Wear Recovery

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• 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 the first assessment for this service. This key question has been rated good.This meant people were safe and protected from avoidable harm.

All areas used to deliver care and treatment were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, record and store medicines. The service managed patient safety incidents well.

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.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider reported that there had been no serious incidents in the last 12 months.

All staff knew what incidents to report and how to report them. Incidents reported within the service included prescription errors, violence and aggression, pharmacy issues and missed appointments.

Staff understood the duty of candour. They were open and transparent and gave clients and families a full explanation if and when things went wrong.

Staff received feedback and learning identified from the investigation of incidents, both internal and external to the service, via emails, team meetings and supervision.

Staff met to discuss that feedback. There was evidence that changes had been made as a result of feedback. For example, death in service reviews had identified a need for staff to contact pharmacies when clients failed to attend their appointment and to better liaise with professionals. Flash meetings were now used to discuss conflicts between clients and to ensure they did not attend the service at the same time.

Staff within the service carried out reviews of client deaths and participated in mortality review forums. These comprised a full review of the client’s care and treatment and were used to identify areas of good practice and any lessons learned for the future.

A mock inspection of the service, completed by the central assurance team, based on the Care Quality Commission’s inspection methodology was undertaken. Following the inspection a report was generated, recommendations were made, and the assurance team undertook a follow-up review to ensure the recommendations had been implemented. Learning from the inspection and subsequent review were shared with the wider team during the monthly integrated governance team meeting.

The service learnt from incidents where service users had been harmed. For example they used learning from a loss of life forum following the transfer of a client to an out of area pharmacy and different service provider to learn from this incident. Whilst no fault was found with the transfer, the forum concluded that there could be an improvement. A working group within the service reviewed current pathways, sourced what other providers in the area do and how the service could work more closely with other providers to ensure transfers were completed more efficiently. An updated pathway was devised and shared with the wider team in an information governance team meeting to implementing these improvements. The learning and new pathway was shared within His Majesty’s Coroners to evidence learning and improvement, despite there being no fault with the previous pathway.

Prescribing incidents had highlighted that out of area prescriptions were being posted for some time without a review. A group consisting of a clinical administrator, pharmacy lead and a team leader now reviewed all out of area prescriptions each month monthly to ensure transfers were under way, that people were seen regularly and no changes to prescribing or dispensing were needed.

Staff were debriefed and received support after a serious incident.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the client was received to determine if the client’s needs could safely be met. The service also operated a drop-in facility, so staff used their professional curiosity to obtain all essential information about the client and their needs.

Staff involved all the necessary healthcare and social care services to ensure clients had continuity of safe care, both within the service and post-discharge. This included the client’s GP, mental health services and housing services.

Following an increase in referrals for support with Ketamine use, the provider recruited a non-opiate lead and specific recovery coordinator to develop and provide specialist support. This led to the development of a Ketamine pathway which was near completion at the time of our inspection. It was developed in conjunction with urology consultants to embed an onward referral pathway, with quicker access to urology support when required. The service also had pathways for pregnant people and clients receiving palliative care.

Staff planned and managed discharge well.

The service’s Aspire team offered short-term interventions of up to 12 weeks to support clients in making positive changes and prevent patterns of use developing further and leading to dependency. Over the 12-week sessions, staff worked with clients to help them prepare to be ready for change, taught clients the effects of alcohol and drug use on their health and wellbeing, how to deal with urges and cravings, the financial benefits of addressing their addiction and helped clients to plan their recovery and set smart goals.

The service had alternative care pathways and referral systems for people whose needs it could not meet or needed specific support. For example, staff referred veterans with substance misuse problems to an external service which it worked in partnership with, as it ran specific veterans’ groups.

The service had shared care protocols in place. Staff understood and followed these where applicable.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. At the time of our inspection, 99% of staff had completed their safeguarding training.

Staff had submitted 10 safeguarding referrals in relation to children and 4 in relation to adults to the local authority in the last 12 months.

