Blossom Street - York Drug and Alcohol Service

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

Good: This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

At our last assessment we rated well-led as good. At this assessment the rating has remained good. Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Staff collected and analysed data about outcomes and performance. They used this to identify improvements. Teams had access to the information they needed to provide safe and effective care. However, governance processes did not always operate effectively.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

Staff told us the leaders of the service encouraged an open, supportive and honest culture. Managers we spoke with were positive about the support they received, and all staff told us that, despite the staffing pressures, they all shared the same goal of ensuring the best outcomes for the clients.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care.

Leaders were visible in the service and approachable to clients and staff. While there were staffing pressures in the service, managers were leading by example by taking on caseloads and working at reception to enable staff to undertake training or so staff could have their well-being hour.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies and procedures to support whistleblowing and the freedom to speak up and managers promoted an open and honest culture within the service.

Staff we spoke with understood these policies and felt comfortable using them without fear of reprisal.

Managers were aware of the risks around closed cultures and implemented actions such as staff surveys, service user engagement and governance processes, such as audits and meetings to disseminate best practice and shared learning.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they were supported and were able to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. Staff told us that managers put reasonable adjustments in place for staff members to help them conduct their role, such as working from home and adaptive equipment in the workplace.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the client group. The service employed some staff with a lived experience and recruited and supported volunteers into the service.

We scored the service as 2. The evidence showed some shortfalls. They did not always have good governance. However, the service did act on information about risk, performance and outcomes. The service had clear responsibilities, roles and systems of accountability and used these to manage and deliver good quality, sustainable care, treatment and support.

Our findings from other quality statements demonstrated that some governance processes did not always operate effectively.

We found the service lacked some oversight of environmental risks. The service had good systems and processes in place for identifying health and safety risks within the environment, but this did not consider ligature risks within the internal or external environment. The service had reliable systems in place to mitigate some of these risks and monitor the environment, such as CCTV, but the service needed to identify and recognise the potential risks to some clients.

We found the service lacked oversight and review of care records which impacted on the quality of these. We found that staff did not make effective use of patients views to ensure care plans were personalised and there was no evidence of how outcome measures were used to formulate clients care plans. In the care records that we viewed we could not find evidence of the assessment of mental capacity on admission or on an ongoing basis. However, all staff had completed training in the Mental Capacity Act and had a good understanding of how to apply it.

Managers spoke with us about the challenges with the client record system, which were specific to this location. The service were unable to pull data to compare outcomes to other sites, staff told us that it was not fit for purpose and the work generated for creating client prescriptions was impacting on staff workload.

However, staff told us they were well resourced as a service, they had access to the equipment they needed to do their work, and the information governance systems included confidentiality of client records. The provider used systems to collect data on the performance of the service, staffing, surveys, and feedback that were not overburdensome for frontline staff. Team managers had access to information to support them with their management role.

There was a clear framework of what must be discussed in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. The service had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the clients.

The service had plans for emergencies, for example, adverse weather or a flu outbreak.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Leaders engaged with external stakeholders and feedback from external partners was positive, stating that they worked together in a collaborative way to support client care and treatment.

The service worked with partner agencies and local third sector organisations to promote joined up care and facilitate engagement, for example the employment service attended the service meetings and maintained regular contacts via drop ins, emails and phone calls.

The service took part in local community activities, for example the service held a remembrance service for people who lost their lives to addiction and an annual summer event in the service’s garden inviting stakeholders, volunteers, staff and clients.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Staff were given the time and support to discuss opportunities for improvements. Staff used quality improvement methods, completed audits, treatment outcomes profiles, engaged with commissioners and gained feedback to ensure the service maintained a good standard.

The service had implemented a ‘Same Day Prescribing’ offer, which had improved communication with external partners and improved the retention rate of and engagement with clients.

The service was working in partnership with the local mental health trust to develop a dual diagnosis worker post and funding was in place for this role.