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Archived: London Regional Office

Inspection Summary


Overall summary & rating

Updated 10 February 2017

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • Change, grow, live (CGL) provided safe and effective recovery-focused care and treatment. Clients were positive about the way staff involved them in planning their recovery and the support staff gave them.

  • Staff thoroughly assessed risks to clients and identified their needs. Staff developed sound risk management plans and kept these under review to ensure that they met client needs effectively.

  • Clients were able to access support and treatment quickly. Staff followed best practice and national guidance when prescribing medicines. Clients were able to access psychological support.

  • At each site there was a multidisciplinary team comprising experienced and skilled staff. Most staff said their caseloads were manageable. At most sites the premises were suitable.

  • Staff understood and implemented safeguarding procedures for adults and children. Staff liaised with commissioners and other local agencies to ensure they met clients’ individual needs and develop local services.

  • CGL involved clients in reviewing and developing services at the local and national services. The service used feedback from clients to make improvements. Clients who had recovered from substance misuse were able to become volunteers at the service.

  • Staff and clients understood the vision and values of CGL.

  • Registered managers carried out audits of the quality of the service and ensured that teams took action promptly to improve services when required.

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

  • CGL had not always sent CQC the required statutory notifications in relation to deaths and other incidents

  • At Peterborough, staff were managing their caseloads but we were concerned that they were doing so through consistently working over their contracted hours.

  • At Barking and Dagenham, interview rooms were not adequately soundproofed and private conversations could be overheard.

  • At Barking and Dagenham, the room used by clients for urine tests was not appropriately designed to provide for clients’ privacy and dignity. The provider was aware of this and there were plans in place to make a more suitable room available.

  • At the Bromley site, the cleaning of the toilets used by clients and by staff was inadequate.

  • The system to identify when the Disclosure and Barring Service (DBS) criminal records check had been received by CGL was not robust at the time of the inspection. Consequently, it was not clear that rigorous measures were in place to ensure staff worked safely with clients whilst CGL was waiting to receive the DBS check. Senior managers advised us that by January 2017 a new human resource management system would be in place that will have an automatic alert system to flag up when a DBS check has not been received.

Inspection areas

Safe

Updated 10 February 2017

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Staff undertook comprehensive risk assessments. Staff fully involved clients in drawing up plans to reduce harm from substance misuse. There were measures in place to promote the safety of clients. For example, staff distributed Naloxone kits that clients could use to help prevent deaths from opiate overdose. Staff regularly reviewed risks to clients and amended risk management plans as necessary.

  • Staff understood how to identify children’s and adult safeguarding concerns. Staff had taken appropriate action in partnership with local agencies to safeguard adults and children.

  • Staff obtained information about clients’ medical history before prescribing medicines. CGL had effective policies and protocols on the safe management of medicines which staff followed in their day-to-day practice.

  • Staff understood and implemented CGL incident reporting procedures and learnt from adverse incidents.

  • The composition and size of staff teams varied at each site in accordance with local commissioning arrangements. At all the sites, managers had arranged adequate cover arrangements for sickness and vacant posts. The average caseloads varied at the different sites. At most sites staff told us their caseloads were manageable.

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

  • At the Bromley site, the cleaning of the toilets used by clients and by staff was inadequate.

  • The system to identify when the Disclosure and Barring Service (DBS) criminal records check had been received by CGL was not robust at the time of the inspection. Consequently, it was not clear that rigorous measures were in place to ensure staff worked safely with clients whilst CGL was waiting to receive the DBS check. Senior managers advised us that by January 2017 a new human resource management system would be in place that will have an automatic alert system to flag up when a DBS check has not been received.

Effective

Updated 10 February 2017

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Staff made a comprehensive assessment of each client’s needs and then developed a recovery plan to meet the client’s individual needs. Staff worked with other agencies as necessary to access support for clients in relation to their physical and mental health needs and their social needs.

  • Staff arranged support for clients with their psychological needs. Clients received one-to one support from a recovery worker. Clients were able to access peer support groups to assist them with their recovery.

  • Staff prescribed and managed medicines in line with national guidance on best practice. All sites offered clients health screening and vaccinations for blood borne viruses (BBV).

  • CGL measured outcomes for clients in relation to treatment completions.

  • At each site we visited, a consultant psychiatrist led the multi-disciplinary team. Staff were experienced and qualified in relation to meeting the needs of clients with substance misuse needs. Staff received regular supervision.


Caring

Updated 10 February 2017

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Clients consistently reported that staff showed them respect and kindness. Staff maintained the confidentiality of clients.

  • Clients were fully involved in planning their support and recovery. Clients were asked to give feedback on the quality of the service. CGL ensured clients were involved in making decisions about service developments at the local and national level. Clients were involved in staff recruitment.

Responsive

Updated 10 February 2017

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • At all the sites we visited clients were able advice and support quickly and access treatment promptly.

  • Staff ensured they followed up clients who did not attend appointments in accordance with CGL protocols.

  • At most of the sites we visited, the premises were suitable.

  • CGL and commissioners had developed local services to meet the needs of the community. At some sites, commissioners had funded CGL to carry out outreach work with hard to reach communities to promote access to the service.

  • At all sites, there were was a range of leaflets available for clients. CGL carried out an audit to drive improvement in meeting the diverse needs of clients.

  • There was a complaints procedure in place. Teams asked clients for their views of the quality of service provided at a local level. Staff had acted to make improvements in response to this feedback and made changes to the services provided.

However, we also found the following issue that the service provider needs to improve:

  • At the Barking and Dagenham site, a member of staff told us interview rooms were not well soundproofed and private conversations could be overheard.

  • At Barking and Dagenham,the room used by clients for urine tests was not appropriately designed to provide for clients’ privacy and dignity. The provider was aware of this and there were plans in place to make a more suitable room available.

Well-led

Updated 10 February 2017

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Staff and clients understood the CGL vision well. Staff were committed to supporting clients to recover through make positive changes to their lives.

  • CGL registered managers had ensured there were effective audits of the quality of the service. These covered record keeping, medicines management and checks that staff were carrying out the appropriate local audits. Each site identified areas for improvement and managers had clear action plans with timescales to ensure they made timely changes to develop the service.

  • Staff kept accurate and up to date client records. CGL kept appropriate staff recruitment records which included evidence of the checks human resources staff made with regard to an applicant’s suitability.

  • Staff were positive about working for CGL and said they could raise any concerns with their managers.

  • CGL had developed a national strategy to promote the use of Naloxone to save the lives of people who overdose on opiates. All sites we visited implemented this strategy.

However, we also found the following issue that the service provider needs to improve:

  • CGL had not always sent CQC the required statutory notifications in relation to deaths and other incidents.

Checks on specific services

Substance misuse services

Updated 10 February 2017