The Care Quality Commission
  • Community
  • Community substance misuse service

Archived: The Wiltshire Integrated Substance Misuse Service - Trowbridge

The Halve, Trowbridge, Wiltshire, BA14 8SA (01225) 718980

Provided and run by:
Turning Point

All Inspections

13 - 15 December 2016

During a routine inspection

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

  • Staff monitored risk and safety throughout the treatment period. There was a clear approach to identifying and managing risk. The service worked well with other agencies to assess and manage risk.

  • Safety was a high priority and there was an open culture around learning from incidents. There was an excellent commitment to learning and improvement in risk and safety with regards to review of client deaths. There were clear and comprehensive safety management systems in place particularly around prescription storage and monitoring.

  • Safeguarding adults and children was a high priority. Staff were proactive in prevention of abuse or allegation of abuse. There was excellent engagement in local safeguarding procedures.

  • The environment at each location was clean and well maintained and the layouts protected privacy. Information was freely available specific to substance misuse issues.

  • The service was highly committed to reaching out to clients not within mainstream services or easily accessible, particularly within the festival circuit, isolated rural areas and with ex or currently serving military personnel.

  • The service prescribed medicine following ‘Drug misuse and dependence: UK guidelines of clinical management’ (2007) and National Institute for Health and Care Excellence (NICE) guidelines. Psychological therapies also followed these guidelines. Staff carried out prescribing reviews on a three monthly basis or more frequently if required.

  • Clients were involved in their care. Staff were committed to working in partnership with clients. Staff empowered people who used the service to have a voice and were determined to overcome obstacles to delivering care. Staff completed recovery care plans with clients that reflected their individual needs and preferences.

  • The service provided support for issues associated with substance misuse. These included health checks such as testing for blood borne viruses and electrocardiograms (ECGs) for clients on high doses of methadone.

  • Staff ensured they completed personalised recovery care plans with clients. They identified their strengths and individual goals to ensure the client’s treatment journey was relevant and personal to them.

  • All the locations had supportive and experienced management and leadership. The service had a committed and knowledgeable registered manager. Robust governance systems supported the service to function effectively. Staff told us they were proud of their achievements. There was good multiagency working to ensure they addressed and identified individual needs and there were plans to improve this.

4 March 2015

During an inspection in response to concerns

We found that staff working at the service were committed to their work and cared about the people they supported. Peer mentors who had been former service users were positive about the service and the help and support they had received.

People who were motivated to engage with services received a range of structured interventions. People who had more complex needs such as mental health problems or alcohol problems did not always receive a consistent service. We found that some people were not being monitored effectively and that people did not always have clear goals set or receive structured interventions.

Medicines were not always managed safely, not all prescriptions had been accounted for by prescribers and prescriptions were not always reviewed according to the provider's policy. Some people were able to obtain medication without adhering to their treatment contract.

Staff told us they felt supported and we saw there were systems in place for this. There was a lack of infection control training and little training for staff to understand people with complex needs, this was evidenced by care plans and notes.

Governance systems had been implemented to monitor staff performance and training, however the checklist of staff competence, whilst developed had not yet been implemented.

There was a lack of systems in place to monitor people who were not engaging but still in receipt of a prescription. There were no systems in place to identify people who had not been reviewed regularly according to the provider's policy.