You are here

Turning Point Leicestershire and Leicester Outstanding

This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 16 January 2019

We rated Turning Point Leicestershire and Leicester as outstanding because:

  • The provider had invested in a strong senior leadership team, who held a shared, clear vision of what the service should look like. The senior leadership team held a collective responsibility for maintaining the high standards of care described in their vision. The provider had invested in developing a robust infrastructure of support teams such as the engagement, partnership, administration, and analytical teams to support the delivery of high quality clinical services. The senior management team had developed and supported team leaders and staff to embed a culture of shared values based on inclusion, partnership working, learning and innovation.
  • Governance was exemplary. The provider had a range of governance and assurance processes that provided structure and maintained high standards of quality for the service and clients. The provider had key performance indicators to gauge the performance of the teams. Between July 2017 and June 2018, 935 clients successfully complete treatment. This placed the services performance above average for comparator local authorities in all substance categories, and in the upper quartile of comparator authorities in city opiate users and county alcohol users.
  • Managers had developed a structured treatment pathway model that followed National Institute for Health and Care Excellence guidelines. The model included five clear treatment pathways: the opiate, and drugs pathway, the dependent alcohol pathway, non-opiate drugs pathway, non-dependent alcohol pathway, and the risk, vulnerability, and complex safeguarding pathway. All pathways included relevant evidence based interventions including psychosocial interventions delivered by recovery workers. Doctors and nurses delivered evidence based clinical interventions including substitute prescribing, community detox and referral to inpatient detox, blood borne virus interventions and a needle exchange service.
  • The provider recognised that continuing development of staff skills, competence and knowledge was integral to ensuring high quality care. Managers proactively supported all staff to acquire new skills and share best practice. The provider recognised staff success with its ‘Inspiring Leicestershire’ recognition and reward scheme, this scheme recognised and celebrated the work of all Turning Point staff.
  • The service had exemplary partnership working arrangements, including a highly regarded and unique partnership with the local constabulary.
  • The service had a good track record for safety. All the hubs were clean and tidy and cleaning records were up to date. Staff had completed environmental risk assessments including the risks posed by ligatures.
  • Clients received holistic packages of care with a choice of treatments guided by needs assessments. Staff personalised the clients’ treatment interventions within the pathway model and based around what the clients wanted to achieve. Staff interacted with clients in a respectful and caring manner. Staff showed compassion, dignity and respect, and provided responsive, practical and emotional support as appropriate. Staff supported clients to understand and manage their care and treatment in a personalised way that suited the client’s needs. Staff directed clients to other services when appropriate and, if needed, supported them to access those services.

However:

  • The physical environment at the Coalville and Loughborough hubs was not as welcoming as that at Eldon Street. The decoration at the hubs was tired and dated, and the waiting rooms and clinic rooms were not as well organised as those at Eldon Street. There was no one, or obvious person, on-site with specific responsibility for the clinic rooms.
  • At Coalville the ground floor interview room was not fully soundproofed. When it was quiet in the waiting area some conversation could be overheard. Managers were aware of this and had taken steps to address this but were not allowed to make structural changes to the rented premises.
Inspection areas

Safe

Good

Updated 16 January 2019

We rated safe as good because:

  • The service had a good track record for safety.
  • All the hubs were clean and tidy and cleaning records were up to date.
  • There were environmental risk assessments including the risks posed by ligatures.
  • There were CCTV cameras in all public areas of the building at Eldon Street, and staff in the main offices could monitor the cameras.
  • Staff had access to emergency naloxone (used to reverse the effects of opioids) and adrenaline in emergency grab bags at each hub.
  • Staff adhered to infection control principles, including hand washing and the disposal of clinical waste.
  • All clients had up to date comprehensive, integrated risk assessments.
  • All hubs had enough skilled staff to meet the needs of the clients and the provider had contingency plans in place to manage unforeseen staff shortages. There was prompt access to a psychiatrist or doctor when needed.
  • Staff caseloads were in line with the national average for similar substance misuse services.
  • Ninety-seven per cent of staff had completed mandatory training.
  • The provider had embedded systems and protocols for assessing and managing client risk. Staff made good use of crisis plans and advanced decisions, as needed.
  • The service had robust safeguarding administration and reporting systems.
  • Staff had easy access to all information they needed to carry out their work safely.
  • The provider reported all safeguarding concerns in a timely manner. The provider had routinely referred safeguarding concerns about children, including those occasions when staff had found the potential for risk to a child’s safety and wellbeing.
  • Staff reported and recorded incidents appropriately. The manager investigated incidents and shared lessons learned with staff through meetings and a newsletter.

