Live Well South

On this page

• 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 is the first assessment for this service. This key question has been rated good.

All areas of the service were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to clients and themselves well. Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe medicines. The service managed client safety incidents well. However, we did identify some concerns in relation to the levels of compliance with certain mandatory training courses and there was a high rate of vacancies and staff turnover.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were no serious incidents relating to the south service in the last 12 months.

Adverse events within the service included prescription errors.

The service had a process for managing unexpected deaths of clients. A full review of the client’s care and treatment was undertaken to identify any areas for improvement and evidence of good practice. Findings from the review were then shared with staff in team meetings and during supervision sessions.

All staff knew what incidents to report and how to report them.

Staff reported all incidents in line with the provider’s incident reporting policy. These included prescription errors, building maintenance issues, safeguarding concerns, violence and aggression and client deaths.

We reviewed 7 incidents that had been reported and investigated. The narrative for each incident was clear, appropriate actions had been taken and lessons learned were noted for sharing with staff.

Staff understood their responsibilities under duty of candour. They knew this included the need to be open and transparent; give clients and families a full explanation and apologise if and when things went wrong.

Staff received feedback from the investigation of incidents, both internal and external to the service and this feedback was discussed in team meetings and daily huddles.

There was evidence that changes had been made as a result of feedback. Staff told us that response systems had been improved to ensure a response was appropriate to incidents happening within the service without too many people becoming involved. Staff also said the governance around producing and issuing of prescriptions had been improved. This included the introduction of additional checking systems to reduce the likelihood of mistakes being made.

Staff told us they were debriefed and supported by their managers following a serious incident.

The service’s referral processes ensured that all essential information about the client was received to determine if their needs could safely be met. Clients were referred by their GP or criminal justice organisations such as probation services, the police or prison services. Most clients entered the service via the drop-in facility, so staff needed to use their professional curiosity and comprehensive assessments to determine clients’ addictions, history and risks.

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 mental health services, social services, criminal justice services, primary medical services and housing services.

There was a whole-time equivalent safeguarding lead within the service who provided advice and guidance around safeguarding concerns and any concerns relating to a client’s mental capacity.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. At the time of our onsite assessment, 98% of staff had completed the mandatory Safeguarding Adults Level 2 module and 97% had completed the mandatory Safeguarding Children Level 2 module.

Staff were able to give examples of the signs that clients were possibly facing abuse such as changes in presentation, missing appointments and financial concerns. Staff made safeguarding referrals to the local authority when required around sexual exploitation, children in the home, self-neglect, severe overdoses, domestic violence, unmet needs, information from the police and social care and concerns relating to mental health.

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. For example, staff attended multiagency children’s hub meetings with external agencies such as child protection services, the police and social care to discuss serious concerns about child welfare. We observed one of these meetings and the service staff member at the meeting demonstrated their level of experience, knowledge and passion about child safety. They made appropriate recommendations to the other attendees as to how to proceed with each case discussed to ensure the safety of the child concerned.

Staff followed safe procedures for children and young people using the service. Appointments for children and young people rarely took place at the service premises and were done in the community by the service’s outreach team. Any appointments were made later in the day to allow children and young people to attend school.

There were only a small number of blanket restrictions within the service, and they were reasonable and what would be expected within a substance misuse service. They included carrying bladed articles and the use of illicit drugs and alcohol on the premises. Any history of clients having weapons on their person was recorded as an alert within the provider’s care records system.

We looked at 17 risk assessments and risk management plans in total during our assessment, 6 of which made specific reference to the South service. However, clients were sometimes moved between the sites depending on their required needs. Risks identified included withdrawals, drug use and children living with the client. Risk management plans evidenced staff had given appropriate harm minimisation advice, referred clients to mental health services and worked in partnership with local safeguarding teams. Staff had offered naloxone to clients at risk of overdosing. Naloxone is a medicine that rapidly reverses an opioid overdose, potentially saving the person's life.

Care records evidenced that staff involved clients in care planning and risk assessments and staff recorded that clients had been offered a copy of their recovery plan and risk management plan.

Staff considered any risks to children and families and encouraged clients to used lockable boxes in which to store their medicine at home if they were on a collection regime.

Staff communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties. Staff ensured clients had access to interpreters, signers and advocates when required and could produce information in a variety of formats such as easy-read or other languages.

Staff created re-engagement plans to prepare for clients potentially dropping out of treatment unexpectedly. These plans included steps to take when clients failed to attend appointments such as telephoning the client or writing to them, contacting relatives or the client's next of kin and contacting GPs and pharmacists. Staff contacted the police when there were concerns about the client's safety and asked them to conduct a welfare check.

The service had a process in place to respond to suspicions or evidence that clients had passed their substitute medicine to a third-party for illicit purposes (an act commonly known as `diversion'). A clinical review was undertaken, which included the consideration of current consumption arrangements, with the potential of placing the client on supervised consumption so they could not take their medicine away with them. Staff liaised with pharmacies about any concerns and intelligence identified.

Staff enabled clients to give feedback on the service they received. Clients could submit feedback via comments cards/boxes, the provider's complaints process or verbally.

