The Care Quality Commission
  • Community
  • Community substance misuse service

Turning Point - City of London and Hackney Integrated Drug & Alcohol Service

Overall: Good read more about inspection ratings

102-110, Mare Street, London, E8 3SG 0345 144 005

Provided and run by:
Turning Point

All Inspections

29 and 30 March 2023

During a routine inspection

Our rating of this location improved. We rated it as good because:

  • The service provided safe care. The premises where clients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed 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. There was an improvement in the monitoring of the physical health care of clients on prescribed medicines.
  • The teams had or were recruiting to a full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Managers had improved induction training and provided baseline training for all staff to ensure consistent ways of working. They had also developed further opportunities for career progression within the service. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated clients with compassion and kindness, and understood the individual needs of clients. 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 continued to use a public health van to take health services to rough sleepers.
  • The service had more consistent and effective governance processes to ensure that its procedures ran smoothly. Managers had implemented significant improvements since the previous inspection in 2021.

However:

  • Although most staff felt well supported, a significant proportion of recovery workers were unhappy with management support to cover their high caseloads. There had been issues with staff retention over the last year, with a third of staff leaving, and this had resulted in some staff morale issues, and had an impact on clients as they described frequent changes of key worker.
  • Newer staff wanted to have more training in the service’s electronic record keeping system.
  • The alcohol detox community pathway had been paused for several months due to insufficient staff with the required competence to conduct this safely.
  • Health and safety risk assessments for the service had not been reviewed recently. The environment of the service had been improved particularly in the reception area, but other areas of the service used by clients were still in need of refurbishment and redecoration.
  • At the time of the inspection, there were no groups available to provide support or therapy for clients on Fridays. The service was not commissioned to provide any support for clients at weekends.
  • The service did not have easily accessible information leaflets translated into locally used languages, at the time of the inspection.

23 & 24 September 2021, 6 October 2021

During a routine inspection

The service has not been inspected before, therefore the service has not been previously rated. We rated it as requires improvement because:

  • The service did not have an effective governance system. Managers did not ensure that all necessary improvements had been made promptly when issues were identified. The service did not maintain an accurate log of when staff supervision had taken place. The outcomes of incidents, complaints and safeguarding cases were not discussed and recorded within individual team meetings. During our inspection, we identified several areas of practice that had been identified for improvement, but staff had not made the changes in their everyday practice. The provider was aware of the areas of practice that required improvement but had not taken quick enough action to address them.
  • The service had not ensured that clients who were required to receive an electrocardiograph (ECG) had been offered one. An audit carried out in June 2021 identified that 11 clients who were prescribed over 100mls of methadone had not been offered an ECG within the last 12 months. At the time of our inspection, the service had still not ensured that the clients had been offered an ECG. The lack of urgency in ensuring clients received an ECG increased the risk of clients’ suffering heart complications or failure as a result of their prescribed medication.
  • Some client records lacked important information and highlighted gaps in care. We identified that there was an inconsistent approach to the recording of risk management plans and re-engagement plans. In one record, we found that the clients’ GP had not been contacted since November 2020 despite the client undergoing a community alcohol detoxification. This increased the risk of the client not being supported or monitored by their GP.

However:

  • Senior leaders knew what areas required improvement. Whilst we identified that the service should have responded more quickly to make some necessary improvements, the senior leaders had already identified most areas of improvement prior to our inspection. The staff had worked hard to ensure they maintained a service throughout the second lockdown of the Covid-19 pandemic.
  • Staff encouraged clients to manage potential overdose risks as well as supporting them to live healthier lives. Staff had distributed naloxone kits to 68% of clients either via the pharmacy or the service directly. Naloxone is a medicine that reverses an opiate overdose. The provider had a target date to distribute to all clients by December 2021. Staff regularly offered clients dry blood spot testing (DBST) to identify those clients with a blood-borne viruses (BBV) such as hepatitis C. The service had trained 98% of staff in DBST.
  • The service had an established involvement group for people who use services. The group were actively involved in improving the service. This included participating in staff interview panels.
  • Clients were mainly positive about the service and felt the staff were caring. Clients understood that the service had been affected by the Covid-19 pandemic but did reflect that they missed the support from their peers in a face to face group setting. The service had continued to provide some of their groups virtually because of the risk of Covid-19.
  • The service was building good working relationships with other care providers and community organisations. The service had recently been given additional funding under a new government project to tackle drug-related crime. The additional funding enabled the service to recruit more staff and employ more specialist roles such as a criminal justice family worker.