Barnsley Recovery Steps

On this page

• 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. We rated this key question as good. This meant people were safe and protected from avoidable harm.
At our last inspection we rated this key question as good. At this inspection the rating has remained good.

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 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service demonstrated a positive and proactive culture of safety, based on openness and transparency. They actively listened to safety concerns and thoroughly investigated and reported safety events.

All staff knew what incidents to report, how to report them and did so accordingly. Staff understood the duty of candour. They were open and transparent and gave clients a full explanation when things went wrong.
Staff received feedback from investigations of incidents, both internal and external to the service. Staff told us that when they reported incidents, they received feedback in several ways including through supervision and debrief sessions. Managers also shared information and data on incidents and deaths of clients with staff during team meetings and daily ‘flash’ meetings. Managers also shared ‘learning loop’ minutes with staff.
There were 6 serious incidents recorded during the previous 12 months.
The service continually identified lessons learnt and embedded good practice. Managers and leaders discussed incidents during monthly compliance meetings and quarterly information governance board meetings. Staff confirmed they received a debrief and were supported by managers after deaths of clients and serious incidents. Staff told us that there was a positive and inclusive learning culture within the service. Staff were actively encouraged to discuss improvements and innovations to the service on a regular basis. They felt able to approach management with any concerns they had and felt assured these would be investigated fully.
Managers described pharmacy issues often related to lost or misplaced prescriptions. It was explained that learning summaries consistently highlighted procedures being followed and were effective in managing these incidents. Following reviews of risks and circumstances, prescriptions were promptly replaced and risks of going off script were managed effectively. Lost prescriptions were noted on records to identify trends and reduce risk of further incidents.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the client was received to determine if the patient’s needs could safely be met.
Clients were referred into the service in a variety of ways. This included self-referrals through a single point of contact, by their GP, mental health services as well as by families and concerned others.
Care records showed that staff gathered comprehensive information about clients prior to commencing treatment through initial contact calls and an assessment. As well as information gathered at initial consultations, clients also completed questionnaires about their substance use to determine the severity of their dependence, and to enable staff to allocate them to the appropriate team.
Staff involved all the necessary health and social care services to ensure patients had continuity of care, both within the service and post-discharge. Each client was allocated a recovery worker and where appropriate a nurse prescriber. Staff offered all clients a physical health care assessment to determine their physical health needs. 
Staff made referrals to mental health services on admission where necessary and there was an Integrated Recovery Team as part of the service. The team delivered comprehensive assessments, joint care planning, collaborative risk management and tailored interventions that addressed client’s mental health, substance use, physical health and wider social needs. Using flexible approaches, including assertive outreach, home visits and joint appointments, the team successfully engaged people with complex needs who were often considered hard to reach.
 

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.

Clients said that they felt safe and supported by staff.
Staff were provided mandatory training in safeguarding adults and safeguarding children and at the time of our inspection the compliance rates were 96% for both.
The service had made 247 safeguarding referrals to the local authority in the 12 months prior to the inspection.
There was a safeguarding policy in place which was subject to regular review. Staff were knowledgeable about safeguarding and knew how to raise a concern when required. They were able to identify different forms of abuse, and the signs associated with these.
Safeguarding referrals were submitted in time and there was evidence of oversight of these referrals from managers. Referrals were reviewed by team leaders, clinical leads, areas managers and the Quality and Performance team, with a record of the referral, actions, and progress recorded.
Staff attended regular meetings where important information and lessons learned were shared. Staff were observed having a caring and compassionate approach when engaging with people.
There were safeguarding leads working within the service who staff or managers could approach for advice or support. Each safeguarding lead had specialist safeguarding knowledge in a specific area such as domestic violence, or children’s services. The safeguarding leads attended meetings with external partners including the local authority to discuss clients with current safeguarding concerns. There were 2 social workers seconded into the service from the local authority; 1 children’s and 1 adult social worker.
Managers held a safeguarding team monthly meeting to share updates and escalate concerns. The safeguarding team completed regular reports on safeguarding activity and reported on findings during senior leadership meetings.

