oasis recovery bradford - care quality commission

This report describes our judgement of the quality of care at this location. It is based on a combination of what wefound when we inspected and a review of all information available to CQC including information given to us frompatients, the public and other organisations

Mental Health Act responsibilities and Mental Capacity Act and Deprivation of LibertySafeguardsWe include our assessment of the provider’s compliance with the Mental Capacity Act and, where relevant, MentalHealth Act in our overall inspection of the service.

We do not give a rating for Mental Capacity Act or Mental Health Act, however we do use our findings to determine theoverall rating for the service.

Further information about findings in relation to the Mental Capacity Act and Mental Health Act can be found later inthis report.

Overall summary

We do not currently rate independent standalonesubstance misuse services.

We found the following areas of good practice:

• Oasis Recovery Bradford had a safe, clean and wellmaintained environment. Medication managementand storage was good, the service had emergencymedication with the appropriate audits in place.There were appropriate staffing levels with a robustprocess in place to replace staff during sickness,vacancy or unplanned leave.There was medical andmanagement cover twenty-four hours a day, seven

days a week. All clients had up to date riskassessments and risk management plans. They weredetailed and staff reviewed risks regularly duringdaily hand overs.

• All clients had a pre admission assessment whichwas done by a nurse and a doctor. The service hadclear criteria for clients entering the service andrecognised its limitations.Care plans were detailed,person centred and holistic. They identified anyphysical health needs and required support. Theservice had a skilled multi-disciplinary teamincluding doctors, nurses, support workers, recoverycoaches and a counsellor. They had good links withexternal community groups, and services such asmental health services, drug and alcohol teams,

OasisOasis RRececoveroveryy BrBradfadfororddQuality Report

21a Bolling RoadBradfordBD4 7BGTel:0203 7334195Website: www.oasisrecoverycommunities.co.uk

Date of inspection visit: 21 August 2017Date of publication: 23/10/2017

1 Oasis Recovery Bradford Quality Report 23/10/2017

mutual aid, and housing.The service supportedclients after their treatment had completed throughan after care service, onward referrals, informationabout mutual aid groups and peer networks.Consent to share information was sought fromclients during the assessment and reviewed regularlythroughout their treatment.

• Clients told us staff were caring, kind andcompassionate. They felt staff did not judge themand were empathetic to their needs. We found theservice was working closely alongside carers offeringthem support if required. The service had asuccessful discharge rate, averaging 92% over thelast 12 months. For those clients who did notcomplete their treatment the service offeredalternatives or additional support. The service metthe needs of its clients, recognising spiritual orcultural requirements. Clients told us they feltcomfortable to make a complaint, and we found theservice responded to all complaintscomprehensively in a timely manner.

• Oasis Recovery Community Bradford was well led,with local governance arrangements in place toensure good quality care, including a range ofperformance indicators, policies and procedures andclinical audit. Staff understood and followedsafeguarding, incident reporting, and complaintsprocedures, and worked within the guidelines of theMental Capacity Act (2005). Staff, clients, relativesand carers were able to give feedback on theplanning, delivery and development of the service.The directors completed detailed quarterly qualityaudits, reviewing the service governance structuresto ensure that treatment and care was safe, effective,and continued to improve.

However, we also found the following issues that theservice provider needs to improve:

• The service had completed a ligature assessment ofthe environment, however had not identified all theligatures in the communal areas.

Summary of findings


Contents

PageSummary of this inspectionBackground to Oasis Recovery Bradford 5

Our inspection team 5

Why we carried out this inspection 5

How we carried out this inspection 5

Information about Oasis Recovery Bradford 6

What people who use the service say 6

The five questions we ask about services and what we found 7

Detailed findings from this inspectionMental Capacity Act and Deprivation of Liberty Safeguards 10

Outstanding practice 22

Areas for improvement 22

Summary of findings


Oasis Recovery Bradford

Services we looked at

Substance misuse/detoxificationOasisRecoveryBradford


Background to Oasis Recovery Bradford

Oasis Recovery Bradford was originally commissioned bythe Department of Health in 2009 as the only as the onlydetoxification unit in West Yorkshire. The service changedprovider twice before UK Addiction Treatment (UKAT)took it over in 2016. The 17-bedded detoxification unit isequipped to accommodate people with limited mobilityand wheelchair users who can self-care. It can makeprovision for some additional personal care needs. OasisRecovery Bradford provides care for males and femalesaged 18 and above to complete a physical withdrawalfrom drugs and/ or alcohol, or stabilise their use safelywith medical support. At the time of the inspection therewere 14 clients receiving care and treatment at theservice. The service accepts statutory and private payingclients. At the time of the inspection, private payingclients comprised 80% of the clients receiving treatment.

As well as medical detoxification, the service alsoprovides psychosocial interventions aligned to clients’medical treatment. The interventions include grouptherapies and one to one work with a full time counsellor.

There was a registered manager in place and anominated individual. The service is regulated to carryout:

• Accommodation for persons who require treatmentfor substance misuse as its regulated activity.

Oasis Recovery Bradford was last inspected in March2016. The service was found to be compliant with theHealth and Social Care Act 2008 (regulated activities)regulations 2014.

Our inspection team

The team that inspected the service comprised of threeCare Quality Commission inspectors, including theinspection lead, Hamza Aslam, and a substance misusespecialist advisor.

Why we carried out this inspection

We inspected this service as part of our comprehensiveinspection programme to make sure health and careservices in England meet the Health and Social Care Act2008 (regulated activities) regulations 2014.

How we carried out this inspection

To understand the experience of people who useservices, we ask the following five questions about everyservice:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well led?

Before the inspection visit, we reviewed information thatwe held about the location, asked other organisations forinformation, and gathered feedback from staff membersthrough an email we asked the provider to send them.

