We rated Recovery Connections as outstanding because:

• Feedback from clients and carers was continually positive. They said staff were always kind, caring, respectful and supportive, went the extra mile and the service they received had exceeded their expectations. The people who used the service felt involved in decisions about their care and treatment and that the service was person-centred.
• Staff empowered clients to have a voice by offering a variety of opportunities to give feedback on the service they received. The service commissioned an external organisation to conduct a non-biased consultation exercise in December 2018 with clients about how they viewed the service. Other mechanisms included weekly residents’ meetings, client surveys, questionnaires, social media pages, the provider’s website and complaints, comments and suggestions boxes.
• Carers and families were offered bespoke support and signposted to peer led carers groups within the community and referrals were made to other organisations in the local area that provided specialist support and carer’s assessments.
• Clients had access to education and work opportunities. The treatment programme provided clients with lifelong learning credits and ambassadors could obtain a level two accredited qualification in peer mentoring and employment skills. The service ran a job club which offered clients work placements and assistance with writing job applications and curriculum vitae.
• The service ensured clients’ emotional needs were met by working in partnership with specialist organisations. This included training and education for clients affected by historical abuse and domestic violence.

• Staff actively planned for patients’ discharge. The service had a sustainable homes lead who ensured clients had suitable accommodation to go to following discharge from the service. Staff offered clients an aftercare service which included help with housing and employment, onsite support at colleges and university and other initiatives to encourage abstinence from alcohol or illicit drugs.

• The service proactively enabled clients to be exposed to areas of life that involved celebration and engagement with other people to combat social isolation. Examples included seasonal celebrations at a local alcohol-free bar, hosting Halloween and Christmas parties and allowing clients to plan and deliver summer holiday events.

• The provider used innovative ways to engage with members of the public to raise awareness of the service’s work and issues faced by people affected by drug and alcohol addictions. This included taking a coffee bike into the community. Members of the public drank coffee which was a blend designed by the recovery community whilst staff and clients shared their experiences and knowledge of issues about alcohol and drug addictions.

• The service had given clients the opportunity to become involved in a Royal College of Arts project which allowed them to express their hopes, dreams and how they felt about their addictions by working in partnership with an art student who was completing their final assignment.

• The provider was committed to promoting a culture of openness and transparency within the service and had appointed its own freedom to speak up guardian to help and support staff in raising concerns about the service and wider organisation and there were plans to extend the role to supporting clients.

• The provider’s governance systems were robust and ensured the service delivered safe and effective care and treatment. The provider had purchased an online system to enable the service to rapidly access evidence required to demonstrate good practice and assist with the overall governance of the service’s processes.

• There were consistently high levels of constructive engagement with staff, the people who used the service and external stakeholders. Leaders invited clients’ representatives to its meetings with Healthwatch to discuss ideas for improving the service, performance and service related themes. The service held regular multidisciplinary meetings which were attended by staff from the two partner organisations within Middlesbrough Recovering Together.

• Staff felt proud, respected and accepted, there was a strong sense of teamwork and collaboration, room to grow and develop and that there was a culture of honesty, openness and transparency within the service.

• There were sufficient numbers of trained, experienced and skilled staff to deliver safe care and treatment. Staff sickness absences were low and lessons learned from incidents, complaints and safeguarding issues were used to improve practice. Staff undertook risk assessments of all clients and put plans in place to mitigate risks identified.

• The service environment was clean, tidy and well-maintained, staff adhered to infection control and health and safety procedures and there was a fully equipped clinic room.

However:

• Staff we spoke with said they did not always find it easy to quickly access client information when using the electronic care records system.

• The layout of the building meant that accommodation for male and female clients could not be kept on separate floors and that some clients of the same gender had to share rooms. However, the multidisciplinary team undertook risk assessments when clients of mixed genders were placed on the same floor and waking night staff monitored movements within the building.

