Archived: Bideford

We rated EDP – Bideford hub as requires improvement overall because:

• Staff were not always managing risk to clients. Clients who had been using the service prior to April 2018 did not have a disengagement plan in place. A disengagement plan details what the client expects from staff when they disengage from the service or do not attend appointments, for example by contacting their next of kin. This meant that if a client disengaged with the service staff might not know who to contact including relatives, carers or health professionals and others involved in the clients care to make them aware this had happened. Three out of six records reviewed did not contain a risk management plan. Risk management plans did not refer to crisis planning.
• Staff were not always developing detailed recovery plans which included client’s goals and what treatment they were receiving. At the time of the inspection, the provider had not started the newly developed local care planning audit.
• Staff did not ensure that clients received a comprehensive assessment of physical health needs from the client's GP or other relevant health professional. Staff were not including client’s physical health needs when developing recovery plans. The provider did not have a physical health monitoring policy and staff were concerned that physical health monitoring was not comprehensive. Only clients who were prescribed medication by the service or undergoing home detoxification had their physical health checked.
• Staff were not carrying out or referring clients for blood borne virus (BBV) testing. Clients should have been offered BBV testing on-site or referred to their local GP for testing but 0% of clients had been tested referred in the 12 months prior to this inspection.
• In the Barnstaple clinic, staff were not adhering to infection control principles when testing urine samples. The urine testing facilities were not being used appropriately by staff. When the clinic room was in use, staff were testing urine samples in the kitchen. Staff were disposing of used sample pots in the clinical waste bin in the clinic room without emptying the contents fully. The dedicated toilet for urine testing did not contain a clinical waste bin or an area to test urine samples.
• The provider did not have a robust recruitment process to ensure all staff had an up-to-date Disclosure and Barring Service (DBS) certificate in place. The human resources (HR) department was responsible for ensuring staff had a valid DBS certificate and had not realised when a number of staff DBS certificates had expired. Managers did not have oversight of this process.
• Staff were not recording informal complaints. This meant that managers could not be assured that complaints were actioned fully, and complaints could not be analysed to determine themes or trends.
• Some needles used for the needle exchange service were out of date in the Bideford clinic.

However:

• The clinical assessment service staff assessed risk at the point of assessment. When clients were allocated a recovery navigator, they would then complete a comprehensive assessment. The comprehensive assessment included completing a risk assessment and incorporated information received from the client’s GP at the point of referral. Clients requiring a prescription received a face to face assessment with the service’s doctors or non-medical prescribing nurses.
• The clinical assessment service were completing initial assessments with clients within two weeks of receiving a referral. Urgent client referrals were seen promptly. High risk clients were prioritised, for example pregnant women and opiate-users. Staff monitored clients on the waiting list to detect increase in level of risk or need.
• Staff treated clients with compassion and kindness. They understood the individual needs of clients and supported clients to understand and manage their care, treatment or condition.
• Staff felt respected, supported and valued by management. Staff and clients described a change in culture in the last six months and felt optimistic and positive about the future direction of the organisation. Managers had introduced initiatives to improve morale such as arranging team away days.