During the inspection visit, the inspection team:

Summaryofthisinspection

Summary of this inspection


• visited the unit, looked at the quality of the physicalenvironment, and observed how staff were caring forclients

• spoke with five clients

• spoke with the registered manager, operationsdirector and lead clinician

• spoke with five other staff members employed by theservice provider, including the lead nurse, deputymanager, counsellor, and a support worker

• attended and observed one hand-over meeting andtwo recovery group work sessions for clients

• looked at seven out of 14 care and treatment recordsfor clients, including eight medicines records

• reviewed medication management, storage andclinic facilities

• looked at policies, procedures and other documentsrelating to the running of the service.

Information about Oasis Recovery Bradford

What people who use the service say

We spoke with five clients receiving care and treatment atOasis Recovery Bradford. The feedback overall was verypositive. All clients we spoke to told us the staff werecaring, compassionate and none judgemental. They saidthey felt safe and staff were knowledgeable in their role.Clients also complimented the environment. They told usit was comfortable, clean and sufficient for their needs.

However, two clients told us they would prefer moreoutdoor space. One client told us they would like to seemore activities available, for example community walks.




The five questions we ask about services and what we found

We always ask the following five questions of services.

Are services safe?We do not currently rate standalone substance misuse services.


• The service had a clean, comfortable environment, withappropriate clinic facilities and good medication management.Medicines were stored securely in locked cupboards and on alocked trolley, within a locked clinic room. This included thesafe storage of controlled drugs. There were processes in placefor the safe disposal of medicines.

• Staffing levels were adequate, and the service had a system inplace to manage sickness, absence and leave by using bankstaff and regular agency staff. The use of bank and agency staffwas low.

• All seven client records we reviewed had up to date riskassessments and risk management plans. We saw staff hadupdated the records and discussed client risk in the dailyhandover.

• The service had a doctor on call and a manager on calltwenty-four hours a day seven days a week.

• Over 90% of staff had completed their mandatory training.

However, we also found the following issues that the serviceprovider needs to improve:

• The service had not identified all the ligatures in the communalareas on their ligature environmental assessment.

Are services effective?We do not currently rate standalone substance misuse services.


• All seven care and treatment records we reviewed had careplans, which were individual and holistic. They identified anyphysical health needs and the plans in place to support thoseneeds. Each client signed all care plans.

• All clients had a full physical health examination during theiradmission. In addition the client’s GP was contacted to get awritten statement of any concerns around their physical heath.

• Clients had access to psychosocial interventions including dailysupport groups and individual support with a qualifiedcounsellor. Psychosocial interventions




• Clients were discussed by the multi-disciplinary team twicedaily in handover sessions. Client did not attend but theiropinions, thoughts and feelings were fed into the handoverthrough the daily diaries that they completed each evening.

• All staff had regular management and clinical supervision, andall eligible staff had received an appraisal within the last 12months.

Are services caring?We do not currently rate standalone substance misuse services.


• Clients told us staff were caring, kind, compassionate and nonejudgemental.

• We observed care that was client focused, empathetic and (sawexamples of positive, therapeutic relationships being builtbetween clients and staff).

• Exit survey results over the last 12 months demonstrated clientswere very satisfied with their care.

• The service worked closely alongside families and carers as partof the treatment clients received.

Are services responsive?We do not currently rate standalone substance misuse services.


• The service had a 92% successful treatment rate for the last 12months.

• The service was able to see statutory clients within the 14 daysreferral to treatment target. Private clients were able to receivetreatment as soon as all the information required was received.

• Clients knew how to complain, and there was appropriateinformation for clients about how to make a complaint. Wefound the service responded to all complaints within 28 days inline with their policy, offering a comprehensive response andan apology.

• Oasis Recovery Bradford had a full range of accessible rooms tosupport clients’ treatment and care, including a fully

• The service was able to cater to clients spiritual, religious andcultural needs. This included

offering food appropriate to religious needs such as Kosher andHalal.

Are services well-led?We do not currently rate standalone substance misuse services.





• Staff had good morale, were positive and highly motivated.Staff demonstrated the services vision, mission and values bythe way they spoke and interacted with clients.

• Staff knew who the senior management team were and feltcomfortable to address any concerns or issues they may have.

• Sickness levels were low and there were no vacancies at thetime of the inspection.

• There were local governance arrangements in place to ensuregood quality care, including a range of performance indicators,policies and procedures and clinical audit.

• The service demonstrated ways in which it was trying toimprove as a service by implementing a bespoke electronicrecord keeping system and developing an online aftercaresystem.




Mental Capacity Act and Deprivation of Liberty Safeguards

Mental Capacity Act and Deprivation of LibertySafeguards were part of the services mandatory trainingmodules. All the staff had completed this training.

Care records we observed and treatment agreementsshowed that clients had signed and consented totreatment, sharing of information and confidentialityagreements. Discussions with clients demonstrated thatthey were all aware of, and agreed with, their treatmentand care.

Examples were given where clients did not have capacityto consent to treatment, for example on admission due tointoxication, and the service had waited to complete theadmission assessment until the client had regainedcapacity to make their treatment decisions.

Detailed findings from this inspection


Safe

EffectiveCaringResponsiveWell-led

Are substance misuse/detoxificationservices safe?

Safe and clean environment

Oasis Recovery Bradford was located within a purpose builttwo-storey building. The ground floor comprised of therapyrooms, dining room and consultation room, and staff areas.The first floor comprised the client bedrooms, laundryroom and the clinic. We found the environment includingthe clinic to be clean and well maintained. Client areaswere comfortable, the fixtures and furnishings were in goodcondition and there was adequate space for clients toreside within.

