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Phoenix Futures National Specialist Family Service Good

Reports


Inspection carried out on 14 and 15 November 2018

During a routine inspection

We rated Phoenix Futures National Specialist Family Service as good because:

  • The service completed appropriate health and safety assessments of the environment including risks associated with mixed sex accommodation. The service had good facilities including the nursery, lounge and garden facilities with play equipment.
  • Staff directed clients to other services when appropriate and supported them to access those services. Staff supported clients to lead healthier lives. Clients had planned discharge exit packs which included harm reduction advice and details of their resettlement plans.
  • Safeguarding was fully embedded in the service. The service worked collaboratively with other agencies and referred, shared or escalated concerns as appropriate.
  • The service had improved and resolved issues relating to medicines management practices following our last inspection. Staff turnover and sickness rates were improving following recruitment to vacant posts.
  • The nursery within the service provided care for clients’ children in an outstanding rated OFSTED environment. This allowed parents to access the therapeutic program and have guidance on childcare and development from qualified childcare workers.
  • Clients were offered practical and emotional support by staff and others in the therapeutic community. Group meetings and therapy were delivered in a relaxed, friendly atmosphere.
  • Clients were fully engaged and participating in their care and treatment. Personal information, histories and recovery goals were evident in care plans and group discussions. Staff supported clients to maintain contact with their families and carers.
  • Families and carers spoke positively of the staff and care and treatment provided; they were happy with the outcomes of the treatment. The service sought client input and made changes following discussions.
  • Staff felt proud to work for the organisation. They felt valued and respected and could raise concerns without fear of retribution. Staff told us they felt connected to the company.
  • The service followed an effective and clear framework to share information. Team meetings, supervisions and handovers had a set agenda that ensured that staff were kept informed of essential information such as client risk and care and learning from incidents or complaints.
  • The organisation encouraged creativity and innovation to ensure up to date evidence-based practice was implemented and embedded. They had achieved recognition for their work from multiple external sources.

However:

  • The service did not have total oversight of the training completed. Sessional staff had not completed all the required training and night staff training compliance figures were not provided.
  • Staffing shortages and vacancies meant that clients’ one to one sessions did not always occur weekly as detailed in the provider’s local protocol and that client leave was not always accommodated.
  • The organisation did not provide clarity around the night staffing expectations.
  • Support plans and client files did not always reflect the levels of personal knowledge and support given by staff.
  • Actions on the continuous improvement plan had been marked as complete when they were not yet fully resolved.
  • The service did not have an overarching improvement plan that included the work the service was doing in response to client feedback. The service did not have any formal mechanisms to obtain feedback from carers about the service.
  • Governance policies, procedures and protocols did not include an equality impact assessment and the service did not have its own service level risk register.

Inspection carried out on 4 and 5 May 2017

During an inspection to make sure that the improvements required had been made

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 at our last inspection of May 2016.
  • Staff did not always administer and store medication in line with their policies. The system in place to risk assess and determine the suitability of clients to self-administer medicines was not robust.
  • Staff did not always report incidents using the incident reporting system and the manager did not have oversight of all incidents.
  • Staff did not always act on file audits to update care plans and discharge plans.
  • Some prescribing policies were not available on-site and the benzodiazepine detoxification policy had not been agreed between the doctor and the service.
  • The provider could not identify all the mandatory training requirements for staff and could not provide compliance data for which grade of staff had completed which training.
  • The provider’s service improvement plan did not always contain specific actions to address deficiencies. Their audit systems did not link clearly to the service improvement plan and they did not have mechanisms for ensuring actions were followed up.

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

  • The provider had purchased suitable equipment and an appropriate waste disposal system, which staff used when carrying out urine tests on clients.
  • The provider had purchased new breathalyser tubes and ensured staff used a fresh tube each time they carried out a breath test.
  • The provider had ensured staff carried out necessary training including paediatric first aid, mental health awareness and managing challenging behaviour. There was a procedure in place for medical emergencies and trained staff to use the defibrillator.
  • The provider had implemented evidence-based scales to monitor client withdrawal symptoms and trained staff to use them.
  • Staff updated client risk plans, where appropriate, following incidents. Staff and managers discussed incidents in team meetings and handovers.
  • The service had taken action to address several areas we said they should consider improving in the previous inspection of May 2016. This included ratifying their adult safeguarding policy and updating their serious incidents policy to include the duty of candour.
  • The provider had also ensured managers were supervising staff in line with their policy.

Inspection carried out on 16 and 17 May 2016

During a routine inspection

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

  • There areas of concerns identified at the service were regarding the detoxification treatment provision that it offered to clients dependent on drugs or alcohol. Whilst there were some safeguards in place, for example admission criteria for clients admitted for a detoxification, and the medicines administration training and procedures completed by staff at the service, there remained some issues that had the potential to make the care and treatment unsafe. In addition, some of the governance arrangements to support these detoxifications had not been agreed and ratified between the service and the doctor overseeing these detoxifications. For example, the contract between the doctor and the service and the detoxification protocols were still in draft format, and the medicines administration policy was in the process of being reviewed.

