We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Staff undertook a detailed assessment of the needs of each client before they started using the service. Staff carried out a comprehensive assessment of risk for each client and ensured information about risk issues was communicated well with others.

• The service had robust safeguarding systems in place to ensure staff responded promptly to any concerns. Staff discussed details of vulnerable clients on the safeguarding register during regular meetings. There was a safeguarding lead at the service that staff could speak to for advice.

• Staff stored medicines securely and there were safe, robust systems in place for the management of prescriptions. The Service had a well-stocked needle exchange in line with National Institute for Health and Care Excellence guidelines (NICE52) needle and syringe programme.

• The service had a mix of healthcare professionals who were all highly skilled and competent. Staff operated safe prescribing practice. The prescribers were knowledgeable and able to assess and prescribe for alcohol and drug detoxification

• The provider had established the staffing levels required through consultation with the service commissioners and worked closely with them to ensure staffing and caseload management remained safe.

• Doctors completed a comprehensive assessment for all new clients and completed regular medical reviews for clients receiving a medically assisted treatment. We observed a medical review, which was structured and comprehensive. The service contacted a client’s GP prior to and after prescribing any medication.

• Care plans contained comprehensive and holistic information. They addressed the client’s various needs, in accordance with the client’s individual preferences and goals. Staff involved clients in their treatment throughout their recovery and treatment pathway. Staff met regularly to review clients’ cases and discuss complex cases and actions plans

• A wide variety of psychosocial interventions was available to support clients’ recovery.

• The service offered residential or inpatient detoxification for opiate and alcohol dependent clients who they considered a higher risk.

• Staff offered testing and vaccinations for hepatitis A and B. They also offered screening for hepatitis C and human immunodeficiency virus (HIV).

• Staff had good working relationships with other agencies including GP’s, pharmacists, the community mental health team, young person’s drug and alcohol service and supported housing providers, to provide comprehensive and holistic care for clients.

• Staff were knowledgeable and experienced for their role. The service had identified staff who acted as ‘champions’ in various roles including safeguarding and multi-agency risk assessment conference (MARAC).

• The service had a good volunteer, apprentice and peer mentor programme which provided former clients the opportunity to gain new skills and support new clients in their recovery.

• We obtained feedback from 14 comments cards from the service. Client’s spoke highly about the care and compassion they received from staff. They spoke of the support they received and said staff were non-judgemental, friendly, courteous and considerate. Staff were compassionate and keen to maintain clients’ privacy and dignity.

• Managers and staff sought feedback and views from clients using the service. Clients had opportunities to give feedback via comment boxes, during key worker sessions or via the peer mentors.

•  The service offered a drop-in session every afternoon so that staff could see people without an appointment. The service offered a late clinic one evening a week to reduce barriers to accessing treatment and staff could see employed clients outside of normal working hours. There was a single point of access telephone number for clients to use outside of normal working hours.

• Needle exchange provision was available including people who were not engaged in structured treatment. Staff provided harm reduction and safer injecting advice to people accessing this service.
• The service undertook outreach in the community to help clients who may find it difficult otherwise to access services. The service offered appointments and groups at five satellite services.
• Where clients did not attend appointments or disengaged from the service, robust systems were in place for staff to follow up with the client and attempt re-engagement.
• The service had a large range of information available relating to other local services including safeguarding, housing and welfare services and mental health and physical health support.
• The service had robust governance structure and good assurance and auditing systems in place. The service completed audits to monitor and develop service delivery. The service had a clear complaints policy and procedure. Clients knew how to make a complaint.
• The service had an operational risk register to identify priority risks and implement an effective plan to mitigate risks. Staff had oversight of dashboards to monitor caseload, risk, care plans and client care and treatment.

• Staff morale was high, their workload was manageable and they had job satisfaction. Staff told us they felt encouraged and motivated to provide the best service they could. There was a culture of promoting staff within the service and supporting them to achieve.

• The service had supportive and experienced management and leadership who demonstrated a good knowledge of the model of delivery for the service

• The provider had worked closely with stakeholders and partner agencies to design their treatment model. The service planned to implement the co-designed model in January 2018. Feedback from the commissioner was that the provider had managed the transition and performance of the service well.

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

• Not all staff at the service had completed the mandatory e-learning courses. Data provided by the service showed that three staff had not completed any of the mandatory e-learning training. Four staff had only completed some of the required modules. Six staff had not completed the policy and compliance mandatory training, which included modules on safeguarding adults and safeguarding children. No staff had completed emergency first aid at work or fire warden training.

• The risk register did not include timeframes for actions to be completed.

• Managers did not have immediate access to Disclosure and Barring Service (DBS) check information for volunteers and peer mentors.

• The provider had completed an analysis of staff training needs. However, they had not acted on the information provided. This meant that the service had not acted on gaps in training for staff.

• The provider did not offer Mental Capacity Act training for staff. Staff knowledge of the Mental Capacity Act was limited. However, staff could explain how to respond if a client attended under the influence of drugs or alcohol.

• Although the service displayed advocacy posters, staff knowledge of support available was limited.

• Data provided by the service showed that six of 15 staff had not completed all of the mandatory training.

• The service was embedding relevant policies. However, the prescribing and treatment policy did not reference the updated drug misuse and clinical management guidelines.