Cranstoun Worcestershire

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

All areas of the environment were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to clients and themselves well. Staff understood how to protect clients 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 safety incidents well.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

Staff could clearly explain incident reporting processes and described learning from incidents through debriefs, daily flash meetings, lessons learnt meetings, team meetings and supervisions. We also heard about service-wide lessons learnt videos that were created and shared with the staff team.

Cranstoun held quarterly organisation wide ‘Governance Activity Learning Group’ meetings to review and share learning from governance activity. These meetings helped ensure effective care, quality and governance mechanisms were in place and that early warning signs of poor governance were identified so that mitigation plans could be developed.

The organisation also held quarterly Drug and Alcohol Related Death Forum meetings where staff reviewed case studies of deaths and near-fatal overdoses. These reviews helped identify learning that could reduce future risks across substance use services.

Leaders attended monthly incident review meetings where they discussed incidents, investigations, and resulting actions. They then shared this information with the wider staff team to support ongoing improvement.

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.

Clients said they received information at admission about their treatment, available activities, their rights, confidentiality, consent, and how information would be shared.

Clients received a comprehensive initial assessment, during which staff completed a risk assessment and developed a care plan in collaboration with them.

Clients told us they felt involved in deciding the content of their own recovery plans.

One client explained that family members could be involved if the client wished, and that staff discussed consent before involving relatives. Another client said their family member felt included and supported throughout their treatment and recovery.

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.

We saw that staff reviewed safeguarding incidents and took appropriate actions to reduce future risks.

We were given an example where a safeguarding concern was raised after a delay in allocating and referring a high-risk case. Staff reviewed the referral and allocation process and made changes to reduce the chance of high-risk cases being missed at referral.

The service held a live register of all safeguarding cases. There were 413 active clients with open safeguarding concerns on this register.

Safeguarding was a regular agenda item at team meetings and in staff supervision.

The service had a detailed safeguarding policy, including guidance for children and young people, and updated these policies at least once a year.

Cranstoun held quarterly safeguarding forums for safeguarding leads and champions to share learning and stay up to date with best practice and current regulations.

Most staff we spoke with had completed safeguarding training and showed they could identify adults and children at risk of significant harm. They also gave examples of when they would escalate safeguarding concerns to a manager.

The staff compliance rate was 94% for safeguarding adults training and 91% for safeguarding children training.

The service had recently introduced face-to-face safeguarding training for staff.

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. They provided care to meet people’s needs that was safe and supportive.

We reviewed 8 client care records and found the associated risk assessments to be of good quality, with clear evidence showing they had been reviewed regularly and recently.

The records demonstrated deliberate and ongoing efforts to involve clients in the development and regular review of their risk assessments throughout their entire time in the service.

Of the 11 clients we spoke with, 8 said they had been offered a copy of their care plan, while 3 reported they had not been offered.

Eight clients told us they had access to advocacy services to support them, while 3 clients said they were unsure whether such services were available to them.

A staff member explained that the clinical team assesses each client’s suitability to collect prescriptions, adjusting collection frequency when staff are confident clients are adhering to their treatment plans. This approach was described as giving clients greater control and independence, while ensuring their safety and ongoing treatment needs continued to be carefully monitored by the clinical team.

In the service waiting area, we saw a poster inviting clients to provide feedback through a scannable QR code, alongside displayed results from a survey in which clients were asked to choose types of groups and activities they’d like to see offered at Cranstoun.

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.

Clients were supported in safe environments that were designed to meet their needs, and facilities, equipment, and technology were well maintained and appropriate for the delivery of care.

The service had recently completed a comprehensive premises risk assessment, which was supported by a clear action plan outlining identified risks, required improvements, and agreed timescales for completion.

Emergency medicines, including naloxone and adrenaline, were available within the service, and staff were appropriately trained and competent in their safe administration during emergency situations.

All of the clients we spoke with told us they felt safe when using the service and were confident that staff always took their safety and wellbeing seriously.

All meeting rooms were fitted with panic alarms, which, if activated, would immediately alert the designated on-site first responder to provide timely support.

Closed-circuit television was installed and operational in communal areas accessible to clients, supporting safety while maintaining appropriate levels of privacy and dignity.

The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Several members of staff we spoke with felt the service required additional staffing, explaining that low staffing levels had increased caseloads and contributed to high stress, burnout, and staff turnover.

Staff described concerns that the nature of the work, combined with staffing shortages, had resulted in some staff leaving the service, which in turn increased pressure and workload for remaining staff members.

