Turning Point Drug and Alcohol Wellbeing Service - City of Westminster and RBKC

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is our first inspection for this service. We rated this key question as good.

This meant people were safe and protected from avoidable harm.

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.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff we spoke with knew what incidents to report and how to report them. Staff reported incidents appropriately, both on the provider’s internal reporting system and to relevant external bodies. 99% of staff had completed the Duty of Care and Handling Incidents Awareness training.

We reviewed information about incidents reported within the service for the past 6 months. There were no incidents classed as severe during this period. Challenging behaviour was a common type of incident. Staff followed the provider’s assisted access procedure and received training in conflict management to help reduce the occurrence of these.

The service had established a number of systems to share learning and best practice. These included thematic continued professional development (CPD)sessions, safeguarding leads, mortality and clinical governance meetings. Managers shared learning with staff in monthly meetings and updated local training with lessons learnt. This process extended beyond the organisational boundaries. Partner agency stakeholders spoke positively about the key role the Turning Point staff took in a number of forums, such as a panel reviewing drug-related deaths, review of continuity of care for prison leavers and the local drug information system. One of the actions included improved training in substance misuse for the local hostel teams.

We reviewed a sample of 5 incidents records. These were reported appropriately and reviewed by managers, with actions documented and risk assessments updated where relevant. Staff received debriefs and support following incidents.

Staff always worked with people and partners to design, establish and maintain safe systems of care, in which safety was always well-managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The service ensured people could access support without delay. People could self-refer without a prior appointment in a way that suited them, online, in person or by telephone. At the time of our inspection, approximately 40% of clients self-referred. The service also received referrals from other agencies, primary and specialist care, local mental health services, probation and other statutory services. Each client was allocated a keyworker who coordinated their care.

The service had established a dedicated team who oversaw new client intake and arranged access to the pathway that met their needs. Staff told us that most people could access support on the day of referral. Staff were acutely aware of the risks of overdose and death from the novel synthetic substances and the importance of immediate access to treatment. A new client presented for assessment during our site visit to the Acorn Hall hub. Within 2 hours of their arrival, staff arranged a comprehensive assessment and access to opioid substitute treatment. Staff also supported them with harm reduction, housing referral and provided a mobile phone. Staff told us the client was thankful for the support and had not expected to receive it on the same day.

The service’s referral and admission processes ensured that all essential information about the client was received to determine if their needs could be met safely. Clinical staff had secure access to clients’ NHS summary care record through the provider’s electronic system. This helped to ensure people could start treatment safely and without delay.

Staff used a multi-agency approach and involved all necessary services to ensure people had continuity of safe care, both within the service and post-discharge. Care and treatment records we reviewed evidenced multidisciplinary input. The daily multidisciplinary team (MDT) meeting included a range of professionals, who contributed to discussions and decisions taken. In the 2 MDT meetings we observed, staff discussed the input of other professionals and agencies where relevant, such as psychology, primary and secondary care.

Feedback from stakeholders demonstrated that Turning Point staff consistently applied a proactive and innovative cross-sector approach to improve access to and continuity of care. For example, we heard how the staff worked with the police to establish referral protocols for individuals issued with criminal behaviour orders (CBOs) and those who referred via an app from contact in the street. Staff had worked with the local Jobcentre to improve the referral process. This meant that work coaches could refer more people who needed support with substance misuse. The Turning Point team also recently led a project to improve continuity of care for prison leavers, which involved people with lived experience.

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff shared concerns quickly and appropriately.

The service had established robust systems to protect people from harm. Safeguarding was part of induction for all new starters and ongoing mandatory training. 99% of staff were up-to-date with Safeguarding training and 92% with Prevent (training aimed at safeguarding people from the risk of radicalisation and extremism). Staff we spoke with knew how to identify adults and children at risk of, or suffering, significant harm. Staff knew how to make a safeguarding alert and did so when appropriate. Staff were aware of the risks specific to their client group and gave a number of examples of making appropriate referrals. Feedback from partner agencies confirmed this.

The service had a safeguarding lead and there were trained designated safeguarding officers at each hub. The team included 2 social workers embedded within the local adult and children’s services. We reviewed the safeguarding register, which was up-to-date and was monitored by the safeguarding lead. Staff discussed safeguarding in a number of forums, including supervision and meetings, and carried out regular audits in this area. We reviewed a sample of audits and minutes of safeguarding leads meeting, which evidenced thorough oversight by managers. In the care and treatment records we reviewed, staff explored safeguarding concerns during initial assessment and made appropriate referrals where relevant.

