Blossom Street - York Drug and Alcohol Service

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 means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

Good: This meant people were safe and protected from avoidable harm.

The service was clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

All staff and managers told us they felt able to raise concerns and felt positive about how approachable and proactive senior managers were. Staff told us that sharing information and continuous learning was implemented through various forms which included emails, handover meetings called ‘Flash’ meetings, regular supervisions, and staff meetings.

Staff recognised incidents and reported them appropriately. Incidents were reviewed and any themes and trends were identified and discussed. Managers could give examples of changes following lessons learnt from incidents such as reviewing policies and staff briefings or training. The service reported 32 incidents in the last 12 months, including 15 unexpected deaths. The service followed the death in service process which included a death in service review and outcomes of the review were shared with commissioners and with staff if lessons learnt or good practice were identified.

Clients were asked to complete feedback forms. They told us they knew how to raise concerns and staff within the service were responsive.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had a clear engagement policy in place. This included maximising engagement with users of the service and outlined the service’s response to unplanned exit or discharge from treatment and the safety of people using services.

Commissioners set a key performance indicator of referral to first appointment within 10 working days. The service received 165 referrals in June, July and August and achieved 97.31%. The service did inform us that due to current staffing pressures the service had some clients awaiting allocation to an alcohol recovery coordinator. This was monitored daily and clients allocated appropriately. Staff made regular contact with those on the list to discuss if there were any changes that may either remove them from the list or expediate their support needs.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff we spoke with told us they knew who to raise and report safeguarding concerns to. Safeguarding adults and children training was mandatory, and compliance at the time of the assessment was 100%.

The provider had systems, policies, and processes in place to ensure that staff identified and reported concerns. Managers attended the local safeguarding adult board, safeguarding adult review board and a safeguarding task and finish group. The manager also attended Multi-Agency Risk Assessment Conference (MARAC) steering committee. In the previous 12 months the provider had made 34 safeguarding referrals. We reviewed 6 care records which captured any relevant safeguarding concerns for individual clients, and these had been actioned correctly.

We scored the service as 2. The evidence showed some shortfalls. The service did not always keep a clear and consistent record to understand and manage risks. However, we found the service worked with people to understand and manage risks by thinking holistically and they provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found that staff completed and updated risk assessments. In some records the risk was identified appropriately and managed but not reflected well in the care records. The quality of record keeping required improvement. We reviewed 6 care records and found that the entries under various sections were presented in a basic fashion with little personalised language.

We spoke with 16 members of staff who all told us they communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties and examples given were the use of visual tools, interpreters, and software programs.

Staff routinely and regularly provided clients with harm minimisation advice in relation to the risks associated with their continued drug and alcohol misuse and safety planning was an integral part of recovery plans.

Staff followed a clear engagement policy which included steps to take if the client unexpectedly dropped out of treatment.

Staff encouraged clients on medicine collection regimes to have lockable storage boxes in which to keep their medicines to safeguard any children or vulnerable people living with them.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. However, they made sure equipment, facilities and technology supported the delivery of safe care.

The service had environmental risk assessments in place and conducted regular health and safety checks to mitigate risks, but this did not include ligature risks within the internal or external environment. All interview rooms had alarms, the premises had CCTV and staff were available to respond. The reception area was managed safely with adequate space and alarms in place. Client’s accessing the service would be supported within the building, however the service also supported community detox clients. These clients had designated rooms and access to a kitchen and outdoor space therefore not all potential risks to these individuals had been fully considered.

The premises were clean, and staff followed infection control guidelines, including handwashing. Staff made sure equipment was well maintained, clean and in working order. The clinic room had the necessary equipment and all areas were clean, well maintained, well-furnished and fit for purpose.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had qualified, skilled and experienced staff, however due to current vacancies and sickness staffing levels were low. At the time of our inspection the service was 3.5 whole time equivalent (WTE) recovery coordinators short. This was due to long-term sickness and waiting for new members of staff to start their employment or redeployment. A member of the medical team was also absent from the service. The service had recruited to vacancies and employed newly developed positions, which had been created to improve systems, processes and outcomes for clients. Managers covered staff sickness and absence with agency staff. Within the previous 12 months the average turnover of staff was 10.5% and average sickness absence was 2.94%.

All staff had received and were up to date with appropriate mandatory training and were 100% compliant. The training was appropriate for the client group using the service and included learning disability and autism awareness. In addition to the mandatory training staff also had access to a range of additional courses on substance misuse training, such as introduction to drug and alcohol awareness, naloxone, ketamine, needle exchange and safer injecting training.

The service had enough nursing and support staff to keep clients safe, however caseload numbers were high due to absent staff and vacant posts. Staff told us that appointments were cancelled due to the volume of work, and some clients were awaiting allocation to an alcohol recovery coordinator.

Managers ensured all staff employed to work with clients had up-to-date Disclosure and Barring Service certificates in place. Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift.

The service also recruited, trained and supported volunteers to work with clients in the service. We spoke with the volunteer coordinator and service user involvement lead who was responsible for recruiting, initial training and conducting supervisions and appraisals for all volunteers.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We carried out a tour of the environment and found that all areas were clean, had good furnishings and were well-maintained. Staff maintained equipment well and kept it clean.

Staff adhered to infection control principles, including handwashing and the safe and appropriate disposal of clinical waste.

The service operated a needle exchange, and they ensured the safe storage of sharps and used needles. Clients attending the exchange were examined using a proforma covering drug use, harm reduction, blood borne virus testing, naloxone and safe disposal and storage of needles.

Clinical areas had the required standard of cleanliness for clients to have thorough physical examinations including areas for blood-borne virus (BBV) testing and wound care.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. We reviewed the medicines management policy and found this was fully adhered to in terms of procurement, storage, stock management, prescribing prescriptions, supply and administration and disposal. The policy also covered incident reporting relating to medication held in the service and we saw examples of good practice in relation to reporting medication incidents and sharing of concerns or lessons learnt.

Staff reviewed each client’s medicines every 3 months and provided advice to clients about their medicines. The service reviewed clients who had been on the same prescription for a long time.

Staff completed risk assessments to determine the safe frequency of prescription pickups and reviewed these regularly. Where changes to pick up regimes were made, there was a clear rationale was in place with a clear and effective risk assessment and documentation in place.

Staff ensured there were always sufficient stocks of emergency medicines on the premises such as naloxone and adrenaline. Staff ensured they reviewed the storage of naloxone, and the process of how it was distributed and monitored, how it was replaced after use and how harm minimisation advice was given.

Staff learned from safety alerts and incidents to improve practice.

Staff managed client withdrawals safely and in line with national guidance. The service supported clients undergoing a community detox. The service had a clear process involving the non-medical prescribers and key workers within the service.