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

• The service’s use of blanket restrictions was disproportionate and included not allowing clients to wear football tops, not allowing clients to make calls in private, limiting access to outdoor space and not allowing newspapers to be brought into the service without permission.
• Staff mandatory training compliance rates were low for in relation to safeguarding children training for staff who predominantly worked with children, young people, parents and carers (50% compliance), a training package from an external provider encompassing a variety of different modules (60% compliance), equality and diversity (0% compliance) and trauma training (50% compliance).
• A client’s care record showed that their risk assessment had not been reviewed since September 2017 but we were told reviews took place every three months as a minimum.
• There were no formal processes for monitoring staff adherence to the Mental Health Act and Mental Capacity Act. There was no central contact from whom staff could obtain advice about the Mental Health Act and Mental Capacity Act. Staff were unsure about the Mental Capacity Act definition of restraint despite the fact that there were blanket restrictions in place at the service.
• The provider had not carried out equality impact assessments on staff policies to ensure they did not negatively impact on people with protected characteristics under the Equality Act
• Clients who spoke with us said they did not know how to make a complaint to an external body such as the Care Quality Commission or the Parliamentary and Health Service Ombudsman.
• Opportunities for leadership development within the service were limited due to the service being an independent charity.

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

• The environment was clean and tidy, environmental risk assessments were regularly conducted, health and safety related tests such as fire, gas and electrical wiring were up to date and a legionella test was scheduled for March 2018. There was a range of rooms within the service to support care and treatment and clients were able to personalise their bedrooms. Bedrooms contained safes where clients could securely store any medication or possessions. There was accessible accommodation on the ground floor, which contained a wheelchair accessible shower room.
• There were sufficient staff to provide safe and care treatment, staff were experienced and qualified, were regularly supervised and appraised, had access to specialist training and were trained in first aid and emergency first aid.
• Staff had access to the safeguarding and whistleblowing procedures, recognised possible signs of abuse, handled complaints correctly, could add items to the provider’s risk register and raise concerns without fear of reprisals. Lessons learned from investigations into complaints were used to improve practice within the service. Staff knew what their responsibility was under the duty of candour in respect of openness, honesty and transparency and offering an apology to the people who used the service when things went wrong.
• Clients had access to advocacy and staff encouraged clients to speak up for themselves. Staff treated the people who used the service with kindness, dignity and respect, were polite, caring and compassionate and encouraged clients to maintain their independence and build upon their life skills.
• The service’s medicines management process was effective and included an amnesty box where clients could covertly dispose of any illicit drugs on admission. Opiate users were issued with naloxone kits on discharge, which blocked the effects of opioids and decreased the risk of further illicit drug misuse. The service’s policies on relapse prevention, naloxone and the process for opiate detoxification followed the National Institute for Health and Care Excellence guidance.
• Recovery plans were holistic, personalised and contained clients’ strengths and goals. All clients had risk assessments in place and risk management plans where appropriate.
• Staff encouraged clients to attend appointments with their GPs, dentists, opticians and other health professionals for routine health checks and ongoing care and treatment needs. Clients’ nutrition, hydration and dietary needs were met as clients planned and cooked their own meals. Staff encouraged clients to make healthy food choices and take exercise to improve their mental and physical health.
• Staff had audited the service’s fire procedures, client care records and clients’ housing benefit applications in the 12 months prior to our inspection visit.
• Staff had received training in the Mental Health Act and Mental Capacity Act. Staff had a good overall knowledge and understanding of the Mental Capacity Act. There was a policy on the Act, which included the use of Deprivation of Liberty Safeguards, best interests and mental capacity assessments that staff could refer to.
• The sustainable homes lead ensured clients had homes to go to that were fit for habitation on discharge. The provider did not report any delays in the discharging of clients due to non-clinical reasons in the six months prior to our inspection visit.
• Clients were given information about how to complain, support services and advocacy. Clients had access to signers and interpreters. Information could be provided in different languages and easy read format. Clients had access to their chosen place of worship and a variety of activities, therapies and peer support groups including at weekends including men’s’ and women’s’ groups, football, music, walking and art therapies.
• The treatment programme provided clients with lifelong learning credits and qualifications. Clients could volunteer to work in a local alcohol free bar to increase their skills and potential employability. The service offered a job club onsite with a Job Centre Plus representative who provided financial advice to clients. There was an aftercare service for clients following discharge, which included two years’ support with tenancy skills training and help to become a member of their local community.
• The chief executive officer had completed a Winston Churchill Fellowship in 2017 looking at young people in recovery and recovery support on university campuses and at the time of our inspection visit, the service was working with Newcastle University to pilot this with an academic attached to capture the outcomes.
• The provider explored continual service development and actions for improvement. The service contributed and participated in local drug related death reviews if they related to existing or previous clients.
• The service employed its own quality assurance assistant and a compliance lead whose role was to map processes, procedures and general practice against the Care Quality Commission’s fundamental standards and key lines of enquiry for inspections.