We are With You North Lincolnshire

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

Good: This meant people were safe and protected from avoidable harm. The service was clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

All staff and managers told us they felt able to raise concerns and felt positive about how approachable and proactive senior managers were. Staff told us that sharing information and continuous learning was implemented through various forms which included emails, morning meetings called Flash meetings, regular supervisions, reflective practice sessions and staff meetings.

Staff recognised incidents and reported them appropriately. Incidents were reviewed and any themes and trends identified and discussed. Managers could give examples of changes following lessons learnt from incidents such as reviewing policies and staff briefings or training. The service reported 87 incidents in the last 12 months, including 13 deaths. The service reported the deaths of all clients up to 3 months post discharge and the service followed the death in service process which included a death in service review and outcomes of the review were shared.

Clients were asked to complete feedback forms and they told us they knew how to raise concerns and staff within the service were responsive.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had a clear engagement policy and procedure in place. This included maximising engagement with users of the service, missed appointments guidance and the service’s response to unplanned exit or discharge from treatment.

The service also worked with the local community and external partners and agencies, such as a local recovery service, mutual aid groups, police, domestic abuse service, mental health services, children’s services, safeguarding, homeless charities, job centre and probation to ensure clear and robust referral pathways.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff we spoke with told us they knew who to raise and report safeguarding concerns to. Safeguarding adults and children training was mandatory, and compliance at the time of the assessment was 95%.

The provider had systems, policies, and processes in place to ensure that staff identified and reported concerns. Managers attended all relevant strategic meetings in relation to safeguarding and also attended partnership boards, suicide learning panel and independent review scrutiny panel which reviewed the quality of reports and decision making. Staff also attended all client focussed meetings such as Multi-Agency Risk Assessment Conference (MARAC) and Multi-Agency Tasking and Coordination (MATAC) chaired by the police. The service sat in children’s services 1/2 a day per week to support concerns that are coming in at the first point of entry. The service also had support from a specialist social worker who was based in service 3 days per week. This position managed the rehabilitation process and provided support for adults with social care needs.

In the previous 12 months the provider had made 7 safeguarding referrals. We reviewed 5 care records which captured any relevant safeguarding concerns for individual clients, and these had been actioned correctly.

Mental Capacity Act

Staff received training in awareness of mental health, dementia and learning disabilities and safeguarding training which addressed mental capacity and staff were 100% and 95% compliant with this training.

Staff we spoke with had a good understanding of the Mental Capacity Act. They were able to identify where mental capacity was a concern in a client consenting to treatment.

Staff took all practical steps to enable clients to make their own decisions.

For clients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We reviewed 5 care records and found that monitoring mental capacity was good. It was reviewed during one-to-one sessions.

Staff ensured clients had agreed and signed consent to treatment forms and they were accessible to all staff involved in the client’s care and treatment.

Staff ensured clients had agreed and signed confidentiality agreements in relation to which parties staff could share their personal information with and they were accessible to all staff involved in the client’s care and treatment.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing people’s emotions. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found that staff completed and updated risk assessments 3-6 monthly depending on circumstances, incidents and other changes to risks. We reviewed 5 care records and found that they contained detailed information and there was a risk management plan present in each.

We spoke with 17 members of staff who all told us they communicated with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties and examples given were the use of interpreters and giving people extra time to support client’s needs and build a rapport.

Staff routinely and regularly provided clients with harm minimisation advice in relation to the risks associated with their continued drug and alcohol misuse and safety planning was an integral part of recovery plans.

Staff followed a clear engagement policy which included steps to take if the client unexpectedly dropped out of treatment.

Staff encouraged clients on medicine collection regimes to have lockable storage boxes in which to keep their medicines to safeguard any children or vulnerable people living with them. Safe storage assessments were reviewed annually or sooner if required.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had environmental risk assessments in place and conducted regular health and safety checks to mitigate risks. All interview rooms had alarms and staff available to respond. The reception area was managed safely with adequate space and alarms in place. Client’s accessing the service would mostly be supported within the building. Clients attending groups had access to the toilets and a small outdoor space and all potential risks to these individuals had been fully considered.

The premises were clean, and staff followed infection control guidelines, including handwashing. Staff made sure equipment was well maintained, clean and in working order. We reviewed the clinic rooms which had the necessary equipment and all areas were clean, well maintained, well-furnished and fit for purpose. One of the clinic rooms could support wound care on site. The service also provided needle exchange and the room designated to this had a toilet within the room for ease and accessibility.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had qualified, skilled and experienced staff. At the time of our assessment the service had 1 Mental Health and Wellbeing practitioner vacancy, 1 whole time equivalent non-medical prescriber and 0.6 whole time equivalent nurse vacancies which were currently backfilled with agency staff. The service had recently been re-awarded the contract following a successful tender process. As part of this new contract there were some newly developed positions, which had been created to improve systems, processes and outcomes for clients. Within the previous 12 months the total turnover of staff was 9.3% and sickness absence was 3.7%.

All staff had received and were up to date with appropriate mandatory training and overall compliance rate was 94.6%. The training was appropriate for the client group using the service. All staff including admin and volunteers also completed Oliver McGowan learning disability and autism training. In addition to the mandatory training staff also had access to a range of additional courses including level 3 trauma training, responding to domestic abuse, living with grief and loss, ASIST suicide training and working with perpetrators training.

The service had enough nursing and support staff to keep clients safe and all staff we spoke with felt that their caseloads were manageable.

Managers ensured all staff employed to work with clients had up-to-date Disclosure and Barring Service certificates in place and this was regularly audited. Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift.

The service also recruited, trained and supported volunteers to work with clients in the service. We spoke with the community engagement coordinator who was responsible for conducting supervisions and appraisals for all volunteers.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We conducted a tour of the environment and found that all areas were clean, had good furnishings and were well-maintained. Staff maintained equipment well and kept it clean.

Staff adhered to infection control principles, including handwashing and the safe and appropriate disposal of clinical waste.

The service operated a needle exchange, and they ensured the safe storage of sharps and used needles.

Clinical areas had the required standard of cleanliness for clients to have thorough physical examinations including areas for blood-borne virus (BBV) testing and wound care.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. We reviewed the medicines management policy and found this was fully adhered to in terms of procurement, storage, stock management, prescribing prescriptions, supply and administration and disposal.

Staff reviewed each client’s medicines and provided advice to clients about their medicines. The service reviewed clients who had been on the same prescription for a long time.

Staff completed risk assessments to determine the safe frequency of prescription pickups and reviewed these regularly and a clear rationale was in place where changes to pick up regimes were made with a clear and effective risk assessment and documentation.

Staff ensured there were always sufficient stocks of emergency medicines on the service premises such as naloxone and adrenaline. Staff ensured they reviewed the storage of naloxone, and the process of how it is distributed and monitored is reviewed, including how it is replaced after use and how harm minimisation advice is given.

Staff learned from safety alerts and incidents to improve practice.

Staff managed client withdrawals in a safe way which was in line with national guidance. The service supported clients undergoing a community detox. The service also offered Buvidal as a detox option as this offers a longer lasting effect reducing the need for clients to have daily doses and improves adherence to treatment. The service had supported approximately 30 clients in the last 12 months to use Buvidal through a community detox.