You are here

County Durham Substance Misuse Service - Centre for Change Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 January 2019

We rated the service as requires improvement overall because:

  • Staff did not always record safety-related information within clients’ care records despite the potential serious risks associated with people with drug and alcohol addictions. We saw three care records which did not include risk assessments or risk management plans, one care record with an out of date risk assessment and four records which contained no evidence of advice given about the risks associated with the clients’ treatment or harm reduction advice.
  • Staff did not record sufficient information about clients who used the service which meant that care was not always person-centred or holistic and patients were not routinely involved in decisions about their care and treatment. Omissions in care records included recovery plans, equality and diversity information, clients’ strengths, goals and motivation to change, alcohol dependency and discharge planning.
  • Staff were not up to date with their mandatory training. Only 65% of staff had completed their e-learning training. The e-learning training included records management and equality and diversity and there was evidence the lack of training was having an impact as we identified gaps in care records in relation to client information, including equality and diversity considerations.

However, we found the following areas of good practice:

  • There were sufficient numbers of skilled and experienced staff to deliver safe care and treatment. Staff received regular supervision, had access to specialist training, knew how to report incidents and handle complaints, engaged in clinical audits, made safeguarding referrals when appropriate, responded appropriately when clients’ health suddenly deteriorated and were open and honest when things went wrong. Staff felt respected, valued and proud to work at the service and contributed ideas towards its future strategy.
  • Staff treated clients in a kind, caring and compassionate manner. Staff supported clients during referrals and transfers between services. Clients were offered alternative treatment options if they were unable to comply with a particular treatment regime. Staff helped clients to understand and manage their care, treatment and condition using a variety of communication methods such as hearing loops, braille, easy read, other languages and large font when required.
  • Staff monitored and addressed the physical healthcare of clients. Blood born virus testing was offered routinely to clients, staff offered advice on leading healthier lifestyles and referred clients to primary healthcare services when appropriate.
  • The people who used the service were able to give feedback on the service they received. There were comments cards and boxes in each of the services’ reception area, a complaints process, you said, we did noticeboards and people provided feedback through one of the service’s third-party organisations. Clients had access to advocacy, signers, interpreters, an independent mental health advocate or mental capacity advocate when required. The service had a policy in place for dealing with clients who were late or missed their appointments which we found to be fair and reasonable in its approach.
  • The service’s range of care and intervention treatments followed national guidance on best practice. The service had effective pathways to other supporting services including local mental health services, bereavement and counselling services and veterans’ services for people living with post-traumatic stress disorder. The service had no waiting lists, urgent referrals were prioritised and the service operated an open access system so clients could attend one of the services and commence their treatment the same day.
  • Humankind had held the Equality North East ‘Equality Standard Gold Award’ since 2012, adapted its delivery to make information accessible to people with dyslexia, literacy issues, visual impairments and for whom English was not a first language.The service had its own equality and diversity champion and the service buildings were accessible. The service had been awarded an Investors in People accreditation. It was also working towards being accredited with a Better Health at Work award.
  • The service proactively engaged with the local community. The Durham service run bi-monthly meetings with residents in the area and provided interventions and advice to students at the local university and colleges within County Durham. Staff attended police crime and commissioner events to provide advice to attendees about substance misuse.
Inspection areas

Safe

Requires improvement

Updated 1 January 2019

We rated safe as requires improvement because:

  • Staff did not always record safety information within clients’ care records. We saw three care records which did not include risk assessments or risk management plans, one care record with an out of date risk assessment and four records which contained no evidence of advice given about the risks associated with the clients’ treatment or harm reduction advice.
  • Staff were not up to date with their mandatory training. Only 65% of staff had completed their e-learning training. The e-learning training included records management and equality and diversity and there was evidence the lack of training was having an impact as we identified gaps in care records in relation to client information, including equality and diversity considerations.
  • Staff were not always categorising scanned information correctly which meant information was scanned in the wrong place. We were unable to see evidence within some care records that consent to treatment forms and confidentiality agreements were in place because staff had made this sort of error.

However, we found the following areas of good practice:

  • The service buildings were clean and tidy, staff adhered to infection control procedures, carried out environmental risk assessments and rooms used to see the people who used the service were accessible.
  • There were sufficient numbers of staff to deliver safe care and treatment. Agency staff were rarely used and appointments were not often cancelled due to staff absences.
  • Staff knew how to report incidents, made safeguarding referrals when appropriate, responded appropriately when clients’ health suddenly deteriorated and were open and honest when things went wrong.

Effective

Requires improvement

Updated 1 January 2019

We rated effective as requires improvement because:

  • Staff did not record sufficient information about clients who used the service. Omissions included recovery plans, risk assessment and management plans, clients’ strengths, goals and motivation to change, alcohol dependency and discharge planning and equality and diversity information.
  • We found some care records were neither person-centred nor holistic and were written using generic language.

