• Residential substance misuse service

Littledale Hall Therapeutic Community

Overall: Good read more about inspection ratings

Littledale Hall, Lancaster, Lancashire, LA2 9EY (01524) 771400

Provided and run by:
Littledale Hall Therapeutic Community Limited

All Inspections

28 November 2019

During an inspection looking at part of the service

We rated Littledale Hall Therapeutic Community as good overall because:

  • The findings of this inspection mean the service is being removed from special measures. The service had taken actions to address concerns identified at our previous inspection. There was clear evidence that the service had improved.
  • The service provided a safe rehabilitation service for individuals with substance misuse problems. The environment was safe, clean and supported recovery. The service had enough staff. Staff assessed and managed risks associated with the client base and rehabilitation well.
  • The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet. The service had facilities and equipment to support the delivery of care. Staff managed privacy and dignity within shared dormitories appropriately. There was access to outside space.
  • The service had taken steps to improve its governance. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.


  • Although the service had reviewed its policies and procedures it had not yet fully implemented them and staff had not yet completed all relevant training.
  • A management plan in place for a client with diabetes did not provide details or instruction for staff to follow if blood sugar levels were outside of the normal range.

5 March 2019

During a routine inspection

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.


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.

13 February 2017

During an inspection looking at part of the service

We do not currently rate independent standalone substance misuse services.

  • During our comprehensive inspection in April 2016, we found Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 were not being met.

  • During this most recent focused inspection in February 2017, we found that the services had addressed the issues that had caused us to issue two requirement notices following the April 2016 inspection.
  • Littledale Hall Therapeutic Community was now meeting Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At this inspection, we found:

  • The provider had introduced a new policy and procedure in relation to medicines management. Audits had been implemented in relation to medicines management and risk assessments were in place for clients who were able to self-administer medicines.
  • A ligature policy and audit had been completed.
  • Systems and processes had been established and operated to maintain an accurate and complete contemporaneous record in respect of each client.
  • All staff had received training on the Mental Capacity Act and the Deprivation of Liberty Safeguards.

And this means that the provider was no longer in breach of regulations.

26, 27 April 2016

During a routine inspection

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

  • The audits of medicines management arrangements were not sufficiently robust or recorded to ensure that the gaps in the medicines administration charts were identified and addressed. Staff were not always following the medicines policy the provider had in place. Where clients wanted to self-administer medicines staff were not risk assessing them.  Adequate checks to confirm what medicines clients were currently prescribed when they arrived at the service were not in place. Individual medicines records were not clearly presented and medicine records we looked at showed that doses of medicine were frequently missed.

  • The provider must ensure a ligature environmental audit is completed. This is to ensure that all that is reasonably practicable to mitigate any ligature risks is in place to ensure the premises are safe to use for their intended purpose.

  • The provider must complete and maintain contemporaneous record for each individual client.

  • Staff did not have a full understanding of their responsibilities to work within the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards.

  • Staff did not review the appropriateness of all blanket restriction practices in place for all clients at all stages of treatment. The restrictions were not individually risk assessed or reviewed throughout the course of the clients’ treatment and the appropriateness of these was applied to all clients without applying any level of trust and or privacy as they progressed and neared completion of their programme.

We found the following areas of good practice:

  • The environment was clean, well maintained, welcoming and comfortable. Staff carried out assessments before clients were admitted to ensure that the service could meet the individuals’ needs. Care plans and risk assessment were in place and were recovery focused. The provider reviewed the care plans regularly throughout a client’s stay.
  • The therapies provided were underpinned by best practice. Clients had access to psychosocial therapies, group sessions and individual one to one sessions with a counsellor. Staff worked with clients to help them develop the skills they needed to sustain their recovery and maintain their independence when they returned to the community providing access to aftercare facilities to support them in their recovery.
  • Staff treated clients with respect and kindness and supported them throughout their stay.
  • All clients had full involvement with their treatment during their stay. They made decisions about their treatment during sessions with their keyworker.
  • There was a structured programme of care, therapy and activities. Discharge planning included an aftercare package to support clients following rehabilitation.
  • Staff had regular supervision, support and on going appraisals of their work performance from their managers.
  • Staff we spoke with were highly motivated in their work and told us they felt supported by senior management. There was an open and transparent culture. Staff told us they felt comfortable raising any concerns or issues.
  • There was an appropriate governance structure in place.

7 January 2014

During a routine inspection

People who received treatment and care from Littledale Hall were very positive about their experience. Comments we received included:

"It is amazing, it has given me my life back, my kids and my family.'

'I have learned loads about addiction and how to keep safe.'

'I have the best chance, and have been offered a place in the flats.'

'With the support of the Hall and the staff I am able to give something back. I am applying for voluntary work and college; and am being helped to set up these connections.'

'It is a community and run like a community. It is the safest place I`ve felt in a long time. Staff support you.'

It`s been brilliant for me. It`s been hard but I've got good relationships with staff.'

We looked at the arrangements for the prevention and control of infection in Littledale Hall. We saw that bathrooms, toilet areas and bedrooms were kept clean and tidy and to a good standard.

As part of our inspection we checked how medicines were being handled. Overall we found that there were safe systems in place to manage and administer medication that help protect the health and wellbeing of people.

We saw there were safe recruitment procedures in place to ensure people were protected and supported by staff with the skills and experiences to meet their needs. Our discussions with a range of staff confirmed they felt well supported in their roles.

Although the house was a listed building and was very old it was clear that a programme of work was underway to upgrade and improve the home. We saw evidence of redecoration taking place.

There were a range of audits and systems in place to monitor the quality of the service being provided.

17 January 2013

During a routine inspection

People using the service that we spoke with all said that staff were respectful. One said, 'The staff are great, even though the structure is sometimes difficult, we are always respected as individuals with our own personalities.'

The service had developed and maintained relationships with a number of professional agencies. This ensured that people's physical, spiritual, developmental, educational and social needs were met. The service had endeavoured to forge these relationships for people's ongoing needs as they moved into aftercare and beyond.

We saw that people living in the community were able to personalise around their bed. This had however left some rooms in need of redecoration. We were told that bedrooms were redecorated within a cycle of redecoration which had been paused to assess the damp and condensation issues.

People we spoke with on the day of the inspection all said that staff were excellent. One said, 'There is a massive element of care around everything they do.' Another said, 'They save lives.'

We saw policies and procedures for records management and data protection. We saw these being followed on the day of the inspection. The employee handbook detailed safeguards the provider took to keep, staff, people living in the community, volunteers and visitors safe. This included information around confidentiality and whistle blowing.

27 February 2012

During a routine inspection

We spoke with three residents who were very positive about the treatment programme they were undertaking and about the staff at Littledale Hall. Recent resident feedback forms all reflected positively on the experience the individual had undergone. Many residents felt that their life was fundamentally changed for the better, their self esteem and confidence had grown, and their ability to cope with life, responsibilities and seeing themselves as a valued member of society had improved beyond all measure. This they felt was all down to the treatment and support they had received at Littledale Hall.

Comments from residents included:

"There is no them and us here we are all us (residents and staff)."

"We are well supported and cared for."

"Because you are able to get to know each other you get to know when someone is not feeling ok and you are able to support them through that period."

"All the staff go out of their way for you here."