We do not currently rate standalone substance misuse services.

This was a short notice announced, comprehensive inspection. Also, during this inspection we checked the progress the provider had made in addressing the breaches of regulations identified at the previous inspection in May 2016.

At this inspection, we found the following improvements:

• The provider had made improvements on the issues found in the May 2016 inspection, which related to the safety of the service. The provider’s management of medicines had improved, the medicine policy now included guidance on monitoring and recording changes to client’s medicines, action to be taken by staff if a client could no longer self-administer and what staff should do if there was a medicines incident out of hours. Staff no longer stored over the counter medicines. The provider had improved clients’ crisis planning and management, this included plans to minimise the risk of overdose when clients had completed opiate detoxification. The provider ensured safe staffing, they had systems in place to ensure pre-employment checks were carried out and improvements made for compliance with mandatory training. The provider had made improvements to ensure a safe and clean environment, there were improved fire safety procedures in place that clients were aware of and there was an improved system for infection control risk.

• The provider had made improvements from the issues found at the May 2016 inspection, which related to the effectiveness of the service. At this inspection, the provider ensured staff received specialist training in substance misuse, mental health concerns and safeguarding children from abuse. The service now kept a stock of naloxone for clients at the recovery house and staff and volunteers were trained on how to use it. Staff had a good understanding of the Mental Capacity Act.

In addition, we found the following areas of good practice:

• The house was visibly clean and furnishings well maintained. Volunteers completed weekly health and safety checks of the house to ensure the kitchen was clean, fire doors were fit for purpose and the naloxone supply was in date.

• The provider had a system in place to deal with staff shortages. Staff sickness levels were low and there was no staff turnover in the last 12 months. There was always a manager on call for clients to contact out of hours. The provider had clear systems in place in the event a client had an unplanned exit. Staff demonstrated a sound understanding of safeguarding issues and their responsibilities. Staff used incident-reporting processes appropriately.

• Staff completed comprehensive admission assessments for clients. Care records were personalised, holistic and recovery orientated. The service offered clients a range of psychological therapies recommended by The National Institute for Health and Care Excellence (NICE). There were good working relationships between the staff and volunteers, and good working relationships with external healthcare professionals. Staff and volunteers supported clients to the GP and hospital appointments to support them with physical healthcare needs. Staff received regular supervision.

• Staff had a good understanding of clients’ recovery and needs. Clients reported staff treated them with dignity and respect. We observed good interactions between staff and clients and this impacted positively on client’s recovery. Feedback from clients confirmed that staff treated them well and with compassion.

• The service offered treatment to clients who had no access to funding through the provision of a bursary. The service offered clients a variety of support and activity groups. The service supported with their spiritual needs. The service had access to an interpreter. Clients knew how to complaint and the service held service user forums for clients to raise concerns.

• Senior management were visible throughout the service and volunteers and clients said they were approachable. Staff and volunteers enjoyed working at the service and were committed to providing good quality care and support to clients with their substance misuse abstinence. Staff and volunteers were able to feedback on the service and they felt valued. The service had a risk register in place and senior management reviewed it regularly. Staff had access to the equipment and information technology to do their job.

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

• On this inspection, we found that the provider did not have appropriate systems in place to assess clients’ ability to self-administer their medicines upon their admission to the service. Although the provider had made effective changes to the management of medicines policy and procedures, these had not been fully embedded yet.

• The service admissions policy did not clearly describe the criteria for accepting a client with complex mental health needs.

• Whilst the service carried out appropriate checks on the environment to ensure client and staff safety, these were not always recorded. Similarly, we saw that for one client a small number of their key working sessions had not been recorded in their care and treatment records.

• The provider carried out a clinical audit regarding infection control. However, staff did not conduct any other monitoring which meant the provider had not assured themselves of the quality of the service they provided for client. The provider had recently introduced measures to identify treatment outcomes for clients, which required further embedding into practice.

• Although the provider reported safeguarding alerts through NHS systems or local council systems, they did not have a policy in place for notifying CQC.