CGL Sefton

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence.

This is the first inspection of this service. This key question has been rated as good. This means people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all clients. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for clients based on national guidance and best practice.

The staff team included or had access to the full range of specialists required to meet the needs of clients. Staff worked together as a team to benefit clients. Staff received regular supervision and appraisal.

However, we found that care planning documentation on the service’s records system was not always detailed and did not always capture the person-centered care we witnessed on site. The service had identified this concern prior to our inspection and were introducing new care plan documentation to address this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of each client. Assessments were completed by a dedicated assessment team. We reviewed 8 care records and found that each client had an up-to-date assessment in place. Assessments covered key areas such as physical and mental health, safeguarding, substance misuse history and social needs. Assessments were reviewed regularly in key worker meetings.

During our inspection we observed 4 client appointments. Appointments were person centred and holistic. They focused on client’s progress, goals and the steps and support required to meet them. Clients we spoke with told us staff were personalised and recovery focused in their delivery of care. However, we found this approach wasn’t always evident in records. We reviewed 8 records and found they lacked the level of detail and person-centred care we witnessed on site. We discussed this with the service manager. They told us that this was, in part the way that the system was set up and the documentation that was being used. Assessments and care plans were amalgamated in a service user plan document which did not always fully capture goals, recovery capital and identified actions. The service manager told us that the issue had been identified through the service’s quality assurance processes, staff feedback and external reviews. They showed us a new specific care plan format that was due to be introduced. The new format provided a more personalised, recovery focused approach and explicitly captured client goals, actions and required support. The service manager told us that this was due to be introduced in the weeks following our inspection and would provide an opportunity in team meetings and supervision sessions to reiterate expected record keeping standards with staff.

Service user plans that were in place were regularly reviewed in key worker sessions. Clinical note demonstrated that staff regularly discussed progress, challenges and next steps with clients in those meetings.

Staff reviewed clients’ physical health as part of their assessment. They made sure that clients understood their physical health concerns and supported them to manage them.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment suitable for the clients in the service. The service had a dedicated assessment team and specific pathway teams for opiate, non-opiate, alcohol and criminal justice clients. The service also offered a dedicated Family Team who worked with clients with young children where there were risk factors or social services involvement. The Family Team offered a 6-week positive parenting course and a Moving Parents and Children Together (M-PACT) programme which was a whole family, structured support programme focusing on the impact of addiction on families.

Staff delivered care in line with best practice and national guidance including those laid out by the National Institute for Health and Care Excellence (NICE). Staff provided opiate substitute prescribing, community detoxification and harm reduction programmes in line with national guidance. Staff supported pharmacological interventions, the provision of harm reduction services such as needle exchanges along with a programme of psychosocial interventions.

Staff were trained in psychosocial interventions. Staff had completed 2-day motivational interviewing and 3-day trauma informed care courses and received training around cognitive behavioural therapies. They were able to provide psychosocial interventions during key worker sessions and care reviews. In addition, managers had completed Motivational Interviewing Development Assessment Tool (MDAT) assessment training. MIDAT assessments help ensure that psychosocial interventions are delivered properly and in a person-centred way. Where clients consented, managers sat in appointments and reviewed the delivery of interventions.

The service offered a comprehensive group timetable and ran a course called Foundations of Recovery. The programme was a structured behavioural change course designed to support clients to understand their addiction, develop coping mechanisms and develop their recovery capital and personal strengths. Additional groups within the timetable included relapse prevention, emotional awareness, self-help and motivation and cognitive behavioural therapy awareness.

Clients with more complex needs could access more in-depth one to one psychological interventions provided by a dedicated psychology team. This included trauma-based therapies such as eye movement desensitization and reprocessing therapy (EDMR) and schema therapy. EDMR is a psychotherapy designed to help the brain process traumatic memories and reduce their emotional impact. Schema therapy is an integrative approach combining cognitive behavioural, experiential and psychodynamic models to manage self-defeating patterns. Clients also had access to a counselling service which offered between 6 and 20 sessions to support the recovery journey.

The service supported clients to develop life skills through access to education, training and work-related opportunities. The service employed an Asset Based Community Development (ABCD) Lead who supported access to educational courses including vocational courses such as barista and landscape gardener training. The service worked with a third sector organisation to encourage and support clients into work. This included advice and support around job searches, writing curriculum vitae’s (CVs), interview skills, work placements and employment opportunities.

Staff made sure clients had support for their physical health needs, either from their GP or community services. The service employed a nursing team who could provide physical health care and advice. Recovery Workers supported clients to attend appointments when required. There were good relationships with local GPs, hospitals and healthcare providers. Staff carried out blood borne virus testing on clients and referred them into services for treatment if necessary.

Staff participated in clinical audits. The service completed audits around areas such as health and safety, infection prevention and control, care records, safeguarding and prescribing. Managers used results from audits to make improvements. Findings of audits were feedback via email and in team meetings. Identified actions were captured in action plans and monitored through governance processes.