The service had accessibility provisions for persons withmobility issues including lift access to the first floor. Wereviewed the fire safety of the building and found therewere two evacuation points on either side of the buildingso clients could exit in a timely manner, all clients hadpersonal emergency evacuation plans, and an emergencyevacuation chair was located on the first floor. The firealarms were last tested in January 2017 and the servicelogged weekly fire alarm tests. The service had annual gassafety checks and portable appliance testing in June 2017and August 2017 respectively.

The service carried out environmental risk assessments,which identified issues within the service and managementplans to address them. Overall, the building was kept safebut we found an example where a television wire within thefamily room that had not been secured properly to the wall.As the wire was suspended in the air, this meant it couldcause a potential risk to children and families visiting theroom.

There was a fully equipped clinic room with anexamination couch and the necessary equipment to carryout examinations, as well as resuscitation equipment.There were crash grab bags on each floor that were stockedand maintained.

The service conducted a ligature risk assessment wherebyit identified ligatures within the service and how staff wouldmitigate risks. A ligature is a place to which clients intent onself-harm might tie something to strangle themselves. Theservice had identified the ligature points where clientswould be left alone for example the client bedrooms buthad not identified all potential ligature points within thecommunal areas in the ligature risk assessment. However,this service did not accept referrals for clients at high risk ofsuicide or self-harm, the client risk assessments werecomprehensive and up to date, staff and clients had apresence in the communal areas. The service had hourlyobservations at night, which could be increased if staff hadany concerns in relation to a client and had a bedroomnext to the staff room should a client require increasedlevels of observation. In addition, there had been noincidents of client attempting to ligature. The registeredmanager confirmed that the service would review andupdate their current ligature risk-assessment identifyingthis mitigation.

The service could accommodate 17 clients at any one time.The bedrooms were single occupancy, except for one triplebedroom available for clients who preferred to share. Asthis was a mixed sex unit, staff told us that only clients ofthe same sex would share a bedroom. All bedrooms haden-suite toilets and shower-rooms and all but onebedroom were situated on the second floor. Clients couldlock their bedrooms and they had fobs to gain entry to theirown room. Staff also had fobs to gain entry to all thebedrooms. We spoke to male and female clients both ofwhom told us they felt safe and shared no areas of concern.The service did not have separate lounge facilities for

Substancemisuse/detoxification

Substance misuse/detoxification


males and females, however, the service had an additionallarge therapy room, which had the same facilities as thecommunal lounge clients could access if they requiredmale or female only space.

The clients did not have an alarm system in their rooms,however, any clients identified as being at risk or unwellwere given a walkie-talkie radio. This had a panic button,which alerted staff directly, as well as enabling them tocommunicate verbally if required. The service had awalkie-talkie policy to which staff could refer to in order forthem to work safely.

The staff office was situated on the first floor. All staff toldus that blind-spots were mitigated using regularobservations, and staff being always visible in communalareas.

The infection control policy for Oasis Recovery Bradfordincluded protocols for hand hygiene, disposal of sharpsand clinical waste, the use of personal protectiveequipment, blood borne viruses and general housekeepingto prevent infection. Cleaning schedules had been signedand dated when the action had been completed. Handhygiene posters were on display. Staff were aware of theirresponsibilities, and knew where to access the policy andprocedures should they require clarification.

Safe staffing

Oasis had 17 substantive working at the time of theinspection. They included the service manager (registeredmanager), a deputy manager, recovery coach (a workerwho supports the client with their recovery usingpsychosocial interventions), support workers, nurses and acounsellor. Oasis used three doctors, who work on an oncall rota so that a doctor is available at all times. A memberof housekeeping staff and maintenance worker were inaddition to these staff.

The service had four whole time equivalent nurses with novacancies for these posts. The nurses covered two 12 hourshifts per day, seven days a week. The service had fivewhole time equivalent support workers at the time of theinspection including one newly recruited member of staff.There was one support worker alongside the nurse over thetwo 12 hour shifts in the day.

The service had additional an support worker workingMonday to Friday 9am till 5pm, and 11am till 5pm on theweekends. Due to the increase in referrals, the service had

newly recruited two support workers to cover a 4pm until12am shift seven days a week. The increase in staffingmeant staff could spend more therapeutic time with clientsand manage the risks more effectively.

The recovery coach, deputy manager, centre manager,counsellor, and administrator worked on weekdays only.However, the service manager or lead nurse were alwayson call. The operations director said he could be on callwhere the service manager and lead nurse wereunavailable.

In the last three months, between May 2017 July 2017,there were 51 shifts filled by bank and agency staff due tosickness, leave and absence. There were no shifts not filledwithin the same time period. The registered manager toldus they had a strong group of regular bank and agency staffto cover short falls within staffing when it occurred.

The nursing staff were responsible for administering theclient medication and overseeing the clients’ treatmentand care, after the initial admission assessment by thedoctors. The centre staff could contact them by telephoneor email and the doctors would attend the centre ifrequired. There was management cover twenty-four hoursa day, seven days a week. There were no reported incidentsin the last 12 months where a doctor or member ofmanagement could not be contacted.

At the time of the inspection overall mandatory trainingfigures demonstrated a compliance rate of over 90%.Training that had a 100% compliance rate included,safeguarding children, safeguarding adults, riskassessment awareness, basic life support and MentalCapacity Act. There were no training modules that had acompliance rate below 75%.

Assessing and managing risk to clients and staff

Oasis Bradford had a clear admission criteria. It did notaccept detained clients and could not accept people thathad a high level of physical support needs. The service didalso not accept clients who were at high risk of suicide orself-harm. Many of the clients may suffer outlier issues totheir addiction such as mental health issues to which theservice had embedded training around supporting peoplewith ‘anxiety’, ‘depression’ and ‘understanding mentalhealth’.

