We are With You - Weston Super Mare

We rated Addaction Weston-Super-Mare as good because:

• The service used a shared care agreement and actively engaged with commissioners, and other relevant stakeholders to ensure services were planned, developed and delivered that met the needs of the local population. The service had excellent multiagency working relationships and worked well with local services. They hosted professionals from maternity services Improving access to psychological therapies (IAPT) and criminal justice services weekly and clients could access these services through their attendance at Addaction.
• The service had enough skilled staff to meet the needs of clients. The service provided staff with a comprehensive induction and mandatory training on relevant subjects. Staff morale was good and the teams worked effectively together. Staff received regular supervision and appraisals and had individual development plans in place, with access to a range of training in specialist areas. The service provided evidence-based treatment and interventions in line with national guidance and best practice. This included National Institute for Health and Care Excellence guidelines and Drug misuse and Dependence: UK guidelines on clinical management (2017). Staff provided a range of care and treatment interventions and groups including relapse prevention techniques, cognitive behavioural approaches, motivational interviewing and mutual aid partnership groups.
• Clinical staff prescribed in line with National Institute of Health and Care Excellence guidelines. The service routinely offered blood borne virus testing and participated in a needle exchange scheme. Clients physical health needs were monitored and met through effective shared care arrangements with local GPs and access to community nurses providing services from the Addaction site.
• Staff completed initial needs assessment which were robust and included a holistic review of clients social, physical, psychological and cultural needs. Staff organised and offered support and treatment based on the needs identified during the assessment. The service provided treatment within five teams which included support with needs such as engagement, criminal justice intervention and family relationships.
• The service treated concerns, complaints and incidents seriously. The service provided a variety of forums for clients and staff to give feedback on the service and raise any issues. There were systems in place to record, review and discuss complaints and incidents and there was evidence of improvement in response to this. Managers did not use restrictive interventions and risk management was undertaken on an individual basis. Staff were proactive in reengaging clients back into the service and used individualised behavioural contracts to risk manage clients who had previously not adhered to the service code of conduct.
• Client and carer feedback was overwhelmingly positive regarding the commitment of staff and benefits of the service. Clients and their families attended service user forums and focus groups and could provide feedback on the service and be involved in the development and running of the service. Clients had taken part in staff interviews and were provided the opportunity to complete volunteer training and become recovery champions.
• The service recognised the value in and participated in research to improve the quality of the service. Managers were innovative and had implemented pilot initiatives in response to local need and new research outcomes. The service had developed a role for an Addaction staff member in the local emergency department to provide education and advice regarding drug and alcohol use. The service had recently been granted the first home office licence to become a drug testing service, assessing the safety of client’s own drugs, and had started a pilot for the service in February 2019.

However:

• Storage and management of blank and cancelled prescriptions was not implemented in line with policy. Clinical staff did not follow voided prescription procedures. Blank and void prescriptions were not stored and logged adequately to reduce the risk of misuse.
• Although staff completed an initial risk screening for clients, they did not consistently develop comprehensive risk assessments and management plans in response to risks identified during initial risk screening. Staff did not review and update risk management plans following client safety incidents and identification of new risk areas.
• We found that the majority of care records did not include a client-led recovery plan. The service expectation was for all clients to have a comprehensive person-centred and client-led recovery plan once they were using the service. Staff did complete brief recovery plans as part of clients’ initial needs assessments but these were not detailed or client-led.