We do not currently rate independent standalone substance misuse services. Our last comprehensive inspection of Western Counselling Services was in November 2016. At that inspection, we issued a requirement notice. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards. On 10 May 2018 we undertook an unannounced, focused inspection to see whether the provider had made the required improvements.

•  At the last inspection in 2016 we said the provider must ensure that all prescription/medicine administration records are signed by a doctor. In May 2018, we saw that all 13 of the current prescription/medicine administration records were signed by a GP.
•  At the last inspection in 2016 we said the provider must ensure that clients are fully informed when methadone is given in tablet form, rather than liquid (as per national guidelines) and should ensure the clients understand the reason for its use and their consent is sought. In May 2018, staff were able to explain their new process for highlighting this in their admission process. Clients who were due to receive methadone as part of their rehabilitation had the reasoning for using tablets instead of oral liquid explained to them. They were then asked to sign a consent form to show their understanding and consent. We saw that this practice was being followed.
•  At the last inspection in 2016 we said the provider must ensure that medicines are administered from their original packaging from the dispensing pharmacy. In May 2018, we saw that the service was now receiving medication from the pharmacy, in sealed dosset boxes to remove the need for staff to decant medicine into another packaging.

During this inspection we spoke with a group of five people from both Meijer House and St David’s House. Three people in the group were from Meijer House. People told us they were very well supported by the staff team. They praised the support they received to attain their goals. One person told us, “They have made such a difference to my life. I admit I don’t want to be here but have already achieved some life changing events”. Another person told us, “The counsellors are really good and the support staff are always available to talk to”. We observed a very professional but supportive rapport between staff and people who used the service.

We found people who lived in Meijer House were involved in the day to day running of the home. They told us they attended house meetings when they could discuss any issues that had an impact on their daily life. They could then discuss this with staff when they would pass on significant event reports.

We saw care plans were written by people who lived in the home. They discussed their identified needs, their goals and agreed how to achieve those goals.

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

The provider had a quality assurance system in place that ensured people were safe and changes could be made to improve the service provided. A clear complaints policy was in place and available for all people who used the service.

We spoke with five people who used the service.

People spoken with were very complimentary about the level of support they received from the staff team to achieve their goals. One person told us, “they have given me my life back. The counsellors are brilliant." Another person told us, "All of the staff work as a team and can understand how we are when we are going through the different steps.”

We spoke to people about how they felt they were involved in the running of the home. People told us that they attended regular house meetings when they would discuss any issues and pass them onto the staff team. We were also told that they completed significant event reports which could impact on the following day’s programme.

We were told by people that care planning was centred around the person’s needs, agreed with the individual and regular reviews were carried out with the individual.

Staff confirmed they were given the opportunity to develop their professional skills and received appropriate support from the provider to do so.

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

We rated Western Counselling as good because:

• The service had sufficient staff to ensure the identified needs of clients were met. Staff were compassionate and respectful and treated clients with dignity. Staff provided practical and emotional support to a high standard.

• Risk assessments and recovery plans were personalised, thorough and reviewed regularly. Staff acted appropriately to keep people safe. Recovery plans were person-centred and included physical, psychological and social needs.

• Clients could access specialist services, support and urgent care when needed, and were supported to live healthier lives. Staff aimed to involve clients in all aspects of the service.
• The service was responsive to concerns identified and acted on these to make improvements.
• The service recruited volunteers, many of whom went on to be offered permanent roles.

• Staff we spoke with felt that leaders and managers of the service encouraged an open, supportive and honest culture. They valued the open-door policy that had been put in place. Staff received regular supervision and annual appraisals.

However:

• The service did not have a clear set of values that staff were able to articulate. Policies and procedures were not all up to date, accurate and fit for purpose despite having been recently reviewed.