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

Controlled drugs were not stored safely. Controlled drugs were stored in a lockable metal tin that was not fixed to the wall within the medication cupboard. The Misuse of Drugs (Safe Custody) Regulations 1973 state controlled drugs must be stored in a lockable cupboard that is fixed to solid surface and cannot be easily removed.

Staff shared client information via their work emails. The email addresses where not secure and documents sent were not password protected.

There were no environmental risk assessments or ligature risk assessments at the treatment centre and both accommodation houses.

The service did not have a legionella risk assessment or a legionella testing certificate.

The doors to the basement were removed at both accommodation houses. The doors were located immediately next to the kitchen which presented a potential falls risk.

The service did not provide Naloxone to clients who used opiates on discharge from treatment in line with best practice. Naloxone is an opioid antagonist that provides short-term reversal of an opiate overdose.

Shared bedrooms did not have curtains around the client’s bed to allow for privacy.

However, we found the following areas of good practice:

We reviewed seven care files and found clients care plans were personalised, recovery focus with linked risk assessments.

Clients going through a detoxification programme received physical health checks in line with the providers policy.

All medications were audited weekly.

The service had a service level agreement with two local GPs who supported clients two days per week. All clients were also registered with the local GP surgery as temporary patients.

Client feedback was mostly positive. Clients told us they felt safe whilst in treatment and that staff were kind and caring.

We do not currently rate independent standalone substance misuse services.

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

• There was no service level agreement with the local GP service that provided medical support to the service. This meant that the organisation relied on informal agreements for the services being provided by the practice.

• Two staff had not signed the controlled drug administration record for clients. There was only one signature space on the records seen.

• Staff had not received specialist detoxification medication training.

• Each staff member had a disclosure and barring service certificate in place. Some of these were over five years old.

• Risk assessments of individual disclosure and barring certificates were not in place.

• There was no provider overall governance policy in place to provide guidance for staff.

However we found the following areas of good practice:

• Clients were positive about the support and treatment received. They told us that staff were approachable, friendly and ensured that everyone was treated the same. There was a peer buddy system in place and that everyone was encouraged to support each other when things got difficult.

• Staff carried out a comprehensive risk assessment of clients prior to admission and on arrival.

• The treatment centre service and both accommodation houses were clean and tidy. Cleaning schedules were up to date. Systems were in place to ensure that any repairs were addressed promptly.

• Managers and staff were aware of the importance of being open and honest with clients. Clients could ask for individual feedback from staff during morning meetings and their key worker sessions.

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

• Staff did not carry personal alarms when seeing clients on their own. Staff did not regularly update risk assessments and plan effective ways to minimise risks to clients. Voluntary staff did not have disclosure and barring service (DBS) certificates in place, and managers had not risk assessed if they were safe to work with clients.

• Staff did not receive training in the Mental Capacity Act (2005) and staff had little understanding as to how this would apply to their service. At the time of our visit 45 % of staff had training in hand hygiene or infection control.

• Senior staff and support workers did not have awareness of national institute for health and care excellence (NICE) guidance.

• Care plans were not holistic or recovery focused. There was a lack of notes about the client’s medical review in their files. This was identified by the Care Quality Commission in the last inspection.

• The fridge designated for medicines was switched off as it was not in use, staff had not monitored fridge temperatures to ensure its effectiveness if needed.

• The service did not provide leaflets or information around the treatment centre for clients to use in relation to risks or advice, detox or withdrawal from alcohol and substances.

• Managers did not supervise staff regularly. There were gaps in supervision records and four staff had not received yearly appraisals to date. Therapists took part in group supervision and did not access one to one sessions.

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

• Staff regularly cleaned the premises. The service and accommodation were visibly clean and tidy.

• Training logs showed 78% of staff were trained in safeguarding vulnerable adults and children. There were two safeguarding leads. Staff knew how to identify and report safeguarding concerns.

• The service employed staff with a range of skills and experience. This included therapist, keyworkers, night support staff and volunteers. Clients spoke highly of staff and said they treated them respectfully, with kindness and were fair. Clients’ said staff were passionate about supporting people to recover.

• Staff gave families details of where they could access support, together with running structured family meetings as part of therapy.

• The service provided a wide range of activities clients’ could engage in alongside the treatment groups.

• The service had not received any complaints over the past 12 months, staff informed us that clients’ could write daily requests and raise issues in the community meeting.