All clients had a pre-admission assessment, whichsupported the risk formulation. Where the service required




further information around risk to complete acomprehensive risk assessment, they made theappropriate steps in contacting relevant agencies, forexample, mental health teams, GP and probation. Forstatutory clients the referring agency sent all the care notesprior to the assessment. Using this pre-admissionassessment and referral information, the service identifiedwhether they could manage the risks pertaining to theindividual in line with their admission criteria .and offer theclients a place at the unit for treatment.

Risk was reviewed by the doctor and the nurse at theadmission assessment that was completed on the day theclient was due to enter the service. Risk information wasreviewed twice daily at the morning and evening handoversby the staff, including the nurses. Each client was discussedin turn using information from staff general observation,nurses’ physical observations and client feedback throughdaily diaries. This information was forwarded to the doctorto review following each handover.

We reviewed seven out of 14 risk assessments andmanagement plans. We found all the risk assessments andplans to be comprehensive, up to date, and reviewedregularly. We found a recent example where a client hadbecome at risk of having seizures; this had been updatedwithin the risk management plan and clinical notes 24hours after the incident had happened. We saw this wasalso discussed within the handover.

The service managed their medication safely. Fridgetemperatures were monitored and the environment wasmaintained and kept clean. We reviewed eight out of 14client medication cards, all of which had appropriatedocumentation and relevant up to date signatures.Medicines were stored securely in locked cupboards and alocked trolley within a locked clinic room, this includedsafe storage of controlled drugs. Controlled drugs aremedicines that are more liable to misuse and thereforeneed close monitoring. We checked a sample of medicinesstored in the service and found these were in date andmatched stock records. An accurate register was in place torecord the handling of controlled drugs. We viewed recordsthat demonstrated the controlled drugs were disposed ofappropriately. The service had a controlled drugsaccountable officer who was also the performance andcompliance manager.

There were procedures in place for children to visit. Thesewere included in the visiting policy, which stated that thechild is the responsibility of the parent and that visits wouldtake place in the family room.

The service had local safeguarding protocol to protectadults and children, which was outlined within theirpolicies. There was a safeguarding children and adultspolicy to which staff could refer to. Staff understood theirresponsibilities under safeguarding and knew who theycould contact if they had any concerns or issues. Staff alsorecognised the responsibility to notify the Care QualityCommission in the event of safeguarding and deaths. Sincethe service had been taken over by a new provider therehad been no safeguarding alerts made to the localauthority.

We reviewed five staff files and found all staff had hadappropriate enhanced disclosure and barring checks doneprior to employment. These checks inform the employer ofany historic or current criminal convictions, including safetyregisters that the individual may be subject to.

Track record on safety

Since UK Addiction Treatment became the provider forOasis Recovery there had been three serious incidentsbetween January 2017 and July 2017. The incidentsincluded two client deaths and an emergency evacuationdue to a fire, none of the serious incidents were related.

One incident required the service to implement theirbusiness contingency plan. Due to a fire in theneighbouring building the service had to evacuate itsclients over safety concerns. The operations director told usthe service could not have done anything differently, andthe business contingency plan was followed accordingly. Asa result clients were still able to carry out theirdetoxification safely until they were allowed back into thebuilding. Staff told us the incident was well managed andthe service worked together in order to continue care andtreatment.

Reporting incidents and learning from when things gowrong

All staff were aware of the types of incidents that should bereported, including environmental concerns, accidents,medication errors, aggression and violence, andsafeguarding. They confirmed that the incident book was




kept in the office and this was completed immediately bythe person witnessing the incident. They stated that theywere encouraged to report all incidents and felt supportedto do so.

We saw staff were regularly reporting incidents, and allincidents were investigated. We found these werediscussed during daily handover meetings and teammeetings where appropriate. There was an example of anincident where a medication error had taken place and theoutcomes included staff re-training in medicationmanagement, as well additional support throughsupervision. This evidence was corroborated within thesupervision notes.

We found good examples of learning from incidents withinteam meeting minutes, handover minutes and supervisionnotes. The service had newly established a monthly innewsletter in July 2017 which managers told us would be aplatform where learning could be shared.

Duty of candour

Providers of healthcare services must be open and honestwith service users and other ‘relevant persons’ (peopleacting lawfully on behalf of service users) when things gowrong with care and treatment, giving them reasonablesupport, truthful information and a written apology.

The service had a Duty of Candour policy in place, whichclearly informed staff what their obligations and dutieswere under this regulation. Staff understood their roles andfelt that they were always honest and open with clients.Where a serious incident had occurred the service hadformally apologised to the family and people involved, andoffered their support where appropriate, for example,bereavement counselling for family and carers.

We reviewed one incident where a medication error hadtaken place. After it had been investigated the member ofstaff involved issued an apology to the client outlining whathad occurred and the actions that had been taken as aconsequence.

Are substance misuse/detoxificationservices effective?(for example, treatment is effective)

Assessment of needs and planning of care (includingassessment of physical and mental health needs andexistence of referral pathways)

The service developed a care plan with its clients within 48hours of their treatment through a care plan meeting. Thecare plans were then regularly reviewed during ‘care planreviews’, whereby clients discussed their outcomes withwhat goals had been achieved and what further workneeded completing. The recovery coaches and thecounsellor conducted the care plan reviews. This fed intothe psychosocial part of clients’ care and treatment.Wereviewed seven out of 14 care and treatment records. Wefound care plans to be holistic and person centred. All thecare plans had been reviewed regularly and were up todate. Clients were offered a copy of the care plans and theywere signed by both the clients and member of staff.

A pre-admission assessment was completed with clients,which included a detailed history of the

client including physical and mental health, relationships,offending behaviour, and social circumstances includinghousing, employment and education. The service alsocontacted the GP to get a statement of any physical healthcomplications or issues which the service needed to bemade aware of. Routine blood tests were completed butthe consultant requested additional blood work prior toadmission where there were other physical healthconcerns. Blood borne virus testing and vaccination wasoffered on admission to the service and then referralsmade to the client’s local GP to complete the treatment.