Staff could give examples of how to protect clients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies such as the police and local authority safeguarding teams. For example, staff were working in partnership with a midwife and the local authority to safeguard a client and their unborn child.

Staff followed safe procedures for children visiting the service.

The service ensured that clients (particularly those with children at their home) understood safe storage of medicines. We saw evidence in care records that staff had issued clients with lockable storage boxes in which to safely keep their substitute medicines.

There had been no serious case reviews in the last 12 months.

Staff took all practical steps to enable clients to make their own decisions.

We saw evidence in care records that staff assessed and recorded clients’ capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When clients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We saw evidence in clients’ care records that clients had agreed and signed consent to treatment forms. We also saw evidence that staff had recorded with whom clients had agreed for staff to share information with about their care, treatment and current health status.

Staff had a good understanding of the Mental Capacity Act, particularly the five statutory principles. They were able to identify where mental capacity was a concern in a client consenting to treatment.

When clients lacked capacity, staff ensured decisions were made in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service had protocols and policies in place to manage clients whose capacity was temporarily impaired due to the use of illicit substances or inebriation.

Staff ensured clients had agreed and signed consent to treatment forms and they were accessible to all staff involved in the client’s care and treatment.

Staff ensured clients had agreed and signed confidentiality agreements in relation to which parties staff could share their personal information with, and they were accessible to all staff involved in the client’s care and treatment.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We looked at 10 risk assessments and risk management plans during our inspection. Staff created risk assessments that were comprehensive, regularly reviewed and up-to date and were developed in partnership with the client.

Staff routinely and regularly provided clients with harm minimisation advice in relation to the risks associated with their continued drug and alcohol misuse and safety planning was an integral part of recovery plans.

Staff created re-engagement plans for all clients which included steps to take if the client unexpectedly dropped out of treatment.

The service had protocols in place for what to do when there were suspicions or evidence that a client had passed on their substitute medicine to a third party for illicit purposes (an act commonly known as ‘diversion’). The multidisciplinary team reviewed the client’s prescription arrangements to determine if they should be placed back on supervised consumption. They also spoke to the client to determine if there were any underlying reasons for their actions such as being bullied or threatened by the third party. Although there was no formal policy and procedure in place for diversion, there was no evidence this had caused any negative impact. However, it is good practice to have a diversion policy and procedure to ensure a safe and consistent approach to this issue.

Staff encouraged clients on medicine collection regimes to take lockable storage boxes in which to keep their medicines to safeguard any children or vulnerable people living with them.

The service’s list of banned items for clients visiting its premises was in line with those expected for a substance misuse service. These included bladed articles and weapons, drugs and alcohol.

We saw evidence in care records that staff involved clients in care planning and risk assessments.

Staff communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties such as providing information in different languages, easy-read and the use of signers and interpreters.

Staff ensured that clients could access advocacy.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff completed and regularly updated thorough risk assessments of all areas and removed or reduced any risks they identified.

All interview rooms had alarms and staff available to respond and clinic rooms had the necessary equipment needed to deliver safe care and treatment. Staff made sure equipment was well maintained, clean and in working order.

All areas were clean, well maintained, well-furnished and fit for purpose. Staff made sure cleaning records were up-to-date, and the premises were clean. Clients and carers felt safe when they attended the service hubs and commented on how clean, comfortable, and beautiful the environment was and how it created a lovely atmosphere.

Staff followed infection control guidelines, including handwashing.

Reception areas were managed safely with adequate space and alarms in place.

Risk assessments were in place to mitigate risks.

We scored the service as 3. The evidence showed a good standard. The service 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.

