We rated Addaction – Cornwall as good overall because:

• The service had developed an innovative approach to providing integrated person-centred care pathways with other service providers, through the development of a team for people with multiple or complex needs.
• Clients found the service easy to access. Staff assessed and treated clients who needed urgent care promptly. The service provided safe care. Premises where clients were seen were safe and clean. •Staff completed risk assessments for clients in a timely manner and updated these regularly. Clients had risk management plans which they had been involved in developing. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• People’s individual needs and preferences were central to the planning and delivery of individual packages of care. Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients. Staff followed national guidance when prescribing medication, which was reviewed regularly.
• The teams included or had access to a full range of staff with the skills needed to meet the needs of the clients. Managers ensured that staff received regular supervision and an annual appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.
• Staff treated clients with respect, compassion and kindness and understood the individual needs of clients. They were non-judgemental in their approach to clients. They actively involved clients and families and carers in care decisions.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.However:
• Staff did not consistently record early exit from treatment plans for clients who had been in the service for more than three months.
• The premises in Penzance was visibly damp.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Addaction’s ethos was to put clients at the heart of their services, empowering them to be successful and take control of their lives. We saw evidence of this in how staff respected client views and wishes as well as actively seeking client feedback. Clients told us that staff were respectful, supportive and non-judgemental.
• There was an effective clinical governance process in place which ensured audits were happening and learning was disseminated across the service.
• The majority of staff across the Addaction sites had received mandatory training and staff were receiving regular supervision and appraisals.
• Office and clinic rooms were clean, tidy and well equipped to meet client needs. Offices were also designed in a way to protect client confidentiality and promote their dignity.
• There were no waiting lists at the service and all referrals came through a single point of contact and were triaged. This allowed staff to see urgent referrals quickly.
• All clients had care plans and red, amber and green rated risk assessments. Staff actively followed up clients who did not attend appointments.
• Addaction Cornwall had good links with other local services. Staff were able to refer clients to services appropriate to meeting their needs and understood the value of multidisciplinary and inter-agency working to address their clients’ needs.

However,

• There was high staff turnover at the service, meaning that recovery coordinators and team leaders were carrying high caseloads. This impacted on the quality and safety of care that staff could deliver.
• There was a lack of discharge planning and clients did not have unexpected exit plans.
• Staff morale varied across the service and stress levels were high. Not all staff felt protected by Addaction’s policies. Some staff expressed reluctance to raise concerns within the organisation.
• Addaction did not routinely ask whether a client would like their family involved in their care.