The Recovery Lighthouse Worthing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had a culture of safety and learning. Staff and leaders told us learning from incidents and complaints were shared during team meetings, handovers, and individual supervision. All staff told us that they were encouraged and supported to raise concerns, they felt confident that they would be treated with compassion and understanding, and would not be blamed, or treated negatively if they did so. Admissions and discharges to the service were safe. People had discharge plans in place. People were informed about any risks and how to keep themselves safe. Staff completed risk assessments for each person on admission, using a recognised tool, and reviewed this regularly, including after any incident. There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care. The service managed medicines appropriately and in accordance with best practice and professional guidance. The service had appropriate policies and procedures in place to support staff to prescribe, supply, administer and monitor medicines.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they knew how to raise concerns about the service they received, and staff encouraged them to raise concerns. For example, people told us that they felt confident in being able to raise concerns and trusted that when they did, the manager would investigate it.

Staff and leaders told us learning from incidents and complaints were shared during team meetings, handovers, and individual supervision. Staff told us the operations manager shared information regarding incidents and learning via email. Staff we spoke with gave recent examples of incidents that had occurred, and action taken to resolve them. All staff told us that they were encouraged and supported to raise concerns, they felt confident that they would be treated with compassion and understanding, and will not be blamed, or treated negatively if they did so.

The service had a culture of safety and learning. Managers completed a range of audits for processes such a as care plans and risk assessments. These audits reviewed clinical practice to ensure the service was safe and effective. However, during our onsite visit, we found out of date medicines in the medication room which shows that the medicines audit was not as effective as it could be. The provider held a monthly ‘operations priorities and learning meeting’ to review the operations and strategic plan for the provider. This looked at strategy, planning, priorities, and learning. The service manager and operations manager were included in these discussions. The service manager also attended a monthly manager's meeting to discuss governance, learning and compliance. We looked at a range of recent incidents reported by the service and saw that they were open and transparent when investigating, and implemented change based on learning identified by the investigation.

Leaders told us that they consult with other agencies when needed. For example, they would contact people’s psychiatrists where mental health concerns had been identified. At the time of the onsite assessment, only 3 people had GP summaries out of 13 people. Staff told us that GP details and peoples' summaries were requested by the admissions team during pre-admission. Leaders told us that GP services could be slow in providing these summaries. The service managed the risk of undeclared physical and mental health issues, through the triage processes and the doctor’s assessment of the person. We saw evidence of this in people's clinical records. Staff told us that people admitted to the service had hourly observations to identify any signs of withdrawal, physical health concerns or mental health concerns.

Admissions and discharges to the service were safe. When people needed to be transferred to a hospital for physical health issues, staff consulted with the hospital to ensure that peoples' treatment was continued. When people were being discharged from the acute hospital back into the providers care, the manager and operations manager would assess that the service could still meet the person’s needs; otherwise, alternative placement would be offered. People had discharge plans in place.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe and told us staff were attentive, welcoming and supportive. People told us there were enough competent and confident staff in the service to support them with their day-to-day activities. However, two people told us sometimes the weekend felt a bit quiet because there was not enough staff to take them out for a walk. People we spoke with told us before they were admitted to the service, they were initially screened by the doctor via online video call and received an initial physical health assessment.

Staff told us risk assessments for each person were completed on admission. This included early exit from treatment plans. Staff told us that if a person decided to exit treatment early, they would have a discussion with the person to encourage them to continue treatment, talked to them about the risks of leaving treatment early and then escalated their concerns to the service manager. Leaders told us that they notified the person’s next of kin and GP regarding their early exit from treatment. The service also arranged transport home for people where possible. Staff told us that risk assessments were updated following any incident or change in circumstance. Staff ensured clients medical, physical health and mental health history were included in their admission risk assessments. Staff knew about procedures in place to manage risk. Staff told us that they checked a person’s possessions on arrival for contraband items, recorded these and stored them safely. Staff told us that Closed Circuit Television (CCTV) was in place to monitor the front door. This meant that staff were aware of any people that left the property. Staff followed procedures to minimise risks where they could not easily observe people who used the service. Staff told us that each person was observed hourly following admission for the first 3 days, in addition to further observation checks throughout the day.

People were informed about any risks and how to keep themselves safe. Staff completed risk assessments for each person on admission, using a recognised tool, and reviewed this regularly, including after any incident. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person, where possible. The care planning system alerted the managers when care reviews were due. At the last inspection in July 2021, we found staff did not consistently monitor and manage risks to safeguard people from harm. Identified risks did not always have a management plan created for staff to know how to minimise a client’s risk. At this assessment, we found that staff knew about any risks to each person and acted to prevent or reduce risks. Staff identified and responded to any changes in risks to, or posed by, people. Staff shared key information to keep people safe when handing over their care to others. For example when people were transferred to the acute hospital. Staff actively discussed risks about people using the service, in handover and developed ways to manage this. Management plans were in place for any identified risks and staff knew how to manage these. Staff followed provider policies and procedures when they needed to search people or their bedrooms to keep them safe from harm. The service had a ligature risk assessment in place. A ligature risk (point) is anything which could be used to attach a cord, rope, or other material for the purpose of hanging or strangulation. At the last inspection, we found people going through detoxification did not consistently have their physical health checks monitored. At this assessment we found this had improved. We saw evidence that people received frequent physical health monitoring.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us there were enough staff in the service to support them when necessary. People told us staff were confident and competent in what they did. For example, people told us staff were very professional, very helpful, welcoming, supportive and gave them advice when they needed it. However, two people told us sometimes the weekend felt a bit quiet because there was not enough staff to take them out for a walk.

