All inspections: Phoenix Futures Sheffield Residential Service

We rated Phoenix Futures Residential Service as good because:

Staff carried out regular checks to maintain the safety of the environment. Males and females had separate sleeping areas and clients told us they felt safe in the service.
Staff had achieved high levels of compliance with their mandatory training and were knowledgeable about safeguarding procedures. They reported incidents and learned from things when they went wrong.
Client care plans were holistic and contained clear goals linked to clients outcomes.
Staff were well trained and received regular supervision and appraisal.
Staff treated clients with care and compassion. They understood their needs and involved them in decisions about their care and about how the service was run. Clients could give feedback and make suggestions for improvement.
Staff involved families and kept them informed about how treatment was progressing where clients wanted them to.
The service had clear admissions criteria and robust care pathways including access to move-on accommodation.
Clients had access to activities and could develop work skills and gain vocational qualifications
The service had strong leaders who were experienced and knowledgeable in addictions. Staff were proud to work for the provider and thought the culture was open and transparent with approachable visible managers.
The provider had improved governance arrangements and provided managers with access to more performance management data. Oversight of training had improved. Care records systems and incident reporting systems were electronic and accessible to all staff.
Staff met with each other to share and improve practice. They reviewed service improvement plans and implemented the actions necessary to improve services.

However:

The defibrillator was kept in a locked area which went against national guidance.
Client crisis plans did not contain contact details for the local crisis service.
The provider did not have oversight of compliance rates for staff engagement with supervision.
The service did not have any formal mechanisms to obtain feedback from carers
Not all clients were given a timescale for a response when their needs could not be met straight away.
Some clients said there was not enough variety of food on offer at meal times.
Service improvement plans did not always specify accurate review dates and we could not identify where higher managers had reviewed actions.

We do not currently rate independent standalone substance misuse services.

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

The provider had failed to make sufficient improvements to fully address the governance issues identified as requiring improvement at our last inspection of May 2016. The provider’s audits did not highlight issues we identified with medication storage such as missing temperatures. Storage of medicine was not in accordance with the provider’s policy.

The system in place for clients who self administered medication was not robust and consistent as there was a lack of clear guidance for staff to follow.

There was contradicting information at provider and service level about what training was mandatory and which staff groups were required to complete which training. Training figures had improved since our previous inspection however, there were still gaps and low compliance in some subjects.

The quality of care plans and their content was inconsistent. Some care plans were not clear about what objectives clients were working towards and when these were to be achieved. There were omissions in records such as names, dates and signatures. The provider’s audits had not always identified all of these issues.

The service improvement plan did not contain specific actions about how improvements would be made. Internal audits and service reviews did not clearly link to the improvement plan. Actions included did not always portray an accurate reflection of actual practice and there were no mechanisms for ensuring actions were followed up. A number of actions were not met.

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

Staff regularly reviewed and updated clients’ risk assessments following incidents. Clients had safety plans in place, which provided guidance for staff about support they needed in a crisis. Risk was discussed on an ongoing basis in handovers and team meetings.

The service provided separate male and female accommodation and risk assessed any situation where they could not facilitate this.

The service had a designated medication administration room and had started to use a new medication system, which received positive feedback from staff. Infection control practices for testing clients had also improved, as there was a dedicated area for staff to undertake urine testing with appropriate equipment in place.

The prescribing doctor’s assessments were kept jointly within clients’ detoxification records so staff had access to necessary information. Staff had been trained in, and used, recognised good practice withdrawal tools in order to monitor withdrawal from opiates and alcohol.

Sessional staff and volunteers received regular supervision and support.

The service had identified a need for, and recently employed, a clinical quality manager. Their role was designed to provide clinical input into the service and assist with clinical governance.

We do not currently rate independent standalone substance misuse services.

