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

• Care records did not capture sufficient information about clients’ care and treatment needs and were not person-centred. This issue was identified in our previous inspection in November 2016 and during the provider’s internal audit in July 2017 but had not been addressed.
• Health and safety was compromised. Only 47% of staff had completed their mandatory health and safety training. Risk management plans were not appropriate to mitigate the risks associated with clients. Fire wardens and first aiders were not easily identifiable. Hand sanitiser gels were being used beyond their expiry date and sharps bins were not signed and dated.
• Infection control was compromised as chairs in the main clinical room could not be cleaned effectively .
• Staff did not have a good understanding of the Mental Capacity Act or apply it in practice.
• Supervision and appraisal was not recorded effectively and some staff did not receive supervision or appraisal.
• Some staff did not know about the advocacy services available to clients or how to arrange for an interpreter to make translations on behalf of a client.
• Nine out of 12 clients we spoke with said that some staff were abrupt, uncaring and unsupportive. We overheard one staff member speaking to a client on the phone in an abrupt manner.

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

• Rooms contained alarms, which sent alerts to the main office. Clinic rooms contained equipment, which was calibrated and correct. The service was accessible for all the people who used the service.
• There were sufficient numbers of experienced and qualified staff to safe deliver care and treatment, staff turnover and sickness absence was low and bank and agency staff were rarely used. There were effective systems for handling medical emergencies, safeguarding issues, incidents and complaints and lessons learned were used to improve practice. Staff engaged in audits of the service’s medicines management arrangements, medical notes and the service as a whole within the 12 months prior to our inspection.
• The service’s medicines management arrangements were effective. Medicines and prescriptions were appropriately stored and produced from a designated printer. The service’s processes and procedures followed guidance from the National Institute for Health and Care Excellence, the Drug Misuse and Dependence: UK guidelines on clinical management and the British Association for Counselling and Therapy, Nursing and Midwifery Council.
• Staff referred clients to their GPs for physical health checks or if there were concerns about physical health deterioration, encouraged clients to lead healthier lifestyles and provided interventions around harm minimisation and motivational interviews. A clinical support worker ran a weekly alcohol group for clients.
• The service worked in partnership with other services effectively. The service held monthly huddles with the mental health service to discuss clients’ mental health needs. The service had a GP liaison who shared information about individual clients with their GPs and a midwife and Hepatitis C nurse visited the service each week to give support and advice to clients.
• The service dealt with late or missed appointments effectively. The service treated all clients who were 10 minutes late consistently and clients knew what the expectations were. The service rang clients who had missed their appointments and alerted the police if there were concerns about the client’s welfare.
• Addaction’s website had translation facilities and supportive software for people with dyslexia, literacy and mild visual impairment. Clients had access to signers. Noticeboards in the reception area contained information and advice about harm reduction, helplines and groups, drug and alcohol misuse and other topics.

We do not currently rate independent standalone substance misuse services.

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

• Staff were not trained in the use of an automatic external defibrillator and had not received resuscitation training for four years.
• An adrenaline pen had expired, however, the service did have adrenaline ampoules in stock which reduced the risk if clients suffered anaphylaxis.
• Patient group directions and competency assessments for staff had expired which risked out of date and unsafe practices being carried out.
• Due to a typing error, a client's prescription for methadone was incorrectly increased by nine milligrams.
• Prescriptions were produced on a printer that was accessible to all staff rather than just those who were permitted to issue prescriptions placing client confidentiality at risk of being breached and used for fraudulent purposes.
• Clients’ recovery plans were not updated.
• Recovery plans did not give details of clients’ strengths, goals and did not cover the full range of clients’ problems and needs.
• Not all clients were given a copy of their care and recovery plans.
• There was an inconsistent approach to how clients arriving late for their appointments were dealt with.

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

• The environment at Addaction Hartlepool Specialist Prescribing Service, including rooms and areas used by clients was clean, tidy, safe and well maintained.
• There was adequate staffing within the service and agency staff were rarely used. Sickness rates amongst staff were low. Health and safety and fire assessments were up to date. Prescriptions were stored at the premises in line with national guidance. The service used lessons learned from incidents to improve its practices. Staff were aware of the need to be open, honest and transparent with people who used the service when things went wrong.
• Clients’ care records contained good quality risk assessments and evidence of good quality physical health checks being undertaken. Clinical reviews of clients and care plans were undertaken every 12 weeks.
• The service followed guidance from the National Institute for Health and Care Excellence, the Drug Misuse and Dependence: UK guidelines on clinical management book (sometimes referred to as the Orange Book), the British Association for Counselling and Therapy, Nursing and Midwifery Council and current legislation. The service had a range of equality and diversity policies, procedures and opportunities to meet the needs of its clients and staff.
• Clients told us that staff were caring, polite and compassionate towards them. We saw good, friendly interaction between staff and clients during our visit. Each client had a named support worker that they were able to contact if they needed help or advice. Clients were able to provide feedback by completing comments cards or by using the Addaction website.
• The service worked with a midwife from the local hospital to support pregnant clients; supported a hepatitis C clinic and a specialist nurse attended the service weekly to see clients that had tested positive for the hepatitis C virus. The service ran an alcohol group every Friday for clients misusing this substance and a 12-week parenting group for clients with children. Complaints were monitored and analysed and the service’s practices were amended to make improvements when necessary.
• Staff were aware of the organisation’s whistleblowing policy. The provider used key performance indicators to monitor service to its clients. Client information was processed and managed in accordance with current legislation such as the Data Protection Act and Human Rights Act 1998.