We rated Swanswell Redditch as good because:

• The service kept people safe from avoidable harm by ensuring there were sufficient staff with the right training, supervision, knowledge and skills. Risk assessments were completed and care was planned around the client’s individual needs. Staff had good awareness of safeguarding issues, they followed the service’s lone working policy, incidents were reported, and lessons learnt were cascaded to staff.
• Staff used best practice and national guidance to complete comprehensive assessments, which enabled the development of personalised and holistic recovery plans detailing the appropriate treatment and care.
• Staff worked well together and with external partners to ensure clients received effective and consistent care and treatment, and monitored outcomes regularly.
• Clients told us staff treated them respectfully and with dignity, and they were involved in their own care. They felt they were listened to and both clients and carers were provided with relevant information and support to manage their recovery. The service invited feedback which was shared at a local and national level.
• The service responded to clients quickly and managed their caseload effectively to ensure they could provide care when the client required it. The service was meeting its targets and dealt with complaints effectively.
• The service supported clients to access work, education and mutual aid to enhance their recovery and was accessible to those people protected under the disability and discrimination legislations.
• There were good governance arrangements in place. Experienced managers and staff monitored the quality of the service using audits, client feedback, reviewing incidents and complaints, and key performance indicators. Morale was high amongst staff and they liked working for the service.
• The service encouraged innovation and had implemented quality improvements across the service to enhance the service they provided to their clients.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Since the last inspection in August 2017, the service had acted upon our findings and had made significant improvements to the delivery of client care. They had introduced governance systems that demonstrated they met the regulatory activity requirements.
• The team was made up of a range of skilled staff such as substance misuse workers, nurses, young people workers, senior practitioners and team leader. The caseloads ranged from 22 to 66 dependant on the role the worker undertook.
• The environment was clean, well presented and the furniture was in good order. The privacy and dignity of clients was protected, as interview, clinic room doors had privacy glass stopping people looking in, the reception area had music playing to prevent conversations between worker and client being overheard when they were using the interview rooms.
• Staff offered clients blood borne virus testing (BBV) for hepatitis and HIV. Staff gave training to clients and supplied naloxone, a medicine to counter overdose, to clients who were at risk of overdose from opiate use.
• All staff completed an induction and a six-month probationary period. Staff had completed their mandatory and role specific training and had completed level 3 safeguarding training delivered by the local safeguarding board. This meant staff had the skills and knowledge to deliver safe care to clients.
• Staff received regular supervision, which included one to one sessions, performance reviews, group sessions (clinical) and caseload management and attended complex case reviews to discuss specific clients. The supervision notes were detailed and contained action points for workers to complete. Staff said the new supervision model was a supportive mechanism to develop their competencies.
• Strong multi-agency working had been developed with statutory and non-statutory agencies and clear client pathways were embedded in the practice. The service had a single point of contact system for referrers to use. This ensured any clients with increased or high risks were offered appointments quickly.
• Clients spoke highly of the service they received and said staff were caring and supportive. They said the workers helped them to achieve their recovery goals and the staff had the skills and knowledge to support them to achieve them.
• The service responded to the lessons learned from incidents, audits or complaints and implemented changes in practice to improve the service it offered to clients.

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

• The provider should ensure the systems they have adopted to monitor the quality of the risk assessments, risk management plans and care plans continue to be monitored to assure the provider they are effective.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The team was made up of a range of skilled workers such as nurses, substance misuse workers and recovery workers. They had mixed caseloads which managers reviewed and monitored through supervision.

• Staff were knowledgeable about safeguarding for adults and children. They had received training and knew what information to report and how to do this.

• Staff offered clients blood borne virus (BBV) testing for hepatitis and HIV. The county-wide service had increased the number of clients tested from none to 400 since the start of the contract in autumn 2015. The service also offered clients hepatitis vaccinations.

• Staff received regular management and clinical supervision. The notes for these were detailed and contained action points for staff to work to. Staff felt this was useful and appreciated that they worked in a team where they felt well supported by managers. They were able to have open discussions and said there was opportunity for career progression.

• The service had developed shared care agreements with local GP practices. This meant clients could access prescriptions from their GP and receive the support of a worker from Swanswell at their local practice which was often more convenient.

• The service had a notice board in Polish to help support the large Polish community who lived locally. They also displayed information about other services available in the local area and information about groups that clients could attend.

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

• The needle exchange was used as a clinic. It did not have hand washing facilities and a glass panel in the door made it easy for clients to see in to the room. The service could not ensure privacy for clients using this room. Two of the smaller rooms used for one to one meetings in the service had not been soundproofed and staff could not always ensure confidentiality was maintained.

• Emergency drug adrenaline, which was given if someone suffered a severe allergic reaction, was out of date. Staff were aware of this but had not checked that the new stock had been delivered. Nurses carried their own adrenaline pen however the out of date items should not have been left in the emergency bags as their was a potential risk to clients if used.

• The fridge that stored vaccines had an inbuilt thermometer however the service  did not  know if the temperature had stayed at an appropriate level has there had been times when the fridge temperature checks had not been recorded.

• The service did not always notify the Care Quality Commission (CQC) of client deaths, which is a requirement of their registration with CQC.

• Risk assessments and recovery plans did not always contain detail. Staff recorded the information in the contact notes on the electronic recording system but did not routinely use this detail to update the risk assessments or recovery plans. This meant that duty workers and staff covering for someone could not easily access this information. The plans did not include information about how staff would contact a client if they unexpectedly exited from the service.

• Consent to treatment and consent to share information forms were completed but staff did not routinely record this on the electronic system.

• Clients used staff toilets, which were in an area accessed by a locked door and next to the staff office and kitchen, which was unlocked during our visit. Staff did not know if clients were monitored leaving this area and could not be sure that conversations were confidential.

• Staff did not receive training in psychosocial interventions such as motivational interviewing and solution focused therapy. This would have enhanced support offered to clients. Not all staff had completed mandatory training.