We do not currently rate independent standalone substance misuse services.

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

• A high risk safeguarding case was not discussed at the case management meeting and was not referred to the local authority. Staff were unaware of who was the safeguarding lead within the service.

• Quality of recovery plans varied. Recovery plans had not been regularly updated and details such as clients name and date of birth were missing. Clients were not offered a copy of their recovery plan. Care plans that we saw were not holistic, specific, measurable, achievable, realistic or time bound.

• Clinical case notes lacked detail; some files had no detail on prescribing dose or frequency. Clinicians did not consistently record information around risks of prescribed medication, how to safely store medication at home or the risk of overdose when receiving medication.

• There was a lack of psychosocial interventions for clients.

• Managers did not supervise staff regularly or in line with the provider’s supervision policy.

• Reception staff handed clients prescriptions in the waiting area. There was no intervention with clients based on their presentation and there were no checks made that a person was safe to receive the prescription.

• There was a lack of consistency in reporting serious incidents to the Care Quality Commission.

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

• The service had a full range of rooms and equipment to support treatment. This included 1:1 rooms, group rooms, a needle exchange room, urine testing suite, a family room, a gym and a recovery café.

• The provider had low levels of staff sickness and no staff vacancies. All staff had completed mandatory training in safeguarding children and young people and safeguarding adults.

• The service had a robust management and storage procedure for prescriptions for substance misuse treatment (FP10).

• Staff received feedback on incidents relating to the service through weekly case management meetings and were debriefed and supported by their line managers following serious incidents.

• The nurse completed a clinical health assessment for every client who was engaging in treatment and offered blood borne virus (BBV) testing and vaccination.

• The service offered six months post treatment support for clients who had finished treatment.

• Clients were able to become involved within the running of the service by becoming peer mentors, recovery champions or volunteers. Clients told us that staff were respectful, polite and compassionate; clients told us they felt involved in their care. Staff morale at the service was high. Staff told us that they felt valued and rewarded for the job they do and they enjoyed their roles.

We spoke with four people who used the service, the registered manager, locality manager, a gp, four members of staff and a volunteer. We looked at the recovery plan files of four people who used the service. We looked at information provided by the provider.

People we spoke with were very positive about the support they received from Addaction Lincoln. One person told us, ““Addaction is a friendly place to be, Approachable people. All open and honest. “Another person told us, “It is such a big thing to have a good keyworker. You need to be able to bond and then you can talk about anything. You need to feel comfortable.”

We found that people’s needs were identified in their recovery plan. People we spoke with told us that they had been involved in their care planning and had consented to the support and treatment they received. This was confirmed by the records we looked at.

Addaction Lincoln provided a needle syringe programme. This enabled intravenous drug users to obtain clean needles and the scheme aimed to cut down the risk of infections such as HIV infections.

People who used the service were asked for their views about their support and treatment. In reception there was a patient opinion notice board. Comments included, “You and your team have worked wonders for our family and we are definitely ending 2013 with a smile thank you. The work you all do is so vital to people like me and our loved ones so thank you for everything. An excellent service you have truly helped me along my road to recovery. Thank you all for being there for us.”

We spent two half hour periods of observation in the reception area when people who used the service were coming to appointments. During that time we spoke with five people who used the service and a volunteer and asked them for their views.

People who used the service understood the care and treatment choices available to them. One person told us, “I have had two orders from the court to come here in the past but I have self referred off my own back because of my previous experience.” Another person told us, “They pushed loads of programmes at me. I don’t always want to do them but then think why not, it might help. They put energy into people who want to change.

People expressed their views and were involved in making decisions about their care and treatment. One person told us, “I was involved in my assessment and recovery plan, they are individual to me. Their input is from being qualified and knowing what works best.” Another person said, “I feel I am getting help from them on what I want. They ask you if you want to do things.”

People who used the service were given appropriate information and support regarding their care or treatment. We were told by one person, “They keep me informed.” Another person said, “I have five appointments a week, sometimes they have to go off elsewhere, I understand that but they could text me if they are not in the building to say we need to reorganise. I have to tell them if I am not able to make it.”

