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Inspection Summary


Overall summary & rating

Outstanding

Updated 29 November 2019

We rated this service as outstanding because:

  • The service provided safe care. The premises where clients were seen were safe and clean. The number of clients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each client the time they needed. Staff managed risk to clients and themselves well, responding to deterioration in client presentation and advising clients of harm minimisation. Staff provided training to clients and carers in Naloxone administration. They followed good practice with respect to safeguarding, incident reporting and duty of candour.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. The service participated in benchmarking and quality improvement initiatives and had consistently higher proportions of clients in effective treatment than the national average reported through the National Drug Treatment Monitoring System and were involved in a Public Health England enquiry as a result.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Staff had appraisals, supervision and opportunities to further develop their skills. All staff, including agency, had a comprehensive induction programme. Staff worked well together as a multidisciplinary team with their partner organisations and relevant external organisations.
  • Clients were truly respected and valued as individuals. Staff always treated clients with compassion, dignity and kindness. They were determined and creative in ensuring clients’ social and emotional needs were met; distributing homelessness kits, accompanying clients to appointments, facilitating improvements to clients’ homes and the registration of an emotion support animal. They actively involved clients and carers in treatment decisions and care planning and went the extra mile when providing care and support.
  • Services were tailored to meet the needs of individuals and delivered in a way to ensure flexibility, choice and continuity of care. They spearheaded significant improvements to the addiction support provided to British military personnel following their introduction of the Mil-SMART programme. They responded proactively and innovatively to the needs of the community, establishing outreach centres in rural locations, extended hours and access to the Breaking Free Online app. The service was easy to access and had established alternative pathways for people whose needs it could not meet.
  • The service was well led, managers promoted the delivery of high-quality person-centred care and continuous learning and development. Leaders had transparently and sensitively managed a period of significant service change. Staff felt respected and valued.

However:

  • Governance processes were not always operated effectively at hub level, although we did not find that these affected the quality of client care or treatment. There were errors in following of service protocols, audit actions were not always completed, and documentation had errors. Risk assessments and recovery plans were not always accurate and up to date.
  • Lead practitioners had not received management training. There was inconsistency in service provision across hubs and psychosocial intervention training had not been given to all eligible staff members. Not all staff demonstrated a good understanding of the Mental Capacity Act 2015.
Inspection areas

Safe

Good

Updated 29 November 2019

We rated safe as good because:

  • All premises where clients received care were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

  • The service had enough staff, who knew the clients and received appropriate training, to keep them safe from avoidable harm. The number of clients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each client the time they needed.

  • Staff used a multidisciplinary approach to assess and manage risks to clients and themselves well. They had a good knowledge of client risk and responded promptly to sudden deterioration in clients’ physical and mental health.

  • Staff made clients aware of harm minimisation and the risks of continued substance misuse. The service provided clients and carers with training in the administration of Naloxone when applicable.

  • Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • The service had a good track record on safety. The service managed client safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave clients honest information and suitable support.

However:

  • Risk assessments were not consistently reflective of the service’s management of client risk, updated according to the provider’s guidance or following significant changes in client risk.

  • There was a lapse in the lone-working protocol at the Northallerton hub during inspection and small errors in the clinic room checks in Scarborough.

Effective

Good

Updated 29 November 2019

We rated effective as good because:

  • Staff completed comprehensive assessments with clients on access to the service. They worked with clients to develop individual care plans. Most care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.
  • Staff provided a range of care and treatment interventions suitable for the client group and consistent with national guidance on best practice. They ensured that clients had good access to physical healthcare and supported clients to live healthier lives, including facilitating couch to 5k groups and walking groups.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives. The service had consistently higher proportions of clients in effective treatment than the national average reported through the National Drug Treatment Monitoring System and were involved in a Public Health England enquiry as a result.
  • The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers made sure that staff had the range of skills needed to provide high quality care. Managers provided a comprehensive induction programme for all staff, including agency staff. They supported staff with appraisals and opportunities to update and further develop their skills.
  • There were excellent working relationships between the partner organisations of North Yorkshire Horizons. Staff from different disciplines worked together as a cohesive team to benefit clients and supported each other to ensure clients had no gaps in their care.