Upon admission, all clients undertook a full physical healthcheck which included; blood pressure, blood sugar, pulse,urine screening, height, weight and oxygen saturationlevels. During the rest of the detoxification the clients hadregular basic physical health check done on a daily basisincluding, blood pressure, pulse and urine tests. If therewere any concerns further detailed checks were carriedout.

The doctor discussed the medication options for thedetoxification with the client, and provided them withinformation around these medications. The detoxification




was overseen by the doctor remotely. The doctorprescribed the agreed medication regime, and the nurseadministered this medication and monitored the client.The nurse would discuss any concerns and changes inmedication with the doctor on an ongoing basis.

At the time of the inspection the service were using paperrecords. All the records were kept securely within a lockedroom which only staff could access. We found staff wereupdating contemporaneous records frequently andreflecting any significant changes within the care plans andrisk assessments. Staff told us this duplication of workrequired more time.

The service were due to move over to a new electronicrecord keeping system after the inspection. All staff hadbeen trained in the new system which was bespoke forsubstance misuse services like Oasis Recovery Bradford.The registered manager told us they would phase in thenew system and begin to use it for new clients entering theservice. The service was due to implement the new systemimmediately after our inspection. The new system aimed tostreamline the record keeping to a more effective system.All the staff we spoke to were positive about moving over tothe new system and recognised the benefits.

Best practice in treatment and care

The service offered medication to assist detoxifications forclients suffering both alcohol and drug dependency. Thedetoxification offered ranged between seven to 28 daysdepending on the substance or substances the client wasdetoxifying from. This incorporated a full therapeuticprogramme to coincide with the medication detoxification.

The psychosocial interventions delivered in one to onesessions and in a group setting were evidence based andrecommended by the National Institute for Health and CareExcellence, including motivational interviewing andcognitive behavioural techniques. There was a four-weekrolling group programme with two therapeutic groups perday. This included a ‘process group’ facilitated by staff tosupport clients to understand their immediate issues,explore them with input of their peers and then come upwith actions to help them to resolve the issue. Other groupsincluded relapse prevention, the effects of detoxifying,exploring emotions and relationships, mind mapping, life

skills and an educational group. The third and final groupof the day was a recreational activity designed to end theday on a positive with the recovery community in theservice, for example a quiz or a walk.

The service had recently employed a full time counsellor tooffer more structured one to one sessions. This approachused psychological models such as cognitive behaviouraltherapy to support clients’ individual needs.

The client completed daily diaries so staff were aware on adaily basis how they were feeling mentally, emotionally andphysically, and how well they were engaging with thetherapeutic programme. These were used as guide foradditional support, like a one to one, increasedobservations, or to contact the doctor regarding a changeof medication. We observed a handover where staffdiscussed individual clients based on their diary and whatsupport could be offered.

We viewed eight medication treatment charts in use at thetime of the inspection and found that these wereaccurately completed. They included the use of clients ownmedicines and administration instructions for medicinestaken on an “as required” basis.

The nationally recognised withdrawal scales used by OasisRecovery Bradford included the clinical institutewithdrawal assessment revised scale for alcohol, theclinical institute withdrawal assessment scale forbenzodiazepines, and the clinical opiate withdrawal scale.

The service had the means to monitor nutrition and fluidintake for clients. They had monitoring charts available forstaff. At the time of the inspection there were no clientswho were being formally observed for nutrition andhydration.

Routine audits were carried out for care and treatmentrecords and medication management. The audits werereviewed by both the registered manager and operationalmanager and discussed in the bi-monthly clinicalgovernance meetings.

Skilled staff to deliver care

The service had a range of skilled staff to support thedelivery of care and treatment to its clients. Theseincluded, nurses, doctors, a qualified counsellor, a recoverycoaches, support workers and staff trained in dialectical




behavioural therapy. The service also linked into otherorganisations or groups including mutual aid groups,community substance misuse services and mental healthservices.

Oasis Recovery Bradford had a training matrix mappedagainst the specific roles for all staff, and

all mandatory training and specialist training was either inprogress or completed. Training included supporting staffin understanding other issues which may impact clientsinvolved in substance misuse such as understandingmental health, anxiety and depression.

All staff received monthly management supervisions fromthe centre manager. The nursing staff also receivedquarterly clinical supervision from the lead nurse. The leadnurse received clinical supervision with the consultant.Supervision ensures that staff are competent to fulfil theirrole, that they are adequately supported and that anyunderperformance can be identified. For nursing staff,clinical supervision was also a requirement of theirregistration. All staff had received an appraisal in the last 12months. Staff that had newly started had a provisionalappraisal date scheduled in. The doctors had theappropriate practising privileges in place and all threedoctors had their practising licence revalidated with theGeneral Medical Council.

Multidisciplinary and inter-agency team work

A multidisciplinary team worked with clients from thepre-assessment stage through to discharge from theservice. The team included doctors, nurses, a counsellorand support workers. The service liaised with externalstakeholders where appropriate and these included theG.P, mental health teams, criminal justice teams, housingproviders, mutual aid groups, and other voluntaryorganisations. The service also had links with organisationsfor onward referrals after the treatment was over. We weregiven examples of how staff referred clients onwards tomental health services out of the area.

Staff had two handovers daily, in the morning and evening.We observed a morning handover and found it to becomprehensive and succinct. Nursing staff reviewed theclinical aspect of each client including medication, physicalhealth and any concerns or areas of progress. The recoverycoach and counsellor discussed in turn the therapeutic andpsychosocial element of each client’s care. They coveredmental well-being, diaries, group engagement,

observations, and concerns. All the notes were shared withthe doctors. Any risk information was also discussed withinthe handover and additional measures were put in placewhere appropriate.