People were supported in promoting their independence and community involvement. One of the people we spoke with said, “I trust them. They have people who have been there and used drugs work in the café (known as recovery champions). That’s good it works well with the others.” Someone else said, “I come here when I am not in jail, it saves me from going back to prison.”

Peoples’ diversity, values and human rights were respected. Each of the people we spoke with said they had signed a confidentiality statement and had given consent for staff to share information with other professionals if they needed to. Two people commented they felt respected, one said, “They’re good here. They treat me with respect, I don’t feel judged here. If I did I would say.” Another person told us, “They have never been rude to me when I’ve been a bit short with them.”

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. When we spoke with people who used the service they told us they valued being able to call in outside of arranged appointments. One person said, “I can come here anytime I want to.” Another person said, “I have been clean for two weeks with the support from here.” One person who had not been seen when they had come early for an appointment said, “It’s hard when they don’t understand, if I need to speak to someone, there should be someone there.

There were arrangements in place to deal with foreseeable emergencies. One of the people we spoke with told us, “Overall it is a great place to come if having a crisis. You don’t just stick to your planned sessions, you explain you’re having a problem and can talk to whoever is available.”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Four of the five people who used the service we spoke with described the service as a safe place. One person told us, “It is a safe place, we are our own community.” Someone else said, “It is safe here, but it can put temptation under your nose.”

Another person told us, “I feel they try to protect me, I pick up my prescription daily. One issue is you get given Sunday’s prescription on Saturday. I think it would help protect people who were feeling vulnerable to have it on the day. I can’t understand why they do that.”

Staff received appropriate professional development. People who used the service told us they thought the staff were suitably trained. One person told us, “I come here as they know what they are doing.” Another person said, “They use good people in here to help us.”

The provider took account of complaints and comments to improve the service. People who used the service described being able to comment on how the service was run and about their experiences. One person said, “There are slips if we get any problems or questions and put them in a sealed letter box. It gives us a chance to have a say. I say straight to people, they take on board what you tell them.” Another person said, “I tell them to their face if I speak like a grown up they listen and if I chuck my dummy out they tell me to go away and come back when I can speak properly to them.”

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Interview, clinic and group rooms were fitted with alarms. Staff had access to personal alarms. All areas were clean and well maintained. Cleaning records were complete and in date.

• The service had a full range of staff to provide the level of safe care and treatment clients required. The service did not use bank or agency staff. Managers covered absences by staff within the team.

• 100% of staff had completed safeguarding adults and children training level 3.

• Staff discussed vulnerable clients, complex cases, new referrals, safeguarding and clients who had not attended for their appointments in weekly case management meetings.

• Staff ensured clients risk assessments were updated in a timely manner. All information needed to deliver care was stored securely and accessible to staff.

• Staff followed National Institute for Health and Care Excellence (NICE) guidance in prescribing. There was good medicines management.

• Staff had adapted care plans to enable client involvement. Care plans were recovery focussed, holistic, and comprehensive.

• Staff completed a clinical health assessment for all clients due to receive medication as part of their treatment pathway.

• Clients we spoke with told us that staff were interested in their wellbeing, understood their needs and were respectful, polite, and compassionate.

• There was a clear referral criteria. The service was meeting their key performance indicator of three weeks from referral to assessment. The service operated extended hours one evening during the week.

• Treatments had been adapted for use with a range of client’s ages, cognitive ability, physical ability, literacy, and communication needs.

• There was 100% compliance with supervision and appraisal. Supervision and appraisal records reflected the services vision and values.

• Staff spoke highly of their managers, and supported the new initiatives being introduced by management to improve caseload management.

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

• There was no substantive clinical lead for this service. Cover was being provided by the offsite director of medical practice, supported by two local general practitioners who provided two on site sessions per week to the service.

• There was no obvious signage alerting members of the public and clients to the fact that CCTV cameras were in use around the building. This was raised with staff at the time of our inspection and they told us they would rectify the situation as soon as possible.

• Interview rooms, clinic rooms and group rooms had clear glass panels in the doors, clients could be seen from the corridor. This was raised with management during the inspection who told us they would rectify the situation as soon as possible.

• Managers had not identified all ligature points. Staff told us they would address these issues immediately and the risks were mitigated anyway because patients were always escorted in these areas, and there was CCTV coverage of the areas.