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

Staff did not assess all known risks to people. Where assessments were in place, staff did not review these after incidents. The environment had not been assessed for risks that may be present for people, particularly where people had incidents of self harm and suicidal ideation.
There was no effective monitoring of detoxification and withdrawal. The tool staff used to monitor alcohol withdrawal was used inconsistently. Staff did not use a tool for monitoring opiate withdrawal. Key policies and procedures such as guidance and practice around detoxifications were still in draft stage.
Recovery plans were not holistic and it was not clear what objectives people were working towards. There were omissions in care records and some documentation was not signed or dated. People did not have discharge plans and plans for potential unplanned exits.
Staff did not report all incidents that met the reporting criteria. Managers did not undertake detailed investigations into the cause of incidents.
The service advertised separate male and female accommodation on their website. We found there was no separation of male and female accommodation. Males and females slept in rooms on the same floor and had access to the same bathroom facilities.
People did not always receive their medicines as prescribed. Infection control practices and procedures for drug and alcohol testing were not robust.
Staff had not completed all necessary mandatory training. Not all staff had received specialist training in order to meet the needs of people they supported. Sessional staff and volunteers did not receive supervisions and appraisals.
Staff did not fully understand the principles of the Mental Capacity Act 2005 and how this applied to their role.
The manager did not have access to all necessary information, such as evidence of completed training, for sessional workers employed at the service.
Monitoring and quality assurance systems were not effective in identifying areas for improvement at the service and risks to people’s health and welfare. All operational risks known to the service were not included on the risk register. Risks on the register were not effectively mitigated.

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

People who used the service, spoke highly of the staff. People felt staff were caring, supportive and listened to them. People had the opportunity to visit the service prior to admission. On admission, people were allocated a keyworker who they said they saw regularly.
Recruitment processes were designed to help ensure people were safe to work at the service. People using the service told us they felt safe.
The service had good links with other agencies and organisations. External stakeholders spoke of positive working relationships with staff at the service.People were registered with a local GP during their stay. The GP practice booked out a weekly half day to solely accommodate appointments for people using the service.
People had opportunities to give feedback about the service and had their own service user forum. They were involved in decisions about the service, for example by being part of recruitment panels for new staff.

An inspection was undertaken to help us answer the following five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

At the time of our inspection 27 people lived at Phoenix Futures Sheffield Residential Service.

Below is a summary of what we found.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s needs were assessed and treatment programmes were planned with the help of individuals and their caseworkers. Care files we checked confirmed that initial assessments had been carried out by experienced staff before people were accepted into the service. This was to ensure the service was suitable for the needs of the people and therefore people were safe.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The model of care programme used was known as Therapeutic Community (TC). The Therapeutic Community is a self-help approach to treatment for people with addiction and related problems. A drug-free environment was provided in which people recovering from drug and alcohol addiction were able to live together in an organised and structured way. The aim was to promote change and make possible a drug-free life when people move on into the community. People we spoke with supported the model and they said they felt safe whilst following the program.

Members of the community which inclded people who used the service and staff, spoke with us were very knowledgeable about what was accepted and what was not. Our observations on the day revealed people were well supported by their buddies and staff. When we asked them if they felt safe, they all said they felt safe within the service environment.

There were effective recruitment and selection processes in place to ensure suitably qualified, skilled and experienced staff were employed. We checked staff files and found the provider had maintained a suitable recruitment process and staff were supervised to make sure people received support which was safe and appropriate

Is the service effective?

Care and treatment was delivered with people’s consent as people who accessed the service agreed to ‘The Therapeutic Community program’. People, who lived at the service, went there voluntarily. They were fully aware of the ethos of the service and they consented to the programme of treatment. This meant when people sought a place at the service they were made aware of the terms and conditions and they agreed to comply with the rules of the service. This made the programme effective for the people who attended it.

People’s needs were assessed and care and treatment was planned and delivered in a way that was effective and intended to ensure people's welfare. The recovery programme had three stages. Welcome house stage, primary stage and senior stage. If people were successful in progressing through the stages they then entered the re-entry and supported housing stage. People told us they had never been in a community where people looked after each other as well. They talked about their community and gave us examples where they had received support from the other people within the community. This meant the programme was effective and people felt they had benefited by the treatment.

People told us, they liked the arrangement where staff and they were members of their community. They said they all had a role to play in the community for it to function effectively. This meant each community member was aware of the impact of their attitude, group dynamics and behaviour on the other members of the community.

Is the service caring?

People’s needs were assessed and support was delivered in a caring manner by the staff team. People told us they were able to see a GP or any health professionals if they needed to. They said they had one to one sessions with the therapeutic staff and were able to talk about their progress, get useful advice and support. We saw care files where the staff had made notes about the sessions. Two people told us they were given the opportunity to read the notes following the sessions if they wanted. This meant staff showed respect and treated people with care.

