Cranstoun Worcestershire

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Systems were in place to manage safeguarding incidents and staff were trained in safeguarding people from abuse. Staff demonstrated good knowledge and understanding of safeguarding, all staff we spoke with were able to describe what actions to take to keep people safe. Care plans were person centred; they were detailed in individual patients risks. Clients told us they were involved in their assessment and their care plans and risk assessment. Appropriate arrangements for the safe management, use and oversight of controlled drugs were in place. There was an effective approach to assessing and managing the risk of infection, in line with relevant national guidance. Safety incidents are reported and investigated and there is a learning culture in place.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Clients stated that they knew how to raise a concern and who to speak to if they were unhappy with the service provided.

The service offers on site recovery worker training. This is combined with a National Vocational Qualification (NVQ). Staff attend a range of training. This includes PIE training (training in substance abuse), Cognitive Behavioural Therapy (CBT), advanced overdose training and advanced alcohol and drug training (in terms of risk), signs of safety and exploitation, needle exchange and first aid. Staff have access to supervision 3 monthly in line with the provider’s policy. The service hold monthly clinical staff meetings at which they discuss prescribing, medication errors, discuss a topic of clinical learning each month, discuss complex cases and Hep C programme to commence as soon as staff have completed the e-learning programme. All staff had completed naloxone training. Naloxone is a life-saving medication that can reverse an overdose from opioids when given in time. Staff are encouraged and supported to raise concerns and feel able to do so without fear of blame.

There is a culture of learning. The service shared lessons learned effectively with staff through various ways such as via individual supervision, the incident review group and ad hoc specific lessons learned meetings about specific cases. There is also an organisation wide lessons learned bulletin that is shared on a quarterly basis. There is also a Worcestershire county wide drug related death group and a Cranstoun drug and alcohol related death and near fatal overdose forum that takes place quarterly to look at case studies and to reduce future reoccurrence. The service has a PowerPoint presentation that is sent to staff quarterly and focuses on themes and trends, highlighting incidents and good practice. An example of a recent video was relating to clients who are supported for alcohol use and thyroid issues.

There is a collaborative approach to safety that involves the service along with other partners in their care. One client interviewed, had recently been transferred from another area. The client stated that the transfer had ‘gone smooth, surprisingly so’. The client spoke about partnership working with GPs via shared care and other stakeholders such as housing.

Care and support is planned and organised to ensure continuity. Flash meetings were held each morning that covered all key issues for the day including hospital admissions and discharges. During the flash meeting we observed, there was a discussion about a client who was being discharged from prison. Staff had a discussion regarding ongoing risks and plans to ensure effective follow up. Staff closely monitored patients who were being discharged from in-patient rehabilitation. Staff support clients into temporary accommodation and link with external agencies such as Emerging Futures. Where clients disengage, staff follow the Engagement policy. All cases are reviewed before closure and certain cases will be referred to outreach support dependent on the service users risk and circumstances.

Clients told us they felt safe at the service and they were supported by competent staff. One client stated that professional help was always available.

Staff demonstrated good knowledge and understanding of safeguarding. They were able to describe what actions to take to keep people safe, knew the policies, protocols and procedures and were confident in identifying different forms of abuse and the reporting of these to the local authority. There was evidence that incidents had been reported by staff. They had completed safeguarding training and had access to a local and organisational designated safeguarding leads. Staff were able to provide clear examples of safeguarding referrals they had made and the process they had followed. Staff raise a safeguarding alert for all clients who are rough sleeping, however the current responses received from the local authority is that ‘this is the client’s decision’. All staff receive specific safeguarding supervision.

Staff had completed and kept up to date with their safeguarding training. Staff training compliance was at 96% overall. The service had a specific Safeguarding Module on the client case management system. This module acts as a live database of all safeguarding cases across the service. This therefore acts as a live safeguarding register and includes; safeguarding cases open to the local authority, domestic abuse cases and cases where there is a potential safeguarding concern that needs further exploration. Due to the way the system works, information on the specific number of safeguarding referrals open is not possible to pull into a report, only the number of cases open relating to safeguarding. At the time of the assessment there were 302 open active clients on the module split into adults, children and young people and families. The provider had several detailed safeguarding policies in place including safeguarding children and young people, safeguarding adults and a domestic abuse policy. All detailed the correct process to follow to report any safeguarding concerns.

