Littledale Hall Therapeutic Community

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all clients on admission. They developed individual care plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for clients based on national guidance and best practice. Staff from different disciplines worked together as a team to benefit clients.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 4 care records during the inspection.

Staff completed a comprehensive assessment of the client in a timely manner at, or soon after, admission. The initial assessments for clients were detailed and there was evidence that historic factors had been explored and considered.

Staff assessed clients’ physical health needs in a timely manner after admission. There were specific care plans in place around physical health issues within the records reviewed.

Staff developed care plans that met the needs identified during assessment. Care plans were personalised, holistic and recovery oriented. Client records were generally detailed and individualised to the clients. There was evidence of client input into their care plans.

Staff updated care plans when necessary.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the client group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. The service had a model of care which was established and emphasised group work and structure for clients. Clients praised the groups within the service and that they had a voice and felt listened to within these groups.

Staff ensured that clients had good access to physical healthcare, including access to specialists when needed. The service had a strong relationship with a local GP to ensure that clients had access to physical health support.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the client group.

Managers provided new staff with appropriate induction. The service had a new starter pack which included induction paperwork.

Managers provided staff with supervision and appraisal of their work performance. Full time staff received monthly supervision whilst part-time staff received bi-monthly supervision. The percentage of staff that received regular supervision was 100%. The percentage of staff that had had an appraisal in the 12 months prior to our inspection was 100%. The service held monthly reflective practice sessions for staff.

Managers ensured that staff had access to regular team meetings. The service held weekly staff meetings which followed a set agenda.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers gave staff opportunities to identify any areas where additional training may be beneficial within supervision and as part of the appraisal process.

Managers ensured that staff received the necessary specialist training for their roles. Managers noted that staff had received additional training in areas such as trauma, along with additional drug misuse training.

Managers dealt with poor staff performance promptly and effectively. Managers could give examples of how they would monitor and manage any concerns about staff performance.

The evidence showed some shortfalls. The service did not always ensure that information and updates about clients were shared within the team.

Staff shared information about clients at handover meetings within the team. We reviewed copies of the handover notes. These followed a standard agenda. During our review, we identified incidents which had been recorded for specific clients however, staff had not always updates recorded in relation to these incidents to indicate that these had then been discussed and recorded at subsequent handover meetings. We were not assured that all staff on the subsequent shifts may be aware of how the incidents had been progressed or resolved.

The service had effective working relationships with teams outside the organisation. We received positive feedback about how the service engaged and interacted with external organisations and stakeholders. Stakeholders noted that communication from the service had improved and that they received regular updates about clients.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives. The service considered everyday health and wellbeing as one of the 4 key components of its programme. The service promoted structure in terms of daily timetables that clients would follow.

The service had links with local community services that clients could access, such as recovery groups along with access to spiritual services and an external gym.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes. Staff regularly reviewed client care and recovery plans. Staff had undertaken relevant assessments of client’s needs at the point of their admission.

Managers had oversight of data around admissions, completions, occupancy and referrals. In the 12 months prior to the inspection, the service had 49 completions of treatment. For the same period, there had been 60 unplanned exits from treatment, either by self-discharge or therapeutic discharge. Managers noted that, following changes made to the life story work within the service, the number of unplanned exits had reduced significantly. Between January and August 2025, the service had 50 unplanned exits. Following the changes to the life story work, this had reduced to 10 unplanned exits between September and December 2025.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable clients to make their own decisions. Staff had an understanding of how to consider clients’ capacity. Managers noted that all clients being admitted to the service would be deemed to have capacity and would not be referred to the service if they did not.

For clients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. At the time of the inspection, no clients within the service lacked capacity. Managers gave examples of how staff might consider clients’ capacity, such as clients making unwise decisions. Where staff had concerns about this, managers would facilitate discussions about these cases to consider the decisions and if any actions were required.

When clients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.