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County Durham Substance Misuse Service - Centre for Change Requires improvement


Inspection carried out on 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 We saw three care records which did not include risk assessments or risk management plans, one care record with an out of date risk assessment and four records which contained no evidence of advice given about the risks associated with the clients’ treatment or harm reduction advice.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.