However, we also found the following areas of good practice:

  • The service offered a range of care and intervention treatments which followed national guidance on best practice. They included substitute prescribing, psychosocial interventions, needle and syringe programmes and substance reduction and detoxification.
  • Staff monitored and addressed the physical healthcare of clients. Blood born virus testing was offered routinely to clients, staff offered advice on leading healthier lifestyles and referred clients to primary healthcare services when appropriate.
  • Staff were skilled, experienced and competent to carry out their roles. Staff were regularly supervised, had access to specialist training for their roles, received an induction when they began working at the service and managers identified and addressed their learning and development needs. Staff participated in clinical audits. These included infection control audits and full inspections at each of the three services. Findings were used to improve practice within the service.
  • One of the service’s third-party organisations employed mental health nurses who advised staff when there were concerns about clients’ mental health and mental capacity. The service also had a service level agreement with the local mental health trust and referred clients to its services when appropriate. Clients had access to an independent mental health advocate or mental capacity advocate when required.

Caring

Good

Updated 1 January 2019

We rated caring as good because:

  • Staff treated clients in a kind, caring and compassionate manner. We saw positive interaction between staff and clients during our inspection and the people who use the service that we spoke with felt supported and treated with dignity and respect.
  • Clients told us that staff helped them to understand and manage their care, treatment and condition. Staff used a variety of communication methods such as hearing loops for people with hearing impairments, arranged for signers and translators to support people and produced written information in braille, easy read, other languages and large font when required.
  • Staff directed clients to other services and supported them to access these services. Staff had helped clients to access mental health services, counselling groups, social services, mutual aid groups and housing support. Clients told us that staff had picked them up at home and taken them to see their GPs.
  • Clients were offered alternative treatment options if they were unable to comply with a particular treatment regime.
  • Staff enabled the people who used the service to give feedback on the service they received. There were comments cards and boxes in each of the services’ reception area, you said, we did noticeboards and people provided feedback through one of the services charitable partner organisations.

However, we found the following areas the service needs to improve:

  • Clients were not always involved in decisions about their care and treatment. This was evidenced by the fact that four clients did not have a recovery plan in place, three did not have risk management plans in place and seven clients’ records did not include their strengths, goals or motivation to change.

Responsive

Good

Updated 1 January 2019

We rated responsive as good because:

  • The service had no waiting lists, referrals were monitored by administrators who prioritised urgent referrals so they were seen quickly. The service operated an open access system so clients were able to attend one of the services and commence their treatment the same day.
  • The service did not routinely refuse to see clients who arrived late for their appointments and made efforts to see them on the same day. The service had a policy in place for dealing with clients who were late or missed their appointments which was fair and reasonable.
  • The service had robust alternative care pathways and referral systems in place for when it was unable to meet the needs of clients. These included veterans’ services for people suffering from post-traumatic stress disorders and counselling services.
  • The service offered alternative treatment options to clients who were unable to comply with specific treatment requirements. Examples included offering buprenorphine for clients intolerant of methadone and inpatient detoxification for clients who were unable to comply with community detoxification.
  • Staff supported clients during referrals and transfers between services. Staff had taken clients to see their GPs and signposted clients to services that could potentially enhance their care and treatment needs.
  • Staff knew how to handle complaints and lessons learned from investigating complaints were used to improve the service.

However, we found the following areas the service needs to improve:

  • Staff did not always plan for clients’ discharge from the service. Out of the 15 care records we looked at, 11 did not contain evidence of discussions or plans around the clients’ discharge from the service.
  • Staff did not always record equality and diversity data in relation to clients. Out of the 15 care records we looked at, six contained no evidence of equality and diversity issues being considered as part of the clients’ care and treatment needs.

Well-led

Requires improvement

Updated 1 January 2019

We rated effective as requires improvement because:

  • There were ineffective governance systems in relation to the completion of clients’ care records. Care records contained significant gaps in relation to discharge planning, equality and diversity information, dependency on alcohol and clients’ strengths and goals.
  • Mandatory training systems were not always effective. Only 65 per cent of staff within the service had completed mandatory e-learning training which covered information governance, equality and diversity and records management.

However, we also found the following areas of good practice:

  • Leaders had sufficient skills, knowledge and experience to perform their roles, provided clinical leadership and had a good understanding of the services they managed.
  • Staff had opportunities to contribute about the strategy for the service and had job descriptions in place. Staff raised their ideas in relation to the strategy of the service during team meetings and daily flash meetings. Staff felt respected, supported, valued and proud to work within the service.
  • The provider recognised staff success within the service. Staff had received or been nominated for awards, there was an employee of the month initiative in place and managers sent thank you cards to individuals for good standards of work. The service had been awarded an Investors in People accreditation. It was also working towards being accredited with a Better Health at Work award.
  • The provider promoted equality and diversity in its day to day work and provided opportunities for career development. Humankind had held the Equality North East ‘Equality Standard Gold Award’ since 2012. The service had adapted its delivery model in response to the 2016 NHS Accessible Information standards to make information accessible to people with dyslexia, literacy issues, visual impairments and for whom English was not a first language. The service had its own equality and diversity champion.
  • The provider had a whistleblowing policy in place. This was accessible to all staff via the provider’s intranet. Staff maintained and had access to the provider’s risk register and agreed the items currently included on it matched their own concerns.
  • The people who used the service had opportunities to give feedback on the service they received. People were able to provide feedback using comments cards and boxes in the reception area or people were able to provide feedback through one of the services third party organisations.
Checks on specific services

Substance misuse services

Requires improvement

Updated 1 January 2019