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Archived: Midlands and North Regional Office


Inspection carried out on 2 and 3 August 2017

During an inspection to make sure that the improvements required had been made

We do not currently rate independent standalone substance misuse services.

We inspected Midlands and North Regional Office on 2 and 3 August 2017. This was an unannounced, focused inspection to find out whether the service had made the required improvements since our last inspection on the 31 October 2016.

We found the following issues that the service provider needs to improve:

  • Clinical waste was not managed safely at Hull and Mansfield. Equipment at Manchester was not safe to use. Medicines were not stored safely or securely. The clinical hand washbasins at Mansfield and Hull were not compliant with the Department of Health guidance on infection control in the clinical environment. Staff had not completed a risk assessment to identify the risk of the spread of infection nor had actions been identified to mitigate the potential risks. Staff were not appropriately recording risks to clients.

  • Staff could not be certain that they were meeting all clients’ needs and achieving their preferences.

  • Some clients did not know how to complain.

  • Monitoring systems in place were not effective in ensuring the safe storage of prescribed dressings. Monitoring systems in place were not effective in ensuring that the registered managers and the service managers had complete oversight of mandatory training, appraisals and disclosure and barring checks.

  • Although some improvements had been made to issues identified at the last inspection, these improvements had not been made at all sites.

  • Audit findings were not always acted upon.

However, we also found the following areas of good practice:

  • Since our last inspection in October 2016, staff at Blackburn had reviewed and improved the management of clinical waste. At Manchester, the clinical hand washbasin had been replaced and met the required standards.

  • Staff were knowledgeable about identifying safeguarding concerns and knew who to contact for advice within the organisation. We found evidence that

    staff made appropriate safeguarding referrals when needed.

  • Staff knew how to handle complaints and records showed that overall complaints were processed in line with the provider’s policy. Since our last inspection, the recording of complaints had improved.

Inspection carried out on 31 October 2016 to 2 November 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

  • The systems in place for managing and storing equipment safely were not effective. We found out of date equipment at two services. We also found that emergency medicines were not stored securely at one service.

  • Staff did not manage clinical waste safely at two services. At one of these services, staff had not completed a risk assessment to identify and mitigate the risks of the spread of infection as a result of a clinical hand wash basin that did not meet national standards.

  • Staff did not keep a complete and contemporaneous care record for each client. Information was stored within an electronic record and a paper record, which meant staff had difficulties accessing information quickly.

  • All staff had not completed mandatory training nor received an appraisal. There were 16 members of staff who required an updated disclosure and barring service check in line with the provider’s policy.

  • Records at Runcorn and Blackburn were not clear as to whether complaints had been dealt with appropriately.

However, we also found the following areas of good practice:

  • Clients had unexpected exit from treatment plans in their care records. Staff took action when clients did not attend their appointments and there was a robust system in place to ensure client safety. There were excellent systems in place for storing prescriptions safely. Serious incidents and deaths were thoroughly investigated and learning from incidents was shared across the organisation.

  • Staff followed national guidance when delivering treatment. Staff routinely assessed clients’ physical health and made referrals to specialists when needed. We found excellent communication and joint working with other services and organisations.

  • We observed staff being supportive and respectful to clients. Clients told us that staff were caring, helpful and approachable. Clients told us they were involved in discussions about their care and treatment and were happy with the treatment provided. We found excellent client involvement in decisions about the services.

  • There was open access at all of the services we visited which meant that clients could present to the service and be seen the same day. Services had evening opening times and some services opened at the weekends. Staff made attempts to engage clients who were reluctant to engage with services.

  • We found good monitoring systems that identified areas for improvement. There was excellent leadership at a local and regional level and managers had received leadership training. We found a strong commitment to quality improvement and innovation. The provider was involved in a number of research projects with local universities.

Inspection carried out on Date of inspection visit: 13 and 14 July 2015

During an inspection to make sure that the improvements required had been made

Overall SummaryThe five questions we ask about our core services and what we found

Are services safe?

  • Staff did not view their caseloads as manageable and this contributed to work related stress and related sickness.
  • Staff undertook a risk assessment for every person who used the service however; they were not always reviewed regularly.
  • The service reported a high incidence of injecting drug use and drug related deaths and naloxone was not a standard method of harm reduction which would be a recommended method to reduce drug related deaths.
  • There was resuscitation equipment available on each site. However, staff told us they were never calibrated. We saw no evidence of calibration of any of the equipment which could impact on accuracy readings.
  • Staff told us that medical reviews were not happening as often as they should to ensure safe assessment, prescribing and treatment.
  • Staff were trained in safeguarding and knew how to make a safeguarding alert when appropriate.
  • Incidents were reported and staff knew what and how to report. Staff reported not being adequately de-briefed and supported after incidents. Staff told us they did not always feel lessons were learned following incidents.
  • Environments were not viewed to be clean or well maintained.

Are services effective?

  • Recovery champions completed comprehensive assessments.
  • Prescribers followed NICE guidance when prescribing medication.
  • The team had access to a range of health professionals required to care for the people who used the service.
  • Staff were supervised and appraised and had access to team meetings.
  • Recovery plans were out of date.
  • None of the staff spoken with were trained in the Mental Health Act or Mental Health Act Code of Practice.
  • The two sites inspected had no policy and staff had no training, knowledge or understanding of the Mental Capacity Act.

Are services caring?

  • Service users told us that staff were compassionate and cared about them.
  • People were involved in their care planning and participated in their clinical reviews.
  • Staff and volunteers were involved in decision making about the service. Volunteers were involved in recruiting staff.
  • People gave feedback on the care they received and in some cases were supported in doing this.

Are services responsive to people’s needs?

  • Not all service users knew how to complain.
  • One service user told us they did complain but did not receive a timely response.
  • There was disabled access.
  • There was access to interpreters, however there were only leaflets available in English at both sites.
  • The teams were able to see urgent referrals quickly and non-urgent referrals within an acceptable time.
  • Service users had flexibility in the times of appointments.

Are services well-led?

  • Not all staff felt free to raise concerns within the service.
  • The teams used key performance indicators and other data to gauge their performance.
  • The results were shared with the team and active plans were developed where there were issues.
  • Staff knew how to use whistle blowing processes.
  • There were opportunities for leadership development.