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We are With You Redcar and Cleveland Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 March 2019

We rated Addaction Redcar and Cleveland Service as requires improvement because:

  • There were areas of improvement required to manage safety in the service. Not all clients had an individual risk assessment. Risk assessments were not consistently fully completed to evidence that all risks had been considered. Where risk assessments had been completed it was not clear how staff planned to manage identified risks effectively.
  • The service was not consistently well led. There was no system for local risks to be identified, recorded, monitored and managed in a comprehensive way which could be viewed by staff, management and senior management. Risks could only be escalated by the service manager. The provider did not ensure that systems and processes, such as clinical audit, were adequate to ensure electronic care records, including care plans, risk management plans and recovery plans, were complete, accurate, and contemporaneous. Issues had been identified by the provider and an improvement plan was in place but this had failed to improve records by the time of our inspection.

However:

  • The service was providing effective care. The service had a multidisciplinary team of competent, knowledgeable staff who worked well together and supported each other to provide effective care and treatment to clients. Staff were well supported by management with regular supervision and support with training provided where learning and development needs and goals were identified.
  • Staff were caring. Feedback from clients was consistently positive about staff attitudes and behaviours. Clients said staff understood and managed their care and treatment in a personalised way and all clients knew their recovery coordinator who acted as a point of contact for the service. The service had access to a range of interventions to support clients and those close to them. This included clients’ social networks, employment and education opportunities.
  • The service was providing care in a way that was responsive to people’s needs. All locations had accessible client areas including clinic rooms and interview rooms. There were no waiting lists, and staff were able to see clients at short notice if required. Staff were flexible with appointment times and locations where clients could be seen and appointments were rarely cancelled. Clients were clear about the complaints process and were confident enough to raise issues if required.
Inspection areas

Safe

Requires improvement

Updated 22 March 2019

We rated safe as requires improvement because:

  • Not all clients had a risk management plan and some risk management plans did not fully detail how staff in the service planned to safely manage the identified risks.

  • The staff toilets and staff kitchen area at South Bank were in a poor state of maintenance, decoration and comfort.

However:

  • Sufficient skilled staff were in place to deliver safe care and treatment to clients.

  • Overall compliance of mandatory training at the time of our inspection was 90%.

  • Staff understood how to protect clients from abuse and the service worked well with other agencies to do so.

  • Staff reported and recorded incidents appropriately. The manager investigated incidents and shared lessons learned with staff through meetings.

Effective

Good

Updated 22 March 2019

We rated effective as good because:

  • The service ensured staff were competent for their roles. Staff received regular supervision with managers to provide support, identify areas of learning and development and receive feedback on performance.

  • The multidisciplinary team of staff worked well together and supported each other to provide good care and treatment. This included working across teams and where appropriate joined up working with other supporting services such as mental health services for the benefit of the clients’ recovery.

  • The service provided a range of care and intervention treatments which followed national guidance and best practice.

  • Staff had a good understanding of the Mental Capacity Act.

However:

  • The service identified numerous issues in the quality of care records following an audit in July 2018. An improvement plan was in place however, to date the quality of recording had not been rectified.

  • Not all staff had an annual appraisal.

Caring

Good

Updated 22 March 2019

We rated effective caring as good because:

  • Staff treated clients in a kind, caring and compassionate manner. Clients and those close to them were provided with practical and emotional support appropriately including access to mutual aid groups.
  • All clients had a named recovery coordinator who acted as a point of contact for the service.
  • Staff supported clients to understand and manage their care and treatment in a personalised way that suited the service user’s needs. Staff directed clients to other services when appropriate and, if needed, supported them to access those services.
  • The service offered interventions aimed at maintaining and improving clients’ social networks, employment and education opportunities and provided support for people to attend community resources.

However:

  • The provider did not seek feedback from clients directly for example using an annual survey, to inform them further about the service they provided with a view to service improvements.

Responsive

Good

Updated 22 March 2019

We rated responsive as good because:

  • The service had a range of client accessible areas including clinic rooms and interview rooms.

  • There was no waiting list and staff were able to see clients at short notice if necessary.

  • Staff were able to make reasonable adjustments to support clients in attending appointments, including disabled access, access to extended opening times and access to translation and interpreting services.

  • Clients over the age of 18 and under 25 years were able to access the children’s and young people’s service if this was identified as more appropriate.

  • Staff ensured that clients and carers were able to raise complaints. Information in relation to raising a complaint was displayed in all locations. Complaints were reviewed in line with the provider’s policy. Clients told us that they felt confident to make complaints if it was needed.

Well-led

Requires improvement

Updated 22 March 2019

We rated well-led as requires improvement because:

  • The systems and processes in place, such as clinical audit, were not sufficient to ensure electronic care records, including care plans, risk management plans and recovery plans, were complete, accurate, and contemporaneous.

  • There was no comprehensive system to record, monitor or manage local service risk for example using a local risk register. This meant that managers did not have oversight of risks and staff were unable to raise risks directly or see if risks identified had been addressed appropriately.

  • Managers did not have access to all information required to support them with their roles and with a view to improving services. This included information regarding the quality of care of clients and appraisals.

  • The provider did not have a regular feedback mechanism to survey staff directly with a view to improving service delivery.

However:

  • Staff told us they felt respected, supported, valued and felt positive and proud to work for the provider. Staff worked well together and used multidisciplinary team meetings to discuss their caseloads and get support if needed.

  • Managers had the right skills and abilities to run the service. Staff told us that the leadership and management of the service encouraged an open, supportive and honest culture.

  • The provider recognised staff success with its national awards. The positive impact of the National team of the year award for the children’s and young person’s team was clear amongst all service staff.

  • Staff were clear about their understanding of whistleblowing and told us that they felt able to raise concerns without fear of retribution.

Checks on specific services

Substance misuse services

Requires improvement

Updated 22 March 2019