Staff were proactive in protecting clients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010, for example pregnant women who used drugs, LGBTQ+ communities and clients with learning disabilities. Staff involved appropriate external agencies and demonstrated an in-depth understanding of the unique challenges these groups could experience.

Staff were acutely aware of the additional risks their homeless clients faced and took action to keep them safe. Dedicated teams supported rough sleepers, working closely with the local hostels and police. Staff provided these clients with mobile phones and facilitated access to hostels. Outreach teams regularly went out to engage with clients and actively followed up any missed appointments.

There were no blanket restrictions within the service. Staff regularly reviewed practices such as supervised consumption (observed administration) of prescribed opioid substitute treatment (OST). Staff followed the provider’s policy for reviewing OST dispensing regime based on individual risk, additionally considering the impact on individuals with protected characteristics.

Staff worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people's needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed risk assessments and risk management plans in 8 care and treatment records. Staff completed comprehensive initial risk assessments and updated these regularly. Staff involved clients in care planning and risk assessment, with clear evidence of client voice in the care records. Clients and carers we spoke with said they felt involved in reviewing their care and treatment. For example, for one client the risk management plan included referrals for support with housing and mental health. Clients and carers told us that staff had provided them with information on what to do in a crisis out of hours.

Staff discussed risks to clients in a range of forums. In the 2 daily meetings we observed, staff shared updates about risks to and from clients. Managers carried out regular audits of risk assessments, with actions and timeframes for their completion clearly documented.

Staff communicated with clients so that they understood their care and treatment. Staff had easy access to an interpreter service. Information in languages spoken by the local communities was displayed on the premises. Staff provided mobile phones to clients who otherwise may find it challenging to keep in touch with the service. Staff we spoke with were aware of differences in cultural perceptions of mental health and substance misuse, and supported clients on an individual basis.

Staff and peer mentors were acutely aware of the importance of harm minimisation and explained their role in supporting people to reduce the risks of ongoing substance use. All the clients and carers who were at risk of experiencing or witnessing an opioid overdose told us that staff had provided them with Naloxone and trained them to use it. Naloxone is a life-saving medication used to rapidly reverse an opioid overdose.

Each hub had needle exchange facilities. People could access safe supplies, tests, vaccinations and treatment for blood borne viruses (BBV) and support with sexual health. All clients were routinely provided with BBV screening.

Although the carers we spoke with said they could give feedback to the service via a survey or directly to staff, some of the clients told us they had not been asked for their feedback. However, the service carried out an annual client survey, which asked about their experience and invited suggestions. The results of the most recent survey for 2024-25 showed that the majority of respondents were very positive about the care they received. The leaders had planned several actions in response to the survey feedback, for example developing new activities and supporting some clients with completing paperwork.

Most of the time, staff detected and controlled potential risks in the care environment and made sure that the equipment, facilities and technology supported the delivery of safe care.

The training records showed that 99% of staff had completed the Health and Safety and Fire Safety Awareness training. Staff carried out appropriate risk assessments regularly. The care environment at Acorn Hall and Wardour Street hubs was well-maintained, although staff told us that one clinic room at Wardour Street was awaiting repairs after a ceiling leak. However, we found some gaps in environmental checks at Harrow Road. The environment at this hub appeared less well-maintained. The lift and intercom were out of order, and staff shared their concerns about this. We also identified some gaps in the fire safety checks. Although a fire risk assessment had been carried out and most of the necessary checks were taking place, staff did not keep records of the weekly fire alarm tests. Managers told us that another building occupant had been responsible for this and that tests were conducted in silent mode. This meant that staff may not have been aware of potential faults in the system, and not sufficiently familiar with the sound of the alarm. We raised our concerns with the leaders, who provided assurance that weekly tests would be conducted in loud mode and sent evidence of the results being recorded with immediate effect.

Entrance to the hubs was secure and equipped with CCTV. This allowed staff to prepare any individual adjustments for clients on arrival, if needed. Staff had access to safety alarms in all clinic and keyworking rooms and carried out regular tests to ensure these were in working order. Staff followed agreed procedures to ensure their own safety during outreach visits.

The service had designated clinical rooms with appropriate equipment for physical examinations. The equipment was well-maintained and calibration records were up-to-date. The hubs were equipped with resuscitation equipment, including emergency grab bags and defibrillators.

Client and relative/carer feedback about the care environment across the 3 hubs was positive. They described it as clean, comfortable and welcoming.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the time of our inspection, the service was fully established apart from 4 vacancies which equated to approximately 4% of the total establishment. Over the previous 6 months, the average turnover rate was 12% and sickness absence rate 6%. The service operated a duty rota system and when necessary, could deploy agency staff. Agency use was low, equating to approximately 1.2 FTE per week, and there was no agency clinical staff.

