raised which will help to move forward and find resolutions. We look forward to seeing the outcomes from this at the next inspection. There was clearly still some work to be done in this area but we are confident that things have improved since the last inspection and progress is being made, therefore this recommendation remains on-going. page 11 of 15

7 Complaints No complaints have been upheld, or partially upheld, since the last inspection. 8 Enforcements We have taken no enforcement action against this care service since the last inspection. 9 Additional Information There is no additional information. page 12 of 15

10 Inspection and grading history Date Type Gradings 16 Nov 2015 Unannounced Care and support 3 - Adequate 3 - Adequate 3 - Adequate Management and Leadership 5 Jan 2015 Unannounced Care and support Management and Leadership 20 Nov 2013 Unannounced Care and support 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good 7 Nov 2012 Unannounced Care and support 5 - Very Good 5 - Very Good 5 - Very Good Management and Leadership 5 - Very Good 10 Nov 2011 Unannounced Care and support 5 - Very Good Not Assessed Management and Leadership Not Assessed 11 Feb 2011 Unannounced Care and support Not Assessed Management and Leadership Not Assessed 11 Jun 2010 Announced Care and support page 13 of 15

Management and Leadership 5 - Very Good 15 Jan 2010 Unannounced Care and support 3 - Adequate 3 - Adequate Management and Leadership Not Assessed 8 Oct 2009 Announced Care and support 2 - Weak 2 - Weak 3 - Adequate Management and Leadership 3 - Adequate 17 Feb 2009 Unannounced Care and support 2 - Weak 3 - Adequate Management and Leadership 3 - Adequate 25 Sep 2008 Announced Care and support 2 - Weak 3 - Adequate Management and Leadership 3 - Adequate page 14 of 15

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. You can also read more about our work online. Contact Us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 www.careinspectorate.com @careinspect Other languages and formats This report is available in other languages and formats on request. Inspection report Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma nithear iarrtas. page 15 of 15