Littledale Hall Therapeutic Community

We rated Littledale Hall Therapeutic Community as Inadequate because:

Systems that were in place did not ensure the safe handling and administration of clients’ medicines. This included incomplete client risk assessments for clients who were self-managing their medicines. Staff did not always proactively support clients to take their medication as prescribed which was evidenced in gaps in medication records. Auditing of medication management was not robust and issues were either not recognised or not acted upon. This included fridge temperatures which significantly exceeded recommended limits. Some medication boxes in the fridge were wet. This meant the service could not be assured the medication in the fridge which included insulin, was safe or effective for use. We issued a warning notice to the provider to make sure they improved their systems that were in place, to ensure the safe handling and administration of people’s medicines.

There were a number of environmental issues which could compromise the safety, privacy and dignity of clients and staff. There were no locks on any bedroom doors including the staff bedroom. This meant that clients and staff did not have a safe and secure place to sleep. There was nothing in place to prevent male and females accessing each other’s bedrooms. The providers lone working policy did not provide sufficient detail to guide staff in how to respond in the event of an emergency. Staff did not have access to ligature cutters.

Clients’ personal work was not kept securely and could be accessed by anyone using the building. This included personal and sensitive information. Staff did not always keep daily contemporaneous records for each client. This meant that staff did not always have access to a record of the daily care and treatment provided to each client. The service did not ensure all policies were up to date and some policies were not relevant to the needs of the service. The governance systems in place did not adequately identify and mitigating the risks to clients and staff. Audits undertaken did not identify all risk issues. We issued a warning notice to the provider to make sure they improved their governance systems.

There were a number of environmental issues that had not been addressed by the provider. These included: access to the family room, the disabled access bedroom not being fit for purpose and the décor in the premises was in need of refurbishment.

Policies and procedures were not specific to the service, they lacked relevant guidance for staff to follow and they did not have review dates.

However;

There were enough staff to keep clients safe and all staff had received safeguarding training and knew which procedures to follow to safeguard clients. Staff had received mandatory training, supervision and appraisals. Staff completed individual risk assessments for all clients, and there were effective risk management plans in place for each client. Staff recorded incidents appropriately and incidents were investigated according to the policy.

All clients had a recovery orientated care plan which was updated regularly. Staff provided a well-structured treatment programme which was based on national guidance and best practice. Staff supported clients to access activities and support in the local community. The team worked in an effective, multi-disciplinary way with other agencies to provide comprehensive support for clients.

Client feedback was universally positive and they felt staff genuinely cared about them and that the programme had made a real difference to their lives.

Clients were active partners in their care and staff supported clients to take personal responsibility for their own treatment.

Staff encouraged and supported contact with family and supported clients to improve relationships that had been affected by substance use including clients’ relationships with their children.

There was a clear admissions process and staff worked effectively with other agencies during this process. Staff planned discharges well and staff ensured clients had adequate support on discharge including 12 months aftercare support.

There was a positive culture within the staff team. Staff were motivated and passionate about their work. Leaders were visible and approachable and effective systems were in place for communicating information between staff and the leadership team.