  • There were some concerns with managing medicines and risk. Staff did not always store medication appropriately and records of controlled drugs were not always completed in accordance with legislation. Risk assessments had not been completed with regard to a number of clinical requirements.

  • The systems in place did not fully ensure that managers could access accurate training information for permanent and sessional staff when required. It was difficult for the service to provide us with consistent information, for example, it was also not clear which training was mandatory and when this needed to be repeated. The service did not have sufficient training in place to enable the staff working there to support the children and the clients in the service, or to complete the clinical tools that staff used. In addition, staff had not received training to manage challenging behaviour, aggression or violence.

  • Systems were not in place to ensure that client information was recorded consistently and that all information was in held centrally so that information was accessible to all staff at all times. Records, including risk assessments were not always accurate, and had not been reviewed or updated, for example following incidents. The service did not have a risk assessment in place to manage aggression or violence. There were concerns regarding the service’s infection control procedures.

  • The governance systems established to assess, monitor, and improve the quality and safety of the service, and manage risk effectively, did not operate effectively and were not embedded in the service.

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

  • There were many areas of good practice identified in the service. Of note was the service’s strong recovery ethos and the evidence based therapeutic programme that was designed to address the clients’ substance misuse, their parenting and child development, which incorporated best practice tools and interventions. The service was committed to innovation and developing its service to meet the families’ needs in conjunction with the clients, relatives and carers, and staff. The service worked in partnership with other agencies from pre-admission, and throughout treatment up to discharge, to support the families. They had good working relationships with these services and professionals, including children’s social care, the local primary care GP, health visitors, specialist midwifery service, as well as local schools and nursery provision. The service achieved positive outcomes and all clients, relatives and carers, and other services spoke highly of the service and staff, and told us they felt involved in their care and treatment.

  • There were areas of good practice identified in the service with regard to managing risk in the service. For example, there were sufficient staff to cover the service, the service had clear admission criteria, and a lone working policy and procedure. Child safeguarding training to level three was completed by all staff, with the managers completing level four safeguarding training, and the service had good working knowledge of child safeguarding procedures. A detailed service guide and a detoxification handbook was available for clients prior to admission or on admission. This gave them a clear understanding of what to expect from the service and what how to complain to the service.

  • The environment at the service was clean, tidy and well maintained. The family areas were comfortable and the furniture, fixtures and fittings were generally in good condition.There was provision in the service environment for both adults and children. This included outside sitting and play areas, sensory rooms for the children that could also be used as a quiet space, a lounge with a TV and DVD and family board games, and a complimentary therapy room for clients. Activities were facilitated for both clients and families during the week and at weekends by the service. The service facilitated access for clients to religious and spiritual support in the community.

Inspection carried out on 12 February 2014

During a routine inspection

People we spoke with were consistently positive about their experience at the service. One person said: “This place is amazing. The support is incredible and they have worked so hard to help me. I feel so positive about my life now.”

We spoke with people using the service and they confirmed that they had consented to their support. They understood what this meant, and understood that they could withdraw their consent. They described how they had signed their records to confirm they had given their consent.

Staff were provided with a range of training opportunities to ensure that their skills and knowledge remained up to date and that they understood the needs of people they were supporting.

People’s personal records, staff records and other records relevant to the management of the service were accurate and fit for purpose.

We identified that there were a number of concerns in relation to the provider’s compliance with cleanliness and infection control requirements.

Inspection carried out on 1 October 2012

During a routine inspection

We spoke with three people who used the service. They all told us they had been given detailed information about the type of service that was offered at Phoenix Futures Sheffield Family Service. Some comments made were; "The information given by Phoenix futures was good which helped me make the decision to come here," "I got a written guide which detailed all the information I needed and I was also able to speak to other people at the service, which helped greatly" and "We are fully involved in the drawing up of our support plans and risk assessments, because it is us who have to do the work to make positive changes in our lives."

People who used the service told us they were very happy with the support provided. They said their own key workers listened to them and worked with them to address their issues. They said the child care workers were very good with their children and had taught them a great deal about good parenting. They also told us they felt both themselves and their children were safe at the service and would feel confident raising any concerns or complaints with any member of the staff team. Some comments made were; "This place has turned my life around, I was not in a good place when I arrived here and now I can see light at the end of the tunnel" and "The structure of the programme has worked for me even though I didn't want to come here. I didn't think I had a problem until I came here and they have made me realise what a bad state I was in."

We sought information from health professionals who visit the service who confirmed they had no issues of concern about how the services supported people in their care.

Reports under our old system of regulation (including those from before CQC was created)