Each client had a clearly identified named nurse whose rolewas to liaise with their community GP regarding any healthconcerns and any medication. They also had a namedrecovery coach, whose primary role was to take ownershipof the relationships with those involved in the clients care,including the referring agency and community careco-ordinators if it was a statutory referral.

As well as the daily hand overs the team had monthlymeetings where they discussed the service as a whole. Wereviewed team meeting minutes and whilst, there was noset proforma for the agenda, the meetings covered areassuch as risk, audits, developments, training, access anddischarge.

Good practice in applying the MCA (if people currentlyusing the service have capacity, do staff know what to do ifthe situation changes?)

Mental Capacity Act and Deprivation of Liberty Safeguardswere part of the services mandatory training modules. Allstaff had completed both modules.

There were no clients subject to Deprivation of LibertySafeguards. Although clients were not allowed to leave thepremises as part of their treatment, they could leave theservice if they wished as they were assessed as havingcapacity to make decisions, even if it was an unwise one.Clients were made aware if they left the premises it wouldbe considered as self-discharge.

Care records we observed and treatment agreementsshowed that clients had signed and consented totreatment, sharing of information and confidentialityagreements. Discussions with clients demonstrated thatthey were all aware of, and agreed with, their treatmentand care.

Examples were given where clients did not have capacity toconsent to treatment, for example on admission due tointoxication, and the service had waited to complete theadmission assessment until the client had regainedcapacity to make their treatment decisions.

Equality and human rights




The protected characteristics of the Equality Act 2010requires services to ensure people using or working at theservice are not treated unfairly. The characteristics include,gender, sexuality, race, religion and disability.

The service conducted an equality impact assessment inJune 2017 on its policies and procedures. This assessedwhether the service was able to meet the needs of all thepeople who used it. Some examples provided by theservice on how it could meet the needs of the people whoused it based on the protected characteristics includedhaving accessibility for people with disabilities or mobilityissues, and providing nutrition appropriate to clientsreligious or cultural beliefs.

A blanket restriction the service had was to search clients’belongings during admission. This was a non- invasivesearch and the clients were made aware of this prior to theadmission. The service conducted this search so that noillicit substances could be brought into the service whichwould jeopardise the detoxification treatment of otherclients.

Management of transition arrangements, referral anddischarge

The target for all statutory referrals was 14 days fromreferral to an admission. The service met this target. Privatereferrals generally took less time from the point of referralto admission as this was based on how quickly the servicecould get the relevant information from the GP.

Clients were aware of their length of stay prior to admissionand this was reflected within their care planning. Clientscould extend their treatment, however, this was basedupon individual need, funding, and availability.

Clients had a structured discharge out of the service. Asmany of the clients were private paying, the service offereda graduation pack which included all the relevantinformation pertaining to the locality of the client,including mutual aid groups, recovery teams, mentalhealth services and other voluntary organisations.Statutory clients were discharged back to the localcommunity team they arrived from with a formal handoverto the clients care coordinator.

All clients had the opportunity to return to the service foradditional support or advice after their treatment. Theoperations director told us they were in the process ofrecruiting a new member of staff who would be responsible

to set up an improved aftercare system. They wereplanning to set up a social media platform so clients couldkeep in contact with the service for further care. It alsooffered the opportunity for continuous peer support andnetworking.

All client care records had a detailed plan if the client lefttreatment early, including who should be contacted andthe address they would return to. Harm minimisationinformation and mutual aid meetings information werealso given on discharge.

Are substance misuse/detoxificationservices caring?

Kindness, dignity, respect and support

All the clients we spoke with were overall very positiveabout their care and treatment at Oasis Recovery Bradford.They told us staff treated them with kindness andcompassion. They felt staff were empathetic, understoodtheir needs and were non- judgemental. Three clientsidentified staff as being knowledgeable and all the clientswe spoke with told us they felt safe.

We observed staff to be friendly and found they interactedwith clients well. They understood their clients’ individualsupport needs, which was demonstrated during the dailyhandovers and group work. If a client needed additionalone to one on the day they could request it and the serviceprovided this support.

Staff and clients were aware of the need to respect people’sprivacy and showed a great awareness of the need forconfidentiality, particularly in groups where personalinformation might be shared as part of the therapeuticprocess. A confidentiality agreement was observed in thetreatment contract, and was discussed in thepre-admission assessment.

Three clients told us they would like to see more regularcommunity activities such as community walks beingmade available to them. They felt this supported theirrecovery and treatment.

The involvement of clients in the care they receive

Clients were fully informed through a clear admissionprocess, which included a pre-admission assessment, a fulladmissions assessment and a full orientation to the




service. This enabled clients to understand the ethos andrestrictions of the service. The admission handbook was inall client bedrooms throughout their stay, and wasavailable on line prior to admission.

Each client was allocated a named worker who wasresponsible for working with the client through theirtreatment journey, including completing the care plan andone to one therapeutic interventions for continuity. Allclients had current, signed care plans and agreed dischargeplans should they leave the service unexpectedly.

All clients completed an exit survey upon their dischargefrom Oasis Bradford. The survey enabled management toevaluate the experiences of clients to drive improvementthroughout the service. We reviewed the combined exitsurvey outcomes, between 1 October 2016 and 31 August2017, which included:

• Seventy one per cent of clients felt their treatment was‘very good’, and 22% felt it was ‘good’.

• Seventy nine per cent of clients felt they were ‘veryinvolved’ in their care and treatment, and 17% felt asthough they were ‘involved’. Only 1% of clients felt thatthey were “not very involved”, and no clients said theywere “not involved” in their care and treatment.

• Ninety seven percent of clients said they ‘always’ gaveconsent for their care and treatment, with 2% sayingthey ‘often’ gave consent.

