We rated Addaction Shropshire as good because:

• The service provided safe care. The premises where clients were seen were safe and clean. The service did not have waiting lists and clients who required urgent support were given priority and seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• The teams included or had access to the full range of specialists required to meet the needs of the clients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence and consent as they apply to young people and managed and spoke with confidence about how this applied to the young people they supported.
• Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients and families and carers in care decisions. Clients were supported to take responsibility for their own recovery and staff supported them in a non-judgemental way to achieve this.
• The service was easy to access. The reception area was friendly and welcoming and reception staff and volunteers were available to greet clients. The service used a duty system with a dedicated team available to respond to phone calls and make initial assessments. The service did not exclude people who would have benefitted from care.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• Although staff did not routinely do lone visits in the community all staff had personal alarms to use in an emergency but not all staff checked that these worked on a regular basis.
• The adult service did not have good links with advocacy services. They had started work to improve this but there were no signs displayed for clients to know how to access this type of independent support.

We do not currently rate independent standalone substance misuse services.

• Records did not demonstrate that staff regularly checked room temperatures, fridge temperatures, and emergency defibrillators. Staff did not seek advice regarding the stability of vaccines after they had recorded that fridge temperatures were outside of accepted ranges. Cleaning records did not demonstrate regular cleaning.

• The transition to electronic care records was incomplete and not all staff uploaded

  completed documentation to the electronic record. This meant that some electronic files did not contain a complete client record.

• Records did not routinely demonstrate client involvement in developing recovery plans or that staff shared plans with them. However, people with experience of using the service reported that staff provided information and choices about treatments.

• Addaction had not ensured that buildings and fire risk assessments were present and responsive to building work at Crown House. Complete and up-to-date environmental risk assessments were only provided to CQC following the inspection.

• Addaction had not ensured that prescribing and treatment interventions were supported by completed and current client documentation. This included risk assessment, risk management plans, unexpected treatment exit plans and recovery plans.

However,

• Staffing levels at the service were safe. Addaction held no staff vacancies, there was a low staff sickness rate and the service did not use temporary staff to deliver the service. Addaction made sure that all staff were appropriately qualified, experience, and gave them access to a range of specialist training suitable to their roles.

• Staff received Mental Capacity Act training and demonstrated good understanding and application to practice. We saw ‘quick guides’ and case studies to support staff in making assessments.

• People with experience of using the service told us that staff were respectful, polite and caring. We observed positive interactions between staff and clients.

• Between April 2016 and April 2017, Addaction Shropshire had not received any complaints. The provider displayed information about how to complain in the waiting area.