Croydon Adult and YP SMS

The service provides specialist community treatment for adults and young people affected by substance and alcohol misuse who live in Croydon. This was our first comprehensive inspection of this service.

We rated it as good because:

• We rated the service as good for effective, caring, responsive and well-led.
• Staff assessed and managed most risks well and followed good practice with respect to safeguarding. The premises where clients were seen were safe and clean. Young people were kept separate from adult clients.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The team included or had access to a range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff treated clients with compassion and kindness and understood their individual needs. They actively involved clients in decisions and care planning.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
• The service was well led, and the governance processes mostly ensured that its procedures ran smoothly.

However:

• We rated the service as requires improvement for safe.
• Clients receiving community detoxification for alcohol misuse did not receive face-to-face contact from clinical staff for the first three days of their detoxification as per the provider’s policy. Furthermore, staff did not regularly use the alcohol withdrawal scale tool or always record the contact details of clients’ named person.
• The number of clients on the caseload of some recovery workers was high. Caseloads in the opiate and alcohol teams were over 75 for some recovery workers. Some staff told us this felt high and they could not provide all clients with holistic care.
• Emergency medicines and equipment were not always managed appropriately. Staff did not complete a record to show which emergency medicines and equipment were present, and that they had been checked.
• Meeting minutes did not always contain details of discussions. This meant absent staff could not update themselves on current trends, issues and learning.
• Staff did not always receive supervision in line with the provider’s policy, although staff did feel well-supported.
• Staff did not always update the referral tracker they used to monitor their contact with clients between referral and allocation.
• The service did not have a clear schedule of local and provider-level audits and some actions from audits had not been completed.