However:

  • The physical environment at the Coalville and Loughborough hubs was not as welcoming as that at Eldon Street. The decoration at the hubs was tired and dated, and the waiting rooms and clinic rooms were not as well organised as those at Eldon Street. There was no one, or obvious person, on-site with specific responsibility for the clinic rooms.

Effective

Outstanding

Updated 16 January 2019

We rated effective as outstanding because:

  • All 29 client records contained up to date recovery focused care plans. Assessment included the client’s physical and mental health needs. There was a truly holistic approach to assessing, planning and delivering care and treatment to people who use the service. Staff ensured care plans were comprehensive, personalised, recovery focussed and included details of the clients’ key worker and other support services. Staff developed care plans alongside the integrated risk assessments.
  • Care records showed how, through the providers partnership working practice, staff supported clients to access specialist services as early as possible. Examples of this included the peer support group, and the multi-agency street lifestyle program. Discharge plans had measurable goals that focused on the client’s strengths, beliefs, and values. At the end of treatment staff discussed aftercare plans with the client which included contact details of additional support if needed and the aftercare groups they could attend.
  • The provider offered five clear treatment pathways. All pathways included relevant evidence based interventions including psychosocial interventions delivered by recovery workers. Doctors and nurses delivered evidence based clinical interventions including substitute prescribing, community detox and referral to inpatient detox, blood borne virus interventions and a needle exchange service.
  • Clients and key workers jointly formulated care packages from a choice of treatments guided by needs assessments. Staff personalised the clients’ treatment interventions within the pathway model. Treatment interventions were consistent with what the clients wanted to achieve.
  • Policies and procedures followed National Institute for Health and Care Excellence guidance in prescribing, and guidelines on needle and syringe programmes. Staff followed Department of Health guidance in the Drug misuse and dependence – UK guidelines on clinical management.
  • Staff received regular appraisals. Staff compliance with appraisals was 98% and 100% for supervision. The provider recognised that continuing development of staff skills, competence and knowledge was integral to ensuring high quality care. Managers proactively supported all staff to acquire new skills and share best practice.
  • The systems to manage and share information needed to deliver effective care were fully integrated and gave real-time information across teams and services. Managers had developed a highly regarded and unique partnership with the local constabulary that supported the sharing of real-time information.
  • Staff teams were committed to working collaboratively with each other and across teams. services and with commissioners. We saw evidence of innovative and effective handovers Examples included regular team managers meetings to share and celebrate good practice, and lessons learned from investigations and incidents, and daily staff flash meetings to review any immediate risk issues, safeguarding concerns, lone working protocols, and ensure adequate cover for all daily duties.
  • The service had exemplary partnership working arrangements. There was a strong and embedded culture of working in partnership with a wide range of other organisations, services and commissioners. We saw evidence of staff working in partnership with statutory, primary and secondary care services.
  • The provider was part of the Pro-active Vulnerability Engagement team, an initiative between the local police force, NHS Trust, and Turning Point. The team provided mental health assessments for anyone within the criminal justice pathway. Its aim was to reduce inappropriate use of Section 136 of the Mental Health Act.

Caring

Good

Updated 16 January 2019

We rated caring as good because:

  • Staff interacted with clients in a respectful and caring manner. Staff showed compassion, dignity and respect, and provided responsive, practical and emotional support as appropriate.

  • Staff supported clients to understand and manage their care and treatment in a personalised way that suited the client’s needs. Staff directed clients to other services when appropriate and, if needed, supported them to access those services.

  • The provider had clear confidentiality and consent policies and procedures in place that staff followed.

  • The provider had set up city and county family and carers support groups. These groups offered information, advice, and emotional support, to carers and family both during and after their family member was in treatment.

  • Clients were involved in the provider’s recruitment processes, helping to design, and run the new coffee bar in the waiting area at Eldon Street. They were also involved in service user forums and training to become service user representatives.

