We do not currently rate independent standalone substance misuse services.

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

• The provider had not ensured a safe and clean environment for clients. The provider had not completed a ligature assessment for the property. There were no ligature cutters on the premises. The property was not clean on the day of our visit. The kitchen cupboards were dirty, we found a dirty chopping board, there was mould around the bath in the ground floor bathroom and a build-up of lime scale around some of the taps. Not all clients were aware of fire safety procedures.
• The provider did not have effective infection control measures in place. There was only one mop in the property for cleaning kitchens, bathrooms and bodily spills. The provider had covered the worktop in a badly fitted laminate, the trim was coming away and tiles in the kitchen around plug sockets and switches had rough edges, which created areas which were difficult to keep clean. We found wooden utensils in the kitchen, these were visibly unclean.
• Clients had no means of summoning help from their bedrooms. There was no procedure in place for the observation of clients undergoing detoxification at the property. Staff told us they would check on clients as and when they thought it necessary. This posed a risk that clients may not receive emergency care if they were to suffer side effects from the detoxification treatment, for example, seizures.
• The stairs in the property were not safe. Two stair treads were loose and one carpet gripper was exposed. The carpet was loose in places. This posed a risk to clients tripping and falling whilst using the stairs.
• Governance of the service was poor. The provider did not have monitoring systems in place to ensure staff followed processes or key performance indicators to monitor the performance of the team. For example, the provider did not know that the new cleaning schedules were not being followed, that there were maintenance issues at the property and some staff were not being supervised.
• Recruitment procedures were not robust. Staff had been appointed to specialist roles with no previous experience or skills and one had not received an induction or training to enable them to fulfil the role.
• Staff did not receive regular supervision. The provider’s policy stated that staff should receive supervision quarterly. We reviewed staff files of two staff who worked at St Stephen’s. Both staff had only received two supervisions in the last year.

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

• Clients were treated with kindness, dignity and respect. Clients reported that staff treated them well and respected their wishes. Staff were open and transparent and explained to clients when things went wrong. This was clear in community meeting minutes and client feedback records.
• Staff completed detailed risk assessments and care plans for clients on admission to the service and updated these regularly.
• Staff adhered to the principles of the Mental Capacity Act. There was evidence in care records that capacity had been assessed and consent to treatment had been gained. Clients signed a treatment contract on admission to the service.
• Access and discharge to and from the service was well planned. Staff planned for early exit from treatment at the assessment stage including details of who should be contacted if a client relapsed or discharged themselves from treatment early.
• Clients told us they felt comfortable to raise concerns in the weekly community meetings and that any concerns raised were responded to quickly. Clients were provided with information on how to complain on admission and could complain at community meetings, individual sessions or directly to the registered manager.
• Staff reported that it was a supportive team; there were no reports of bullying or harassment. Staff spoken with told us they knew how to use the whistle-blowing process. Staff told us that morale was high and they gained a great deal of job satisfaction from supporting people with their recovery.