The service was last inspected in 2016, at which time we did not rate independent substance misuse services.

Following this inspection:

We rated Detox Support Project as Outstanding because:

• The service was well staffed with a range of well trained, supported and experienced staff. Staff put into practice the service’s vision and values. Staff had contact with managers at all levels of the organisation, including the most senior, who were said to be supportive and visible.

• All staff members we spoke with were enthusiastic and highly motivated to provide support that is kind, promotes people's dignity and recognises the totality of people's needs. This made clients feel that they mattered.

• The service was clean and comfortable, with effective systems ensuring any issues were rectified quickly. Staff worked hard to create a warm, safe environment.

• Clients were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally. 

• There was a proactive approach to understanding the needs and preferences of different groups of people, and to ensuring the service met these needs, promoting accessibility and equality. The individual needs of each client were considered very carefully by staff, ensuring their individual  preferences and needs were always reflected in how care was delivered.

• Clients were always treated with dignity by all those involved in their care, treatment and support. Consideration of people’s privacy and dignity was consistently embedded in everything that staff do.

• Staff managed risk well using effective systems and protocols, including clients at risk of exiting the service without completing treatment. All clients had holistic, personalised support plans, and were encouraged to take an active role in their own treatment and risk management.

• Staff managed opiate detoxification safely. Staff assessed clients for suitability for detoxification in collaboration with their local substance misuse detoxification prescribing service prior to admission and clients received a full prescribing assessment on the day of admission. Detoxification prescribing regimes implemented by the local substance misuse detoxification service supported the DSP. These were in line with “Drug misuse and dependence: UK guidelines on clinical management (2017)” and relevant National Institute of Health and Care Excellence (NICE) guidelines. Staff effectively monitored withdrawal symptoms and were knowledgeable about what actions to take if a client’s health deteriorated during detoxification.

• Clients spoke very highly about their experiences of the service, their relationships with staff and the impact the service had on their lives. Relationships between clients and staff were strong, caring, respectful and supportive. These relationships were highly valued by staff and promoted by leaders.

•  Incidents, complaints and safeguarding concerns were monitored to identify where improvements could be made. Clients were involved in reviews of how complaints were managed to ensure their view was taken into account.

• The culture within the service was that of openness, transparency and learning. Staff and clients were confident to raise issues.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service was fully staffed. Clients and staff reported feeling safe within the service.

  Staff and volunteers were familiar with the service and needs of the clients as they had all been through the service themselves. Each of the clients had a keyworker from the staff team and had dedicated time with this keyworker each week.

• Staff considered client safety throughout their stay at the project and completed a comprehensive risk assessment of each client before they moved in to the project. The risk assessment included physical health, accommodation status, previous detoxes (if any), current support from other agencies and covered any mental health risks. Staff completed risk assessments and management plans clearly with brief bullet points for each risk.

• The project used appropriate outcome measures, for example, the homelessness outcome star tool. Clients were involved in support planning and they told us they could see their own support plan whenever they wanted to. Support plans were holistic and incorporated self-care, independent living skills, mental wellbeing, offending behaviour and potential relapse triggers.

• The service had a full programme of groups and individual 1:1 time for the clients to participate in, for example, a daily planning group, twice weekly recovery skills group, weekly goals group, weekly art group, weekly 1:1 shiatsu and a one hour weekly keyworker session. Staff empowered clients to take responsibility for the daily planning meeting on a weekly rota.

• The manager had a robust system in place for ensuring all staff supervisions and appraisals were up to date. Staff had regular monthly supervision with the project manager and staff appraisals had been booked for the forthcoming year. All staff and volunteers received a comprehensive induction and attended core mandatory training. Volunteers received a full induction, attended on-going support groups and had access to core training as required, depending on their role.

• Staff had a positive approach to working with the clients and were client focussed at all times.Staff observed clients’ confidentiality and maintained their dignity throughout their stay. The service promoted a flexible approach to the clients’ detox and this was individually planned for in a safe way. The clients’ valued the individual approach and flexibility offered by the service.

• The project had sufficient rooms to allow for groups and individual 1:1 sessions. Clients could speak with staff in confidence in safe spaces if required. Clients could use the communal lounge and there was an outside area with tables and seating. Each client had their own room which they could personalise as they wished.

• Staff and volunteers felt well supported by the project manager. The project manager reported a good level of support from more senior managers in the organisation.

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

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Medicines were stored on labelled shelves, not compartmentalised sections, which meant there was potential for error. The service reported one error due to medicines being stored incorrectly.

We used a number of different methods to help us understand the views and experiences of people who used this service. We spoke with all four people who used the service. We observed care and looked at supporting care documentation. We spoke with staff and the manager.

People who used the service understood the care and treatment choices available to them. People told us that their choices had been respected and listened to. They said that they could suggest and make changes to the service as long as they were appropriate and would not jeopardise the detoxification programme or people’s safety.

People described the staff as "Very ‘proactive". They said staff,“Sensed the potential for using” and intervened very quickly.

Everyone who lived at the home said that they felt safe; they said that the biggest threat to them would be if someone brought substances into the home. They told us that staff had been good at checking and sensing any potential for substance use and they had dealt with it immediately. We asked the people what the best thing about living there was. As a group they answered that it was their relationship with the staff, the support from the staff and how the staff made them feel.

There was a manager employed at the home. However the time of our inspection they had not submitted an application to register. We discussed this with the nominated individual and they gave an assurance that a registered manager application would be submitted.

We visited the Detox Support Project and spoke with three people who were going through a detox programme there. We spoke with the manager and two support workers and looked at care and service monitoring records. We returned to Brighton to see examples of recruitment records at the provider’s central office.

There were boundaries around people’s interaction with the community. People could only go out of the house in company of peers, staff or volunteers. One person going through the programme told us “It’s not control, it’s a structure for recovery. There’s no bars on the windows, we’re free to leave any time. But we’re here to face up to changing old behaviours. I feel I go out enough.” A person who had just been admitted said the restrictions on community contact were “essential to keep me safe from risk of relapse.”

We have asked the provider to note restrictive aspects of the programme were not detailed in writing and people were not given the opportunity to sign their agreement to acceptance of them.

A medication plan and the associated prescription medicines were already in place when a person moved in. People were kept continuously involved in addressing their addictive behaviours. They agreed written support plans, which were continuously updated during their stay. These were to meet their identified and changing medical and social needs. A person told us “it’s a whole package, we get support in every aspect of life.” Residence in the project was used as an opportunity for people to access treatment through their GPs and a specialist dental service. We saw there was liaison with mental health services when necessary.

Staff received annual training to refresh their understanding of safeguarding vulnerable people. In effect, people’s safety was continuously monitored through staff direct involvement in individual treatment and support programmes and daily group work sessions. The content of groups helped people address issues such as anger, gender dynamics and recognising what constitutes bullying, thus promoting safety overall. A person in the project told us “the group work is all done in a healthy way, very open and honest.”

Recruitment records we saw showed workers appointed had worked as volunteers in the project, developing skills in supporting people. Recruitment was conducted in a consistent and transparent way to ensure candidates met the criteria needed by people using the service. Staff and volunteers in the project had themselves experienced detoxification and recovery from dependency. People staying in the project told us they would find it difficult to relate to staff or volunteers from any other background.

We saw how the quality of the service was kept under continuous active review. The manager had systems for monitoring how well planned outcomes were met. People who used the service gave feedback through meetings, questionnaires and surveys and the service made changes in response to feedback received.