Phoenix Futures Wirral Residential Service

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

This key question has been rated good. This meant people were safe and protected from avoidable harm.

All areas of the service were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to community members and themselves well. Staff understood how to protect community members from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. Safety incidents related to community members were professionally managed.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The service had clear rules about who could access it. Anyone making a referral, as well as people wanting to access it, had to follow these rules. This included, being told that peers (people with lived experience) helped to facilitate’ the smooth running of the therapeutic community model, for example is work as therapy (Departments) peer group counsel, the buddy system, peer led activities. Community members were expected to take part in household tasks such as cooking, cleaning and maintenance. People had to be free from drugs or alcohol for at least 24 hours before joining, unless they were on a medically supervised detoxification programme. They also had to live in an area that funded the service or have funding agreed before they could be accepted. Referrals were only taken once all the basic requirements were met.

Staff and leaders worked closely with other organisations to arrange funding for people who needed it. They accepted referrals from commissioners and worked with groups such as the Ministry of Justice, probation services and local Integrated Care System (ICS) commissioners. Assessments often took place while people were still in prison; to alleviate pressure upon people transitioning into the service and making sure they had a smooth transition into the service.

The first referral and discussions with other agencies helped decide whether the service was suitable for the person and whether they met the admission criteria. If a referral did not meet the admission criteria the individuals were guided to a more appropriate service. Each referral was checked to make sure it included all essential information such as the person’s physical and mental health and any risks they faced or posed. People were then assessed in person, which involved gathering detailed information about their health, psychological background and social history. Assessments took place wherever the person was living, for example, in prison, hospital, or other settings. Professionals already involved with the person were included so that a full, “whole person” assessment could be completed. This included an up‑to‑date GP summary so that any ongoing treatment or adjustments could be planned for during rehabilitation. The GP summary from the person’s own GP included important medical history (such as seizures, previous detoxification attempts and mental health problems), details of their current prescribed medicines and their blood‑borne virus status.

The full assessment completed by the service assessment staff, covered the person’s current drinking history, any use of illegal or unprescribed drugs, their physical and mental health needs, and their family and social background.

After the assessment, the service’s multidisciplinary team (the registered manager, nurse and GP) reviewed all the information. All documents had to be complete before the team could decide whether the person could join the programme. Initial risk assessments and plans were written before the person was admitted.

Before someone joined the service, arrangements made sure all community members hade onward accommodation when leaving the residential service. The service utilised the provider housing pathway or referred into other housing provider in case a community member decided to leave the programme early. This meant arrangements were in place ready for them in supported housing run by the provider or another partner organisation. This formed part of their risk assessment, along with any past criminal, violent or forensic mental health history. A “move‑on” plan was also created to show what support would be available if they left early. This helped reduce risks such as relapse or homelessness.

The organisation had developed a dedicated Sustainable Recovery Team (SRT) based at the Wirral service to support people as they prepared to leave residential treatment and move back into the community. The team worked with people to plan safe discharges, including directing people who had left the service to local housing providers and ongoing support needs. After leaving the service, people usually stayed in touch through phone or video calls. The team also provided support to people in crisis, using volunteers where appropriate and tailoring support to individual needs. A key strength of the team was building on existing relationships and using staff members lived experience to support recovery. The service was developing ways to measure the impact of this work, including reducing the need for people in emotional crisis or relapse to attend accident and emergency departments by offering timely support instead.

Transfers between the provider and other services only happened when agreed and signed off by the registered manager. They informed the relevant head of department or deputy director of operations and check the community member would have continuity of care and treatment and they had agreed to the transfer. A transfer of service was agreed to make sure it remained relevant to the person’s changing needs and ambitions. A transfer only took place once funding was agreed with commissioners.

The service offered a specialist prison fast track programme, that took prisoners directly on release from prison. This allowed prisoners to be released early and to work on their substance misuse within the community and gave them a better chance to integrate back into society and to gain the skills needed to live substance-free lives.

Commissioners and partner organisations gave positive feedback about the service, especially its work helping people rehabilitate and resettle into the community. They praised how the service advocated for the people it supported and helped improve wider systems, in line with the NHS Five Year Forward View and the NHS Long Term Plan.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

In the 12 months prior to assessment, the service made 4 safeguarding referrals and submitted the relevant notifications to the Care Quality Commission. These referrals were about people who were not currently using the service, including former community members. The service had policies, systems and processes to make sure staff could identify and report safeguarding concerns properly.

Staff told us they felt confident recognising when someone might be at risk of significant harm. They knew how to report concerns and how to work with partner agencies when needed. Safeguarding adults training was mandatory, and 90% of staff were up to date. Safeguarding children training was 88% compliant, and the remaining staff were booked onto training before the end of 2026.

During the assessment for admission, staff identified any relevant safeguarding concerns and created detailed risk management plans for each community member. The referral and admission process also considered any safeguarding arrangements for community members’ children, including access to the service and visiting arrangements. The service had separate child‑friendly spaces available for supervised visits.

