Archived: SMART Wokingham

Updated 15 May 2019

SMART Wokingham is based in Berkshire and provides a service to adults, older adults and young people. The service is commissioned by Wokingham Drug and Alcohol Action Team, and is one of the services delivered by a charity called SMART Criminal Justice Services. The contract had recently been re-tendered by the local authority and awarded to SMART.

SMART provides opioid substitute therapy (OST), which involves the prescribing of medicines like methadone and buprenorphine to people needing treatment for heroin dependency. In addition, SMART supports clients with community alcohol detoxification. The service provides one to one work and group psychosocial interventions to help people to develop their recovery skills and support networks to sustain their recovery from alcohol or drug misuse. This service operates a needle exchange, which allows injecting drug users to safely obtain and dispose of injecting equipment at no cost. Needle exchanges operate from many pharmacies and community treatment services and reduce the spread of blood borne viruses including Hepatitis C and HIV. Staff had set up information points in local GP surgeries to advertise the service and, in addition, offered support to dispensing pharmacies.

The service did not have a registered manager. The area manager for this service was providing operational management and an application was due to be submitted to the Care Quality Commission following this inspection visit, for the area manager to be the registered manager.

SMART Wokingham was registered with the Care Quality Commission (CQC) in December 2014 for the treatment of disease, disorder or injury.

This is the third time the CQC have inspected SMART Wokingham using our new approach of asking five key questions about the quality of services. At that time of the previous two inspection visits, CQC did not rate substance misuse services.

The first CQC inspection of SMART Wokingham took place in May 2016. CQC issued the provider with two requirement notices in respect of breaches of regulation. The first was in relation to a failure to notify CQC of the death of a client and the second was in relation to staff training and development.

The second inspection took place in April 2017. This inspection focussed on assessing whether the provider had made improvements to its service since the comprehensive inspection in May 2016. On this occasion, CQC found that the provider had made all the required improvements.

Updated 15 May 2019

We rated SMART Wokingham as requires improvement because:

• The service has not had a registered manager since August 2018. At the time of our inspection visit, the provider was finalising arrangements for which individual it would nominate for the CQC registration process. CQC requested that the provider confirm it’s plans for registering a new manager without further delay. The provider subsequently confirmed that the area manager had commenced the registration process.
• Staff told us that management issues within the service had led to poor staff retention levels. Staff turnover during the 12-month period to 09 January 2019 was over 100%. Staff stated that this high turnover led to the service being short-staffed and clients receiving poor continuity of care.
• Clients reported that individual and group sessions had been cancelled due to staffing shortages. Some staff expressed a feeling of anxiety due to inadequate staffing levels and the workload pressures that placed upon them.
• Risk assessments we reviewed did not contain a risk management plan in relation to potential risks associated with an unexpected exit from treatment.
• The provider had not conducted any water tests for the Legionella bacteria since it took over the running of the service in 2014. Following our inspection the provider confirmed that a Legionella risk assessment and water sample testing had been completed within two weeks and a plan was in place for monthly water temperature tests and an annual Legionella risk assessment to take place.
• None of the eight care records we reviewed contained a copy of the client’s medical history from their own GP; none contained evidence of the client’s initial medical assessment within the service; and, only four contained some evidence of ongoing physical health assessments.
• Clients told us they were unhappy with the quality of soundproofing within the building. They said it could be distracting when they were trying to focus on their session, when there was noise within the reception area. In response to the concerns raised by clients, staff tried to minimise the number of people in the vicinity of meditation sessions, which were adversely affected by noise outside the room.
• Some staff we spoke with expressed anxiety about raising concerns, for fear of negative consequences.

However:

• Client records contained recovery plans written with the joint input of the clients and their support worker. Recovery plans were holistic, addressing all the identified needs of each client.
• Staff attended team meetings, that occurred an average of twice per month, during which staff discussed a wide range of topics, including learning from recent incidents. Staff received a supervision session every four to eight weeks. Managers addressed staff performance issues in supervision.
• Staff demonstrated that they had effective working links with local external services such as community mental health teams, housing providers, children and family services, social work and criminal justice agencies. Staff referred clients to partner agencies as appropriate.
• Staff adapted appointment times to meet the needs of clients. The service was open two evenings per week and had early morning clinic slots available, to give working clients additional opportunity to attend appointments and therapy sessions.
• Staff provided a joint monthly drop in session for clients, with a local homelessness charity, a social housing provider and a community mental health team. The venue for the session rotated between the partner agencies. The aim was to provide clients with a one-stop shop advice forum.

Updated 15 May 2019