• Community
  • Community substance misuse service

County Durham Substance Misuse Service - Centre for Change

Overall: Outstanding read more about inspection ratings

88 Whinney Hill, Durham, DH1 3BQ 0300 026 6666

Provided and run by:
Humankindcharity

All Inspections

15-17 February 2022

During a routine inspection

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.

However:

  • 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.

1 and 2 October 2018

During a routine inspection

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.