All clients interviewed stated that they had been involved in their assessment and risk management process. One client stated that staff provide harm reduction advice and make them aware of risks, for example alcohol consumption reduction. One client stated that the care and risk planning process was an equal split between the client and their designated worker.

The service had a number of policies in place to ensure risk was managed effectively. There was a clear incident reporting policy in place which staff followed appropriately. All deaths or serious incidents are reviewed by a incident handler and these are discussed at the incident review group on a monthly basis. The group review the investigation and look at the findings and recommendations made and decide if any further action is needed.

The service had a number of policies in place to ensure risk was managed effectively. There was a clear incident reporting policy in place which staff followed appropriately. All deaths or serious incidents are reviewed by a incident handler and these are discussed at the incident review group on a monthly basis. The group review the investigation and look at the findings and recommendations made and decide if any further action is needed.

Clients felt safe when at the service. Clients are not left unsupervised within the building and none of the clients interviewed raised any concern regarding the safety of the environment.

There are numerous blind spots and ligatures within the building. The service manager advised that a ligature risk assessment had not been completed but advised that clients were always supervised when in the building. Incidents and complaints are reported onto an incident reporting system, which are reviewed and overseen by the Incident Review Group. The process is that the worker enters an incident which is then reviewed by the manager. An ‘investigation handler is then appointed to review the issue. The seniority of the investigation handler depends on the seriousness of the incident or complaint. The service closed any case where the client has not been in treatment for six months or over. Therefore, they do not necessarily investigate deaths of clients who have not been in treatment for 6 months or more. However, the coroner regularly insists on reports. The incident handler commences the investigation and serious incidents are sent to the Incident Review Group meeting (IRG) which is chaired by the Clinical lead and/or Service Manager. The IRG considers if they are comfortable with the investigation and recommendations. If not, further work is requested. All prescription related incidents are reported to Controlled Drugs Local Intelligence Network (CDLIN). The service has reported 2 serious incidents. These are considered by SIRG (serious incident review group), who undertake the similar process as the IRG. All suicides and drug related domestic abuse cases and sent to SIRG for review. Leaders state that the SIRG had been generally happy with all investigations.

The building was clean, spacious and well kempt. All equipment had been well maintained and calibrated. There were numerous blind spots and ligatures within the building. The manager advised that a ligature risk assessment had not been completed but advised that clients were always supervised when in the building and never on their own.

The service has a premises risk assessment in place that covers any hazard, associated risk and demonstrates the control measures in place to minimise each risk with appropriate scorings and ratings associated. All risks were managed effectively with appropriate controls in place.

Clients felt that staff were experienced and skilled. One client told us that they were offered help and support. One client told us that professional help is available on the phone or in person, adding that the “key worker and nurse were both supportive and informative.

The service offers on site recovery worker training. This is combined with a National Vocational Qualification (NVQ). This has enabled the service to improve the recruitment and retention of staff. There were a number of staff off with short term sickness associated with a chest infection/flu like symptoms. There were enough staff to ensure that any patient with opiate dependency had access to prescribing. Staff were in receipt of regular 3 monthly supervision in addition to which staff received specific safeguarding supervision and group supervision. All staff indicated that they felt that they were fully equipped for their job roles. In terms of staffing numbers, we were told conflicting information from different members of staff. Most staff told us that staffing had been an issue, however that had now been addressed. One staff member told us that there was one staff vacancy in Kidderminster and that there were 2 vacancies in Redditch. However, another staff member told us that there were issues with staff recruitment and retention, adding that the service has 14 vacancies in Redditch, 2 vacancies in Kidderminster and 7 across the county. The provider told us that there were 15 vacancies across all funding streams, including posts that had been appointed to but were not yet in post.

There were no concerns around the staffing schedule on our assessment visit.