The programme facilitated a buddy system. This meant people who were ahead of the programme were able to assist and mentor people who were at a lower stage of their recovery programme. This included supporting them with activities or in joining them in outings. But if staff identified that an individual needed support from them this was provided by staff. This meant the provider ensured people’s recovery was promoted and their safety and wellbeing was taken care of at all times.

Is the service responsive?

People’s care needs were followed up by robust risk assessments to make sure the programmes took steps to minimise risk to them and others. We saw risk assessments for people when they went out or out shopping or when they took part in activities in or outside the home.

The provider had systems in place to refer staff who were no longer fit to work in health or social care settings to appropriate organisations.

Is the service well-led?

There were arrangements in place to deal with foreseeable emergencies. The manager and staff we spoke with were knowledgeable about the procedures to follow if there was an emergency. The provider had made sure staff were familiar with the policies in place to deal with emergencies.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Phoenix Futures Sheffield Residential Service provided people with alcohol and drugs addiction recovery by abstinence. Therefore people who used this service were fully aware of their treatment programme and their expectation. We observed people who used the service were capable of voicing their opinion about the service. The manager shared with us the findings of a ‘Service User Satisfaction Results’. The survey asked people about the environment, people’s involvement, staff support and the suitability of the programme. This was a national survey by Phoenix Futures and Sheffield had fared above average.

Staff members told us they had regular staff meetings. They said minutes were taken and made available to those who were unable to attend. They told us the manager was approachable and listened to their comments. This meant staff felt supported and this had a positive impact on the people who used the service.

Decisions about care and treatment were made by the appropriate staff at the appropriate level. As this was a recovery service, the manager and staff told us that they worked closely with GPs, case workers and community health professionals to ensure people received suitable referrals and treatments. This was confirmed by people who spoke with us

People who used the service told us they were treated with dignity and respect, and their independence was respected. We found that people's views and experience were taken into account in the way the service was provided and delivered in relation to their care.

We found that people's health, safety and welfare was protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.

People told us they were satisfied with the way their access to medicines was managed. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People told us staff seemed competent in their job and knew what they were doing. We found that staff received an appropriate level of training and professional development.

People who used the service told us they knew how to make a complaint and who to complain to. There was a complaints procedure in place and staff were aware of their responsibilities to report complaints so they could be formally investigated.

We spoke with three people who used the service about if they were treated with respect by staff and how their views and experiences were taken into account in the way the service was provided and delivered. One person said, 'I've never felt respect like it ' genuine concern. I'd never question it (respect). The service encourage involvement. I can question their authority. Is it rationale? They will explain why.'

The other two people, whilst describing their experiences at the service identified they were not always treated with respect by staff at the service. Both spoke of staff swearing.

We also observed during the administration of medication that staff came in and out of the room, often without knocking first, demonstrating a lack of care for maintaining people's privacy.

People who used the service confirmed that prior to admission they had an assessment to determine their suitability for the programme. On admission they said they were given a brief overview of the service. One person felt improvements could be made to the detox programme when they started the service. This was because there was a high number of people on that phase of the programme, where people had just come from living chaotic lifestyles, but there were insufficient peers to offer that support. At night there was one member of staff to offer the necessary support and they told us staff expected a lot from the more senior community (this means people who had been using the service for a longer period of time, who were further along their recovery journey) to assist them at that time. They felt it was good that staff valued them in this way, but that staff gave little thought that they were busy, tired and still in treatment as well. This role and expectation was also supported by another person using the programme.

Despite that they felt overall it was a good service where the delivery of treatment and support met their needs. Some comments included, 'Overall, it's good. The key working is brilliant. It's the community that's fractured' and 'I'd definitely recommend it. It's well organised. If people do want to leave, they try their best to encourage people to stay. It's safe. There's no violence. If you go 'off project' someone will always look for you. We all look after each other, as a community.'

Discussions with people identified sometimes they did not have their medication when they needed it.

Two people spoke highly of staff at the service. One person said, 'They're (key worker) amazing. They passionately care about people. They're good support staff. They're inspirational and human.'

Archived: Phoenix Futures Sheffield Residential Service

All Inspections

12 and 13 November 2018

During a routine inspection

2 and 3 May 2017

During an inspection looking at part of the service

16, 17, 18 May 2016

During a routine inspection

14 April 2014

During a routine inspection

20 June 2013

During a routine inspection

13 September 2012

During a routine inspection