• Eighty five percent of clients felt their needs were‘always met’ within their care plan, 95% of clients saidthey were ‘always’ treated safely, and 91% felt they were‘always’ treated with respect.

The figures for the exit survey demonstrated positiveresults across all the questions that were asked of clients.Clients could provide informal feedback throughout theirstay, this was captured in one to ones and communitygroup meetings.

We found the service worked closely with family and carersand involved them in the care and treatment of clients.During handovers staff discussed any family issues whichmay impact on clients’ wellbeing, as well as which carerswanted updating and which carers were coming to visit.

Are substance misuse/detoxificationservices responsive to people’s needs?

(for example, to feedback?)

Access and discharge

At the time of the inspection there were 14 clients receivingcare and treatment. The service could take up to 17 clientsat any one time. The service had clear admission criteria,which included the client having a willingness to engage inthe service and to agree to the treatment contract. It alsoensured they were not detained under a section of theMental Health Act, and they had a detailed discharge andaftercare plan in place.

The average length of stay for client detoxing from alcoholand drugs ranged between 10 to 20 days. There was amaximum of a 28 day treatment package available forclients which included therapeutic work. The length of staycould be changed during the treatment should the needsof the client change.

The service took both statutory and private (self) referralsinto the service. The majority of referrals were privateclients which accounted for 80% of the clients during thetime of the inspection. Over the last 12 months, privateclients accounted for 66% and statutory clients were 34%of referrals into the service. The service manager told ussince the new provider had taken over the service therehad been a significant increase in private clients. We foundreferrals for the service came from a number of areas whichincluded, North Yorkshire, Manchester, Lincolnshire andBlackpool. The service target to take on statutory clientswas within 14 days. They met this target in allcircumstances unless there was a delay receiving thereferral information. Private clients could receive treatmentas soon as the essential information was received fromtheir GP.

The service could admit clients seven days a week,however, weekend admissions were planned and theservice increased their staff to appropriate levels shouldthere be a weekend admission. In the last six months therewere 31 weekend admissions.

We reviewed the discharge data for the last three monthsand found :

• In May 2017 there were 47 admissions with three non-completions. This meant the service had a 94%successful completion rate.




• In June 2017 there were 34 admissions with eightnon-completions. This mean the service had a 77%successful completion rate.

• In July 2017 there were 50 admissions with fivenon-completions. This meant the service had a 90%successful completion rate.

Where there service identified ‘non-completions’, thismeant clients did not always fully complete their treatmentdue to self discharge, breach of contract, or completingtheir medical part of their treatment early but notremaining for the psychosocial element of it. Figures overthe last 12 months demonstrated the service had anaverage 92% successful treatment completion rate. Allclients were offered additional support if they left theirtreatment early. This included a transfer to anothertreatment facility, an appointment made with their GP,information and/or referral to mutual aid groups,telephone support and onward referral back to thecommunity referring service (statutory clients).

The facilities promote recovery, comfort, dignity andconfidentiality

Oasis Recovery Bradford had an accessible clinic room,including a couch and space to examine clients. It also hada full range of rooms to support clients’ treatment and care.This included rooms available for one to oneappointments, a lounge for group activities, a family room,a dining room including facilities to allow clients to getinvolved in community chores like washing up, laundryrooms for clients and staff, and a whirl-pool bath to helpclients relax and alleviate some of the discomfort thatclients can experience during detoxification.

Confidentiality, policies and procedures were discussedwith clients on admission and in the weekly communitygroups. Clients had a large outside space for clients to haveaccess to. This provided an area for clients who wished tosmoke to do so. One client told us that this may have anegative impact for clients who do not smoke and theservice should provide an alternative space or moreoutdoor walks. The exit survey results over the last 12months demonstrated 40% of the clients rated theaccommodation as ‘very good’ and 38% rating it as ‘good’.

Clients had access to snacks, and drinks 24 hours a day,and had a chef to cook lunch and dinner. Eighty fivepercent of clients rated the food as ‘always being sufficient’with only 3% rating the food as ‘rarely sufficient’.

All client bedrooms had TVs as well as the two lounges.Clients had access to board games and afternoon activities.Two clients told us they felt there could be morecommunity based activities during the afternoons andevenings. At the time of the inspection the service hadafternoon walks scheduled in. The service manager told isit was difficult to facilitate more frequent communityactivities due to clients being at different stages of theirdetoxification and having different risks. We found clientswere able to create their own groups and activities, wefound one example of a spa evening that had been set upby the clients.

Clients could personalise their bedrooms, we sawexamples where clients had put memorable picturesaround their room.

Meeting the needs of all clients

The service had accessibility for people with mobility issuesor disabilities. There was lift access to the first floorbedrooms. They also had adapted bedrooms whichincluded modified wash facilities and pull cord alarms.

Information leaflets were widely available throughout theservice. Information was available in easy read. Leaflets inlanguages other than English could be accessed if required.Leaflets included how to make complaints, localcommunity services, information about the service, clients’rights and activities that were happening within the service

The service was able to provide food according to clients’cultural and religious needs. The service manager told usthey could cook food that was Halal, Kosher, vegan, or theycould adapt the menu to meet a client’s needs. Any dietaryneeds were established at the pre-admission assessment.

Clients also had access to spiritual and religiousobservations. We saw an example of the service inviting apriest to visit a client who wanted some spiritual support.

Listening to and learning from concerns andcomplaints

The service had a complaints policy which outlined theirresponsibility in responding to complaints. Information onhow to complain was in the client treatment contract andthe admission handbook which all clients had a copy of.Complaints information was accessible throughout theservice and the clients we spoke with told us they feltcomfortable to make a complaint should they need to.