The service assessment process included an exclusion criterion, so people referred to the service who had a history of violence or criminal offences could be excluded depended upon the person’s risk to self and others. This included people referred from prison.

Community members were expected to take part in the rehabilitation programme, as well as domestic, catering and maintenance tasks.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

In the 12 months prior to assessment, the service made 4 safeguarding referrals and submitted the relevant notifications to the Care Quality Commission. These referrals were about people who were not currently using the service, including former community members. The service had policies, systems and processes to make sure staff could identify and report safeguarding concerns properly.

Staff told us they felt confident recognising when someone might be at risk of significant harm. They knew how to report concerns and how to work with partner agencies when needed. Safeguarding adults training was mandatory, and 90% of staff were up to date. Safeguarding children training was 88% compliant, and the remaining staff were booked onto training before the end of 2026.

During the assessment for admission, staff identified any relevant safeguarding concerns and created detailed risk management plans for each community member. The referral and admission process also considered any safeguarding arrangements for community members’ children, including access to the service and visiting arrangements. The service had separate child‑friendly spaces available for supervised visits.

The service assessment process included an exclusion criterion, so people referred to the service who had a history of violence or criminal offences could be excluded depended upon the person’s risk to self and others. This included people referred from prison.

Community members were expected to take part in the rehabilitation programme, as well as domestic, catering and maintenance tasks.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour.

We reviewed 5 community members’ records and found that all risk assessments had been completed and were kept up to date. Risk management plans were thorough and holistic, and staff managed identified risks well. As part of the admission process, community members were assessed for any physical, psychological and social risks, and an individual risk management plan was created for each person. We observed the risk management in practice, as there were separate designated male and female accommodation areas. In addition, we saw the provider had recognised window restrictors in place were to be replaced with more modern ones and assessed as no longer meeting the provider’s safety standard.

Staff and community members worked together to develop care plans and risk assessments. Community members told us they were involved in this process and felt ownership of their care plans. The care plans were high quality, person‑centred, person specific and clearly reflected everyone’s voice. Staff said they understood the risks for each person, and during the inspection we observed them discussing risk management in the multidisciplinary team (MDT) meeting.

The service used the recovery radar, a provider assessment tool was used to support community members to identify and understand their triggers and effects of drug and alcohol misuse on themselves and others, so they can make the changes they wanted to.

We saw that staff followed best practice and were confident in de‑escalating and managing distressed behaviour while keeping everyone safe.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were carried out every month. When risks were identified, action was taken to make the area safe. Individual risk assessments were also completed for community members. If someone had accessibility needs, staff worked with them to make sure these were met, including access to ground‑floor accessible bedrooms and bathroom, shower and toilet facilities.

The service had up‑to‑date environmental health and safety assessments. The operational risk assessment covered gas safety certificates, fire safety certificates, infection prevention and control, safe food storage and kitchen cleanliness.

Fire safety arrangements were in place. The service kept a list of staff trained as fire marshals, had completed a fire risk assessment, and had carried out full fire drills and evacuations. Certificates were in place for the safe disposal of clinical waste and used cooking fat, which was sent for recycling. The service also had a ligature risk assessment, and people referred to the service who had a current or historical ligature risks would be assessed and risk managed on an individual basis. In addition, the ligature risk assessment identified window restrictors were to be replaced as part of the refurbishment of the main building and several first-floor bedrooms were not accessible to potential admissions if their assessment indicated a ligature risk.

The service did not use personal alarms or call buttons, except in accessible bathrooms. At night, alarms were set on the building’s entry and exit points. These alarms triggered a warning system in the staff member’s bedroom so they could respond without disturbing community members. There was an emergency on‑call system that allowed staff to contact a manager for guidance outside normal working hours.

Men and women had separate areas of the house, and the service could provide separate bedrooms for transgender or non‑binary people if needed. The service followed accommodation guidance that required people not to share sleeping areas, bathrooms or toilets with people of a different sex. Community members did not have to pass through opposite‑sex areas to access their own facilities. Living spaces were separated, with different landings for men and women, and a lounge was designated for women only.

The service was clean and although the house was an older building, it had been well maintained, with additional outbuildings built over time. Furniture was comfortable and in good condition.

Inside the building there were extra rooms, including group therapy rooms, a multi‑purpose room, computer room, gym, management offices, a kitchen and rooms used by other services provided by the organisation. The large outdoor space included a garden, an area for growing vegetables and kennels for community members’ dogs if needed. The service planned to relocate the dog kennels to a quieter space to better support therapeutic activities involving pets. Community members will be supported to retain their dogs close to them and the service business plan to create facilities for dog care highlighted by community members and staff as a positive commitment to maintaining their care of their pets.