The service had enough nursing and support staff to keep clients safe and caseload numbers were not so high that adequate support could not be offered. Roles within the service included:

• 5.28 whole-time equivalent nurses
• 41.11 whole-time equivalent recovery coordinators
• 6.8 whole-time equivalent team leaders
• 1 whole-time equivalent quality and performance lead
• 1 whole-time equivalent service manager/registered manager
• 1.2 whole-time equivalent social work leads
• 2.6 whole-time equivalent medical professionals
• 2.8 whole-time equivalent programmes practitioners
• 2 whole-time equivalent project managers
• 1 whole-time equivalent pharmacy liaison lead
• 5 whole-time equivalent administrators
• 1 whole-time equivalent consultant psychiatrist
• 0.48 whole-time equivalent consultant psychologist
• 2 whole-time equivalent counsellors
• 1 whole-time equivalent data analyst
• 1 whole-time equivalent engagement workers
• 2.6 whole-time equivalent family support practitioners
• 1 whole-time equivalent healthcare assistant

There were no vacancies within the service, and no bank or agency staff had been used within the last 12 months.

Managers supported staff with their caseloads. At the time of our inspection, the average caseloads per worker were 40 alcohol clients and 60 opiate clients. Criminal justice cases tended to fluctuate but were significantly lower than the other case types.

Managers made arrangements to cover staff sickness and absence. Staff worked overtime or across teams when there were unexpected absences due to sickness or unforeseen circumstances. Members of the leadership team also covered any unexpected absences.

All staff had received and were up to date with appropriate mandatory training. This included basic life support and anaphylaxis, data protection and information security, equality and diversity and health and safety. Other, non-mandatory training included harm minimisation, motivational interviewing, an introduction to drug and alcohol awareness, conflict management and overdose management (including the use of naloxone).

At the time of our inspection, the average staff turnover in the last 12 months was 6%. Three staff had left due to career progression, and another 2 due to personal reasons.

The average sickness absence level for the last 12 months was 5.7%. The provider reported the main reason for sickness absence was non-work-related stress.

Managers supported staff who needed time off for ill health and encouraged staff to access the employee assistance programme.

Managers used the number of assessments, caseloads and client need on which to calculate the required numbers and grades of staff.

Managers ensured all staff employed to work with vulnerable groups had up-to-date Disclosure and Barring Service certificates. At the time of our inspection, 98% of staff had a current certificate in place. One staff member was on maternity leave, and another was awaiting their certificate and was due to commence working at the service once it was available.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date.

All areas were clean, had good furnishings and were well-maintained.

Cleaning records were up to date and demonstrated that the areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing and the safe and appropriate disposal of clinical waste.

Staff were trained in infection prevention and control and they ensured the safe storage of sharps and used needles.

Clinical areas had the required standard of cleanliness for clients to have thorough physical examinations. Including areas for blood born virus testing.

An Infection control audit of all 4 sites was conducted in January 2025. The services were found to be compliant in 63 of the 64 standards laid out in the audit. One of the 3 sites did not meet the standard for the storage of cleaning equipment. However, this was rectified following the audit.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe medicines safely.

Staff reviewed each client’s medicines regularly and provided advice to clients and carers about their medicines. The service reviewed clients who had been on the same prescription for a long time.

A clear rationale was in place where changes to pick up regimes were made with a clear and effective risk assessment and documentation.

Staff completed medicines records accurately and kept them up to date.

Staff stored and managed all medicines and prescribing documents safely.

Staff ensured there were always sufficient stocks of emergency medicines on the service premises such as naloxone and adrenaline.

Staff followed national practice to check clients had the correct medicines when they were assessed or they moved between services.

Staff learned from safety alerts and incidents to improve practice.

We saw evidence in care records that staff reviewed the effects of each client’s medicines on their physical health in line with the National Institute for Health and Care Excellence guidance.

Staff managed client withdrawals in a safe way which was in-line with national guidance.

Staff completed risk assessments to determine the safe frequency of prescription pickups and safe storage of medication at clients’ homes such as safe storage boxes and reviewed these regularly.

Staff ensured they reviewed the storage of naloxone, and the process of how it was distributed and monitored was reviewed, including how it was replaced after use and how harm minimisation advice was given.