We do not currently rate independent standalone substance misuse services.

We found the following issues where the service provider needs to make further improvements:

• The provider had created a training matrix system. However, the system was ineffective. The system in place did not give a clear oversight of the current staff training compliance rates. The provider had not set a mandatory training compliance target, therefore could not be assured of when an acceptable level of compliance had been achieved.

• Several of the provider’s policies and procedures did not align with everyday clinical practice. The provider had not ensured that a policy review system was in place to ensure that policies were regularly reviewed and updated following national guidance and changes in clinical practice.

• The provider had not ensured that there was a clear system in place for clients to raise the alarm for assistance at night and at weekends. Staff were unclear of the newly implemented pendant alarm system which increased the risk to clients and lone working staff members in case of an emergency.

• The provider had not ensured that for one person attending the service as an ‘experienced service-user’ a completed criminal background check (DBS) and proofs of identity were not available. An experienced service-user was an ex-client continuing their engagement with the service which could develop into a peer mentor role. However, the person had access to vulnerable clients undergoing treatment at the service and attended staff clinical supervision. The service could not be assured they were of good character. This put clients at risk of harm.

However, we found the service had made some improvements since our last inspection in November 2016. We found the following areas of improved practice:

• The provider had ensured that a service medical emergency risk assessment had been carried out. The risk assessment recommended actions staff should take in a medical emergency, outlining medicines and equipment to be used.

• The provider had ensured that all appropriate emergency medicines were available and that there were sufficient stocks in place should they be required. These medicines were checked regularly and the checks were well documented.

• Staff regularly checked physical health monitoring equipment. Staff recorded when this had been completed.

• The provider had ensured that the admission consent forms had been updated to reflect the changes in practice. References about restraint interventions being used in the event of an emergency had been removed.

• The clinic room was no longer used as an office and was a dedicated space to assess and examine clients.

At the May 2018 inspection, we found that, whilst the service had made improvements to areas of practice and met some of the requirement notices, further improvements were required and some systems in place were ineffective. As a result of non-compliance of regulation 18 of the Health and Social Care Act 2014 (staffing) and the potential risks to clients at the service, we issued the provider with a warning notice for the same regulation. The provider must address the warning notice actions by 20 June 2018.