Turning Point Somerset Maltravers House

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Staff monitored clients safely and regularly throughout the treatment period. Risks were managed well in all locations. Staff had a good understanding of individual risks, and were skilled and experienced. Safeguarding was a high priority, and the teams ensured clients with safeguarding risks were referred to appropriate agencies and monitored. There were clear policies and procedures in place safeguarding adults and children.

• The environment at each location was clean and well maintained and the layouts protected privacy. Information was freely available specific to substance misuse issues.

• All the locations had experienced and supportive managers. The service had an approachable and knowledgeable registered manager. The senior management team provided excellent oversight supported by robust governance systems. Staff told us they were proud of what they had achieved over the previous year. Staffing numbers in all locations were sufficient to manage caseloads safely. Managers monitored staffing requirements against caseload numbers on an on going basis. An experienced clinical consultant led a dedicated team of medical and non-medical staff. There was good multiagency working. The service worked closely with other agencies, for example, mental health services, to ensure they addressed and identified individual needs.

• Staff followed ‘drug misuse and dependence: UK guidelines of clinical management’ (2007) and National Institute for Health and Care Excellence (NICE) guidelines for substitute prescribing and psychological therapy. Prescribing practices were excellent. Dedicated staff monitored and audited prescriptions, and staff carried out prescribing reviews on a three monthly basis or more frequently if needed. The service provided support for all healthcare needs associated with substance misuse. Staff supported clients with blood-borne virus testing. Electrocardiograms (ECG’s) were taken for clients receiving high doses of methadone to monitor the effects on the heart.

• Staff were caring and demonstrated commitment and enthusiasm towards supporting clients who accessed the service. Staff attitudes were warm, clients described them as non-judgmental and they seemed cheerful.

However, we also found the following issues that the service provider needs to improve:

• Staff did not ensure they transferred all pertinent information from initial assessment to the recovery care plans, for example, risks or treatment goals. This meant there was no relevant means of monitoring progress or demonstrating actions. In addition, although risk management was good and staff considered risks throughout the treatment period, it was difficult to locate where they reviewed and updated risk assessments.

• Discharge planning was not sufficiently robust, which meant that clients could remain in the system for longer than they needed.

• Although the service provided mandatory training, this was all electronic learning and was not well monitored or managed. Staff completed Mental Capacity Act training; however, some staff were not confident in identifying or applying it when needed.