The service’s business plan showed that refurbishment work would continue throughout 2026 and 2027. This included redecoration, structural changes which included building a new dining area after the current one was demolished. Plans for new buildings were to enhance provision for one-to-one meeting facilities, with additional offices and there will be an office for the Phoenix housing manager. The plan included replacing window restrictors, as the provider had identified the current ones as potentially unsafe. This was recorded in the ligature risk assessment and the service’s risk register.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service made sure it had enough qualified, skilled and experienced staff across clinical, recovery, therapeutic, administrative and operational roles. During the day, there were at least 8 staff on shift, as well as facilities staff who supported community members with practical requests. Overnight, the service previously used a live‑in support worker, but this has now been replaced with a waking‑night staff member following a budget review.

In the 12 months prior to assessment the service bank staff mainly covered 285 shifts, with some shifts covered by agency staff. The service had no current staff vacancies. When there were short‑term shortages due to unexpected sickness, additional cover was provided by community, SRT and other therapy staff from the wider team. Between October 2024 and September 2025, the average sickness rate was below 2%. This included some extended periods of absence, which were monitored and supported, and no patterns or concerns were identified.

Training compliance was monitored through a central training matrix, which flagged any overdue or upcoming training. Two mandatory courses were below the organisation’s compliance target of 75%: professional boundaries (3 staff were due to complete this in February 2026) and trauma‑informed care (a four‑part course which three staff were still completing).

Staff told us they received regular support, appraisals and supervision, both internally and externally. All staff received enhanced DBS checks, which were tracked by the service, all staff had a current enhanced DBS check.

During our assessment we observed that staffing levels were good. Activities did not have to be cancelled due to staffing shortages, and only external factors occasionally affected group outings, which was rare. Community members told us they could always speak to staff when needed and that they had their regular one‑to‑one sessions with their key worker.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas of the service were clean, well-furnished and well maintained.

Community members were responsible for daily cleaning and household tasks. They had access to cleaning products, and we saw that both bedrooms and communal spaces were clean and in good condition. The department head completed regular checks of communal areas and bedrooms to make sure standards were maintained.

Community members worked to a daily cleaning rota so that all rooms were cleaned regularly. During our visit, we saw that activity rooms, communal areas and kitchens were clean and well cared for. Daily cleaning records and monthly cleaning audits were in place. These audits identified any areas that needed immediate action, such as extra cleaning or restocking personal protective clothing (PPE). The audits were thorough, ensuring good hand hygiene practices and correct use of PPE.

We observed community members preparing meals and saw that they wore appropriate PPE, including hair and beard nets. The kitchen had a five‑star cleanliness rating from the local authority’s environmental health service. Menus were displayed and included information on any content which may cause allergies.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, and preferences.

The service had strong medicines management policies and procedures that guided staff on the safe handling of medication, including storage, administration and disposal. Staff files showed they had received the correct training, and the supplying pharmacy provided additional training and audits.

Medicines were prescribed by an external GP with specialist experience in substance misuse, under a service level agreement. As part of admission, each person’s medication was reviewed, and any medicines restricted by the service, whether prescribed or bought over the counter, were identified and received by staff as part of the service’s medicines policy. Staff assessed whether community members were safe to keep and self‑administer their medication, which depended on whether they were on, or had recently completed, a detoxification programme. If not, staff administered their medicone.

Community members could keep essential medicines such as inhalers, nasal sprays and nicotine‑replacement lozenges with them. Safe storage of medicines was provided in bedrooms for those assessed as suitable for self‑administration.

Medicine reconciliation began when a person arrived, with their medicine information already uploaded into the electronic system. The service GP reviewed and signed off the medicine administration record. The same GP oversaw all detoxification, visiting twice a week to monitor progress and review medicatine. The registered nurse oversaw daily medicines management, including checking administration records and ensuring doses had not been missed, especially if someone had been off site.

We checked the medicine administration records of 5 community members and found that good practice was being followed.

Medicines requiring refrigeration were stored in a dedicated fridge within the medicines store, with minimum and maximum temperatures monitored and recorded.

The service used recognised tools to monitor community members withdrawal symptoms, which were reviewed by the prescribing GP:

• Clinical Opiate Withdrawal Scale (COWS) for drug detoxification
• Clinical Institute Withdrawal Assessment (CIWA) for alcohol detoxification

These assessments were completed by the registered nurse and reviewed by the GP prescribing and reviewing medicines to community members to monitor their effectiveness.

The service restricted certain items and medicines to maintain a safe, substance‑free environment. These restrictions were explained during admission through the information pack and the medicines agreement. When a prescribed medicine was restricted, staff worked with the onsite nurse and GP to explore safe and clinically suitable alternatives.

The service had a supply of Naloxone, prescription-only medicine used to rapidly reverse opioid overdoses, for example, in heroin, morphine, and fentanyl. The service had a documented Naloxone provision plan covering supply and training. In addition, the service had nitazene testing strips, rapid, single-use tests to detect the presence of nitazene (synthetic opioids in powder, liquid, or pill samples). This was part of the provider pilot and strategy to reduce drug related deaths through early detection within some services in response to the risk of synthetic opioids.