Archived: Turning Point Chatham

Updated 28 November 2016

Turning Point Chatham is commissioned by Medway council to provide community-based substance misuse services for people living in Medway.

They operate an integrated drug and alcohol service from two locations. The main base is in Chatham town centre, the other base in Gillingham offers after care services. This base was being refurbished at the time of our inspection and was not visited.

The service also operates from a number of satellite locations, including a mobile outreach service, within the community to ensure accessibility.

The service was previously registered with the Care Quality Commission at the Gillingham base on 28 July 2014 and had not previously been inspected.

Updated 28 November 2016

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The service environment was safe for clients and staff. All rooms were well maintained and equipped for staff to be able to safely facilitate groups, monitor clients’ physical health and provide a secure needle exchange service.
• The service had appropriately qualified staff to provide an integrated drug and alcohol misuse service. They were competent in assessing and recording clients’ risk. Staff had manageable caseloads with good oversight and support from managers.
• Staff were provided with mandatory training that was relevant to their roles. Completion rates for training were high across the board. Staff were trained and knowledgeable in safeguarding issues and in how to report incidents. This was backed up by processes that allowed the service to maintain oversight in these areas.
• The service completed checks and audits to ensure that medicine was managed, prescribed and administered safely. Staff were trained in giving Naloxone (a medicine used to reverse the effects of opiate overdoses) and the service was committed to sharing this knowledge with relevant external agencies.
• The service offered enough clinics to ensure that people were offered comprehensive assessments in a timely manner. Staff had safe protocols in place to allow them to offer assessments outside of the main hub.
• Clients and staff worked collaboratively to produce meaningful care plans that addressed the clients’ needs. Staff effectively recorded all client information effectively on the service’s electronic care records system.
• The service used evidence-based psychosocial interventions to support their clients. These were backed up by recognised outcome scales so clients’ progress could be monitored whilst they were receiving treatment.
• The service provided staff with comprehensive induction and supervision arrangements. This ensured they were prepared, monitored and supported to carry out their roles effectively. Staff attended regular meetings to maintain oversight on clinic and operational issues.
• The service actively audited its clinical and operational practice. Senior management delegated auditing responsibilities to the most appropriate members of staff. Outcomes of audits were discussed and used to improve practice.
• The service engaged with a number of external agencies that were used by its clients. They demonstrated a commendable approach towards equality, diversity and human rights and had set up links to support clients from marginalised groups.
• Clients felt supported by the service and staff treated them with dignity and respect. Clients had responded positively to the service’s boundaried approach and felt involved in their care and treatment.
• The service offered support to clients’ families and carers. Structured carers support was available and details of this were displayed around the hub.
• Clients had opportunities to become involved in the service via a structured peer mentor programme and volunteering opportunities. The service acted on feedback given by clients.
• Clients were able to access the service easily. The service was able to respond to clients who required prompt such as people being released from prison without prior notice. Staff demonstrated flexibility and were able to respond to clients who were running late for appointments.
• The service was available to clients, who found it difficult to access the main hub, via satellite sites; the use of a mobile vehicle; and by providing evening and weekend opening times. The service provided dedicated engagement staff to support clients who were not engaging with the service.
• The service had a comfortable waiting area that provided information relevant to clients. The service had facilities that catered for clients with reduced mobility and who did not speak English as a first language.
• The service had a clear vision and values. Staff morale was high and they and were committed to supporting clients to make positive changes to their lives. They had confidence in their senior managers and agreed with their plans for the service.

However, we also found the following issues that the service provider needs to improve:

• The service supported many clients and this led to them regularly attending or phoning the service. We observed one occasion where the reception area was not sufficiently manned to respond to client demand.
• The service did not have equipment, and staff did not have training, to respond to medical emergencies. Clients who required emergency medical assistance relied on response from generic emergency services.
• Staff used ongoing personal reviews as a way as setting objectives. Reviewing these objectives was expected to be included in monthly supervision. We found that the reviewing of these objectives was being overlooked in some cases.
• Supervision arrangements and competency monitoring for peer mentors was unstructured. They told us that they received good support from their line manager. However, we found no documentation to confirm this.