Clients told us they would discuss issues informally withstaff before proceeding to make a formal complaint.Complaints were also collated through the client exitsurveys and on a daily basis through the client daily diaries.

In the last 12 months there were six formal complaintsmade to the service, none of which were upheld. Wereviewed three complaints and found all three wereinvestigated and responded to within 28 days and led bythe operations director. All three complainants received awritten outcome including the evidence for and againsttheir concerns. All complaints also had an apology from theservice that the client felt the need to make a formalcomplaint.

Are substance misuse/detoxificationservices well-led?

Vision and values

The registered manager told us the visions and values ofthe service had been adopted from the previous providerand agreed by staff and the board. Oasis Recovery’smission statement was to provide high quality, outcomefocused drug and alcohol addiction recovery servicesnationwide. Their vision was, every person and familysuffering from drug and alcohol addiction has a free choiceto fully recover from their addiction and achieve theirpotential.

The core values comprised:

• We act with integrity and show respect

• We are all accountable

• We are passionate about our business, our service andour clients

• We have humility and hunger to learn

• We love success

• We strive for simplicity.

Although staff could not tell us about the core values, theywere able to demonstrate it with the passion they spokeabout the service and through their interactions withclients. Staff were aware of senior management within theservice and their roles. Staff felt senior management werevisible and approachable.

Good governance

The senior management team for Oasis Recovery Bradfordcomprised the service manager, lead nurse, director ofquality, operations director and lead clinician. The hospitalhad an embedded governance structure with a number ofroutine meetings, which allowed senior managers to haveoversight of quality and key performance indicators. Theclinical governance meetings were held bi-monthly andwere well attended by all of the senior management team.We reviewed meeting minutes for quarter one and two of2017 and found that during the meeting the service werereviewing key performance indicators, audit outcomes,incidents and governance changes within the organisation.The senior management team had access to an electronicdashboard, which provided live figures from the exitsurveys completed by clients leaving the service. The teamreviewed the data to drive improvement and changeswithin the service. An example of this is the service installedtelevisions in all client rooms, as it was identified thoughfeedback that clients wanted to improve their comfortwhilst having their treatment.

Staff attended monthly team meetings as well as dailyhand over meetings. The team meeting did not have a setagenda, however, we saw the team discussed, audits, exitand entry into the service, training and supervisions. Itemsfrom the team meeting could be fed into the clinicalgovernance meetings. Although the team meeting minutesdid not learning from incident embedded as part of theirteam meeting, we found examples of staff taking actions asa result of an incident happening.

We reviewed policies in relation to the running of theservice, including the adult and child safeguarding policy,managing incidents policy, duty of candour policy andwhistleblowing policy. We found all polices had beenreviewed by the service within the last 12 months and weredue for their next review in October 2019.

The whistleblowing policy provided staff with a clearescalation process, and the opportunity to raise anyconcerns internally. It also provided staff with details toaddress concerns externally if they felt unable to raiseconcerns internally. The policy encouraged staff to raiseany concerns or issues to ensure the safe running of theservice. The duty of candour policy made clear how theservice would be transparent, honest and communicateany failings towards clients.




Oasis Recovery ensured that clients’ views were sought viaentry and exit questionnaires in order to improve theirservice delivery and the experience of the clients duringtheir treatment.

There were local governance arrangements in place toensure good quality care, including quarterly qualityaudits. All mandatory training was up to date and matchedthe current job descriptions of staff. The service managermonitored compliance with mandatory training and used asystem which flagged up any staff which were dueundertake training again. At the time of the inspection, theservice had an overall compliance rate of over 90%. Staffhad regular management and clinical supervision anddocuments. All staff had received an appraisal within thelast 12 months and staff that had been employed for lessthan 12 months had their appraisal scheduled in.

The service had a risk register that had been reviewed inFebruary 2017. The highest risk was admitting clients withchallenging behaviour. Actions to mitigate this risk were forstaff to complete relevant training during induction and notto lone work with clients who were presenting aschallenging.

Leadership, morale and staff engagement

Staff felt confident in being able to approach the registeredmanager with concerns without fear of victimisation andwere aware of the whistleblowing policy.

Sickness levels were low (below 5%) and there were novacancies at the time of the inspection. The service hadnewly recruited two members of staff to work a 4pm until

12am shift. These staff were undergoing their induction atthe time of the inspection. This shift was created as theservice felt there was a need to have extra staff on site atthat time for therapeutic purposes.

All staff we spoke with were highly motivated and spokepositively about their work at the service. They said thatmorale was good, despite the potentially stressfulenvironment they worked in. They told us that all membersof the multi-disciplinary team listened to each other andvalued each other’s opinion. We observed a handoverwhere this was demonstrated, all staff present had achance to share their views and everyone within themeeting made positive contributions.

Commitment to quality improvement and innovation

The service was in the process of implementing new waysof working to improve the service delivery. The service weremoving to an electronic system to store client care andtreatment records. This system was designed specificallyfor substance misuse services such as Oasis RecoveryBradford. Management told us it would help streamline therecord keeping, reduce duplication and improve the qualityof documentation.

The operations director told us the provider had newlyrecruited someone to set up an online platform for allclients accessing the service across the country. Thisplatform would enable more structured aftercare serviceremotely via the internet. It meant clients could have facetime support from the service they received care from evenif they lived out of area. It also enabled a peer networkplatform so clients could support each other through theirrecovery journey. The operations director felt this servicewould be in place and embedded at the beginning of 2018.




Areas for improvement

Action the provider SHOULD take to improve

• The provider should ensure all ligature points withinthe premises clients have access to are identifiedwithin the ligature risk assessment. All ligatures andhealth and safety risks should be safely mitigated oreliminated.

Outstandingpracticeandareasforimprovement

Outstanding practice and areasfor improvement


oasis recovery bradford - care quality commission

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