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Inspection Summary


Overall summary & rating

Good

Updated 19 July 2019

We rated Swanswell Newbury as Good.

  • The service provided safe care. Premises where clients were seen were safe and clean. The number of clients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each client the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with clients. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the clients.
  • Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Capacity Act 2005.
  • Staff treated clients with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved clients and families and carers in care decisions.
  • The service was easy to access. Staff assessed and treated clients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude clients who would have benefitted from care.
  • The service was well-led and the governance processes ensured that that procedures relating to the work of the service ran smoothly.

However:

  • Since the organisation had joined a larger group of charities, there was not yet a unified set of policies and procedures and staff had access to policies for the parent organisation as well as the ones specific to the service. No risk to service users arose from this, because staff understood all relevant clinical policies clearly understood, but there was scope for confusion amongst staff.
  • There was scope to improve staff morale. Staff told us that better terms and conditions offered to staff doing the same roles within other services run by the same provider had an impact on staff morale and retention.
Inspection areas

Safe

Good

Updated 19 July 2019

We rated safe as Good because:

  • The environment was clean, tidy and well maintained. Environmental risk assessments were carried out regularly and staff had safety alarms for one to one working and a robust lone working procedure. Staff adhered to the services infection control procedures.

  • Staff assessed and managed client risk effectively, stored information safely and shared it with partners as appropriate.

  • Staff and managers maintained a strong focus on safeguarding adults and children from abuse.

  • Staff were proactive in engaging clients with the service and to prevent clients dropping out of treatment early. Staff gave personalised and appropriate harm reduction advice at every opportunity.

  • Medical cover was provided through a service level agreement with a local GP practice with a specialism in substance misuse, and through a part time alcohol detox nurse who also carried out health checks with all clients.

  • Incidents were reported and investigated effectively. Outcomes of investigations were fed back to staff and clients. The service fulfilled its duty of candour.

  • Staff turnover created pressure on recovery workers, however staffing did not fall below safe levels and sickness was low.

  • The needle exchange was safely managed, and equipment was securely stored. All staff were trained to deliver needle exchange interventions and to provide naloxone to clients.

  • Physical monitoring equipment was calibrated regularly.

Effective

Good

Updated 19 July 2019

We rated effective as Good because

  • We found excellent interagency working between the service, the local authority, and the local NHS trust to ensure that clients’ needs were met, as well as effective networking with the wider social care system. This included effective partnerships with mental health, sexual health, hepatology, domestic violence, homelessness, family safeguarding, and criminal justice services. These partnerships consisted of clear referral pathways, joint working agreements and co-location of staff, enabling clients’ holistic needs to be met seamlessly. Examples of this partnership work included a project to engage heavy, entrenched drinkers. They also worked with probation and  the police to support offenders, including diversionary work to prevent people who had been caught with small amounts of substances from re-entering the criminal justice system. The service also had close links with a specialist women’s organisation and was a member of the local homelessness strategy network.

  • The service had identified travel to the main hospital being a barrier to clients engaging in treatment for hepatitis C and had developed a partnership agreement with the hepatology department for treatment to be delivered on site at the service. This had improved access to treatment for hepatitis C and improved the health of this group of clients.

  • The service actively monitored client outcomes through the use of the drug and alcohol outcome star as well as the treatment outcome profile tool required by Public Health England. Service data showed client outcomes for the successful completion of treatment to be better than the national average, and service user survey results showed the majority of clients (82%) reporting positive changes as a result of their engagement with the service.

  • Staff ensured all clients received a comprehensive assessment of their needs and a holistic, personalised care plan. Records were thorough, and staff gathered consent to receive treatment and to share information.

  • All clients were offered physical health checks, which were completed by the nurse employed by the service.

  • The service delivered treatment in line with National Institute for Health and Care Excellence guidance, including group work and key-working tools.

  • Staff tested for blood borne viruses and offered Naloxone to all opiate users accessing the service for treatment or needle exchange.

  • The continuing development of the staff’s skills, competence and knowledge was recognised by the service as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice.

  • Supervision was provided four weekly by managers and appraisals for all six eligible staff were up to date.

  • Staff understood the Mental Capacity Act as it applied within the service and adhered to its principles.

However

  • Although the service had qualified staff and safe protocols in place to provide community alcohol detox, no clients had received this service in the 12 months prior to the inspection. The service was unsure about whether this was due to low referrals, the criteria applied or the application of those criteria by staff carrying out assessments of need and suitability.

Caring

Good

Updated 19 July 2019

We rated caring as Good because:

  • Staff treated clients with dignity and respect, and showed a non-judgemental approach, speaking of clients with high regard and understanding, and avoiding the use of stigmatising language.

  • Clients were treated as partners in their recovery planning.

  • There was support provided to families and carers.

  • The service user forum had recently gathered momentum and was used to consult service users on service developments. We found evidence of the forum affecting positive change within the service.

Responsive

Good

Updated 19 July 2019

We rated responsive as Good because:

  • The service had open access sessions and extended opening hours twice a week, to maximise accessibility for clients. The service operated seven satellite locations across the area, including GP services and a substance misuse service in a neighbouring local authority, in order to overcome the significant barrier posed by many clients of travel costs and distance in a mainly rural area. Home visits were also provided where needed.

  • Satellites and the main service hub had adequate disabled access.

  • The service offered an evidence based on-line advice, information and treatment tool to all clients which could be accessed remotely from the service.

  • Complaints were dealt with effectively and outcomes were fed back to clients and staff. We saw evidence of the service discharging its duty of candour and apologising when things had gone wrong.

  • The service engaged pro-actively with local community organisations in order to fundraise and to take part in community engagement events that promoted social integration for service users and challenged stigma around substance misuse.

Well-led

Good

Updated 19 July 2019

  • The service had a clear vision and values, and good quality assurance systems in place, to monitor all aspects of service delivery

  • The manager of the service used the resources to maximise the range of skills within the staff team, through training and specialist roles, and ensured a strong network within the local statutory and voluntary networks to extend the reach of the service as far as possible.

  • The service had a stable and skilled management team and staff reported generally high morale despite some workload challenges.

  • There was a robust incident and complaints processes that were utilised effectively with lessons learned shared appropriately

  • The service used key performance indicators to assess its performance and fed these back to the commissioners monthly.

However:

  • Since the organisation had joined a larger group of charities, there was not yet a unified set of policies and procedures and staff had access to policies for the parent organisation as well as the ones specific to the service. No risk to service users arose from this, as all relevant clinical policies were clearly understood, however there was scope for confusion amongst staff.

  • There was scope to improve staff morale. Staff told us that better terms and conditions offered to staff doing the same roles within other services run by the same provider had an impact on staff morale and retention.

Checks on specific services

Community-based substance misuse services

Good

Updated 19 July 2019