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Barnsley Recovery Steps Good

Inspection Summary


Overall summary & rating

Good

Updated 25 January 2019

We rated Barnsley Recovery Steps as good because:

  • The service had a strong and positive culture. Staff were committed to delivering a service that was inclusive, non-judgemental and caring. The feedback from clients was universally positive about the service and the staff that worked there. The service sought feedback from clients and acted upon this to improve the service. Clients had been involved in co-producing the provider’s vision, mission and values.
  • It was very clean and well-maintained and had a warm and welcoming atmosphere.
  • Governance systems and processes assessed, monitored and improved the quality and safety of the service. Systems and processes were not over burdensome for staff to generate information required on performance. The incident reporting and management system was robust and reports were developed to identify trends and learning from incidents. Most of the issues that we identified had been identified by the provider and leaders had a plan in place to address these.
  • The service had strong links with external organisations. They provided a hospital liaison service, specialist midwifery, had increased the uptake of hepatitis C treatment significantly and had set up a training skills exchange.
  • Overall, mandatory training rates were high at 95%.
  • Staff understood their roles and responsibilities in safeguarding adults and children at risk and carried these out.

However:

  • Clients care plans and risk assessments did not fully reflect the personalised and holistic care and treatment that was delivered in practice and was documented in other parts of clients’ care and treatment records.
  • The service’s environmental risk assessments did not consider the risk of potential ligature anchor points.
Inspection areas

Safe

Good

Updated 25 January 2019

We rated safe as good because:

  • The service had robust incident reporting and management systems. Systems had clear audit trails and processes. Staff received feedback from incidents. That included a quarterly report on incidents that contained information on trends, themes and learning identified. Incidents involving aggression were assessed using a behavioural assessment and response tool to ensure that consistent and appropriate action was taken by staff.
  • Staff demonstrated detailed knowledge on safeguarding adults and children and acted appropriately to safeguarding adults and children at risk of significant harm.
  • The service was very clean and well-maintained. Clinic rooms had the equipment needed that had been checked regularly.
  • Managers were working on ways to improve the service and staff caseloads through the implementation of a segmentation model, which was in line with the UK Clinical Guidelines on Drug Misuse and Dependency 2017.
  • Overall, mandatory training rates were high at 95%.

However:

  • Environmental risk assessments did not identify or assess the risk of potential ligature anchor points.
  • Client risk assessments contained brief and generic information. They did not reflect staff knowledge on client risk and the information recorded in the other areas of clients’ records.

Effective

Good

Updated 25 January 2019

We rated effective as good because:

  • Following changes made by the service, the provider had seen an increase in the uptake of hepatitis C treatment from 40% up to above 90%.

  • The service provided a multi-disciplinary team of staff who could deliver a range of care and treatment interventions appropriate to the needs of clients. The team included specialist midwives and two designated hospital liaison hope workers that had led to 103 referrals from the local acute hospital in quarters one and two of 2018 to 2019.

  • The service had access to external training through a training skills and knowledge exchange they had set up with the local authority.

  • The service had strong links with external organisations including, GPs, community pharmacies, social services and the local acute hospital.

  • Staff used outcome measures and performance returns appropriately. Where performance had been lower than expected for successful opiate treatment completions, the service had been open in discussions with commissioners about the challenges in working with complex client groups. Commissioners had been supportive of the service.

However:

  • Clients’ care plans were brief and basic and did not fully reflect the personalised, holistic and recovery oriented care and treatment that clients and staff told us about and that we could see evidence of in other areas of clients’ care and treatment records.

Caring

Good

Updated 25 January 2019

We rated caring as good because:

  • The service had a strong and positive culture. Staff demonstrated they were inclusive, respectful and non-judgemental. Staff were highly motivated to their roles in supporting clients to improve their lives through treatment and recovery.
  • Clients provided universally positive feedback about staff and the service. They described that staff had excellent attitudes and worked flexibly to support them. Many clients told us that staff had changed their lives and some thought that staff had saved their lives because they had believed in them.
  • Staff provided education and information to help clients understand and manage their substance misuse.
  • Clients told us that they had a named worker who they saw consistently and knew them well.
  • The service sought feedback from clients and acted upon this feedback to make improvements to the service.

However:

  • Clients’ recovery plans contained limited information to show how clients had been involved in their care and treatment. They were not personalised to individual clients.


Responsive

Good

Updated 25 January 2019

We rated responsive as good because:

  • The service had clear referral criteria and an effective single point of contact that screened referrals promptly and could see urgent referrals quickly.

  • Staff informed referrers where clients had not responded to contact made or had declined involvement.

  • Hospital liaison staff worked closely with the acute hospital to respond to referrals and provide support.

  • The service operated at two sites, which meant that clients living on the outskirts of the area could access services close to where they lived.

  • The service had a warm and welcoming atmosphere. It was well decorated and contained a wide range of relevant and well-presented information for clients aimed at recovery and well-being.

  • Staff supported clients to maintain and develop positive and meaningful relationships and opportunities in the community to maximise recovery in the longer term.

Well-led

Good

Updated 25 January 2019

We rated well-led as good because:

  • Leaders were visible, approachable and supportive.

  • The provider had undertaken a project to co-produce their vision, mission and values with staff and clients. Staff identified and demonstrated the provider’s vision and values in practice.

  • Systems and processes were mostly effective in assessing, monitoring and improving the safety and quality of the service. The provider had plans in place to address issues that we identified including a new system to manage supervision and training to improve the quality of care plans and risk assessments.

  • The service had a clear structure of meetings with processes to escalate and cascade information to and from the provider’s board.

  • Most systems enabled leaders to prepare information for reports and submissions automatically and this meant that it was not over burdensome on frontline staff.