Our rating of this service improved. We rated it as outstanding because:
- Feedback from people who use the service and those who were close to them was continually positive about the way staff treated them. People thought that staff went the extra mile and their care and support exceeded their expectations. Staff actively involved clients, families and carers in care decisions.
- The service developed innovative approaches to meet the needs of a range of people who used the service. This included using a mobile public health facility to engage with people who lived in rural areas with complex needs.
- Staff supported rough sleepers by helping them get COVID-19 vaccination appointments, providing them with clothing, toiletries, showering and laundry facilities and helping them to find housing accommodation. Staff provided sanitary items to clients as they recognised the impact of period poverty and condoms to prevent clients contracting sexually transmitted infections.
- The organisation had created an app called Drink Coach which people could use to assess the level of their alcohol intake and book an appointment at the service if needed. This had resulted in an increase in older people accessing the service for treatment. The service had procured a testing machine to determine if clients had a blood borne virus and needed treatment. The service was developing an initiative with the local university in response to students’ drinks being spiked and its recommendations included testing students and confidential one to one sessions with any students who were concerned about being spiked.
- The service had its own safeguarding lead and three supervisors had received National Society for the Prevention of Cruelty to Children training. Staff were up to date with their safeguarding and unconscious bias training which was appropriate for their role and followed good practice.
- The service provided safe care. Clinical premises where clients were seen were safe and clean. Staff caseloads were not high so staff were able to give time to each of their clients that they needed. There were no waiting lists within the service, so clients were seen promptly. Staff were highly motivated, client-focussed, skilled, experienced and up to date with their mandatory training requirements. Staff received appraisals, supervision and a comprehensive induction programme.
- Staff assessed and managed risk well, there were no serious incidents in relation to harm or risk to clients or staff. All incidents, complaints and client deaths were fully investigated, and lessons learned from investigations were routinely shared with staff to improve the service. There were safe and effective processes in place for lone working, clients who did not attend their appointments and cases in which substitute medicines had been passed to third parties for illicit purposes
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration and partnership with clients, families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the clients.
- The teams included or had access to the full range of specialists required to meet the needs of the clients. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
- Staff understood and discharged their roles and responsibilities under the Mental Capacity Act 2005. Staff had access to a dual diagnosis nurse within the partner organisation and the local mental health trust from whom they could seek advice and support when there were concerns about a client’s mental capacity.
- The service was easy to access. Staff assessed and treated clients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude people who would have benefitted from care. No appointments had been cancelled as a result of staffing issues despite the pressures faced as a result of the COVID-19 pandemic.
- The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.
- Seven clients told us they had either not been offered a copy of their care plan or could not recall being offered it. We also noted that two client’s care records did not indicate if they had been offered a copy of their care plan.