Luton Alliance Clinical and Care

On this page

• 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

We rated safe as good. We assessed 8 quality statements. Staff responded promptly to sudden deterioration in service users physical and mental health. Staff made service users aware of harm minimisation and the risks of continued substance misuse. Safety planning was an integral part of recovery plans. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each service users mental and physical health. The service managed service user 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.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 5 service users as part of this inspection. Service users told us they felt safe raising concerns and one service user told us that when there was an incident with another service user in the reception waiting area, that staff dealt with it swiftly and professionally.

Staff we spoke with knew how to record incidents or accidents and told us they felt safe to do so. Staff told us accidents and incidents were suitably investigated, and they received an effective debrief following incidents.

Leaders were able to explain the system for learning from accidents, incidents and complaints and could demonstrate how learning had been shared from incidents, such as death learning reviews and following up on service users who had missed appointments.

The service completed regular mortality reviews, where any service user deaths were discussed with individual keyworkers and any learning shared between staff. In addition to this, the provider held monthly Integrated governance team meetings (IGTM) any learning shared was shared across CGL as an organisation.

Service users we spoke with said the referral process went smoothly for them. However, one service user said they were unable to get through to the service on the telephone and when they requested a call back no one contacted them.

One service user said that when they transferred from the previous service, the most noticeable difference was that people were allocated individual keyworkers.

Staff were able to explain how information about service users care was shared when people were working with multiple agencies or services.

Leaders could describe the process for referrals, which included self-referring through a webform or a professional referral through a webform, the service was also able to support walk in and telephone referrals.

Staff told us about the service pathways to ensure smooth transitions when service users moved between services or out of the service, including a liaison service which supported the local acute hospital and a rough sleeper's team.

Staff told us there was a collaborative, joined-up approach to safety that involved service users, staff and other agencies involved in service user care.

There were a variety of ways in which service users could be referred into the service, including self-referral through a secure online referral system. Service users could attend a walk-in appointment and receive a triage assessment on the same day. The service did not have waiting lists, those referred were offered a time and date to be assessed in a timely manner. Staff saw urgent referrals quickly.

Most service users spoke positively of their treatment, service users said staff treated people well and they felt safe around staff.

Service users knew who to speak with if they had concerns about abuse or neglect.

Staff understood how to monitor for signs of abuse or escalate concerns, they were able to give examples of referrals of what signs to look out for and who to inform.

Staff had received safeguarding training and were confident in using that training. Overall compliance with both safeguarding adults and safeguarding children training was 96%.

Leaders could describe how safeguarding concerns were managed, and information shared at team meetings where safeguarding was a standing agenda item.

Staff had access to a safeguarding lead and qualified social worker who was based within Resolutions Luton.

Staff understood how to protect people’s human rights, including their rights under Mental Capacity Act (MCA) and the Equality Act. Overall, 97% of staff had completed MCA and Deprivation of Liberty safeguards training.

Overall, 99% of staff had completed introduction to equality, diversity and inclusion training.

The service had a clear process to record safeguarding concerns, and notifications were made to the local authority or CQC in a timely manner. The service ensured other authorities or agencies were involved if needed.

The service had good oversight of safeguarding concerns, action taken or lessons learnt.

Service users felt their risks were well supported and felt involved in their risk assessments. Service users we spoke with confirmed they were involved in their risk assessment and that risks of continued substance use were discussed with them. Risk assessments included providing service users with medication lock boxes to store medication safely at home and naloxone, a medicine that rapidly reverses an opioid overdose.

Staff carried out risk assessments with service users as part of the initial assessment. Staff also discussed service user risk or any changes in risk during the daily morning meeting.

Staff assessed and managed risks to service users and themselves well. They responded promptly to sudden deterioration in service users physical and mental health. Staff made service users aware of harm minimisation and the risks of continued substance misuse. Safety planning was an integral part of recovery plans.

Staff completed risk assessments for each service user on arrival, using a recognised tool, and reviewed this regularly, including after any incident. We reviewed 12 service user records and found all records except one had an initial risk assessment and one had a risk management plan in place.

Caseload sizes were dependent on complexity and teams regularly discussed caseload sizes in supervision and team meetings to ensure service user risk was taken into account,

Service users said that facilities and equipment was well maintained and that the needle exchange room was well equipped.

Leaders told us that the building maintenance was managed centrally and that they had regular health and safety meetings. Leaders told us that team leaders were allocated as first responders for each day and responded to any incidents that happened. There was a contingency plan in place if team leaders were not in work.

Staff regularly completed risk assessments of all areas, facilities, equipment and technology were well-maintained.

All rooms where service users were seen had panic alarms in place. Team leaders were allocated as first responders to incidents on a daily basis. All areas were clean and well maintained and had the facilities and equipment needed.

The service had an environmental risk assessment in place and an external fire risk assessment had been carried out. The service had access to provider wide health and safety policies in line with current best practice guidance and legislation. The provider submitted a mandatory training overview which showed 98% of staff had completed introduction to health and safety e-learning.

Service users told us the service was accessible, and one service user said they attended evening appointments as they were working and described the service as flexible. Service users felt staff were experienced and knowledgeable.

Staff told us they had a thorough induction when they started working for the service, and felt they had good training opportunities, including in specialist areas.

Staff felt there was a good skills mix amongst the team, which included specialist roles within the integrated team, this included specialist teams including opiate recovery workers, alcohol recovery workers, a family and carers worker, a rough sleeping and outreach team and hospital liaison recovery workers.

Staff told us they felt they had adequate supervision and support from managers.

The provider had a training database in place to monitor training and development. Recruitment information was kept centrally with the provider’s central human resources team. The provider had a supervision and appraisal database in place to highlight when staff were due supervision. At the time of inspection, the supervision compliance rate was 89%, and appraisal compliance was 77%.

Service users felt the environment was kept clean and confirmed the service supported them with blood borne virus testing and treatment.

Staff felt that the environment was clean and tidy and well equipped. Staff told us that Infection, Prevention and Control was discussed at integrated governance team meetings.

The provider had policies in place and in line with best practice guidance around infection prevention and control. Infection prevention and control training was not part of the providers mandatory training. The service had cleaning schedules and checklists in place that had been completed.

Service users told us they received regular medical reviews, and they understood the medication they were receiving. Service users who collected medication from a pharmacy confirmed they were involved in choosing a convenient pharmacy to suit their needs and that collection regimes were discussed with them prior to commencing treatment. Service users confirmed they had access to naloxone and locked boxes to store medicine if required.

Staff had a good understanding of people’s medicine. Staff told us they followed CGL’s policies relating to medicine and they had access to doctors and non-medical prescribers who issued and reviewed prescriptions for service users. Medical reviews were completed within the providers timescales.

The needle exchange room and clinic room were clutter free, clean and well equipped. Overall, 83% of staff had completed basic life support training.

Staff monitored the temperature of the clinic room and medication fridge and knew what to do if the temperature went outside of range. The blood pressure machine, pulse oximeter and weighing scales had been calibrated to ensure they were working correctly.

Service users were offered Blood Borne Virus testing at the start of treatment and throughout their treatment episode. Hepatitis vaccinations were routinely offered at the point of assessment and at review appointments to all service users.

Staff were trained to administer naloxone in case of an emergency. Staff gave service users naloxone and trained them on how to administer it to reverse an opioid overdose.

Medicines and prescription forms were kept securely. Their use was monitored in line with national guidance. The service had systems to ensure staff knew about safety alerts and incidents, so service users received their medicines safely. Medicines incidents were reported on an electronic system and fully investigated,