We do not currently rate independent standalone substance misuse services.

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

• Staff did not always maintain the dignity and privacy of client’s during treatment in clinic rooms at Irford House and two clinic rooms at Armley Park Court. Staff told us that clients would on occasion need to partially undress for physical health examinations, including electrocardiogram monitoring. There were no privacy screens around examination couches in these rooms and the glass panels in the doors were not obscured.

• Staff at Forward Leeds did not always receive an induction into their role and as such did not have the necessary skills and training to ensure their own safety and that of the people using the service. Staff attendance at mandatory training was low in Forward Leeds and compliance with local mandatory training was low in Calderdale Recovery Steps. Developing Initiatives for Support in the Community did not have effective systems in place to monitor this.

• The provider did not have a system or process established to monitor compliance with the Mental Capacity Act 2005. Staff understanding of their responsibilities under the Act varied and they take not take a consistent approach to assessing clients’ capacity.

• At Forward Leeds, staff did not always ensure that risk assessments contained all identified risks for each client and did not always develop a clear plan to manage those risks. They did not always review risk at the frequency defined by national guidance and the provider's policy.

• Recovery plans at Forward Leeds were not always personalised and reviewed as required. Recovery plans at Calderdale Recovery Steps did not always contain sufficient detail, or the client's views.

• Developing Initiatives for Support in the Community did not always ensure that systems and processes were operating effectively in Forward Leeds, where they were the lead contract holder. This led to issues with infection control procedures, emergency medicines and the management of clinical waste.

• We found equipment at the Kirkgate hub that was unclean.

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

• The majority of feedback from clients and their carers was very positive about the services Developing Initiatives for Support in the Community provided. Clients and carers reported staff were kind and respectful and involved them in decisions about their care and treatment.

• Staff used evidence based assessment tools to measure clients’ substance misuse and emotional wellbeing. Developing Initiatives for Support in the Community offered access to treatment recommended by national guidance, depending on the needs of each client.

• Developing Initiatives for Support in the Community encouraged clients to become peer mentors to support others in the early stages of treatment. Clients were able to attend service user forums and provide feedback on the service to inform its development and delivery. Developing Initiatives for Support in the Community had developed a Recovery Academy in Leeds, which offered a wide range of recovery focused activities and structured group work. Recovery Support was also available at Calderdale Recovery Steps and North Yorkshire Horizons.

• Developing Initiatives for Support in the Community took into account the diverse needs of the client group and made a number of adaptations to their services to ensure they were accessible to all. Staff worked with vulnerable and heard to reach groups to support them to access services. Developing Initiatives for Support in the Community had held the Equality North East ‘Equality Standard Gold Award’ since 2012.

• Developing Initiatives for Support in the Community were committed to quality improvement and innovation, which involved the use of external standards and frameworks. Developing Initiatives for Support in the Community had been awarded the Investors in People silver award in August 2016 and had an action plan in place to work towards gold standard.

• Staff felt valued by the organisation and stated that they were able to input into the delivery of services. Staff were passionate about the work they did and most reported good morale and relationships within their teams.