Camden Community Drug Treatment 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 this inspection, we have rated it as good

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety and learning based on openness and honesty. Staff knew what incidents to report and how to report them. Staff received training on how to report incidents using the electronic reporting system. Managers or an appropriate staff member investigated incidents and shared lessons with the whole team and wider service. The service promoted an open learning culture with clear routes for reporting and sharing through daily meetings, team meetings and governance forums.

In the last 6 months, there had been no serious incidents. We saw staff reported a range of incidents including deaths, medication incidents and aggressive behaviour. The service completed robust investigations of each incident as required. These investigations included learning and actions to help reduce the likelihood of these incidents happening again.

Managers shared learning from incidents with staff in monthly integrated governance meetings. In addition, managers shared alerts from other services it provided in other locations, to ensure learning across the whole organisation. The interim service manager attended a regular meeting with other CGL service managers where key findings from serious incidents were discussed.

Staff understood responsibilities under Duty of Candour. Duty of Candour is a legal requirement. It means providers must be open and transparent with clients about their care and treatment when something goes wrong.

The service referral and admission process ensured that all essential information about the client was received to determine if their needs could be safely met. The criteria for the service were that the person must be a resident in Camden and over the age of 18.

The service received referrals from GP surgeries, community mental health teams, social workers, homelessness centres and self-referrals.

The service offered clear pathways for new clients to meet their needs. Where appropriate, there were systems and processes to transfer or share care with other services such as a GP surgery, local community mental health teams or another support network identified during their care.

The service offered pathways to support people with addressing use of opiates, alcohol, non-opiate substances, benzodiazepines and engaging with chemsex. There were pathways or specialist staff teams to support people involved in the criminal justice system, accommodated in hostels, those who had a dual diagnosis and/or were homeless. The service could refer and support someone to access shared care, acute hospital care, health clinics, inpatient detox and rehabilitation, recovery support, individual placement support and counselling.

The service offered service users a tele health offer. This involved the service using entirely digital means telephone or video calls to deliver time-limited structured interventions for people experiencing issues with low level non-dependent alcohol, cannabis or cocaine use. This helped improve accessibility for those service users who needed to access support.

The service had robust alternative care pathways and referral systems in place for people whose needs could not be met by the service.

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. Staff involved all the necessary healthcare and social care service to ensure clients had continuity of safe care, both within the service and post-discharge.

Staff provided assessments as soon as clients came into the service. In practice, if anyone self-referred staff tried to provide an immediate assessment as they recognised that it could be challenging for people to make a first contact.

Treatment started as soon as necessary medical checks had been performed. Waiting times for non-urgent referrals to assessment was two working days. Referrals were screened and clients were contacted by phone or letter. Routine triage occurred within 7 days of referral. The service was able to see urgent referrals more quickly. The service had designated time slots during the day to see urgent referrals or clients who turned up to the clinic without an appointment.

Allocated practitioners followed up client non-attendance pro-actively, and where necessary would refer clients to the outreach team to follow up with a home visit.

Staff from different disciplines worked together as a team to benefit clients. They supported each other to make sure clients had no gaps in their care.

Staff carefully planned clients’ discharge and worked well with external services to make sure this went well. There was a regular multidisciplinary meeting to review discharges.

We reviewed 11 care records. Risk assessments and recovery plans were present, clearly documented and regularly reviewed, and prescribing decisions showed multidisciplinary input. Staff described structured discharge pathways and joint working with probation and other providers to support continuity.

Staff consistently described what they would do in practice should a person exit unexpectedly from the service. This included contact with next‑of‑kin, attempting rapid re‑engagement and discussion of risk with them. Although formal plans for unexpected exit were not consistently documented in care records, we saw evidence in some records that staff acted promptly and followed their described approach, including contacting next‑of‑kin and attempting rapid re‑engagement.

Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. The service had a safeguarding lead who was the service manager. These responsibilities were also delegated to the senior social worker, deputy service managers and team leaders. Staff we spoke to knew who this was. This meant that staff had a person they could go to for advice and guidance if they had a concern about a client’s safety, or the safety of others in contact with the client.

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 internally and externally quickly and appropriately.

Staff received training on how to recognise and report abuse, and they knew how to apply it. Staff received training in level 3 safeguarding for children and adults. The completion rate for safeguarding adults was 83 %. The completion rate for safeguarding children was 85%. Leaders told us that safeguarding was reviewed in case management reviews and multi-disciplinary (MDT) meetings. They also held leadership oversight data and performance meetings. Staff from the service attended the Camden strategic safeguarding boards in the borough and combating drugs board.

The service had completed 26 safeguarding referrals in the last 12 months with follow‑up evidenced in care and treatment records.

The service had a monthly safeguarding meeting, where all current safeguarding concerns were discussed and actions updated. Safeguarding concerns were also reviewed daily at check in meetings and at the weekly multi-disciplinary team meeting.

All clients and carers we spoke with reported that they or their loved one felt safe when using the service.

The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Records confirmed staff completed and updated risk assessments. Incident entries showed appropriate immediate actions (including de‑escalation and, where required, liaison with emergency services). People told us they understood group rules and reflected on the impact when someone attended under the influence. Care and treatment records showed staff sought to keep people engaged and clarify expectations after incidents.

Risk plans were updated after changes, and people using the service and their carers confirmed they were involved with and knew about these changes.

The premises where clients received care were safe, clean, well-equipped, well furnished, well maintained and fit for purpose. The rooms where group sessions and one-to-one key working sessions each had individual theme names and corresponding decoration. For example, in ‘river’ room, there was a large mural of a river.

Staff could access personal panic alarms. The rooms were fitted with alarms. The service assigned two staff members at the start of each shift as first responders to attend to an emergency. These staff had received training in this role. There were staff on site to respond to alarms. Staff tested the alarms monthly to ensure they worked.

Access to the service and staff offices in the building was secured. There was clear information about this for staff and visitors.

Staff completed daily and weekly environmental checks including a monthly premises check, weekly fire alarm testing, monthly legionella testing, alarm testing, emergency lighting testing. A fire risk assessment had been carried out for the service, and the risk assessment identified the key risks of fire and how these should be mitigated, including the training of fire wardens and first responders being assigned each day. The service assigned two fire wardens for each shift. This was confirmed in every morning meeting. We saw that a fire drill had taken place in March 2026, and all staff and clients had been evacuated safely.

Staff competed monthly health and safety audits to assess the safety of the building.

The service detected and controlled potential risks in the care environment and made sure that the equipment, facilities and technology supported the delivery of safe care.

The service embedded personal safety protocols for staff to follow. Staff were aware of and followed lone working protocols to ensure their safety on home or external agency visits. Staff used mobile phones when they visited client’s homes and always went in pairs. Staff discussed which staff were going on home and external agency visits in every morning meeting so that staff were aware of the time of visit and location. Staff at the service had landline and mobile telephones to call emergency services.

In the 12 months prior to the inspection the supervision compliance rate for staff was 57%. Supervision is important because it provides a structured space for staff to reflect on their practice, enhance their skills, ensure safe and effective care, and receive support when managing complex cases. Leaders told us that this number was low due to some supervisions being completed offline and not being updated onto the system, some members of staff being on long term sickness, unplanned absence and vacancy and recruitment delays.

There were enough staff to meet the needs of clients accessing CGL Camden and the service could manage any unforeseen shortages in staff. CGL staff received relevant training to keep clients safe from avoidable harm. For example, in safeguarding and assessing risk. The service had a morning meeting where a part of the meeting was to discuss staffing and cover arrangements.