Staff enabled clients to make advance decisions when appropriate. The registered manager told us there were clients with life-limiting conditions who had do not attempt cardiopulmonary resuscitation orders in place. These orders were devised in partnership with the clients' GPs and safeguarding teams.

Staff did regular risk assessments of the care environment. We looked at health and safety related information for the service premises and saw evidence of regular checks and assessments of the areas used to carry out care and treatment. We also saw certificates in relation checks for gas, fire, electrics, personal appliance testing and legionella which had been carried out and were in-date.

There were first aiders within the service and all staff were trained as fire wardens. There were posters to show who the first aiders were, and which staff members were currently on the fire warden rota.

Staff had access to alarms so they could call for assistance from the response team when needed.

Clinic rooms were equipped with naloxone and adrenaline and staff ensured there were sufficient levels of stock in place. Naloxone is a medicine that rapidly reverses an opioid overdose, potentially saving the person's life.

There were sufficient numbers of skilled and experienced staff to safely meet the needs of clients using the service. Some roles were site specific but some staff members worked across other sites to meet the needs of clients using all three sites. Roles included:

• 11 whole-time equivalent managers (including the registered manager)
• 9 whole-time equivalent team leads
• 7 whole-time equivalent nurses
• 6.19 whole-time equivalent administrators/receptionists
• 5 whole-time equivalent early intervention workers
• 31.8 whole-time equivalent caseworkers
• 2.8 whole-time equivalent outreach workers
• 2 whole-time equivalent quality and development leads
• 1 whole-time equivalent identification and brief advice lead
• 2 whole-time equivalent young persons risk and resilience workers
• 2 whole-time equivalent rehab and detox workers
• 1 whole-time equivalent safeguarding lead
• 4 whole-time equivalent support workers and,
• 0.8 whole-time equivalent specialist doctors.

There were 22.4 vacancies across the three sites, the majority of which were fixed-term roles only. The provider was already covering or in the process of covering some vacancies via agency staff. One staff member working 1 whole time equivalent was due to return from maternity leave. Three of these Caseworker vacancies were fixed term posts until 31 March 2025; therefore the provider was not seeking to fill these roles.

In the last 12 months, 1,154 shifts had been covered by agency staff.

The average staff sickness rate within the service in the last 12 months was 4%.

The average staff turnover rate within this time was 15%. The main reasons for staff leaving were in relation to finding alternative employment in the public or private sector, dismissal, employment breaks or death in service.

Managers had calculated the number and grade of nurses and healthcare assistants required. Managers based the required staffing levels on caseload numbers being between 40 to 60 per worker, with 60 being classed as high. The maximum number of cases per worker was not allowed to exceed 80.

Managers could adjust staffing levels daily to take account of current workloads, staffing levels and client need.

When agency staff were used, they received an induction, which included a considerable amount of shadowing permanent staff and having a buddy from whom they could seek support. The manager of the team the agency staff member was working in always assessed their competency prior to allowing them to work independently. Most of the agency staff used were in fixed term roles so were familiar with the service.

Staff shortages did not result in client appointments being rescheduled very often. In the last 12 months, 36 appointments had been cancelled. If an appointment needed to be rescheduled, clients were offered support from a duty worker or helpline. However, as most clients preferred to see their assigned worker, appointments were rearranged as soon as possible. Any appointments where a prescription was due went ahead as planned.

There was adequate medical cover within the service. There were staff trained in first aid and basic life support who could attend to physical health emergencies.

There were also two specialist doctors who provided prescribing clinics for clients with complex health needs.

Managers ensured staff received mandatory training which was appropriate for the client group using the service. Modules included prescription security, health and safety, first aid and emergency first aid, mental health first aid, fire warden training, safeguarding children and adults and the Mental Capacity Act.

Managers monitored staff compliance with their mandatory training. The overall compliance rate for mandatory training at the time of our assessment was 89%, which was in-line with the provider’s target of 85%.

The following modules were below the provider’s target:

• Infection control (30%)
• Incident investigation awareness (72%)
• Community tensions (7%)
• Enhanced personal safety and conflict resolution (62%).

However, staff were scheduled to complete the infection control module between February and March 2025. Team leads had been notified about the need to complete the incident investigation awareness module by the service’s compliance lead, so this was set to improve. The enhanced personal safety and conflict resolution module was a one-off course in response to staff feedback and the community tensions module was a new course which had only been released in January 2025.

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

All areas of the service’s premises were clean, had good furnishings and were well-maintained.

Staff adhered to infection control principles, including handwashing.

We saw no evidence that low levels of compliance with mandatory training in infection prevention and control negatively impacted on the cleanliness of the service.

Other than naloxone and adrenaline, medicines were not stored at the service premises. Naloxone is a medicine that rapidly reverses an opioid overdose, potentially saving the person's life.

Staff followed good practice in relation to prescribing substitute medicines to clients and did it in line with national guidance.

We saw evidence in care records that staff reviewed clients' compliance and tolerance of medicines and their effects on clients' health and wellbeing regularly and in line with the National Institute for Health and Care Excellence guidance.