CGL Drug and Alcohol Service Warwickshire

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this service. This key question has been rated requires improvement. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes did not always operate effectively, because we found lack of MCA assessments recorded for ongoing monitoring, supervision and appraisal not recorded appropriately and environmental audits not identifying IPC cleanliness and security concerns. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

The service was in breach of regulation 17 for governance at the service.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard of care. The service had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and a good understanding of the challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff told us the senior leadership team were supportive and that they could talk to them at any point openly.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing.

Staff could explain how they were working to deliver high quality care within the budgets available.

We scored the service as 3. The evidence showed a good standard of care. The service had good inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Leaders are visible and open and transparent with staff. They are kind warm and welcome.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders were visible in the service and approachable for clients and staff.

Leadership development opportunities were available, including opportunities for staff.

We scored the service as 3. The evidence showed a good standard of care. The service was good at fostering a positive culture where people knew they could speak up and their voice would be heard.

Clients had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

Managers and staff had access to the feedback from clients and staff and used it to make improvements. Staff felt safe to speak up Staff had the confidence to be open and share any concerns.

Clients were involved in decision-making about changes to the service.

Clients and staff could meet with members of the provider’s senior leadership team and governors to give feedback.

We scored the service as 3. The evidence showed a good standard of care. The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

Staff were able to apply to work flexibly for example there were flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. There were no specific barriers to access. The service monitored inequalities and they had approaches and recognised inequalities in access. Part of contract meetings included discussing any health inequalities or barriers to access.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the client group.

We scored the service as 1. The evidence showed shortfalls in governance. The service did not always have clear recording systems of accountability and good governance. The provider’s own governance systems did not address concerns related to infection prevention and control, cleanliness, security, recording of mental capacity and low rates of staff supervision and appraisal.

We observed IPC issues at the Leamington location where sharps bins were not dated, naloxone and thiamine were kept in an unlocked cupboard and there were cleanliness issues in the drug testing rooms. Environmental audits did not identify these issues.

We observed a security concern at the Leamington location, where the door leading to the 1st floor at the top of the stairs was unlocked and easily accessible to anyone entering the building.

Managers completed audits of care records to ensure these were comprehensive and that recovery plans and risk assessments were updated and reflected individual client needs. However, we found a lack of ongoing monitoring of the MCA recorded in records. 6 care records reviewed did not evidence this.

There were low rates of staff supervision and appraisals recorded. Supervision for the past 3 months was 73%. The appraisal review rate in the last 12 months was 47.54%. There was lack of evidence to show if supervision and appraisals were recorded appropriately.

Staff and volunteers had the required skills, competence and knowledge to deliver high quality care, and share this securely with others when appropriate.

There were no concerns with safety and how safeguarding was managed.

The service had good links with the coroners and attended quarterly Drug Related Death panels led by Public Health. The service provided data, information and worked collaboratively to identify learning and actions.

Where clients had co-occurring substance misuse and mental health issues, the service worked closely with the mental health trust and delivered a group project, employing psychologists to support people when needed.

The service had a strengthened multidisciplinary team. The service met with the mental health trust weekly to consider any access barriers. There was reciprocal training between the two services and sustainability plans for training. The service actively tried to combat any barriers to access for people with cooccurring mental health problems.

There were drug related and harm reducing subgroup sessions on co-occurring diagnosis. The service provided training to some non-clinical staff as well. They also engaged, involved and contributed to strategic work on this.

The local authority told us that the service was innovative and proactive in response to feedback about how to make improvements.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Information governance systems included confidentiality of client records.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and client care.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

We scored the service as 3. The evidence showed a good standard of care. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

Partners were involved in the review of deaths of people using the service and full reports were provided and shared with commissioners. Reports were produced once per quarter and they were thorough and included lessons learnt.

The local authority had carried out a recent quality visit to the Rugby hub and there were no concerns raised.

The service worked with commissioners and quarterly contract review meetings were in place where key performance indicators and outcome measures were reviewed.

Leaders attended drug and alcohol strategic partnership meetings, Director of Adult social services and Director of Adult social services subgroups. There were a variety of other partnerships, meetings with education and Designated Safeguarding Leads briefings.

Staff attended a variety of partnership meetings to improve outcomes these included domestic abuse subgroups and suicide prevention networks.

We reviewed substance misuse community meeting minutes and saw evidence of meetings with partners across the country. The service had formed a new recovery alliance which aimed to hear the voice of people who used the service.

The service worked closely with The National Lived Experience Group which was a collective of individuals from across the UK who had lived experience of using the service and represented the diverse voices of people using the service. They championed lived experienced perspectives at local, regional and national levels and worked closely with staff, volunteers, and the leadership to improve services.

There was excellent feedback from external partners, clients and families of the work and support CGL staff were doing to help clients with their treatment and recovery.

The service had a hospital in reach team. They delivered over 300 121s within the quarter. The service had a positive partnership working where dedicated staff went into the hospitals for engagement and referrals. Commissioners told us that feedback from the staff at the acute trust was always very positive and that the staff that visited had a great relationship with the staff on the wards.

Commissioners shared that the service worked closely with other CGL services in the area. This collaboration made it easier to share information across borders. The service had good working relationships with a few residential substances misuse services too.

The registered manager told us, CGL also provided intelligence to the Local Drug Intelligence System and were part of their panel to share information to reduce drug related deaths and harm and supported with harm reduction messaging where appropriate.

We scored the service as 3. The evidence showed a good standard of care. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The key new area for the service this year, was the subcontracted ITS thinking skills (intuitive thinking skills, peer led approach to skill development). The service ran courses for clients to gain a qualification and supported access to employment and volunteering opportunities. There were 11 clients that had completed the course and 9 that had secured volunteering or work opportunities. This reflected a really positive partnership with CGL and the ITS. Clients fedback that they had been supported to rebuild their lives.

In Rugby the service extended to the first floor and refurbished this into a recovery hub for its clients and the community. Various creative activities and groups took place and the launch had been supported by local MPs.

Recently the service had held a speaker event attended by 18 clients, people said it had been beneficial to come together to listen and share their experiences.

The service said that from January 2026 they would run a women only space which could be shared by partners.

The service held wellbeing days throughout the year. Minimum 3 times per year per hub. Any partner and client could attend and this included a sound bath, art, music, and mindfulness sessions.

People using the service had positive outcomes. The provider performed above the national average for NDTMS (National Drug Treatment Monitoring System).

The service was currently recruiting a senior domestic abuse worker, to provide specialist support for victims of abuse and work with drug and alcohol services to provide specialist support. The service was in the process of working with the local council to provide a Family First team as part of a nationwide Test and Learn project. This would see a team of substance misuse workers embedded into a multidisciplinary team within children’s teams across the county, to work alongside social workers and other professionals such as domestic abuse and mental health to provide a whole family approach.

The service also offered a range of interventions such as Buvidal (long-acting buprenorphine injection) access as part of the core contract. Clients told us CGL staff and leaders engaged well and helped to enable a range of interventions. The service offered and delivered BBV (Blood Borne Virus) screenings and had achieved Hep C micro elimination. Leaders told us, they worked really hard at this and had a fantastic team for this.

The service tracked local drug trends and actively tested drugs using three-panel test strips. They searched for warning signs or synthetic, dangerous ingredients. To prevent overdoses, they immediately alerted the harm reduction team.