The service had a range of staff employed to meet the needs of the clients and manage the safe running of the service. There was an interim service manager, data analysts and administrators and receptionists. Clinical staff included psychologists, social workers, recovery coordinators, group facilitators, criminal justice recovery workers, prison link workers, speciality doctors and dual diagnosis nurses. Within this staff had lead roles. These included a harm reduction lead, women's lead, employment lead and a lead for community and partnership training.

Staff received regular supervision. Supervision is important because it provides a structured space for staff to reflect on their practice, enhance their skills, ensure safe and effective care, and receive support when managing complex cases.

At the time of inspection, the vacancy rate was 11.8%.

In the 12 months prior to the inspection, the staff sickness rate was 1.7% for long term sickness and 2.51% for short term sickness. The service had arrangements in place for annual leave and sickness absence. For example, staff covered each other during periods of absence.

The service had a designated duty workers assigned to each shift. They ensured cover arrangement were made for staff in their absence.

In the last 12 months prior to the inspection, the staff turnover rate was 20.5%. Reasons given for staff leaving included moving country, career progression and fixed term contracts coming to an end.

At the time of the inspection, the service had 1357 clients accessing care and treatment. This was an average caseload of 26 clients per recovery practitioner. Staff reported that this was manageable. Recovery practitioners, nurses and prescribing teams were responsible for booking appointments for clients, being involved in assessments, maintaining regular contact with them, and ensuring client records were kept up to date. Managers reviewed caseloads with recovery practitioners during supervision.

In the last 12 months prior to the inspection the appraisal compliance rate for staff was 89%.

Staff had received and were up to date with most of the mandatory training. Overall, compliance with mandatory training was 94%. Staff had completed training in basic life support and anaphylaxis, data protection, equality and diversity, health and safety, learning disabilities and autism, mental capacity and the deprivation of liberty safeguarding and safeguarding adults and children.

The service ensured robust recruitment processes were followed in line with provider policies. This included current criminal record checks, a minimum of two references and evidence of suitable experience for the role to ensure staff were safe to work with vulnerable adults.

The service had arrangements in place to ensure staff had received vaccinations recommended by the Centres for Disease, Control and Prevention. For example, hepatitis B or chickenpox.

Clients reported that staff rarely cancelled appointments.

Staff adhered to infection control principles, including hand-washing. Staff disposed of clinical waste appropriately.

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.

Medicines were managed safely and in a way that supported person-centred care. People told us they received clear information and were involved in decisions about their medicines. Staff described how they used national and regional forums to discuss complex cases and share good practice, and how supervision supported safe prescribing decisions.

Standard operating procedures (SOPs) were in place for each prescribing pathway, including opioid substitution therapy, detoxification, and relapse prevention. These operating procedures aligned with national guidance such as National Institute for Health and Care Excellence (NICE) recommendations. Staff demonstrated awareness of these procedures and described how they applied them in practice.

We reviewed 11 care records across different pathways. Each showed consistent documentation of prescribing decisions, physical health monitoring, and risk assessments. For example, records included Electrocardiogram (ECG) monitoring for higher-dose methadone prescriptions. Staff interviews and a review of care and treatment records confirmed that SOPs were being followed in practice, with evidence of clinical oversight and adherence to safe prescribing protocols.

Medicines were stored securely and appropriately. Staff checked existing prescriptions during assessments using GP records and confirmed details directly with the person and their pharmacy. They described working collaboratively to reduce risks, including monitoring for signs of misuse or diversion and adjusting treatment accordingly. Naloxone was available in both nasal and injectable forms, and staff were familiar with its use.

The service had a structured framework to ensure all clients received a medical or non-medical prescriber review annually, in line with policy. Compliance was reported at 89.93% at the time of inspection, with mitigation plans in place for missed reviews. These included conducting reviews in absence, holding prescriptions at the hub, and enhanced communication with pharmacies. The provider’s audit confirmed that overdue reviews were tracked, risks assessed, and actions taken to ensure safety, such as issuing naloxone, scheduling follow-ups, and reviewing dispensing regimes. Additional prescribing capacity had been introduced to support delivery.