We rated EDP – Newton Abbott hub as requires improvement overall because:

• Staff were not always managing risk to clients. Clients who had been using the service prior to April 2018 did not always have a disengagement plan that was accessible in place. A disengagement plan details what the client expects from staff when they disengage from the service or do not attend appointments, for example by contacting their next of kin, other professionals or support networks. This meant that if a client disengaged with the service staff might not know who to contact including relatives, carers or health professionals and others involved in the clients care to make them aware this had happened. The clinical staff did not have access to a ‘Did Not Attend’ (DNA) policy specific to people who failed to attend prescribing reviews as it was in draft form. Three out of six records reviewed contained a risk management plan. Staff were not always developing detailed recovery plans which included client’s goals and what treatment they were receiving. The recent care plan audit carried out at team level was of a small number of files and as such insufficient to identify these issues.
• Staff did not ensure that clients received a comprehensive assessment of physical health needs and concerns from the client's GP or other relevant health professional. Our specialist advisor observed clinical sessions and noted that physical health checks were not undertaken. The provider did not have a physical health monitoring policy and staff were concerned that physical health monitoring was not comprehensive. Only clients who were prescribed medication by their service or undergoing home detoxification had their physical health checked.
• The provider did not have a robust recruitment process to ensure staff had an up-to-date Disclosure and Barring Service (DBS) certificate in place. The human resources (HR) department was responsible for ensuring staff had a valid DBS certificate and had not realised when a number of staff DBS certificates had expired.
• Staff were not recording informal complaints. This meant that managers could not be assured that complaints were actioned fully, and complaints could not be analysed to determine themes or trends.

• However:

• The clinical assessment service staff assessed risk at the point of assessment. When clients were allocated a recovery navigator, they would then complete a comprehensive assessment. The comprehensive assessment included completing a risk assessment and incorporated information received from the client’s GP at the point of referral. Clients requiring a prescription received a face to face assessment with the service’s doctors or non-medical prescribing nurses.
• The assessment team were completing initial assessments with clients within two weeks of receiving a referral. Urgent client referrals were seen promptly. High risk clients were prioritised, for example pregnant women and opiate-users. Staff monitored clients on the waiting list to detect increase in level of risk or need.
• Staff treated clients with compassion and kindness. They understood the individual needs of clients and supported clients to understand and manage their care, treatment or condition.
• Staff felt respected, supported and valued by management. Staff and clients described a change in culture in the last six months and felt optimistic and positive about the future direction of the organisation. Managers had introduced initiatives to improve morale such as arranging team away days.