The Calico Group - St John’s Court

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

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. Staff responded promptly to sudden deterioration in clients physical and mental health. Staff made clients aware of harm minimisation and the risks of continued substance misuse. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each client’s mental and physical health. The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

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 within the service in the last 12 months. 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, safeguarding concerns, client behaviour and client deaths. We reviewed incidents and found all had been investigated and appropriate actions had been taken as well as lessons learned noted for sharing with staff.

Staff understood their responsibilities under the duty of candour. They knew this included the need to be open and transparent; give clients and families a full explanation and apologise when things went wrong. There had been four incidents requiring a duty of candour response, three were medication errors and the other a breach of confidential personal data. The service had followed the process correctly.

Staff received feedback from the investigation of incidents, and this feedback was discussed in team meetings and daily huddles.

Since the last assessment governance procedures had been improved and there a clear structure of meetings and who was responsible for conducting investigations and audits.

Clients said the referral process was smooth, and they were seen quickly following referral. Clients confirmed they were supported with accessing other agencies for support and the service offered home visits where required.

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 could be referred by their GP or criminal justice organisations such as probation services, the police or prison services. There was a significant number of clients who entered the service by self-referral or via the daily drop[1]in sessions which were available for anyone to attend without a prior appointment.

Staff told us they had specialist roles within the integrated team, this included opiate recovery workers, alcohol recovery workers and criminal justice workers. Teams delivered a multi[1]agency approach, including hospital liaison and prisons. Staff told us there was a collaborative, joined-up approach to safety that involved clients, staff and other agencies involved in client care. T

here were 32 people waiting to access the service but all of those had not responded when the service had offered them appointments. We saw evidence that the service continued to try and establish dialogue with those on this list. Staff saw urgent referrals as soon as possible with appointments available daily.

Staff were trained in safeguarding vulnerable adults and safeguarding vulnerable children. At the time of the assessment, the training compliance rates were 100% for level one and 65% for level 2. Safeguarding level 2 was a face-to-face course with staff booked onto sessions taking that number to 92%.

Managers had introduced other courses so that staff could safeguard clients. These included child sexual exploitation and cuckooing (Cuckooing is where criminals use a vulnerable person’s house for criminal purposes).

The service had an identified safeguarding lead who had oversight of all ongoing safeguarding issues.

The service submitted 52 safeguarding incidents, which led to 25 safeguarding referrals being forwarded to the local authority. 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 suicidal ideation, sexual abuse, domestic violence, physical and financial abuse, child neglect and concerns relating to mental health.

Staff worked in partnership with other agencies. For example, staff attended multiagency meetings with external agencies such as child protection services, the police and social care to discuss serious concerns about clients. Internal “risk hub” meetings took place daily where staff could discuss safeguarding concerns. We observed one of these meetings and noted that the staff member demonstrated their level of not only safeguarding but also the mental capacity act while discussing a patient about to be discharged from hospital, who in their opinion lacked capacity to return home and needed new supportive accommodation.

At our last assessment we found the service did not always complete risk assessments with clients. Staff had not completed or had not updated risk assessments in the timeframes stated. On this assessment we looked at eight client records and found they were all up to date with risks reviewed in monthly client progress appointments. We also saw staff reviewing risk when referrals were made to the service.

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 assessment and staff recorded when 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.

There were clear re-engagement plans for staff to follow if clients dropped 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.

The service rented several floors of a town center office block. While reception was on the first floor there was a lift and emergency equipment to help people navigate the steps in an emergency such as in the event of a fire making the lift unusable. There was a separate entrance on the ground floor for people wishing to access the needle exchange.

The service had completed a risk assessment for the building and all gas, legionnaire and fire safety checks were in place. Staff had access to alarms so they could call for assistance when needed and the entrance to the service was locked and controlled by reception staff.

There were staff trained as fire wardens and in first aid.

Clinic rooms were neat and tidy with equipment available for conducting physical health checks such as blood pressure, height and weight.

There were sufficient numbers of skilled and experienced staff to safely meet the needs of clients using the service.

There were 66 staff working at the service. This included nine staff employed by a sister company of the Calico group who provided unregulated activity such as group work.

Staff at the service included three Doctors, two non-medical prescribers, five nurses, 27 recovery co-ordinators, managers, team leaders and support staff which included two counsellors.

There were five vacancies, three of which had been recruited to and the other two still covered by the staff moving pending appointments being completed. No bank or agency staff had been used to cover shifts.

The average sickness absence rate over the last 12 months was 6.78%.

The service had divided its staff into six teams, and caseloads reflected the client’s needs within those teams.

• Assessment – average 28 clients per key worker

• Core – average 47 clients per key worker

• Alcohol – average 29 clients per key worker

• Criminal Justice – average 41 clients per key worker

• Complex – average 20 clients per key worker

• Recovery – average 12 clients per key worker.

At the last inspection the service had either not provided or recorded bank and agency staff induction. While there had been limited use of bank or agency staff in the last 12 months managers were able to demonstrate they now had a procedure in place with an induction checklist.

Staff records had also been incomplete at the last inspection. We checked five records on this assessment and all had references, work history and relevant professional medical registrations recorded.

Managers ensured staff received mandatory training which was appropriate for the client group using the service. Modules included health and safety, first aid, fire warden training, substance misuse, trauma informed care, 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 high. There were 43 mandatory courses and six were below the providers target of 85%. These were handling information (62%), motivational interviewing (73%), prevent (71%), safeguarding adults level 2 (65%) and two staff development course which looked at management skills and career development.

However, there were measures in place for those not having completed the training to have done so soon.

All areas were clean, well maintained, well-furnished and fit for purpose.

Staff made sure cleaning records were up-to-date, and the premises were clean.

We observed that identified maintenance issues were reported and logged appropriately.

Staff adhered to infection control principles, including handwashing.

Other than naloxone, buvidal and adrenaline, medicines were not stored at the service premises.

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.

Staff followed systems and processes to prescribe and administer medicines safely. There was a mixture of nurses and non-medical prescribers responsible for the prescribing and monitoring of medicines supported by two prescribing administrators. Prescriptions for clients’ medicines were carefully controlled, and a system was in place to record changes to prescriptions and to track each prescription. This included tracking the delivery of each prescription to community pharmacies.