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Archived: Addaction - Cornwall

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All reports

Inspection report

Date of Inspection: 2, 3, 8, 9 January 2014
Date of Publication: 11 February 2014
Inspection Report published 11 February 2014 PDF | 95.92 KB

Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)

Meeting this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by competent staff.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 2 January 2014, 3 January 2014, 8 January 2014 and 9 January 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff, reviewed information given to us by the provider and took advice from our specialist advisors. We were accompanied by a specialist advisor.

Our judgement

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Reasons for our judgement

People who used the service told us staff were caring and responsive to their individual needs. Everyone we spoke with was satisfied with the service they received.

The service was in the process of introducing nurse (NMP) prescribing. This process commenced prior to the service transition in April 2013. We were told NMP provision was likely to play an important part in enabling efficient skill-mix. We were told more staff were being encouraged to pursue NMP training.

Prior to the inspection concerns had been raised to the Care Quality Commission, by a third party, about the place of non-medical (NMP) prescribing within Addaction. At the time of the inspection this was an area still in development and there was only one actively-prescribing NMP, although a second person would be starting imminently. The registered manager told us the service had six trained NMPs but had delayed starting their prescribing work because of the other significant changes within the organisation. We checked arrangements in place and were satisfied that Addaction had monitored this closely.

In respect of training for nurse prescribers, this was provided through Plymouth University (Peninsula Medical School). Trainees were mentored by an addictions consultant or a General Practitioner with Special Interest (GPwSI). Since the transition all NMPs were separately accredited prior to starting work with Addaction by the addictions consultant and the Addaction national pharmacy lead.

From discussion and from records inspected we saw there was a detailed protocol outlining the NMP’s role and supervision. We were told all NMPs were supplementary (rather than independent) prescribers. This meant Clinical Management Plans were signed by the independent prescribing doctor. Suitability of people who used the service was discussed between NMP and independent prescriber and will vary according to confidence and expertise of the NMP. The independent prescriber retained clinical responsibility for the people concerned. Clinical Management Plans (CMP) were reviewed at appropriate intervals. We were told the software system prevented dosage change outside the parameters of the CMP, there were regular governance meetings and regular clinical audits (for example involving, every three months, Addaction’s Lead Pharmacist) to minimise the risk of human error.

We were also told NMPs were specifically supported by named GPwSI's for their client base. People’s cases could also be ‘escalated’ from the Local Enhanced Services (LES) GP to GPwSI or specialist/consultant care as needed, and back again when problems were resolved. At the time of the inspection there appeared to be an appropriate skill-mix in prescribing, albeit currently with limited NMP contribution, as this aspect of the service was still in development.

We subsequently concluded there was no evidence that clinical governance around prescribing might be inconsistent or fragmented across different prescribing sources, or prescribing systems were not robust or were inflexible.

We also assessed general staff training. Staff and managers told us that training was delivered by a variety of methods for example in-house training, e-learning and attending courses from external training providers.

The staff we spoke with confirmed they had received an induction prior to them working unsupervised. The people we spoke with all had experience either as a person who had used similar services and /or as a volunteer and/or working professionally in another drug and alcohol service. Staff told us they had shadowed an established and experienced member of staff, which had enabled them to learn the role prior to working on their own.

The registered manager provided us with a copy of the organisation’s policy which outlined what training staff, of different grades and roles, needed to be provided with. This was made up of ‘mandatory’ training (such as safeguarding, first aid, alcohol and drug awareness a