Staff reported that managers attempted to reduce the impact of staffing pressures by using agency staff, trying to recruit new employees, and monitoring workloads to ensure individuals were not consistently overworked.

Another staff member highlighted the impact high caseloads had on clients, explaining that workload pressures contributed to burnout, and that managers had previously capped their caseload to improve manageability.

Staff also reported that high caseloads affected the length of appointments offered to clients, resulting in shorter appointment times to ensure all clients could be seen.

Some staff highlighted that keyworkers held significant responsibility while receiving relatively low pay, which they felt contributed to high staff turnover, which negatively affected continuity of care.

Ten of the 11 clients we spoke with said staffing levels felt sufficient, appointments were on time, and they had not experienced cancellations due to staffing issues. 1 client reported having appointments cancelled due to staffing issues.

Leaders acknowledged ongoing recruitment challenges and described using agency staff to maintain service capacity while actively recruiting to fill permanent posts and cover sickness absence.

We saw evidence that leaders recognised when staffing shortages affected service capacity and took appropriate action to reduce the impact on staff, clients, and the overall running of the service.

Leaders explained that alternative recruitment methods, including the use of specialist recruitment agencies, had been introduced due to lower-than-expected applicant numbers. The introduction of this new approach to recruitment had resulted in the service identifying more suitable candidates for vacant posts.

Leaders also told us the organisation was undertaking a comprehensive review of salary levels to remain competitive within the sector and support the recruitment and retention of staff.

The service had an established workforce of 88.68 full-time equivalent posts, with 78.23 full-time equivalent staff in post. This equated to a vacancy rate of approximately 5.9%.

Caseload data we reviewed showed that average caseloads were generally aligned with target caseload levels. Based on the data provided for 7 teams within the service, 3 of the teams exceeded their target caseload levels and the remaining teams were operating within target.

One staff member felt the specified target caseload numbers were too high and required review.

Data reviewed showed that 91% of mandatory training was either completed or within required timescales, with managers developing team plans to address overdue training. We saw that staff had received mandatory training relevant to their roles, and records showed training was appropriate for the needs of the client group using the service.

Staff told us that training provision had improved, with increased use of external providers, better training frequency, and a broader range of subjects being offered. However, one staff member reported that there was no alcohol-specific training available and felt this was an area requiring further development.

All staff had completed Psychologically Informed Environments training, which focused on trauma-informed practice and supporting clients with complex emotional and psychological needs.

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 observed the service to be clean and well maintained, reflecting the organisation’s commitment to providing a safe, hygienic environment for clients.A comprehensive Infection Prevention and Control policy was in place and reviewed regularly, ensuring staff remained informed of best practices and the service consistently met required operational safety standards.

The Clinical Director carried out an annual Infection Prevention and Control audit, after which detailed action plans were implemented to address concerns, with progress monitored consistently by the Care Quality Governance team.

The most recent Infection Prevention and Control audit produced an overall compliance score of 87%, suggesting that the service maintained a high level of adherence to infection control procedures and policies.

The service operated a needle exchange scheme under a formal policy, which continued to be well managed, maintaining safe and accessible provision of injecting equipment for clients. To address reduced pharmacy participation, the organisation promoted a discreet direct delivery service, enabling clients to order free injecting equipment online, which was securely packaged and delivered to support harm reduction efforts.

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.

All aspects of medicines management were assessed as compliant with policy; the clinic room was well kept, equipment was calibrated, and systems were observed to always ensure safe handling of all medication.

Medication was stored securely, including controlled drugs, with appropriate arrangements in place to prevent unauthorised access or misuse, ensuring client safety and adherence to legal and organisational requirements.

The controlled drugs book was well maintained, up to date, and accurately recorded all relevant details, demonstrating strong governance and compliance with regulatory standards for handling-controlled substances.

The medicines policy provided clear guidance on managing risks to clients regarding drugs and alcohol, ensuring staff followed defined procedures to minimise harm and maintain safety in all clinical interactions.

Prescription management was carried out to a high standard by a designated team, ensuring safe delivery and dispensing of medications, although occasional missing signatures were observed on records of prescriptions collected.

Emergency drugs, including naloxone and adrenaline, were present, in date, and accompanied by relevant policies for their management and use, ensuring staff could respond effectively to clinical emergencies.

Several clients reported receiving specific advice about their medication and confirmed that they were regularly involved in medication reviews, supporting informed decision-making and safe, personalised care planning.