CGL Norfolk Alcohol and Drug Behavioural Change Service

We rated CGL Norfolk as requires improvement overall because:

• Information relating to the safety of clients was not always comprehensive or timely. During the inspection we found risk assessments for clients that were out of date and not reviewed following an incident. Not all records contained GP summaries and there was a lack of crisis plans throughout. Care plans lacked detail. Overarching recovery goals were not routinely documented and did not reflect discussions held with the client. There was a lack of discharge planning and clients’ plans did not always address the potential risks of early exit from the programme.
• The service did not keep a safeguarding log. Therefore, managers were not able to review outcomes and did not have oversight of reporting.
• Staff compliance with basic life support skills was 19%.
• Staff had not received an annual appraisal of their work performance.
• We found some incidents reported had passed the timeframe for review by managers of the service.

• The provider did not always have governance systems in place to effectively manage the service. Governance policies, procedures and protocols were regularly reviewed and improved to ensure the service delivered safe, good quality interventions in line with national best practice. however, these were not fully embedded.

However:

• The service had robust health and safety systems in place to manage the safety of the environment. All areas at the services were clean and well maintained. Clinic rooms, testing rooms and needle exchanges were well stocked and were kept locked when not in use.

• Staff held daily flash meetings where all staff engaged in detailed discussion of client risks. Where appropriate these risks were shared with relevant stakeholders. Staff worked effectively within teams, across services and with other agencies to promote safety including systems and practices in information sharing.

• Staff completed an initial assessment for clients in a timely manner and the care plan identified the person's recovery worker. The service ensured multidisciplinary input into people's initial assessments and staff provided a range of care and treatment interventions suitable for the client group.

• Staff were open and welcoming to all who attended. Clients were able to drop in to the service and staff would see them. Staff would offer responsive and emotional support. Staff talked about clients with compassion and respect.
• Clients we spoke with told us that staff were always available and they received positive support. Clients felt safe and said that staff were caring and welcoming. Staff enabled families and carers to give feedback on the service they received.
• The service was able to see clients who were urgently referred quickly. There was a system in place to ensure priority cases were given the earliest appointment available. Those people discharged from hospital were also made a priority and seen quickly. The service had alternative care pathways and referral systems in place for people whose needs could not be met by the service.
• Staff demonstrated an understanding of the potential issues facing vulnerable groups. Staff at the service promoted equality and diversity, this included lesbian gay bisexual transgender+ and black and minority ethnic groups. Staff were passionate in this area and were involved in events in the local community to support this.
• Leaders at the service had the skills, knowledge and experience to perform their roles, and provided leadership to their staff.  The organisation had a clear definition of recovery and this was understood by all staff. Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing.