Cranstoun Royal Borough of Windsor and Maidenhead

We do not currently rate independent standalone substance misuse services.

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

• The provider did not have robust procedures around health and safety and maintenance in the building. The local authority was responsible for the building and whilst the provider had asked for information to ensure appropriate measures were in place this had not been received. The provider had not been able to access the risk assessment for the building environment or the fire risk assessment. Electrical appliances had stickers where the portable appliance testing (PAT) was out of date. The service manager had placed this issue on the service risk register.

• The provider had an ineffective alarm system. Whilst wall mounted and personal alarms were available they did not ensure staff would receive support when needed in a timely manner.

• The provider had a lone working policy but this was not implemented at local level. This meant Resilience could not ensure the safety of staff who were working away from the building.

• The provider employed one nurse for community alcohol detoxification. The provider had no current process in place to cover for the nurse in case of unexpected absence. This could put clients at risk during the detoxification programme. The pathway had not yet been implemented and the service manager agreed to address this concern prior to any detoxification programme being started.

• Risk management plans did not reflect the risks identified. Risks identified during assessment were not mitigated in the management plans.

• Staff assessed physical health specifically in relation to drug and alcohol use such as examining injection sites and offering testing and vaccinations for blood borne viruses. However staff did not assess other physical health concerns unless the client was seen by the GP in the clinic. We saw no evidence of physical health care assessments in the care records. However, the provider recently employed a nurse and planned to implement physical health care checks for all clients.

• The provider did not have a written partnership agreement with the prescribing GP practice. The two services worked well together but there was no formal agreement outlining lines of responsibility and accountability in relation to assessment and planning of care. However, the provider, the GP practice and commissioners expressed a commitment to producing a written partnership agreement.

• The provider took over the service in April 2017. No staff had received an appraisal but these were all due for March 2018. Staff reported reflective group supervision was no longer offered and that this would be beneficial.

• The provider did not have a robust complaints process in place. Information on how to complain was not readily available. We did not see a process in place to log verbal complaints. Clients informed us they had not been given information on complaints, however they stated they felt confident in raising concerns with their key worker or manager. The provider did not display information on local advocacy services. However staff and clients reported staff advocated on their behalf when needed.

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

• Clients gave very positive feedback about the service. Clients described staff as helpful, supportive and responsive. Staff involved clients in their care plans and listened to their views. We observed positive and supportive interactions between staff and clients throughout the inspection. The provider encouraged service user involvement and there was a weekly service user forum chaired by a service user representative.

• The provider offered appropriate support to staff. All staff reported regular supervision and regular team meetings. New starters reported comprehensive inductions. Managers and staff received support with performance management concerns. The provider ensured safe staffing levels and all staff and clients reported activities were never cancelled.

• Staff demonstrated good awareness of safeguarding issues for both children and adults. Staff discussed safeguarding concerns during assessment, key worker sessions and within the team during the morning meeting and team meetings. Staff referred appropriately to the local safeguarding teams when necessary.

• All staff reported a significant improvement in mandatory and specialist training since the new provider took over. Staff received training in harm reduction, blood borne viruses, domestic violence, the outcome star and other specialist training. Staff employed by the service had previous training or relevant experience in substance misuse interventions. Staff took the lead in certain areas such as mental health or criminal justice which further improved expertise.

• The provider invested in apprenticeship and volunteer schemes. One staff member was on an apprenticeship programme and the service manager was looking to offer more of these. The provider offered an accredited volunteer and mentor scheme and recently employed a lead worker in this area which would give further opportunities to people wanting to work in the service.

• The provider offered flexible appointment times to clients and attempted to reach groups who may find it difficult to access treatment. Staff worked closely with domestic violence services and the police and all staff reported links with mental health teams had improved significantly. The criminal justice worker provided in reach work to the prison and worked closely with probation. The provider was planning to work more closely with learning disability teams and was working towards a partnership agreement with some of these teams.

• Staff were overwhelmingly positive about the change to the new provider. Staff reported better processes, structures and direction. Staff morale was good and all staff reported feeling supported by the Resilience management team.