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New Directions Bradford Requires improvement Also known as Change, Grow, Live

Inspection Summary


Overall summary & rating

Requires improvement

Updated 11 January 2019

We rated New Directions Bradford as requires improvement because:

  • There were areas of improvement required to manage safety in the service. Not all clients had an individual risk assessment. Risk assessments were not consistently fully completed to evidence that all risks had been considered. Where risk assessments had been completed it was not clear how staff planned to manage identified risks effectively. Staff had not identified environmental risks in client accessible areas. Not all staff had received the required mandatory training to ensure they could respond to physical health emergencies.
  • The service was not consistently providing effective care. Whilst the service offered a full range of interventions these were not reflected in recovery plans. Recovery plans did not meet the individual needs of each client including their physical, psychological and social needs. Staff did not record discharge plans or clients’ individually agreed plans for unexpected exit from treatment. Staff did not have a good understanding of the Mental Capacity Act. Records did not support that staff consistently received supervision.

However:

  • Staff were caring. Feedback from clients and carers was consistently positive about staff attitudes. All clients had a named recovery coordinator who acted as a point of contact for the service. The service had access to a range of interventions to support clients and those close to them. Families and carers were appropriately involved in clients’ treatment. Staff understood and addressed specific needs regarding equality, diversity and human rights.
  • The service was providing care in a way that was responsive to people’s needs. All locations had accessible client areas including clinic rooms and interview rooms. Staff were flexible with appointment times and locations and appointments were rarely cancelled. Staff could make reasonable adjustments to support additional client needs. The service ensured that clients knew how make a complaint and was responsive to feedback.
  • The service was well-led. There was a stable management team with managers at all levels who had the skills, knowledge and experience to perform their roles. Managers and team leaders were visible in service and staff told us that managers were approachable. All staff we spoke with told us that they felt respected, supported and valued. There were good systems and processes in place to assess and monitor quality and safety within the service. Managers had identified and had plans in place to address most areas of concern.
Inspection areas

Safe

Requires improvement

Updated 11 January 2019

We rated safe as requires improvement because:

  • Staff had not completed risk assessments for each client. Risk assessments were not consistently fully completed to evidence that all risks had been considered. Risk management plans were brief and did not address in sufficient detail how staff mitigated risks identified in the risk assessments.
  • Staff had not identified all environmental risks in client accessible areas.
  • The service provided mandatory training in key skills to all staff but did not ensure all staff completed it as compliance with basic life support training was 40%.

However:

  • 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.
  • 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 followed best practice when prescribing, giving, recording and storing medicines. The service worked closely with local pharmacies to ensure that clients received the right medicine at the right dose at the right time.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean.

Effective

Requires improvement

Updated 11 January 2019

We rated effective as requires improvement because:

  • Not all clients had a recovery care plan. The service’s range of interventions were not reflected in recovery plans. Recovery plans did not meet the individual needs of each client including their physical, psychological and social needs.
  • Staff did not record discharge plans or clients’ individually agreed plans for unexpected exit from treatment.
  • Records did not support that staff consistently received supervision.
  • Staff did not have a good understanding of the Mental Capacity Act.

However:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff of different kinds worked together as a team to benefit clients. Doctors, nurses and other healthcare professionals supported each other to provide good care. The service had effective daily multidisciplinary meetings.
  • The service made sure staff were competent for their roles. Managers held regular supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Health screening was routinely conducted as part of clients’ care and treatment and to help inform appropriate treatment.
  • The service had effective procedures in place for the transfer of people who use their services including the transfer of young people to adult services.

Caring

Good

Updated 11 January 2019

We rated caring as good because:

  • Clients and those close to them were provided with access to appropriate emotional support including access to mutual aid groups.
  • All clients had a named recovery coordinator who acted as a point of contact for the service.
  • The service offered interventions aimed at maintaining and improving clients’ social networks, employment and education opportunities and provided support for people to attend community resources.
  • Staff understood clients’ needs regarding equality, diversity and human rights e.g. their gender, ethnicity, religion, sexual orientation, age and disability and how these might relate to their substance misuse.

Responsive

Good

Updated 11 January 2019

We rated responsive as good because:

  • The service had a range of client accessible areas including clinic rooms and interview rooms.
  • Staff were able to make reasonable adjustments to support clients with identified needs including disabled access, access to extended opening times and access to translation and interpreting services.
  • Staff ensured that clients and carers were able to raise complaints. Information in relation to raising a complaint was displayed in all locations. Complaints were reviewed in line with the provider’s policy. Clients told us that they felt confident to make complaints if it was needed.
  • Clients told us that appointments were rarely cancelled. Staff were flexible with appointments and were able to see clients at short notice in emergencies.
  • Staff reviewed clients who disengaged with the service on a case by case basis and used a range of approaches to re-engage with clients.

However:

  • Staff told us that interview rooms in Keighley lacked appropriate sound proofing. This was identified as part of planned improvements to the building.

Well-led

Good

Updated 11 January 2019

We rated well-led as good because:

  • Local governance arrangements supported the delivery of good quality care. Most areas of poor performance were identified and managers had action plans in place to improve these areas.
  • Managers at all levels in the service had the right skills and abilities to run a service. Staff told us that the leadership and management of the service encouraged an open, supportive and honest culture. Staff told us that they felt respected, valued and supported.
  • The service had, and staff had good awareness of, the provider’s values.
  • Managers used key performance indicators and other indicators to gauge the performance of the service.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • Staff spoke positively about communication within the service and the organisation as a whole. There was evidence of a culture of constructive challenge within the team.
  • Staff were clear about their understanding of whistleblowing and told us that they felt able to raise concerns without fear of retribution.

However:

  • Local governance arrangements had not identified concerns in relation to the service’s assessment of environmental risks.
Checks on specific services

Substance misuse services

Requires improvement

Updated 11 January 2019