We rated Cranstoun as good because:

• Staff treated clients in a caring, compassionate and respectful way. Clients we spoke with praised staff for their professionalism and non-judgemental attitude. Staff supported carers individually and in groups. Clients could provide feedback on service delivery and suggest improvements during regular meetings and in annual survery.
• Staff understood the provider’s safeguarding policy and procedures on how to raise a safeguarding referral. Safeguarding was a topic discussed during team meetings and the service had strong working relationships with their local authority safeguarding team. The provider had a policy in place for visitors under the age of 16. Staff supported clients to arrange for a local creche to look after their children whilst they attended appointments.
• Staff had completed mandatory training in topics such as children and adult safeguarding, health and safety, equality and diversity, and the Mental Capacity Act. Staff received monthly supervision and an annual appraisal. Managers supported staff to manage their high caseloads.
• Staff recorded incidents electronically and managers de-briefed staff after a serious incident. Staff discussed learning from incidents at regular meetings and the service employed a member of staff whose role was to investigate every serious incident. Staff were open and honest with clients when things went wrong.
• Staff had effective working links with local external services such as community mental health teams, GPs, maternity services, children and family services, social workers and criminal justice services. Staff consulted with, and referred clients to, these teams as appropriate. Staff from partner agencies attended each other’s team meetings, to share information and adopt a coordinated approach to service delivery.
• The service had a dedicated lesbian, gay, bisexual transgender plus (LGBT+) care co-ordinator who had appeared on local radio and had magazine articles published, highlighting the work of the service to the local LGBT+ community. Staff provided outreach support to local homeless people and had installed two kennels at the provider’s offices, to enable homeless dog owners to attend appointments.
• The provider’s reception area and client meeting rooms were accessible for people with restricted mobility. Staff offered evening and weekend support for clients unable to attend during the day due to personal commitments and outreach appointments for clients whose physical or mental health issues made it difficult for them to visit the offices.

However:

• The clinical governance system had failed to ensure that client records contained holistic, up-to-date client risk assessments, risk management plans and care plans. Much of the detailed information stored about clients was only held within ongoing electronic case notes, which meant that important information about each client was not readily accessible to staff who were unfamiliar with that individual.
• Some client risk assessments did not contain a management plan in respect of risks associated with unexpected exit from treatment. The management plans present, were brief and did not provide a meaningful guide on what action the member of staff and the client should take.
• Some staff we spoke with were unaware of the provider’s whistleblowing policy.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service had a team of committed, trained and experienced staff to care for the clients and their level of need. Staff knew and put into practice the service’s values, and knew and had contact with managers at all levels, including the most senior.

• All clients had comprehensive assessments with good risk management and care planning throughout their treatment.

• Staff offered a variety of therapeutic support to clients both in the service and in the community to support their recovery. This support also included working with local wellbeing and social care agencies.

• All clients we spoke with told us about the high levels of care and treatment they received from dedicated staff members.

• Staff we spoke with told us that caseloads were between 50 and 70 per key worker which was very high and produced a lot of administrative duties. However these were reviewed regularly by team leaders in monthly supervision sessions.However, we also found the following issues that the service provider needs to improve:

• Risk assessments did not include a plan for unexpected exit from treatment. This meant that we did not see evidence that staff were able to discuss risks with clients, and how to manage them, in case they left treatment early.

• Cranstoun had a policy for managing aggression in the service, however it did not have a policy for visitors under the age of 16. This meant that staff had no guidance to manage visitors under the age of 16. We raised this with the registered manager.