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Turning Tides Recovery Project Good

Inspection Summary


Overall summary & rating

Good

Updated 11 July 2019

The service was last inspected in 2016, at which time we did not rate independent substance misuse services.We rated Turning Tides Recovery Project as Good because:

  • The service was well staffed with a range of well trained and experienced staff. Staff put into practice the service’s vision and values. Staff had contact with managers at all levels of the organisation, including the most senior, who were supportive and visible.

  • The service was clean and comfortable with a very good range of facilities. Effective systems ensured any issues with the building or facilities were rectified quickly.

  • There was a proactive approach to understanding the needs and preferences of different groups of people, and to ensuring the service met these needs, promoting accessibility and equality. The individual needs of each client were considered carefully by staff, ensuring their individual preferences and needs were always reflected in how support was delivered.

  • Staff managed risk well using effective systems and protocols, including clients at risk of relapse. All clients had holistic, personalised support plans, and were encouraged to take an active role in their own recovery and risk management.

  • The organisation did not subscribe to any specific recovery model and would support any option that suited an individual. It also offered a unique managed withdrawal from alcohol programme, designed by the registered manager in partnership with colleagues from other disciplines. The service managers advised us that this programme had been independently evaluated by a medically qualified detoxification specialist, and approved by Public Health England.

  • Incidents, complaints and safeguarding concerns were monitored to identify where improvements could be made.

  • The community ethos of the organisation was very strong and effective. The organisation had very strong community links and a recovery pathway for people to move through. Support was available for as long as people needed it.

  • The service had excellent links with partner organisations and the wider community, offering a broad range of opportunities to clients to engage, build relationships and undertake training, educational or employment opportunities.

  • Clients told us they liked the feeling of inclusion, one example being the family feeling of Christmas-time, with gifts being exchanged and a full Christmas dinner prepared and eaten together.

  • Clients were consulted on all aspects of the running of the service and participated in staff recruitment. The Partnership and Co-Production Team (PACT), which was a group of clients and ex-clients, were significantly involved at all levels of the organisation, including budgets and policy changes, and met regularly with the trustees.

However:

  • Although the service had an appropriate Mental Capacity Act policy which formed part of the induction, not all staff knew or understood the legislation, how it applied to this service or how to use it appropriately. This may have been because some of the staff were quite new.

Inspection areas

Safe

Good

Updated 11 July 2019

We rated safe as Good because:

  • Comprehensive systems ensured the building was safe, clean and comfortable. Managers and external auditors undertook appropriate reviews and checks. There were processes in place for ensuring issues were rectified.
  • There was enough suitable staff at the service. Staff had training appropriate to their roles, and were well supported. When the service used staff from agencies, managers ensured they were familiar to the service, or, if they were new, enough time was set aside to provide orientation and support.
  • Risk assessments were comprehensive, detailed and regularly updated, and staff used recognised assessment tools. Staff worked very effectively with other professionals to ensure clients were kept safe. We saw evidence that clients were involved in their recovery, and encouraged to participate in managing their own risks, especially around relapse.
  • Each client had a personalised relapse plan, on which they worked with staff to develop strategies to manage risks and reduce the likelihood of a relapse occurring.
  • Where appropriate, clients carried Naloxone, which is a treatment to rapidly reverse the effects of an opioid overdose. All staff, and clients who needed it, received training in the use of Naloxone. Naloxone was also easily accessible in the staff office.
  • Systems were in place to keep people safe from abuse and harm. Managers had good relationships with the local authority and the service had a full-time social worker, who supported clients to build and maintain effective relationships with their family and children.
  • Staff managed medicines safely, and followed clear protocols in line with national guidance. Effective systems ensured staff were competent to administer medicines to clients safely.
  • Systems were in place to ensure incidents were managed safely and the service learned from incidents to improve practice.

Effective

Good

Updated 11 July 2019

We rated effective as Good because:

  • Each client had a comprehensive, highly personalised support plan. These were regularly reviewed and evidenced client involvement. Where appropriate, their care-coordinator was identified.
  • Staff used a good range of recognised tools to assess and manage risk, and measure outcomes.
  • The service employed a range of professionals to ensure a holistic wraparound service was provided, including mixed complex needs workers, a social worker and a dual diagnosis worker.
  • Staff followed best practice guidance including National Institute for Health and Care Excellence (NICE) guidance around the management of medicines.
  • A training coordinator ensured all staff and volunteers were trained and competent for their role. Regular supervision and appraisals provided support and the opportunity to discuss personal development.
  • All referrals were considered by a multi-disciplinary team, and no client was left on the streets as a placement option would be identified elsewhere in the organisation, or within a partner organisation if the recovery project was not suitable.

