Archived: Addaction - Rugby

We do not currently rate standalone substance misuse services.

We found the following areas of good practice:

• Clients who used the service were very positive about staff. Some clients linked their reduction in substance misuse to the support staff had provided. Clients felt staff listened to them and treated them as partners in their recovery. Clients described staff as caring, attentive, supportive and good listeners. The service routinely gathered feedback from clients and looked at ways they could change things as a result of client suggestions.

• Clients were assessed and treated in a timely manner. There were no waiting lists. Clients received a holistic assessment which looked at all of their needs. Medical staff carried out a physical examination and communicated with clients’ GPs before prescribing medication. The service had a robust policy for re-engaging with clients who had missed their appointments.

• Staff began the risk assessment process as soon as they met with clients. They developed risk management plans when they felt these were required.Staff were able to identify when there may be safeguarding concerns for adults and children and they knew how to report these to the local authority. They understood mental capacity and how to support clients who needed help to make decisions.

• Staff were committed and passionate about their work. They supported each other well. Sickness absence rates were low and the service provided external counselling and support for staff that needed it.

• Staff received regular supervision, annual appraisals, mandatory training and role specific training. There was a thorough role induction process and staff had opportunities to develop special interests. They knew how to raise concerns and some were confident they could do so without recrimination.

• Clients using the service reflected the diverse ethnic and cultural backgrounds found in the local population and the service catered for all of their needs.

• The service had developed good working relationships with other agencies and worked effectively together to support their clients. There were strong links with other local voluntary groups who offered support to clients and their families.

• There were low numbers of complaints but when a person made a complaint, the service investigated it. Staff understood their duties under the duty of candour and if they made mistakes, they were open about these with clients.

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

• Staff morale was low and staff turnover had been high in the year leading up to the inspection. Most staff said the team was not a happy one and some felt managers did not listen to them. Several staff said they did not receive debriefs after incidents. The managers’ office was located on the second floor of the building and some staff felt the physical and professional distance between them was too great. Managers did not demonstrate that they fully appreciated the extent of low morale.

• The service had not been providing the Care Quality Commission (CQC) with regular notifications. This is a requirement of all providers registered with the CQC.

• The service did not have access to cleaning schedules for the building. They only had a communication book between themselves and the contract cleaning company. This meant staff could not easily monitor cleaning carried out on the premises and the kitchen area in particular looked grubby and not well cleaned. The client fridge was dirty and excessively frosted and there were stains on the wall and around the bin.

• The service stored clinical waste bins on a carpeted floor. This meant there was an increased risk to the spread of infection.

• The service could not evidence that medical equipment had been regularly calibrated. This meant there was a risk that equipment such could give inaccurate readings.

• There was no blind or other covering to the window of the needle exchange room. Other clients used the area and could easily see in. This meant there was a risk to the privacy and dignity of clients using this room, particularly if they wanted to show staff their injecting sites.

• The door to the main staff office on the ground floor was routinely left open. Staff said clients sometimes walked into the office, and some had been angry or upset. This meant staff could potentially be at risk of violence or aggression from clients.

• The service had their last Fire Risk Assessment in March 2015. Seven low / medium risk issues were identified as requiring attention, either within three months or by March 2016. Managers did not provide evidence that they had rectified these actions in line with the report recommendations.

• The service did not assess for potential ligature risks in unsupervised areas of the building such as toilets. Managers had not included any ligatures risks in their environmental risk assessment.