Staff told us that they were up to date with their mandatory training. Staff confirmed they had good training to perform their role and that the manager prompted them to update their training regularly. Staff and leaders told us that they could request further training when needed. Staff told us that they had received specific training on how to complete risk assessments, risk management plan and care plans. They had also received a comprehensive four-day training on medicines management with a competency assessment. Staff received the support they needed to deliver safe care. Staff told us there were enough staff to provide safe treatment and care for people. Staff told us managers operated an on-call rota to ensure staff were supported during out of hours. Staff told us they were up to date with their induction and that the induction process was good.

Staff were visible on the day of the assessment. We observed the correct levels of staff and the right roles were available. People using the service were actively engaged in activities and therapy on offer.

There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that met their needs. The service had enough staff, who knew the people using the service and received basic training to keep people safe from avoidable harm. Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift. Staff received training appropriate and relevant to their role. At the last inspection, we found that managers did not ensure that staff received appropriate specialist training in substance misuse, detox or mental health. At this assessment, we found that this had improved. All staff had completed and kept up-to-date with their mandatory training. Staff had access to specialist mental health, substance misuse and detox training; which was included in the providers mandatory training. The mandatory training programme was comprehensive and met the needs of clients and staff. Managers monitored mandatory training and alerted staff when they needed to update their training. Managers made sure staff attended regular team meetings or gave information from those they could not attend.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff supported them with their medicines when they needed them. For example, people told us staff explained the side effects of their medicines to them and they felt involved in their medicines administration. People told us they read a consent form and gave their consent to receiving medicines. People told us they felt confident about their treatment and where they had concerns they could speak to the prescribing doctor for advice. People told us they spoke to a doctor virtually during their admission process and the doctor explained all the various medicines and its side effects to them.

People’s medicines were appropriately prescribed, supplied, and administered in line with the relevant legislation and national guidance. This included the Mental Capacity Act 2005. Staff could explain the process for storing and administering medicines for people using the service. This included medicines advice and stock monitoring. However, expired medication were found. When reviewing the medicines at the service, we found 6 boxes of the same medication had expired in November 2023. Staff told us that they explained to people the signs of withdrawal and checked for these when administering the medicines.

Clinic rooms were fully equipped with emergency drugs that staff checked regularly. Naloxone was available for staff to use in an emergency and all staff were trained in how to administer it. Resuscitation equipment was easily accessible on the ground floor office, in case of emergency. The service had a medicines room that could only be accessed by staff. The room was clean and tidy and fridge temperatures were in range and checked daily. Whilst staff ensured that all clinical equipment was maintained, we identified on the day of the assessment that 1 breathalyser located in the clinic room had not been calibrated. Although staff had access to several other breathalysers, that were calibrated, there was an increased risk of staff receiving inaccurate results due to the outdated breathalyser. The manager removed the outdated breathalyser and assured us that there were other breathalysers available for staff to use. We saw evidence that a new breathalyser was ordered to replace the outdated one. We also found that the service was stocking large amounts of methadone. Whilst there is no national guidance available that determines safe stock levels for this type of medicine, there was a risk that stocking large amounts of methadone increased the chances of it being misused. We asked the provider to consider their rationale for storing this quantity of medicines and what safeguards they had in place to reduce the risk they present. Following our on-site assessment the provider told us they had reduced their stock of methadone to 100 tablets and were in the processes of reviewing their medicines stock levels following our feedback.

The service had implemented a system to improve the safe management of medicines following a number of medicine administration errors. Medicine stock checks were conducted three times a day by two members of staff. The service manager did weekly medicines audits. All inaccuracies were investigated, and action was taken as a result. The service had a medicines management action plan in place which had resulted in a decrease in the number of medicines administration and recording errors. The service had a controlled drugs policy in place. The approach to medicines reflected current and relevant best practice and professional guidance. The service had appropriate policies and procedures in place to support staff to prescribe, supply, administer and monitor medicines. However, processes regarding the monitoring of stock medication were not being followed. We found 6 boxes of the same medicine, which had expired in November 2023. We raised this with the manager, and action was taken to dispose of the expired medicines on the day of the onsite assessment. Accurate, up-to-date information about people’s medicines was available. People’s medicines were recorded on a computer system. This included any medicines that were brought in with person on admission. The service had Emergency Protocol with secondary care providers during emergencies. The two doctors employed by the service provided an on-call service seven days a week.