Mental Capacity Act
96% of staff had received training in the Mental Capacity Act.
Staff we spoke with had a good understanding of the Mental Capacity Act, particularly the five statutory principles.
There was a policy on the Mental Capacity Act, including Deprivation of Liberty Safeguards. Staff we spoke with were aware of the policy and told us they had access to it.
Care records showed clients were supported to make decisions for themselves wherever possible. Where clients lacked capacity to make certain decisions, staff made decisions in their best interests, and decision specific mental capacity assessments were evidenced in care plans. If staff were concerned about a client’s mental capacity, staff would also refer to the social worker within the service.

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 clients and themselves well and followed best practice in anticipating, de-escalating and managing signs of distress. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 6 client care records during the inspection and found that each client had an up-to-date risk assessment in place and all care plans were holistic in their approach. Risk assessments were reviewed regularly as well as after any incidents or changes in presentation.
Staff involved clients in care planning and risk assessments and clients were offered copies of their care plans. 
We saw evidence of harm minimisation advice being discussed with clients when care plans and risk assessments were being formulated and safety planning formed an integral part of recovery plans. Staff assessed and recorded client tolerance levels to substances based on their usage or period of abstinence, and their physical health, and this helped them to determine the risks associated with both ongoing use and relapse. Staff had access to Naloxone (a medicine that rapidly reverses an opioid overdose)and distributed this to clients that were at risk of overdose. Clients we spoke with told us recovery plans included action to support them in case they relapsed and said staff revisited this with them regularly. We also saw that clients had plans in place if they unexpectedly disengaged from treatment which highlighted ways in which re-engagement could be achieved.
Staff communicated effectively with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties, such as access to interpreters, easy read documents and documents specifically formatted for neurodiverse clients.
Staff enabled clients to give feedback on the service through 1:1 sessions, scannable QR codes, feedback and complaints forms, community meetings and service user satisfaction surveys. 
We observed staff issuing secure, locked boxes for the storage of medicines at home to safeguard vulnerable people and children living with them.
Staff shared key information to keep clients safe when handing over their care to others. We observed a morning ‘flash’ meeting and saw that managers gave staff relevant updates and key information to keep clients safe. This included information about appointments, high-risk clients, safeguarding concerns, fire safety and first aid arrangements for that day.
 

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.

The service was fully aware of all potential risks in the care environment and managed them well. There was CCTV, convex mirrors and staff situated throughout the buildings to mitigate blind spots. Staff completed quarterly environmental risk assessments of the care environment.
Staff had access to personal alarms as well as alarms fitted in interview rooms and there were staff available to respond.
There was disabled access at each site for clients with limited mobility or physical health conditions. There was also clinic rooms located on ground floors for clients unable to use the stairs.
Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs. All equipment had been checked within the appropriate timescale. Were viewed a sample of clinic room temperature records and saw these were fully completed and all temperatures within the appropriate range.
Client areas, including the reception area and meeting rooms were clean and well maintained with regular cleaning audits carried out. The service used a waste removal company to dispose of clinical and non-clinical waste.
Staff carried out regular checks of specialist equipment at all the sites we visited. The service had enough suitable equipment to help them to safely care for clients and there was adequate space to store these securely.

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 there were always staff with the right qualifications, skills, training and experience to keep clients safe from avoidable harm and to provide the right care and treatment. They worked well together to provide safe care which met people’s individual needs. Managers accurately calculated and reviewed the number of recovery workers needed for each shift in accordance with national guidance. 
All staff including volunteers and bank and agency staff received induction training which included training in safeguarding, information governance, the Mental Capacity Act, equality and diversity in the workplace, unconscious bias, and health and safety in the workplace.
All bank and agency staff were familiar with the service and received an induction prior to commencing clinical duties to ensure continuity of care.
Following feedback from new starters, managers and existing staff,
the service undertook a comprehensive review of the local staff induction process and commenced a pilot to drive improvement. A multidisciplinary working group, representing all service areas, was established to co-produce an improved induction programme. 
A comprehensive welcome pack was subsequently developed, providing clear information on team structures, staff roles, referral pathways and key processes, helping newly recruited staff to navigate the service more confidently. A peer buddy system had also been introduced. Every newly recruited staff member had a dedicated colleague within their own team who could provide day-to-day support.