Clients we spoke with told us staff were always available. One said: “Feels like they are on stand-by for anything I need”. Staff also felt the service was adequately staffed and their individual caseloads were manageable.

Leaders told us about the positive impact of the Government’s 10-year drug strategy, which meant they had been able to increase the staffing capacity due to the extra funding. For example, they had created new training posts aimed at improving substance misuse awareness both internally and externally. At the same time, there were some long-standing key staff working for the service. External stakeholders we spoke with described this as a positive factor in building strong working relationships.

The multidisciplinary team included a range of specialist roles that met the needs of its client group. The team comprised doctors, nurses, non-medical prescribers, clinical psychologists, social workers, mental health practitioners, criminal justice and street outreach teams.

There was sufficient medical cover, with clinical staff always available on site. Clients said they could speak with a prescriber when needed. Clinical staff had protected diary slots for walk-ins. The clinical lead, who was a consultant psychiatrist, was accessible to staff and clients and oversaw the more complex cases.

Staff participated in regular training, appraisal and supervision and leaders monitored the completion rates. These were consistently high, with 96% of staff up-to-date with mandatory training, and 100% of new starters having completed their induction in the past year. The training and induction programmes were tailored for the client group using the service. Local induction for new staff was a comprehensive 2-week programme. 93% of staff were up-to-date with supervision and 97% with appraisal. Staff had access to additional supervision formats, such as clinical supervision, continued professional development (CPD), flash meetings and reflective practice sessions.

The service had robust systems for safe recruitment of staff who worked with vulnerable people. This included criminal record and right to work checks, and where relevant, evidence of continued professional registration. Managers audited the completion and renewals of these. The provider’s policy detailed a thorough and proportionate process for risk assessing any offences disclosed during criminal record checks. The decisions in this process required the approval of senior staff who developed a personalised onboarding plan with the individual.

Staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Wardour Street and Acorn Hall hubs were visibly clean and well-maintained. However, not all areas at Harrow Road appeared clean. For example, there was some dust on a trolley in the clinic room. Cleaning records at this hub were not completed consistently in the weeks prior to our inspection. Leaders told us they had already identified this as an area for improvement and started monitoring their completion.

Staff carried out appropriate safety checks to detect and prevent the spread of infections. Regular Legionella risk assessments and monitoring of the water systems took place at the 3 hubs.

Staff completed mandatory Infection Prevention and Control training, with 98% of staff up-to-date with it. Staff adhered to infection control principles and used personal protective equipment. Staff disposed of sharps and clinical waste safely and a specialist contractor removed this waste regularly.

Staff made sure that medicines and treatments were safe and met people's needs, capacities and preferences. Staff involved people in planning, including when changes happened.

We reviewed a sample of prescribing charts and clinical audits. Staff followed the provider's policy and national guidance to ensure good practice in medicines management. Staff reviewed the effects of medicines on clients' physical health in line with the National Institute for Health and Care Excellence (NICE) guidance. Clients received a medical review every 3 months, or more frequently if indicated. Staff managed prescriptions safely, in line with the national guidance. Medicines management was overseen and audited by the clinical services manager, clinical lead and the provider's national team.

Clients we spoke with felt involved in reviewing their medicines. They told us they could speak with a prescriber when needed and that staff discussed medicines thoroughly and clearly. Clients said they received regular blood tests if indicated. Staff told us they involved clients in decisions about treatment choices at the initial assessment and provided written and verbal information on any side effects. The clinical lead, who was a consultant psychiatrist, provided support to staff and clients with these decisions.

The service supported a small group of clients whose injectable opioid treatment was initiated previously by other providers. Staff managed their care safely and sensitively with oversight from the clinical lead. Independent advocates supported some clients in discussions about their medicine choices.

All the clients and carers who were at risk of experiencing or witnessing an opioid overdose told us that staff had provided them with Naloxone and trained them to use it. Naloxone is a life-saving medication that can rapidly reverse an opioid overdose. Staff provided lock boxes to all clients receiving medically assisted treatment, so they could store their medicines safely at home.

The service had designated clinic rooms with appropriate equipment for physical examinations. Clinical equipment was stored appropriately, with calibration records in date. Trained staff had access to resuscitation equipment and emergency medicines. The medicines were stored safely and were in date. Staff kept appropriate records of controlled drugs stored. Staff reported any incidents or errors on the provider's electronic reporting system and notified the relevant external bodies when required.