We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• All clients had an initial risk assessment. Risk assessments were comprehensive and updated regularly and following incidents. Staff completed comprehensive admission assessments for each client.

• The service manager completed environmental risk assessments, including ligature audits.

• Key workers allocated weekly one-to-one time with clients. Staff documented interactions with clients in treatment records.

• All staff had completed a comprehensive induction. Staff had access to specialist training.

• Staff undertook physical health checks prior to client's starting detoxification, and regularly throughout. Clinical assessments, case notes and discharge summaries were comprehensive. Clients accessing treatment were temporarily registered with the local GP surgery and dentist for any healthcare needs.

• Care plans were reviewed and updated weekly. Care plans were holistic, personalised, recovery orientated and looked at a client’s areas of strength.

• Staff had access to weekly team meetings and clinical meetings and daily handovers.

• Oxygen provided follow on support for clients who had completed their treatment programme. Clients who had completed treatment had the opportunity to live at move on housing and attend the service for additional support. All clients were contacted following discharge.

• We observed staff interacting with clients in a kind, considerate and caring manner. Clients we spoke with told us staff were interested in their wellbeing and that staff were respectful, polite and compassionate. Clients felt involved in their care.

• Families could be involved in treatment with client agreement.

• The provider rarely cancelled appointments or groups due staff shortages or sickness.

• We saw comfortable dining areas. Snacks and hot or cold drinks were available at all times. Clients were encouraged to take responsibility for therapeutic duties.

• The service had not received any formal complaints since June 2015, clients we spoke with knew how to complain.

• We saw thank you cards and letters displayed on the information board from clients who had successfully completed treatment.

• Staff turnover and sickness levels were low. Staff morale at the service was high. Staff told us that they felt valued and rewarded for the job they did. We saw evidence of recruiting from within the service. Staff felt able to contribute to developments within the service.

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

• The clinic room temperature was not recorded. The fridge in the clinic room was used for staff lunches and not as a clinic room fridge, there was no medication that required refrigeration at the time of inspection. We saw disposable cups in the sink within the clinic room that were being reused. Staff could not confirm if they were used for giving clients medication or for urine testing.

• The service had nine single bedrooms, all of which were unisex and risk assessments did not include the risk of shared sex accommodation. Bathrooms were not designated for males or females.

• Only one member of staff was allocated to an overnight shift which both staff and clients felt was unsafe. Clients we spoke with said if there was an issue with the staff member they would need to exit the building to summon help as clients did not have access to phones or alarm systems.

• Staff did not transport medication to other sites in lockable transportation bags.

• The service did not have a standardised way of reporting incidents. We saw incidents reported on incidents templates, by email and on word documents.

• Staff were not being supervised regularly in line with the provider’s supervision policy.

• Clients felt the house rules, confidentiality and information sharing should be revisited a week after admission as there is a lot of information given to them on admission and they may have been under the influence of substances on admission.

• There was a lack of 1:1 space available.