The Applegarth

We rated this service as outstanding because:

• The service provided safe care. The premises where clients were seen were safe and clean. The number of clients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each client the time they needed. Staff managed risk to clients and themselves well, responding to deterioration in client presentation and advising clients of harm minimisation. Staff provided training to clients and carers in Naloxone administration. They followed good practice with respect to safeguarding, incident reporting and duty of candour.
• Staff developed holistic, 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. The service participated in benchmarking and quality improvement initiatives and had consistently higher proportions of clients in effective treatment than the national average reported through the National Drug Treatment Monitoring System and were involved in a Public Health England enquiry as a result.
• The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Staff had appraisals, supervision and opportunities to further develop their skills. All staff, including agency, had a comprehensive induction programme. Staff worked well together as a multidisciplinary team with their partner organisations and relevant external organisations.
• Clients were truly respected and valued as individuals. Staff always treated clients with compassion, dignity and kindness. They were determined and creative in ensuring clients’ social and emotional needs were met; distributing homelessness kits, accompanying clients to appointments, facilitating improvements to clients’ homes and the registration of an emotion support animal. They actively involved clients and carers in treatment decisions and care planning and went the extra mile when providing care and support.
• Services were tailored to meet the needs of individuals and delivered in a way to ensure flexibility, choice and continuity of care. They spearheaded significant improvements to the addiction support provided to British military personnel following their introduction of the Mil-SMART programme. They responded proactively and innovatively to the needs of the community, establishing outreach centres in rural locations, extended hours and access to the Breaking Free Online app. The service was easy to access and had established alternative pathways for people whose needs it could not meet.
• The service was well led, managers promoted the delivery of high-quality person-centred care and continuous learning and development. Leaders had transparently and sensitively managed a period of significant service change. Staff felt respected and valued.

However:

• Governance processes were not always operated effectively at hub level, although we did not find that these affected the quality of client care or treatment. There were errors in following of service protocols, audit actions were not always completed, and documentation had errors. Risk assessments and recovery plans were not always accurate and up to date.
• Lead practitioners had not received management training. There was inconsistency in service provision across hubs and psychosocial intervention training had not been given to all eligible staff members. Not all staff demonstrated a good understanding of the Mental Capacity Act 2015.