Staff feedback from all new starters who participated in the pilot had been overwhelmingly positive, with 100% reporting that their induction was thorough and enabled them to understand their role. 100% confirmed that the buddy system helped them settle into their team, and 100% stated that they felt supported to transition successfully into their role and were up to date with appropriate mandatory training. 
The service used bank staff to cover 178.5 shifts over the previous 12-month period and 1 agency prescriber for a 6-month period whilst the recruitment process for a substantive prescriber was carried out. 
The mandatory training provided to staff was comprehensive and met the needs of clients and staff. Training modules included health and safety, infection prevention and control, and training in the use of defibrillators. All staff completed training on recognising and responding to patients with mental health needs and learning disabilities and autism. The organisational target for mandatory training was 85% except for cyber awareness and information governance modules, which was 95% in line with NHS requirements. Mandatory training compliance overall was 96%. Managers monitored mandatory training compliance and alerted staff when they needed to update their training.
The service had low vacancy rates. At the time of our inspection there were 8 vacancies within the service. 6 out of the 8 vacancies had offers of employment formally made and 2 vacancies were out to advert. 
The service had an average annual staffing turnover rate of 19% over the previous 12-month period. This equated to 15 members of staff voluntary leaving the service. Exit surveys carried out by the provider showed that 7 out of the 15 members of staff left to pursue other careers or moved to a different sector. In the same time period, there were 18 new staff members that joined the service.
The service had low staff sickness rates. The average absence during the last 12 months was 2%.

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.

Staff followed good infection prevention and control procedures in line with organisational policy, this included the use of personal protective equipment. People who used the service did not raise any concerns about infection control. They told us that they felt safe in the environment and that all areas were cleaned regularly.
Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly.
Areas were observed to be clean and tidy. Staff completed regular environmental and infection prevention and control audits and where areas of improvement had been identified, appropriate action plans were in place.
Staff demonstrated a good knowledge of infection prevention and control. Staff followed the provider’s waste disposal processes with clinical and non-clinical waste discarded and stored appropriately.
During our tour of clinic rooms, we found that staff had recorded that they cleaned equipment after each client contact. All equipment was labelled to show when it was last cleaned.
The service provided a confidential needle exchange. We found that the service ensured the safe disposal of sharps and used needles.

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, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely. Staff we spoke with knew where to access relevant guidelines including British National Formulary (BNF), the National Institute for Health and Care Excellence (NICE), and Drug Misuse and Clinical Dependence: UK guidelines on Clinical Management. There were relevant medicines management policies in place which were comprehensive and reviewed regularly.
Staff accessed GP summaries to ensure they were aware of any allergies and contra-indications prior to prescribing or administering any medicines.
Staff learned from safety alerts and incidents to improve practice. We saw posters around the buildings alerting clients and staff to an increase in the risk of synthetic opioids.
Clients told us staff reviewed their medicines regularly and provided advice to them about these such as harm minimisation and side-effects. Care records showed that staff recorded ongoing discussions with clients about the nature, purpose and potential side effects of their medicines.
The service ensured that clients understood safe storage of medicines. Barnsley Recovery Steps offered locked boxes for the safe storage of medicines at client’s homes, especially if children were present. Supervised collection and consumption of medicines were also considered for clients deemed to be a higher risk. Barnsley Recovery Steps were also licensed to administer Buvidal, a long-acting injection used to treat opioid dependence. The use of Buvidal removes the need to store medication at home.
The service provided drop-in clinics which allowed clients that had stopped engaging with treatment plans to receive a same day prescription in most cases.
Staff made sure each client had face-to-face medicines review every 6 months or more frequently if clinically appropriate.
We reviewed a sample of prescription charts. These were accurate and staff kept them up to date. Staff stored and managed all medicines and prescribing documents safely.