Archived: SMART Windsor and Maidenhead

Updated 19 July 2016

SMART Windsor and Maidenhead is a fully integrated adult drug and alcohol team covering the Royal Borough of Windsor and Maidenhead. It is a community based service offering a range of interventions and provides a community alcohol detoxification programme. It also provides a needle exchange which is a place for people who are injecting drugs to obtain free sterile injecting equipment and advice. SMART provides the first point of contact for people who would like to, or are required to, access support for their substance misuse issues.

The local drug and alcohol action team (DAAT) commission the service which is provided in partnership with Claremont GP surgery. We did not inspect Claremont surgery as part of this inspection. The current contract for SMART has been extended until 31 March 2017 while a complete review of the substance misuse services is undertaken by the council.

SMART Windsor and Maidenhead is registered to provide treatment of disease, disorder or injury and has a registered manager. This location has not been previously inspected.

Updated 19 July 2016

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

• Mandatory training was poor and figures for completion of mandatory training were very low. Specialist training was also poor. Very few staff were trained in interventions normally associated with substance misuse services such as motivational interviewing, cognitive behavioural therapy, harm reduction, ITEP mapping (international treatment effectiveness project). This impacted on the safety of the service as staff were not adequately trained. Senior managers recognised this and a robust action plan was in place to improve training across the service.

• The service did not notify the CQC of three recent deaths in the service. We raised this with senior managers during the inspection and they agreed to address this.

• There was no duty of candour policy. We raised this with the Chief Executive Officer who agreed to address this, while there was no specific policy both the Incident Reporting and the Complaints Policies included openness and transparency

• All staff we spoke with reported staff shortages. Turnover in the last year was 47%. This impacted on the safe management of the service.

• There had been four different service managers over the last year and this had impacted greatly on staff morale. Local service delivery approaches had changed with each manager and staff were receiving inconsistent messages. Staff reported feeling stressed and worried about how their views would be received. Senior management had recognised this in recent weeks and had been visiting the service on a regular basis and offering support to staff. Staff reported this had helped. Plans were in place to ensure service management was consistent and well led.

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

• Risk assessments in the care records we reviewed were up to date and thorough. We saw risk being reviewed in the key working sessions we observed.

• Assessments were present and thorough in all care records we reviewed. Care plans were holistic, recovery focused and up to date.

• Staff were aware of safeguarding procedures and were able to give examples of child and adult safeguarding issues.

• New incident reporting and investigation procedures had been implemented in 2015. All staff we spoke to were aware of how to report incidents.

• Policies referencing NICE guidelines were in place for alcohol detoxification and for substitute prescribing. Clinic protocols and four way agreements between all involved in substitute prescribing were present.

• We spoke with five clients of the service who gave very positive feedback and said staff were encouraging and supportive. We reviewed eight comment cards which all gave very positive feedback about the staff and the service.

• All staff interactions we observed were caring and supportive. Staff treated clients with kindness and respect. The key working and clinic sessions we observed were client centred.

• SMART had recently developed a bespoke training programme accredited to AIM awards that provided training and access to employment for volunteers, and standardised training for permanent staff members. This would ensure all staff were trained to a minimum expected standard.

• SMART encouraged volunteers to work at the service and had developed a comprehensive training programme. SMART volunteer management had been validated by investors in volunteers accreditation.

• Public Health England and the drug and alcohol action team (DAAT) had no current concerns about performance. SMART regularly filled in treatment outcome profiles (TOP) forms which were used in care planning to set goals and measure progress.