Archived: Addaction - Chesterfield

Updated 29 November 2016

Addaction Chesterfield provides a community service to people in Derbyshire who have alcohol problems. The service provides community detoxification services and one to one advice, treatment and support. It provides a prescribing service. The service is based in Chesterfield and has additional staff offices in Derby and Glossop as the service covers a large geographical area. The service operates Monday to Friday, usually between 9 am and 5 pm.

The service was commissioned for a 3-year period from April 2013 until March 2016, then extended for a further year by the local commissioning team responsible for substance misuse commissioning for Derbyshire County Council. The service commissioned was based on predicted client use. The Care Quality Commission regulates Addaction Chesterfield to provide the treatment of disease, disorder, or injury. The registered manager for the service is Laura Caryl, she is also the service manager.

We previously inspected this service in June 2013. We found they needed to improve the information they held in relation to workers who had joined the service from another provider. When we checked in October 2013, the service had made the necessary improvements.

Updated 29 November 2016

We do not currently rate independent standalone substance misuse services.

We found the following issues that the service provider needs to improve:

• The service although reporting incidents and safeguarding internally had not routinely notified the Care Quality Commission (CQC).

• We found the quality and completeness of records we reviewed varied. We found one recovery plan was from a previous episode of care and dated 2014. Two records did not have current risk assessments. Of the 15 records we checked only three records contained a plan should a client leave treatment early. One record did not contain an assessment of alcohol use or contain a record of staff providing advice on harm reduction. The inconsistencies within the records and lack of detail could have put clients at risk.

• The client area in the Chesterfield office was poorly soundproofed. Conversations between people could be overheard from room to room. The service had a radio to try to manage this but conversation could still be overheard. Viewing panels were present in doors, which meant clients could see each other. This meant that the service did not maintain client confidentiality.

• Access to the Chesterfield office was limited for wheelchair users or clients with mobility issues. Toilet facilities were on the second floor and shared with the staff team. There were no toilet facilities on the ground floor.

• Staff did not monitor the waiting area. Two clients told us they would feel safer if CCTV was in place. We saw children accompanying clients to appointments, although the staff were trained in safeguarding adults and children, the service did not have a protocol or policy in place for children visiting the service. Clients and children could have been at risk, as staff did not monitor the waiting area.

• There was a cleaning contract. However, there were no cleaning records to demonstrate cleaning of the building. Chairs in the waiting room were fabric covered which would have made them difficult to clean. This could have been an infection risk.

• Not all staff provided clients with information on how to make a complaint. This could have meant clients who were dissatisfied did not know how to raise this. Staff were not familiar with advocacy services this could have put clients at a disadvantage if they needed support. Most staff had not received training in the Mental Capacity Act although this was planned.

• The national target for the service to carry out an assessment of clients is within 15 days of referral. Over 40 % of clients waited longer than this time for an assessment. Waiting lists varied across the different areas that the service covered. Staff reported due to an increase in referrals and changes to practice the service was under pressure.

However, we also found the following areas of good practice:

• The team had regular team meetings. Staff discussed learning from incidents and complaints. Staff received de-brief following serious incidents. They received an annual appraisal and regular supervision. The service manager identified staff training needs and development opportunities. Staff received the training needed to complete their jobs. Staff had a good understanding of their role in safeguarding clients, helping to keep clients safe. The service manager planned for staff leave helping to ensure the service had sufficient staff to operate safely.

• The team took account of national guidance to support their practice meaning that clients received care in line with best practice. Nurse prescribers received supervision with a medical practitioner helping to keep their practice safe. They felt supported by this. The service had inclusion criteria for clients but it was not so rigid that it excluded a client who could potentially benefit from the service provided. Staff used outcome measures to monitor client progress. The service actively targeted client groups who did not freely access the service such as pregnant women.

• Staff were warm, friendly, and relaxed when interacting with clients. Clients said staff were respectful and professional and never judged them. Clients were universally positive in their feedback about staff and the service they received. Clients were active partners in planning their care. There was a good range of information readily available to support clients.

• The staff team were a happy team. The team felt they had good relationships with each other and were supportive of each other. The staff felt their line managers were approachable and supportive.

• The service had governance systems in place. The service had developed two local protocols to meet the needs of their service and locality. There was open communication with local commissioners and other partner agencies.

• The service was visibly clean and carried out regular health and safety checks to ensure it was safe for clients and staff to use.