We rated Addaction Herefordshire as good because:

• The service provided safe care. Premises where clients were seen were safe and clean. Staff completed risk assessments for clients in a timely way 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.
• 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 and this was reviewed regularly.
• The teams included or had access to the full range of staff required to meet the needs of the clients. Managers ensured that staff received training, supervision and 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 easy to access. Staff assessed and treated people who required urgent care promptly. The service provided a range of rooms for clients to use which were bright and pleasant. Clients could use computers to seek out work opportunities or access advice and staff gave out food parcels to those in need.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

• Addaction Hereford had made improvements to the space in their building to provide confidential areas for clients to speak to workers. Staff knew the lone worker policy and used this appropriately.

• Staff checked clinical areas, which were clean, and equipment had been checked. Information was available in different languages. Young people were seen promptly on receipt of a referral and did not have to wait for a service.

• Managers ensured recruitment processes were in place and followed the providers recruitment policy.

However:

• The service used both electronic and paper records for clients. Risk assessments and recovery plans were not stored together and both documents varied in quality and detail depending on who had completed them.

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• The service was not consistently managing risk, staff did not always complete client risk assessments and where completed, they did not always contain a risk management plan. Staff were not recording team discussions about client risk.

• Not all staff understood lone working procedures; three staff did not know the code word to use if there was an emergency.

• Recovery planning was not always effective. Staff did not routinely complete recovery plans with clients. Clients that we spoke with were not familiar with their recovery plans and had not received a copy. However, clients talked about staff offering them choices in their treatment. Staff were not consistently recording clients’ consent to treatment.

• At the Hereford team there were not always enough rooms for staff to see clients, this meant that staff sometimes had to see clients in a public place or communal area in the building, this could make it difficult to maintain confidentiality.

• The service had a waiting list for young people who wanted to access treatment, despite low numbers of young people in treatment.

• The service had not been providing the CQC with regular notifications as set out in their registration requirements.

However, we also found the following areas of good practice:

• The service was prescribing in line with National Institute for Health and Care Excellence guidance and staff assessed clients’ progress in treatment.

• Ninety-eight percent of staff had completed mandatory training. Staff could access a range of training, including specialist training in substance misuse. Managers and team leaders were able to develop as leaders.

• The Hereford team was open access, this meant clients and people not yet in treatment could access support and staff could help people in crisis. There was no waiting list for adults entering treatment.

• Staff were confident in managing safeguarding issues, they had support from managers who also monitored safeguarding. All staff completed safeguarding training.

• Staff treated clients kindly, were warm in their interactions and treated them with respect. Staff supported clients to give feedback. Carers and families were offered support and the service ran a regular carers group.