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Inspection Summary


Overall summary & rating

Good

Updated 23 August 2019

  • Spectrum had health and safety systems in place to manage the safety for clients and staff across all hubs. Fire risk assessments and the health and safety folders were up to date.

  • All hubs had a range of appropriate rooms to meet client’s needs. The clinical rooms were clean, well-stocked and regularly reviewed by the clinical lead nurse. Staff had access to Naloxone (Naloxone is used to reverse the effects of opioids) and adrenaline which were stored in emergency grab bags at all hubs.

  • The provider had robust policies, procedures & training related to medication and medicines management. These included: prescribing, detoxification and assessing people’s tolerance to medication. Staff adhered to infection control principles, including hand washing and the disposal and storage of clinical waste.

  • Adverse events were planned for. The provider had a business continuity plan in place which was regularly reviewed by the hub managers.

  • There was enough staff at all grades to meet the needs of the clients. All staff received mandatory training suitable for their role. Additional specialist training was provided for example, Recovery workers had access to qualifications and credit framework (QCF) diploma level three in a therapy related subject. The multidisciplinary team met regularly to discuss client progress and needs. Each day a morning meeting was held at all hubs, where the team discussed the clients they were scheduled to see that day.

  • Clients received a comprehensive assessment in a timely manner which included a physical health assessment. Staff were able to identify signs of deteriorating in mental health. Risk management plans were discussed upon first assessment and regularly reviewed thereafter.

  • The service bench marked their service performance against Public Health England treatment outcomes. We were provided with performance evidence where the provider was performing above the Public health England performance data for successful completions of treatment, opiate representation, incomplete Hepatitis B vaccinations and levels of incomplete Hepatitis C screening.

  • Staff worked well with external agencies. Recovery workers and nurses were co located in hospitals, local authority family safe guarding team, GP surgeries, the job centre and police custody suites. This meant staff were able to share key information immediately.

  • Staff in leadership roles had the skills, knowledge and experience to perform their roles and provide strong leadership to staff. Managers had a good understanding of the service they were responsible for and could explain clearly how the teams were working to provide high quality care.

  • Staff we spoke with told us they felt respected, supported and valued by the provider. They reported that work related stress was minimal and manageable and that team morale was positive.

  • There were robust governance systems in place to effectively manage the service. The manager had oversight of the service. Performance was monitored by completing regular audits and the outcomes were recorded on key performance indicator dashboards. This meant the manager could monitor performance over a period of time to ensure continuous improvement.

Inspection areas

Safe

Good

Updated 23 August 2019

We rated safe as good because:

• The service had robust health and safety systems in place to manage the safety of clients and staff across all four hubs. Fire risk assessments were up to date. Where actions were identified through the fire risk assessments appropriate action was taken.

• All hubs had a range of appropriate rooms to meet clients for group meetings, one to one appointment, medical reviews and a needle exchange. Staff had access to Naloxone (Naloxone is used to reverse the effects of opioids) and adrenaline which were stored in emergency grab bags at all hubs.

• Managers had planned for adverse events. The provider had a business continuity plan in place which was regularly reviewed by the hub managers.

• Managers ensured that there was enough staff at all grades to meet the needs of the clients. The registered manager booked agency staff to cover staff shortages and distributed work load amongst the team.

• All staff received mandatory training suitable for their role.

• We reviewed 26 care and treatment records and found all clients had risk management plans in place. Risk management plans were discussed upon first assessment and regularly reviewed at client plan reviews and three-monthly full risk reviews.

• Relevant staff had received safeguarding training.

• The provider had robust policies, procedures & training related to medication and medicines management which included: prescribing, detoxification and assessing people’s tolerance to medication.

However:

• The decoration at Watford hub and Hertford hub were dated and needed redecorating.

Effective

Good

Updated 23 August 2019

We rated effective as good because:

• Clients received a comprehensive assessment in a timely manner which included a physical health assessment and on-going physical health assessments as required.

• Staff completed recovery focused care plans. Where a need was identified through the comprehensive assessment, the recovery worker and client developed a person-centred care plan.

• Recovery workers supported clients to minimise risks associated with substance misuse. Blood borne virus testing was routinely offered.

• Staff used technology to support patients effectively. For example, at all four hubs there were posters promoting third party mobile phone applications that include self-help tools.

• Recovery workers regularly reviewed care and recovery plans with the person using the service. As part of the review, recovery workers and the clients used recognised dependency tools.

• All staff received a comprehensive induction.

• The multidisciplinary team met regularly to discuss client progress and needs and there were evidence recovery workers worked close with external agencies.

Caring

Good

Updated 23 August 2019

We rated caring as good because:

• We observed staff interacting in a kind and respectful manner throughout the inspection.

• Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes to patients without fear of the consequences.

• Staff supported clients to understand and manage their care, treatment or condition.

• The service had clear confidentiality policies in place that are understood and adhered to by staff.

• The provider had developed a dual diagnosis and learning disability joint working protocol which ensured staff shared information with clients in a way they understood.

• Staff enabled families and carers to give feedback on the service they received for example, via surveys or community meetings, feedback reviewed was generally positive.

However

• One client told us they were allocated a new recovery worker without being told why. Another client told us at times whilst attending group they felt like the recovery worker didn’t listen to their concerns all the time.

Responsive

Good

Updated 23 August 2019

We rated responsive as good because:

• The provider had a clear documented acceptance and referral criteria in place, that had been agreed with relevant services and key stakeholders which all staff were aware off.

• The service monitored targets for length of time, from referral to triage to comprehensive assessment and from assessment to intervention.

• Staff completed recovery and risk management plans, which reflected the individual needs of the client. These included clear care pathways to other supporting services for example, maternity, social and housing services.

• Managers had ensured that clients with limited mobility needs were able to attend the hubs for their reviews. The hubs had rooms on the ground floor which clients with a disability could access for group interventions.

• The providers complaint procedure was on display at all of the hubs. Clients spoken with told us they knew how to complain and felt like they would be supported if they wished to raise a complaint.

Well-led

Good

Updated 23 August 2019

We rated Well-led as good because:

The registered manager had strategic oversight of all hubs. Staff in leadership roles had the skills, knowledge and experience to perform their roles and provide strong leadership to staff.

• Staff knew and understood the vision and values of the team and organisation and what their role was in achieving that.

• Staff we spoke with told us they felt respected, supported and valued by the provider. They reported that work related stress was minimal and manageable and that team morale was positive.

• Staff had access to support for their own physical and emotional health needs through an occupational health service.

• Managers had ensured that there were robust governance systems in place to effectively manage the service.

• Staff had the ability to submit items to the provider risk register.

Checks on specific services

Substance misuse services

Good

Updated 23 August 2019