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Turning Point Leicestershire and Leicester Outstanding

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

Reports


Inspection carried out on 05 - 07 November 2018

During a routine inspection

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 carried out on 19 June to 21 June 2017

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • Interview rooms were fitted with alarms. Staff had the option of carrying personal alarms. CCTV cameras were in all public areas of the building at Eldon Street.

  • There was access to doctors and a team of 27 accredited voluntary peer mentors.

  • The service was meeting their referral to assessment targets of three weeks. Treatment started immediately following assessment. There was no waiting list. The service was able to see urgent referrals within 24 hours.

  • Managers and staff held weekly meetings to discuss new referrals, complex cases, and clients who had not attended for their appointments.

  • There were robust systems and processes for reporting, investigating, tracking, and monitoring incidents, complaints, and safeguarding alerts. The service had a comprehensive audit programme. The provider had a comprehensive and ongoing programme of service improvements.

  • Staff used encrypted laptops to work remotely away from base. This meant that staff could update care plans and colleagues could see the information in real time.

  • Ninety percent of staff had completed mandatory training, 97% of staff had received an ongoing personal review (annual appraisal) and 100% of staff had to date supervision.

  • Carers and family members had access to facilitated support groups. The service operated extended opening hours.

  • Clients had designed the reception area and chosen the furnishings at Eldon Street with a proposal to have a coffee bar located in the reception area.

  • Staff discussed alternative treatment options with clients including plans in the case of unexpected exit from treatment.

  • The organisation had a clear vision, set of values and a definition of recovery that was understood by staff and clients.

  • Senior managers, hub managers, and team leaders demonstrated the skills, knowledge, and capacity to lead effectively.

  • The service recognised staff achievements through the Turning Point Inspired by Possibility Awards 2017 and Inspiring Leicestershire awards.

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

  • The ligature audit for Eldon was not complete.

  • Staff had not labelled clinical waste bags in accordance with guidance and protocols.

  • Staff had not checked first aid boxes. Staff could not produce maintenance certificates for the stair lift at Granby Street.

  • The needle exchange service at Loughborough was located in the reception area of the building. Therefore, staff could not assure clients’ privacy and confidentiality while using this service.

  • Staff had not updated the original risk assessments in 14 out of 20 records we reviewed. However, they had updated the daily care notes with changes to a client’s risk and the risk management plans. This meant that not all risk information was readily available. Managers were aware of this issue and were addressing it with the staff concerned.

  • Some staff believed they could not carry out mental capacity assessments and were referring these cases to doctors and GP’s.

  • The provider was not offering a community detoxification service or comprehensive physical health care. Both of these activities are considered best practice for a recovery focussed substance misuse service.