However:

  • Four of the 10 recovery plans reviewed had a period of over three months without update and two had no evidence of consent to treatment.

  • Staff had been trained in the Mental Capacity Act 2015 but not all staff were able to describe how this would be used in practice.

  • Only 50% of staff who were eligible for training in psychosocial interventions had completed it, though some did have comparable experience. There was a large disparity between the group interventions provided to clients across each hub.

Caring

Outstanding

Updated 29 November 2019

We rated caring as outstanding because:

  • Clients were truly respected and valued as individuals and empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.

  • There was a strong person-centred culture and staff provided care with compassion, dignity and kindness.

  • Clients felt cared for and valued their relationships with the staff team. Feedback from clients and carers was universally positive, and said staff treated people “as a whole person”, with “empathy” and “no judgement”.

  • Staff recognised, appreciated and sought to address clients’ social and emotional needs, as well as their physical ones. For example, they assisted a client in de-cluttering their home, established a clothes exchange in Scarborough, and had a fund that clients could request to use for personal projects to improve their quality of life.

  • They understood the individual needs of clients and supported clients to understand and manage their care and treatment and maintain independence.

  • Staff went the extra mile when providing care and support. They showed determination and creativity to overcome obstacles to clients accessing care; such as supporting a client’s pet in becoming an emotional support animal.

  • They ensured that clients had easy access to additional support, taking clients to external appointments and advocating for them where necessary.

  • Clients were supported to be active partners in their care, staff involved clients and carers in care planning and risk assessment and actively sought their feedback on the quality of care provided.

Responsive

Outstanding

Updated 29 November 2019

We rated responsive as outstanding because:

  • The importance of flexibility, informed choice and continuity of care was reflected in the service.

  • The service was easy to access. They had alternative care pathways and referral systems for people whose needs they could not meet and showed determination to ensure clients received the right support.

  • The service was flexible and responsive to the needs of its local communities and had established multiple outreach clinics in rural locations, such as Malton, and conducted home visits to make it easier for clients to access support.

  • There was a proactive and persevering approach to understanding the needs and preferences of difficult to access groups; influencing national change with the pioneering work conducted with the military community.

  • The service worked to improve knowledge of substance misuse within external organisations, conducting overdose awareness training with the police and naloxone training with homelessness services.

  • The service met the needs of all clients, including those with protected characteristics, communication support needs or those receiving palliative care. They had displays promoting inclusion and showing support for the LGBT+ community and attended Pride events to advertise the service provision.

  • Clients who could not attend appointments in working hours had late night access for one evening a week across all of the different hubs.

  • Technology was used to improve clients’ access to support out of hours and increase appointment attendance, including a text messaging service and the introduction of the Breaking Free Online app.

  • The design, layout, and furnishings of treatment rooms supported clients’ treatment, privacy and dignity. The service responded to client feedback about ways to improve this, introducing a card to allow clients to access the needle exchange without having to ask reception staff.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Good

Updated 29 November 2019

We rated well led as good because:

  • Leaders had the skills and experience to perform their role and a good understanding of the services they managed. They were visible in the service and approachable for clients and staff.

  • Leaders had transparently and sensitively managed a period of mobilisation which was creating significant change in staffing and service structure.

  • Staff felt respected, supported and valued and there were processes in place to promote staff wellbeing. Staff felt able to raise concerns without fear of retribution.

  • The organisation had processes to manage current and future service developments and staff collected and analysed data about outcomes and performance.

  • There was a strong focus on continuous learning and development; using staff, client and incident feedback to influence service development and implement change.

However:

  • Our findings from the other key questions demonstrated that governance processes were not always operated effectively at hub level, although this was not directly impacting on the quality of client care and treatment. We observed errors in following of service protocols, recommendations from audits were not always actioned, and documentation had errors.

  • Information within care records did not always reflect staff knowledge, to evidence how they were providing safe and effective care.

  • Staff reported that management staff had not yet received management training and there was not always opportunity for progression. Staff records did not always evidence that staff were receiving regular supervision.

Checks on specific services

Substance misuse services

Outstanding

Updated 29 November 2019