However

  • Although the service had an appropriate Mental Capacity Act policy which formed part of the induction, not all staff knew or understood the legislation, how it applied to this service or how to use it appropriately. This may have been because some of the staff were quite new.

Caring

Outstanding

Updated 11 July 2019

We rated caring as Outstanding because:

  • There was a strong, visible person-centred culture. Staff treated clients with dignity, kindness and respect. They provided a holistic service which met the totality of clients’ needs. Each client had a key worker with whom they had plenty of one to one time
  • Support and treatment was highly personalised. Staff worked hard to empower clients to manage their own recovery and signposted them to other services as required.
  • Clients told us that they felt staff cared about them and that they felt they mattered. Clients said staff made time for them when they needed it.
  • Staff recognised the importance of building and maintaining support networks in the community and they were very strong in supporting people to do this.
  • Staff and clients knew how to raise concerns and were confident to do so if they needed to.
  • Staff worked hard to ensure clients were involved in their care and treatment, offering a wide range of opportunities for them to have their say, such as meetings, feedback forms and surveys.
  • A charter created for clients by clients, and an associated staff charter, set out agreements about how everyone should treat each other.
  • Clients told us they liked the feeling of inclusion, one example being the family feeling of Christmas-time, with gifts being exchanged and a full Christmas dinner prepared and eaten together.
  • Staff recognised that relapse was part of recovery and treated clients in a respectful non-judgemental way when they relapsed.
  • The partnership and co-production team (PACT), which was a group of current and ex-clients was involved in every aspect of running the service, including budgets, policy changes, service reviews and audits.
  • Clients participated in recruiting new staff, including interviewing and training.

Responsive

Good

Updated 11 July 2019

We rated responsive as Good because:

  • The organisation encompassed a full recovery pathway as clients’ needs changed. Clients were fully supported by an inclusive, wraparound service which met the totality of their needs, and continued to do so for as long as necessary.
  • The multi-disciplinary team consisted of a good range of professionals to ensure diverse and complex needs were fully met.
  • The service had excellent relationships with partner agencies and the wider community in general. A broad range of activities, fellowships, groups, social events and other services offering employment, training and education opportunities was available to clients.
  • The service was comfortable and well maintained with a very good range of facilities, including a family room where clients could build and maintain healthy relationships with their children, with the full support of a qualified social worker. Each client had their own room which they could personalise as they wished.
  • Clients had access to a very wide range of activities, community services and support. The service had excellent links with the community, and provided education, training and work opportunities.
  • Staff gave new clients a range of information on admission. This information was also available in communal areas. Key workers and peer buddies were assigned to each new client to help orient and support them.
  • The service had a very inclusive admissions policy and there was a proactive approach to understanding the needs and preferences of different groups of people, and to ensuring the service met those needs, promoting accessibility and equality.
  • Staff welcomed complaints as opportunities to resolve issues, to learn and improve the service provided.

Well-led

Good

Updated 11 July 2019

We rated well-led as Good because:

  • Managers had the skills, experience and motivation to do their jobs well. The organisation operated with a minimal management structure, and managers at all levels, including the trustees, were visible, accessible and supportive.

  • Managers were provided with specific training, and annual away days for all staff ensured there was integration across the organisation and staff at all levels felt their voice was heard.

  • A clear meetings structure ensured that learning and information was cascaded appropriately through the organisation. All staff we spoke with were clear about the organisation’s vision and values and were aligned to them. Staff at all levels had the opportunity to contribute to changes and the way the service was run. This was evident in the way services were delivered.

  • Staff were happy in their roles, were well supported and had access to their own support services if they needed it, such as counselling and occupational therapy. Staff also attended monthly reflective session facilitated by an external counsellor.

  • The service had management systems in place to capture and collate various types of information including feedback and complaints, incidents, safeguardings and client outcomes. This was then analysed to see where improvements could be made.

  • A range of internal and external targets and key performance indicators were used to regularly monitor and review the service.

  • A risk register was maintained, ‘rag’ rated (given a red, amber or green priority rating) and regularly reviewed.

  • Service managers had developed effective joint-working arrangements and information sharing protocols with a wide range of other professionals and stakeholders. The inclusive, community ethos of the organisation was very strong and effective.

  • Service managers strove to be innovative, and participated in several research and learning groups to ensure services for people with substance misuse and homelessness issues improved across the local area.

  • The service offered a unique managed withdrawal from alcohol programme, designed by the registered manager in partnership with colleagues from other disciplines. This was the only programme of its kind in the country, and service managers advised us that this programme had been independently evaluated by a medically qualified detoxification specialist, and approved by Public Health England.