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Inspection Summary


Overall summary & rating

Updated 14 May 2018

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • The service had a robust system in place to oversee the service and to drive improvements. The governance structure, information from audits and senior management meetings, and the quality of the service improvement projects demonstrated that leaders understood the needs of the client group and delivered services to meet them.
  • The service had a safeguarding tracker for children and adults, which they reviewed monthly. This tracker included clients and their children for whom a safeguarding referral had been made by the provider, the referrer or by other agencies. The service had a Hidden Harm practitioner to link the service with children and adult social services.
  • The service provided naloxone training and kits to clients who use opiates and staff members. The delivery, storage and issuing of naloxone medication to clients was monitored and audited by the chief pharmacist during prescriptions and medicines management audits. Two clients had averted potentially fatal episodes because of this scheme.
  • The provider had responded to national concerns about long-term substance misuse and its impact on people of late middle age by conducting an audit of clients within the risk group and then implementing actions to try to improve their quality of life.
  • The service had strong links with the Tamil community and staff supplied information and counselling in the Tamil language. The service was also able to provide counselling in Urdu, Punjabi and Hindi to support the large Asian community in the area.

  • Staff supported LGBT+ clients with a dedicated approach and pathway, which the service created for them. This included referrals to rehabilitation services, which met their needs.

  • Qualified or trained and experienced staff provided a range of therapeutic support in line with best practice guidance. The service was rolling out the Capital Card Scheme, which provided rewards to help motivate clients to attend.

  • The service had a service level agreement with the hepatology services at a local hospital, which allowed clients to access monthly clinics at the hospital for hepatitis C testing and treatment.

  • The service had enough staff to safely care for the clients’ needs. The provider had systems in place to ensure that 97% of staff had undertaken mandatory training and were inducted and trained into other responsibilities such as fire warden or first aider as required.

  • Staff routinely completed risk assessments and risk management plans at the start of clients’ engagement with the service and updated them regularly afterwards.

Inspection areas

Safe

Updated 14 May 2018

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • The service had enough staff to safely care for the clients’ needs. The provider had systems in place to ensure that 97% of staff had undertaken mandatory training and were inducted and trained into other responsibilities such as fire warden or first aider as required.
  • Staff routinely completed risk assessments and risk management plans at the start of clients’ engagement with the service and updated them regularly afterwards.
  • The service addressed risks to adults and children in a robust way. The service kept a safeguarding register to monitor ongoing safeguarding concerns and had a Hidden Harm practitioner in post to provide close links with children and adult social services. Staff understood safeguarding procedures.
  • The service provided naloxone training and kits to clients who used opiates and to staff members. The delivery, storage and issuing of naloxone medication was carefully monitored. This had resulted in the avoidance of a fatal overdose in two episodes during the past year.
  • Staff monitored clients’ prescriptions through a prescriber tracker, which gave prompts to staff when it was time for clients’ medications to be reviewed. Staff saw clients who were having detoxification from alcohol or opiates at least three times a week during treatment.
  • Staff escalated deterioration in clients’ mental and physical health appropriately.
  • Staff learned from incidents at their own service as well as from incidents that happened at other provider locations through monthly meetings. Changes had been implemented as a result.

Effective

Updated 14 May 2018

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Staff completed comprehensive assessments using recognised tools and were trained for their role.
  • Staff routinely monitored clients’ physical health and referred clients to other local services if intervention was required. The service tracked blood borne virus results to make sure clients received appropriate vaccinations and testing if required.
  • The service had a service level agreement with the hepatology services at a local hospital, which allowed clients to access monthly clinics at the hospital for hepatitis C testing and treatment.
  • Staff worked with clients to develop holistic recovery plans, which addressed clients’ priorities and included contingency plans for early exits from treatment. Clinicians worked with clients to agree on prescribing medication and treatment plans.

  • Qualified or trained and experienced staff provided a range of therapeutic support in line with best practice guidance. The service was rolling out the Capital Card Scheme, which provided rewards to help motivate clients to attend.
  • The service had built strong links with other local services to meet clients’ assessed needs; for example, the local liver unit and children’s social services.
  • Staff supported LGBT+ clients with a dedicated approach and pathway, which the service created for them. This included referrals to LGBT+ dedicated rehabilitation services.

Caring

Updated 14 May 2018

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Clients found the staff caring and non-judgmental. They were treated with dignity and respect. They said they felt safe within the service.

  • Staff knew clients’ individual needs and took steps to respond to them.

  • The service held monthly service user feedback forums with the involvement of service peer mentors and volunteers, as well as the service management team to hear concerns and feedback from clients

    .

  • Staff informed and involved families and carers appropriately and provided them with support when needed. Carers were able to access a number of groups and activities. The counselling service was also open to carers.

  • There were strict protocols in place to keep client information confidential.

Responsive

Updated 14 May 2018

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • Staff saw clients quickly after referral. There were no waiting times between referral and first appointment, or from first appointment to full assessment and allocation. The service aimed to see clients within 48 hours of referral.

  • The service had strong links with the Tamil community and staff supplied information and counselling in the Tamil language. The service was also able to provide counselling in Urdu, Punjabi, and Hindi to support the large Asian community in the area.

  • The provider had responded to national concerns about long-term substance misuse and its impact on people of late middle age by conducting an audit of clients within the risk group and then implementing actions to try to improve their quality of life.

  • The service had a dedicated education, training and employment worker who supported clients in recovery and reintegration into the community.

    Clients were also recruited and trained to become peer mentors.

  • The team tried to engage with people who found it difficult or who were reluctant to engage with services. They monitored the number of clients it worked with who had extra needs, such as those with mental health issues

    .

  • The service had a safe and welcoming environment for the clients, including a comfortable reception area.

  • The service reviewed and responded to complaints in line with the provider’s policy.

  • The service had identified some clients needed access to a safe space at weekends; they had contracted with a separated provider to run weekend social groups on the premises to meet this need.

Well-led

Updated 14 May 2018

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

  • The service had a robust system in place to oversee the service and to drive improvements. The governance structure, information from audits and senior management meetings, and the quality of the service improvement projects demonstrated that leaders understood the needs of the client group and delivered services to meet them.

  • There was strong, visible leadership at the service and good support from the provider’s head office; this was recognised by staff and they were proud to work for the service. Managers promoted a positive culture and high quality within the service.

  • Both the provider and staff within the service were well-informed about risks associated with the delivery of the service. The provider was implementing a new care record management system to address the issue of dual record systems.

  • Within a short time, the service had established strong links and care pathways with other local providers and had identified where further links could be made.

  • Training records showed, and staff confirmed, that there was a commitment to staff training and development. The service encouraged skilled staff to train colleagues.

Checks on specific services

Substance misuse services

Updated 14 May 2018

See overall summary.