We rated Addaction Weston-Super-Mare as good because:

• The service used a shared care agreement and actively engaged with commissioners, and other relevant stakeholders to ensure services were planned, developed and delivered that met the needs of the local population. The service had excellent multiagency working relationships and worked well with local services. They hosted professionals from maternity services Improving access to psychological therapies (IAPT) and criminal justice services weekly and clients could access these services through their attendance at Addaction.
• The service had enough skilled staff to meet the needs of clients. The service provided staff with a comprehensive induction and mandatory training on relevant subjects. Staff morale was good and the teams worked effectively together. Staff received regular supervision and appraisals and had individual development plans in place, with access to a range of training in specialist areas. The service provided evidence-based treatment and interventions in line with national guidance and best practice. This included National Institute for Health and Care Excellence guidelines and Drug misuse and Dependence: UK guidelines on clinical management (2017). Staff provided a range of care and treatment interventions and groups including relapse prevention techniques, cognitive behavioural approaches, motivational interviewing and mutual aid partnership groups.
• Clinical staff prescribed in line with National Institute of Health and Care Excellence guidelines. The service routinely offered blood borne virus testing and participated in a needle exchange scheme. Clients physical health needs were monitored and met through effective shared care arrangements with local GPs and access to community nurses providing services from the Addaction site.
• Staff completed initial needs assessment which were robust and included a holistic review of clients social, physical, psychological and cultural needs. Staff organised and offered support and treatment based on the needs identified during the assessment. The service provided treatment within five teams which included support with needs such as engagement, criminal justice intervention and family relationships.
• The service treated concerns, complaints and incidents seriously. The service provided a variety of forums for clients and staff to give feedback on the service and raise any issues. There were systems in place to record, review and discuss complaints and incidents and there was evidence of improvement in response to this. Managers did not use restrictive interventions and risk management was undertaken on an individual basis. Staff were proactive in reengaging clients back into the service and used individualised behavioural contracts to risk manage clients who had previously not adhered to the service code of conduct.
• Client and carer feedback was overwhelmingly positive regarding the commitment of staff and benefits of the service. Clients and their families attended service user forums and focus groups and could provide feedback on the service and be involved in the development and running of the service. Clients had taken part in staff interviews and were provided the opportunity to complete volunteer training and become recovery champions.
• The service recognised the value in and participated in research to improve the quality of the service. Managers were innovative and had implemented pilot initiatives in response to local need and new research outcomes. The service had developed a role for an Addaction staff member in the local emergency department to provide education and advice regarding drug and alcohol use. The service had recently been granted the first home office licence to become a drug testing service, assessing the safety of client’s own drugs, and had started a pilot for the service in February 2019.

However:

• Storage and management of blank and cancelled prescriptions was not implemented in line with policy. Clinical staff did not follow voided prescription procedures. Blank and void prescriptions were not stored and logged adequately to reduce the risk of misuse.
• Although staff completed an initial risk screening for clients, they did not consistently develop comprehensive risk assessments and management plans in response to risks identified during initial risk screening. Staff did not review and update risk management plans following client safety incidents and identification of new risk areas.
• We found that the majority of care records did not include a client-led recovery plan. The service expectation was for all clients to have a comprehensive person-centred and client-led recovery plan once they were using the service. Staff did complete brief recovery plans as part of clients’ initial needs assessments but these were not detailed or client-led.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The comments and feedback from the service’s clients, partners and commissioners was excellent. Clients told us that Addaction staff were very welcoming, caring and non-judgmental. If clients’ treatment pathway was not working, the service had several different options. For example, a client told us they were provided alternative rehabilitation pathways, one to one and plan by the next day. Clients also told us that to aid their recovery and reduce their risk of relapse staff had taken the client to social meetings external to the service in their own time. The service had received 182 compliments from their clients.

• Staff and managers at Addaction Weston Super Mare were skilled, trained and experienced in delivering substance misuse care and treatment. The service had a good mix of staff in its multi-disciplinary team including psychiatrist, non-medical prescribers, psychologists, substance misuse staff and volunteers. The service was providing an excellent range of non-mandatory training for staff and volunteers to aid clients’ recovery for example cognitive behaviour analysis. The service’s psychiatrist provided bespoke training packages to support those with a mental health and addiction diagnosis.

• The service’s multi-disciplinary team had a good understanding of clients’ risks. They had a robust process for assessing risk, reviewing high risk clients and clients who were disengaging with the service.

• The service was learning and monitoring from incidents, trends and complaints. We saw examples of the service was a listening, learning and adapting their practices to improve the service.. The service had reviewed it relapse rates for women, which were higher than mens’ and had started a ‘WAGs’ (women only) recovery group.

• All care plans were up to date. The service was updating the care plans to a new format. Three of the four care plans reviewed were in the old format. The three old style plans seen were recovery orientated. However they are written in the third person and not always holistic. The new care plans were designed to be recovery focussed, holistic and reflected the patients voice and involvement. Clients told us they really liked the new recovery plans. .

• The service prescribed medicine following ‘Drug misuse and dependence: UK guidelines of clinical management’ (2007) and National Institute for Health and Care Excellence (NICE) guidelines. Psychological therapies clients received also followed these guidelines.

• The service was engaging with community and partners. Clients told us the service was easy to access. There was very good multiagency working. The service worked closely with other agencies, for example GPs, to ensure they addressed and identified individual needs. They also worked closely with partners in the community; offering other services, such as training, free food and advice with housing.

• Staff told us that managers were supportive and good leaders. The morale in the staff team was very high; there were no vacancies, low turnover and low levels of sickness. The management team provided excellent oversight supported by robust governance systems at local and national level.

However, we also found the following issues that the service provider needs to improve:

• Care records were being held on two systems, paper and electronic. Although an internal audit had identified the need to merge the systems in 2015 this work had not yet been completed fully.

During our visit at Addaction Weston-Super -Mare we spoke with seven people. They all told us they were very happy with the support they had received from Addaction. One person told us “I personally think without this place a lot of people wouldn’t make it”. Another person told us, “The programme is very structured which works for me, we build up trust within the group and can discuss things openly”.

We were told staff treated people who used the service with respect and dignity. One person told us, “X, a member of staff, is absolutely brilliant; they have deep compassion and empathy which is very important to me”. We observed staff speak with people in a respectful manner and listen to their opinions and comments.

We saw care planning was person centred and agreed with the individual. One person told us, “The goals set are ours not theirs, we say what we want to achieve and they support us”. Regular reviews were carried out and involved the individual at every stage.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager and team leaders.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

We saw the provider had a robust process for handling complaints.