We do not currently rate independent standalone substance misuse services.

We found the following areas where the service provider needs to improve:

• Staff did not always follow the service policy to store, generate and issue prescriptions for controlled drugs and other medicines. Medicines were not stored at a safe temperature or in area where staff could monitor the temperature.

• Staffing levels did not meet the needs of the clients. There were staff vacancies and although agency staff were used, this still left shifts which were uncovered. Staff had caseloads of between 50 and 60 clients and some staff we spoke with did not feel that that staffing levels were safe since commissioners had approved the redesign of the service. Clients said they were not always told when their key worker changed.

• Risks and management of risk were not clearly recorded. Staff had not developed management plans for unplanned exits of clients from the service.

• Mandatory training was not up to date and some staff did not receive regular supervision.

• The service did not consistently communicate with GPs.

• The service did not have robust governance processes to ensure the service operated effectively. We did not see evidence of learning from incidents and whilst some staff could describe examples of learning from incidents, others were unable.

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

• The service provided treatment for alcohol withdrawal through an ambulatory detoxification programme. Ambulatory detoxification. The service had a policy and procedure that described a client’s suitability for the programme in line with National Institute for Health and Care Excellence National (NICE) guidance .The service had a policy in place for establishing safe starting doses for substitute medicines for clients known as titration.

• The building was clean and well maintained. The service had a reception area that was spacious and bright. The service had recently lowered the desk to create a more inviting atmosphere.

• Staff worked together and supported each other well to provide support, care and treatment to clients.

• Staff had a good understanding of safeguarding adults and children and how to make an alert.

• We observed that staff demonstrated a welcoming attitude to clients. Clients spoke positively about staff and described them as helpful. Clients could provide feedback about the service and were invited to attend fortnightly service user meetings to discuss issues within the service. Clients knew how to make a complaint about the service. There were no restrictions on anyone accessing the service.

• The service recorded client outcomes using the Treatment Outcome Profile (TOPs). The service measured outcomes when clients entered treatment and every three months.