Responsive

Good

Updated 16 January 2019

We rated responsive as good because:

  • The provider had a documented acceptance, referral, and admission criteria that they had agreed with relevant services and key stakeholders.
  • Average waiting times for assessment and treatment were within the providers stated timeframes and usually sooner than the timeframes stated.
  • Staff signposted clients who did not meet the criteria for acceptance to the service, or who decided the services offered were not for them, were signposted to alternative services, and staff advised referrers of this decision.
  • The provider had a faltering engagement policy to meet the needs of those people who found it difficult to engage in treatment.
  • The providers service model, based on five distinct treatment pathways, streamlined access to, and transition through, the drug and alcohol service by sharing staff expertise and providing a wider range of treatment options for clients.
  • During treatment staff supported clients to remain in work, education or training, and encouraged clients to maintain and develop their relationships and social networks.
  • We saw evidence of staff working to support vulnerable clients, such as those from the lesbian, gay, bi-sexual and transgender community and the black minority ethnic community, as well as people experiencing domestic abuse and sex workers. Staff engaged with clients who were homeless via its street lifestyle outreach programme.
  • Although the young people and young adults team primarily focussed on people under the age of 18 they also provided services for people up to age 25 where their approach was more beneficial than the adult services.
  • Managers ensured that clients and staff had access to interpreters if needed.
  • Staff worked flexible hours to accommodate evening and weekend appointments.
  • There was a robust and clear complaints policy and procedure. Feedback forms were available in all hub reception areas. The hub manager at Granby Street had personalised these to suit the needs of the young people who attended that service. Managers had responded to the complaints and had made changes and fed back to the teams via lessons learned in team meetings and bulletins.

However:

  • The ground floor interview room at Coalville was not fully soundproofed. When it was quiet in the waiting area some conversation could be overheard. Managers had taken steps to address this but were not permitted to make structural changes to the rented premises.

Well-led

Outstanding

Updated 16 January 2019

We rated well-led as outstanding because:

  • The provider had invested in developing a strong infrastructure of managers, leaders and systems to underpin the service, including the appointment of a change facilitator to help ensure that service development was managed effectively.

  • All managers including senior managers and hub managers demonstrated the skills, knowledge and experience to lead effectively and could explain how their teams were working to provide high quality care. The management team worked cohesively. Leadership strategies were in place to develop a culture that inspired and motivated staff to succeed. The provider recognised staff success with its ‘Inspiring Leicestershire’ recognition and reward scheme. The scheme recognised and celebrated the work of Turning Point staff.

  • Managers were visible in the service and approachable for both patients and staff. A recent staff survey showed there were high levels of staff satisfaction across all staff groups. Staff told us they felt respected, supported, valued and felt positive and proud to work for the provider. There was a high level of constructive staff engagement, managers had introduced a regular quarterly lunch with staff as an opportunity for informal discussion about service developments and to address any concerns staff had.

  • Managers had successfully communicated the provider’s vision, values and objectives to frontline staff in this service. The providers strategy supported the objectives which were stretching, challenging and innovative while remaining achievable. Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Staff knew how they were working to deliver high quality care within the budgets available.

  • Staff worked well together and used multidisciplinary team meetings to discuss their caseloads and get support if needed. There was strong collaboration and support across all functions and a common focus on improving the quality of client’s experiences.

  • Managers had embedded a culture of learning within the service and implemented change in a thoughtful and considered way. Constructive challenge from people and staff who use the services, the public and stakeholders was welcomed and seen as a vital way of holding their service to account.

  • Governance was exemplary. The provider had a range of governance and assurance processes that provided structure and maintained high standards of quality for the service. Managers reviewed their governance and performance arrangements to reflect best practice. We heard how senior managers within the organisation had adopted this services’ mortality recording and reporting process data base, for use across their other sites.

  • The provider had key performance indicators and other measures to gauge the performance of the teams. Between July 2017 and June 2018, the service saw 935 clients successfully complete treatment. Data produced by commissioners placed the services performance above average for comparator local authorities in all substance categories, and in the upper quartile of comparator authorities in city opiate users and county alcohol users. Managers took a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.

  • Managers had access to information that supported them with their management role. This included information on the performance of the service, staffing and patient care. Information was in an accessible format, and was timely, accurate and identified areas for improvement.
Checks on specific services

Substance misuse services

Outstanding

Updated 16 January 2019