The service included or had access to the full range of specialists required to meet the needs of the client group. Staff were experienced and qualified and had the right skills and knowledge to deliver care and treatment. In addition to the mandatory training programme staff had access to a range of additional specialist training. The provider offered a catalogue of additional training in a range of formats including e-learning, virtual classrooms and face to face settings. Staff within the service had completed additional training in areas such as dual diagnosis, physical health, steroid use, phlebotomy, adverse childhood experience and a range of psychosocial interventions including trauma informed care, cognitive behavioural therapies and motivational interviewing. Staff had also accessed non-medical prescribing programmes as part of their career development. Training needs were identified through supervision, appraisal, service development initiatives and learning from incidents, complaints and audits.

Managers provided new staff with an appropriate induction before they started work. This included orientation to the service and client base, mandatory training, policies and procedures and an introduction to the care records system.

Managers provided staff with regular supervision. There was a supervision tree in place detailing which staff were responsible for supervising different staff groups. Staff we spoke with told us they received regular supervision and that they felt supported in their role. Where required staff accessed additional specialist supervision, for example non-medical prescribers and staff working in the counselling and psychology teams.

Managers ensured that staff had an annual appraisal. Appraisals were values based and included conversations around goals, objectives and carer development. Staff we spoke with told us they received annual appraisals.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings to discuss clients and their care. These were held at service, location and pathway team levels. Both locations held a daily flash meeting to discuss operational details and planned clinical activity for the day. This included duty cover, planned appointments, complex clients and any planned discharges. Meetings at pathway team levels were used to review complex cases, allocate new clients and consider staff caseloads. There was evidence of good multidisciplinary working at all levels with effective communication to support the delivery of care. Staff completed multi-disciplinary reviews of clients and worked collaboratively to help the client achieve their goals. Staff made sure they shared clear information about clients and any changes in their care, including during transfer of care.

Staff had effective working relationships with other teams in the organisation. and external teams and organisations. The service was committed to working collaboratively with other healthcare providers. For example, dual diagnosis workers from the local NHS mental health service attended the teams weekly, hospital liaison workers engaged with local acute hospitals and the service partnered with a GP surgery to deliver shared care in Bootle.

The service had an Asset Based Community Development Lead and a Community Educator. They worked with external providers including probation, pharmacy, social care and homeless services. They provided outreach as well as training and advice on substance misuse, addiction and the support CGL Sefton could provide to individuals and organisations.

The service was also working with external agencies to support clients in accessing employment and educational opportunities. The service contributed to a range of multi-agency forums including safeguarding groups and mortality reviews.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives by supporting them to take part in programmes or giving advice. Staff provided access and referral to smoking cessation programmes. Clients we spoke with told us that staff had supported them to improve their physical health and wellbeing. They gave examples of staff providing advice around diet, exercise and healthy eating as well as instances where staff had supported them to attend GP or other medical appointments.

The service facilitated group activities to promote social inclusion and physical exercise. These included walking groups, support to access gyms and ‘lark in the park’ which was a weekly visit to a local park where clients played games such as rounders. Activities were tailored to need, for example there was a walking group that was less strenuous and stayed on level ground and a walking group that required more effort and covered more hilly areas. The service had recently obtained a batch of bicycles and were intending to start a cycling group at the time of our inspection.

Staff routinely offered harm reduction advice to clients. The service provided needle exchanges to reduce the risk of infection and provided advice, testing and referral to treatment for blood borne viruses.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes. Staff completed Treatment Outcome Profiles (TOPs) and submitted these to the National Drug Treatment Monitoring System. This enabled staff and managers to track outcomes, identify areas for improvement and inform risk discussions in MDT meetings. Team managers provided a quarterly narrative around outcomes as part of their submission to the Performance Monitoring Framework within the governance process. Treatment outcomes were also monitored in the local Combatting Drugs Partnership (CDP). Combatting Drug Partnerships are multi-agency networks that were established to deliver the UK Government’s drug strategy.

In addition, relevant staff completed intervention and treatment specific outcome measures. For example, within the alcohol pathway staff used the AUDIT tool (Alcohol Use Disorders Identification Test), which is a standard screening tool used to identify alcohol-related harm. The psychology service worked with clients to complete measures such as the General Anxiety Disorder (GAD-7) tool, the Patient Health Questionnaire (PHQ9) and the Service User Recovery Evaluator (SURE) tool which helps evaluate substance misuse recovery and associated lifestyle changes.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff received and kept up-to-date with training in the Mental Capacity Act. At the time of our inspection, compliance with Mental Capacity Act training was 100%. Staff we spoke with were able to discuss how they would identify possible capacity concerns and describe how they could access support from managers, medics within the service or the local NHS mental health trust. The provider had developed a Mental Capacity Act policy to provide further support.

We did not review any care records where mental capacity concerns had been identified but the provider’s policy incorporated process documents and assessments covering mental capacity assessment and a best interests decision template.

There were protocols in place to support staff when clients attended the service with impaired capacity as a result of alcohol or illicit substance use. Staff had access to appropriate equipment, such as alcohol breathalysers to measure client’s blood alcohol level. Staff we spoke with were confident in how to manage such situations

Staff ensured they obtained and recorded clients consent to treatment. Records we reviewed included signed consent forms as well as information sharing agreements.