We do not currently rate independent standalone substance misuse services.

Our last comprehensive inspection of Turning Point was in September 2016. At that inspection, we issued one requirement notice. Issuing a requirement notice notifies a provider that we consider they are in breach of legal requirements and must take steps to improve care standards. The requirement notice we issued following that inspection related to breaches of Regulation 9 HSCA (RA) Regulations 2014 (Person-centred care).

On April 2018 we undertook a short-notice focused inspection to see whether the provider had made the required improvements.

• At the 2016 inspection we asked the provider to ensure that recovery care plans identified all risks, contained all information relevant to treatment and had clear reviews and actions. During this current inspection we found the provider had achieved this to a sufficient standard.
• Staff completed comprehensive assessments, risk assessments and had risk management plans in place. Staff had a good understanding of individual risk which was reflected in the client records. Risk management plans were comprehensive and staff were aware of all risk history.
• Clients developed their own care plans in small groups with their peers which were supervised by staff. Care plans were recovery focused and included plans to re-engage those who dropped out of treatment.

However:

• Clients would benefit from more individual support when completing their care plans to ensure they considered all the challenges they were facing as part of their detoxification and how they would manage these during their treatment and rehabilitation.

During our inspection we spoke with one person who used the service, the team leader and four members of staff. We were told by people who had used the service that it was well led and responsive to their needs. We were told “it is really good, they have really helped me”. We heard that the support provided was individualised to meet people’s needs. One person told us "I joined a therapy group for a month and didn’t get on well with it so I had a break and now I’m going back and it’s better".

We saw the service was effective because people were consulted and informed consent was obtained before any treatment was provided. People told us “I have been coming here on and off for seven years and it is my safety net from using street drugs”. We heard the support from the staff team was “sound” and “I feel they help me with other things as well”.

We were able to see documentation was maintained on behalf of people and was stored safely with their consent. People confirmed they understood about consent. Although we were told “I have to come as part of my probation program but they always go through and confirm the process with me”.

We found people were provided with information and equipment that safeguarded them against the risk of infection. Records were stored appropriately and securely destroyed when appropriate to do so.

We visited the Yeovil office at Maltravers House for Turning Point Somerset and spoke with one person who was happy to speak with us. They told us they were very happy with the support they had received from Turning Point Somerset, Maltravers House.

We were told staff treated people who used the service with respect and dignity. We observed staff speak with people in a respectful manner and listen to their opinions and comments.

We found that care planning was person centred and agreed with the individual. Regular reviews were carried out and involved the individual at every stage.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager and team leader.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

We rated Turning Point Somerset as good because;

• Staff managed risk safely and effectively. Risk assessments and risk management plans were comprehensive, of a high standard and regularly updated. There were clear and robust policies in place for safeguarding adults and children.
• Staff were confident and competent at identifying when adults or children were at risk of avoidable harm and a robust system was in place for the management and review of safeguarding concerns.
• Prescribers followed “Drug misuse and dependence: UK guidelines on clinical management (2017)” and the relevant National Institute for Health and Care Excellence (NICE) guidelines to a high standard. Prescribers reviewed all clients every three months and their keyworkers communicated well with prescribers in-between reviews.

• Clients accessed prescribing appointments easily. Through use of the teleconferencing system, the clinical lead reviewed clients anywhere in the county when urgent appointments were required.

• Care plans were collaborative, person-centred and holistic. They contained information highlighted at assessments and were regularly reviewed. Discharge care planning was comprehensive and timely, with the option to be brought back into treatment three months after discharge if the client needed further support.
• The service had an approachable and experienced registered manager. The senior management team and risk and assurance team had created highly comprehensive governance systems and ensured processes were consistent across all teams. 
• Staff morale across all sites was high and staff were exceptionally proud of the work they did.