The service had used 2 WTE agency workers in the 3 month period prior to the assessment as Engagement and Recovery workers. The service uses a number of funding streams; core contract funded positions, rough sleeper drug and alcohol treatment grant to fund the homelessness outreach team, supplementary substance misuse treatment recovery grant funding and Worcestershire children first family safeguarding that fund 2 drug workers who are seconded into the children services family safeguarding team. The short term sickness rate for the 3 month period prior to the assessment was 3.1% and long term sickness absence rate was 1.8%. The staff turnover rate was 3.95% with 3 leavers in the same period. The training compliance for staff was at 96.2%. The services supervision model operates over a financial quarter and consists of one-to-one supervision, group supervision and case consultation. Supervision rates for the third quarter were 94.5%. The service also has Psychologically Informed Environment (PIE) reflective practice. This is delivered in a group setting by an external Clinical Psychologist. Groups are made up of up to 6-8 staff members and run monthly. To improve staff confidence around safeguarding cases, safeguarding supervision was introduced. This supervision takes case samples of each workers caseload which are initially reviewed independently by the supervisor and supervisee. These are then reviewed together and discussed to identify differences in safety scoring and action planning. This supervision is based on the ‘Signs of Safety’ model used by the local authority. The appraisal rate at the time of assessment was 100%.

Patients did not express any concerns regarding infection prevention and control (IPC). Hand sanitizers were available on entry to the building, which was clean and well kept. Staff provided clients with needles via the needle exchange service and provided safe disposal bins, to reduce the likelihood of a needle stick injury.

Staff assess and manage the risk of infection. Staff focus on ensuring that sealed sterile needles and syringes are provided to clients in the community. Staff educate clients on safe injecting and provide clients with a safe needle disposal box to reduce the risk of needlestick injuries and the sharing of needles. Staff do blood borne virus testing via a finger prick where the client agrees. Staff receive education regarding the risk of infections.

Cleaning records were reviewed and had been completed fully. Clinical equipment was checked and cleaned on a weekly basis. Equipment calibration was completed annually.

The IPC audits from 2023 had identified that there were a number areas of non compliance. There was no designated infection control lead, no paper towels mounted on walls and some concerns with relation to the handling of sharps related to the incorrect colour bin being used and ensuring they were correctly labelled with the provider name. An area of low score on the audit was for decontamination at 57%. This was linked to schedules not being in place so they were not able to be reviewed or monitored. The service had an action plan in place to address these issues with a clear time frame in place and actions assigned to specific staff members. There was a clear IPC policy in place, however there were non compliance actions from the audit that went against compliance such as a lack of infection control lead and no paper towels mounted on the wall.

Clients were involved in decisions about their medicines. Clients were involved with reviews of the level of support they needed to manage their medicines safely and their preferences were included. One client told us they were able to discuss an increase in their prescription for opiates.

All clients were assessed by the nurse or non-medical prescriber, who prescribed medication in line with best practice and professional guidance. All clients who used opiates were given Naloxone and were encouraged to use an app ‘BuddyUp’ . This ensured that someone knew when they were using substances and were able to raise an alert when required. The provider had shared care arrangements in place with local GPs. Clients attended the GP practice, where medications were prescribed by the GP. Clients were also able to see a member of staff from the service. This promoted engagement and reduced the risk of disengagement. Staff provided outreach to clients who were unable to engage due to their physical health status. There were enough staff to ensure that any patient with opiate dependency had access to prescribing. There was funding for 10 patients to have access to Buvidal injections. Buvidal is a medicine used to treat dependence on opioid (narcotic) drugs such as heroin or morphine. Information is supplied to all clients when medication is prescribed. Recovery staff undertake harm reduction training to support clients. Any medication errors were raised via incident reporting. Staff told us there had been no medication errors other than prescriptions that had been lost by pharmacy. Staff followed the drug misuse and dependence: UK guidelines on clinical management.

Prescription forms were stored in a locked safe in a locked room. Batch numbers were linked to the prescriber. There was good record keeping in line with Nursing Midwifery Council standards. Controlled drug destruction kits were available in the clinic. There are no controlled drugs stored on site. Buvidal is collected by the client and administered on site. Hepatitis C and Pabrinex were stored in the medication fridges. The temperature of the clinic room and medication fridge were recorded and witnessed. Cleaning records were reviewed and were accurately completed.

The service had a number of policies in place in relation to medicines management, for example, naloxone administration, treatment and detoxification of alcohol dependence guidelines, prescribing policy and prescribing guidelines for the management of drug misuse. Staff followed policies and guidelines to ensure the safe management, use and oversight of medicines. Additionally, the service complete the Herefordshire and Worcestershire Integrated Care System Independent Sector Provider Organisations Self-Assessment Checklist biannually. This is reviewed by commissioners and the councils medicine management assurance representatives from the integrated care board (ICB).