Archived: FOCUS12 - Treatment Centre

We do not currently rate independent standalone substance misuse services.

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

• Staff had not received regular training around the safeguarding of vulnerable adults and children. There was not an identified safeguarding lead.
• There was no list of mandatory training for staff and no records which reflected which staff had received training. Staff did not receive mandatory training specific to substance misuse or dual diagnosis. Staff had a lack of awareness around the Mental Capacity Act 2005. Staff had not received training. There was no policy in place for staff to refer too.
• The medication policy did not include guidance on the ordering, storage, administration and disposal of controlled drugs. There were no records of stock checks on any medications having been completed by staff in accordance with their policy. Staff did not return medications to pharmacy when no longer required.  The medications policy did not include regular room temperature checks where the medications were stored. There were duplicate records of the administration of medications to clients.  The fridge storing medications contained no lock.
• Staff did not clearly document risks to clients undergoing detox from alcohol or opioids. Staff did not carry out regular physical health observations. Staff did not use approved national rating scales routinely.
• The service had a policy in place for blood borne virus testing. Staff aimed to gather information upon admission. We saw however, that one client had been waiting for over four weeks for this to be completed.
• Staff were not clear on their roles and responsibilities for incident reporting. Staff had not reported any incidents on the incident reporting forms since 2014.
• Staff recruitment files were not up to date. We found criminal record bureau (CRB) check from a different employer in one staff record. Managers did not complete risk assessments for staff that had previous convictions to ensure they were safe to work with clients. There was a lack of references for staff in post, and not all staff had a job description.
• There was no appraisal system in place for staff. Staff told us that they had not received an appraisal. Senior managers confirmed this. We saw no evidence of regular clinical supervision for staff although we were told that regular supervision was held, and each staff member had an allocated supervisor.
• There were ongoing difficulties with their electronic systems. There had been three instances of computer virus attacks in the past four months. Staff did not have duplicate copies of important documents relating to the service.
• The service had no established links with advocacy services, and relied upon local agencies such as the citizen’s advice bureau.

• There was a lack of effective governance structure and leadership, with no quality assurance management or frameworks in place to monitor the quality of the service. Examination of clients files identified there was not consistent recording in the clients’ progress notes. Managers did not regularly assess risks to clients that may be caused by the environment.
• The service did not have a current policy for lone working. A night intervention worker works alone across the accommodation sites up until 11pm.

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

• The admissions staff had established links with other external agencies and shared information to promote client safety. Staff communicated with, and received information from other professionals to form part of a comprehensive assessment prior to and during treatment.
• Staff completed an initial telephone assessment with each client referred. A staff member acted as a point of contact between referral and admission.
• Clients were involved in the implementation and review of care plans. Care plans were holistic.
• Managers identified and addressed instances of poor performance by staff.
• Staff provided support for families of clients, through weekly support groups and the use of family conferences.
• Staff were caring and respectful during interactions observed and passionate about their roles.
• All clients received a welcome and introductory pack upon admission to Focus 12.
• Focus 12 had a clear vision and values, which was visible throughout the building.
• The care settings were visibly clean, comfortable, homely and fairly well maintained. The managers had utilised the available space productively, enabling accessible rooms to see clients.
• The service had up-to-date fire risk assessments.
• The service did not use bank or agency staff, which provided continuity of client care and treatment.
• The staff team held a debrief / handover every day which gave an opportunity to discuss clients presentation and progress.
• Clients met their designated counsellor on a weekly basis. Counsellors had up to five clients at any one time.