We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Staff managed medications safely and recorded weekly audits.

• Staff completed risk assessments on all clients on admission and updated these weekly.

• We reviewed eight care records and found that they all had an assessment completed on admission.

• The service registered any clients with physical health concerns with the local GP surgery for ongoing monitoring and treatment. This included blood borne virus testing and vaccination.

• The service offered a weekly aftercare group for up to a year after leaving treatment and telephone calls to those clients who were not able to attend the group.

• Client feedback was positive, with clients feeling cared for and supported in their recovery.

• Clients were involved in setting their care plan goals and were all offered a copy of their care plan.

• Managers held weekly governance meetings to review audits outcomes, incidents and complaints.

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

• The detoxification policy did not specify how regularly observations should take place on clients during detoxification, and we saw a record where no observations had taken place for 18 hours.

• The policy for detoxification did not match practice, with staff implementing a standard alcohol detoxification regime for clients that did not reflect their clinical alcohol withdrawal scale score.

• The service did not offer Naloxone to clients who used opiates on discharge from treatment. Naloxone is an opioid antagonist that provides short-term reversal of an opiate overdose.

• The service did not provide supervision for the non-medical prescribers. However, they had recently recruited a consultant to provide supervision.

We do not currently rate independent standalone substance misuse services.

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

• Managers had not fully addressed the previous requirement and warning notices issued by the Care Quality Commission. This meant that the service remained in breach of regulations and was not delivering safe care and treatment in regards to medication.

• The service’s pre-admission process did not include a full assessment of the client’s physical health. Staff told us that they asked clients to bring a health summary from their GP on admission but that not all clients arrived with the documentation. The service did not contact GPs to request healthcare summaries and staff did not record summaries in client notes.

• The non-medical prescribers did not monitor clients’ physical health during detox as recommended by the ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management (2017). The service did not offer staff any training in how to undertake observations for clients who were on detoxification programmes.

• Serious health concerns had arisen during client’s detoxification and the service had not monitored the clients fully or followed up on these concerns.

• Senior staff were not aware of the latest guidance issued as ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management (2017). A copy was not available in the service.

• Care and treatment records did not contain individualised risk assessments or harm reduction plans. Care plans were not holistic and did not include actions to address physical health needs, relationship and social needs or financial concerns including debt management.

• Managers did not seek references from previous employers prior to staff starting work at the service or conduct risk assessments on staff with previous criminal convictions.

• Staff had not received management supervision on a monthly basis in line with service policy.

However we found the following areas of good practice:

• The service provided a variety of treatment, including structured group sessions and one to one sessions.

• The service offered access to mutual aid support groups.

• The service had a peer buddy system. This enabled clients to support each other through treatment.

• Senior managers worked at the service and delivered group sessions, attended meetings and worked some of the sleep in shifts. All staff knew who the management were and said that they were approachable.

We do not currently rate independent standalone substance misuse services.

We found the following issues the provider needs to improve:

• The service did not prescribe medication in a safe way. Staff did not re-assess one clients medication following a break and did not always establish dependency before the medication was re-started. Staff did not follow best practise guidance. Staff did not record that the consultation with the prescriber took place before re-starting medication.

• Staff did not update risk assessments when risk to clients changed. Staff did not transfer risks identified at initial assessment to the initial risk assessment. Staff did not routinely re-assess risk during treatment.

• The safeguarding lead for the service had completed basic safeguarding awareness training which posed a risk that they did not have sufficient knowledge for their role.

• Information was missing from client records and staff files. Staff did not record if clients were able to safely manage any physical health conditions.

• Managers did not complete appropriate checks to determine that staff were safe to transport clients to appointments.

• Managers did not have a clear definition between the roles of volunteers and peer mentors and the responsibilities of each role.

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

• Staff took part in regular handovers to discuss client care and treatment.

• Managers provided staff with up to date safeguarding and medicines administration training. Managers had addressed infection control issues raised from the last inspection.

• Clients said they felt safe at the service and that staff listened to them and treated them as individuals.

• Staff reported good morale and were committed to supporting clients in recovery.