3 Kendrick Mews

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

This is the first inspection for this newly registered service. This key question has been rated Good. This meant people’s needs were met through good organisation and delivery.

The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity. Staff supported clients with activities outside the service, such as work, education and family relationships. The service met the needs of all clients – including those with a protected characteristic. Staff helped clients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

We have not awarded this service a score for Responsive.

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

The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Managers ensured that the service was tailored as much as possible to meet the needs and preferences of the clients using the service. One client gave an example of receiving their daily therapy from a therapist in the local park as they preferred to walk and talk at the same time.

Clients could access both male and female therapists depending on their preference and their needs. The service ensured that both male and female staff were trained to provide eye movement desensitisation and reprocessing therapy (EMDR).

The service was also in the process of trying to source a female consultant psychiatrist to enable clients to have an option of working with either a male or female consultant psychiatrist.

Staff had a well embedded and clear process to monitor client’s conditions and discussed any changes at daily handover meetings. Staff knew their clients well and could promptly pick up and share concerns if they noticed a change in a client’s behaviour whilst they were progressing through their recovery journey. The approach to this was very person centred and staff shared concerns with clients in an open conversation with their therapist so they could be resolved.

Staff consistently encouraged clients to be active partners in their care and treatment and clients could discuss care with their therapist daily. Staff described building a relationship of trust with the client so that the client has the best chance of recovery whilst using the service. One client fed back that staff took the time to get to know them and their individual needs.

Staff assessed people’s needs and identified their recovery goals on admission. Nursing and therapy staff reviewed client goals daily to help clients work towards their sobriety.

Staff thought about client’s needs after they left the service, staff described sourcing local Alcoholics Anonymous and Narcotics Anonymous groups in the client’s local area when they returned home.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

When appropriate, staff ensured that clients had access to education and work opportunities. The service encouraged clients to remain in employment if they were accessing the outpatient service for their recovery.

Staff supported clients to maintain contact with their families and carers. Family members were involved in the client’s care and treatment and recovery journey if the client consented to this.

Family and carers could attend a weekly support group to support their needs. Therapists also provided family members with psycho-social education on substances, which was recommended by national guidelines. This helped family members understand substance misuse, the effects on their family member and how to develop the necessary skills to best support the client once they had returned to the community. We spoke with 1 family member, and they gave positive feedback about the service. They said they were updated on the client’s progress throughout their recovery journey, and their needs were also considered as well as the clients’ needs.

The service encouraged clients to access the local community and activities during their stay. The service provided vouchers so that clients could access massages from a local salon. Clients were supported to access the local gym and swimming pool. Staff encouraged clients to attend yoga and other activities that they preferred to in the community, such as art exhibitions. Clients gave positive feedback about the activities on offer.

The service promoted and facilitated client’s regular hobbies whilst they were in the treatment programme. For example, one client was supported to attend a pottery workshop as they had an interest in this.

Staff worked closely with other teams, such as social workers and community mental health teams to ensure that client’s other needs were met.

Staff recognised that client’s using substances and suffering from a mental illness at the same time was a common occurrence, so they ensured that the client was reviewed by the consultant psychiatrist within the service. Clients had their mental health reviewed weekly by the consultant psychiatrist.

The service offered an in-person and online after-care group for clients to receive ongoing support once they were discharged from the service.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff ensured that clients could obtain information on treatments, local services, clients’ rights, how to complain and so on. Each client was provided with access to a laptop during their stay and could access a patient portal where clients could access information about the service. This included the client welcome pack. This contained information on what to expect from the service, treatments, a summary of the policies, local services and activities, clients’ rights, how to complain and how to give feedback to the service.

Staff made notifications to external bodies as needed.

Information governance systems included confidentiality of client records.

Staff ensured that information provided was in a form accessible to this particular client group. If a person was intoxicated, they ensured that information was repeated at a later date.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Clients and family members knew how to complain or raise concerns. Clients told us they could raise concerns in the daily planning meeting or directly with the service manager. The client welcome information pack contained details on how to complain about the service.

Since January 2025, the service had received 3 complaints. One was concerning a medicines issue and the other two were regarding care and treatment, none of which were upheld. The service treated concerns and complaints seriously. The service had a clear complaints policy, outlining the full complaints investigation process. The service offered the client an initial face to face meeting to discuss the concerns raised.

Managers investigated the complaints and monitored complaints to see if there were any similar trends or themes that could be further improved in the service. Staff received feedback on the outcome of investigation of complaints and acted on the findings. Any themes were reviewed in the weekly management and compliance meetings, and shared informally through daily handovers where necessary.  Clients received feedback from the manager after the investigation into their complaint.

Staff protected clients who raised concerns or complaints from discrimination and harassment. Staff encouraged clients to access an advocate to help with their complaint if they wished to do so.

Clients were encouraged to give their feedback, complaints, concerns and suggestions about how the service could be improved. All clients we spoke to said they would feel confident to raise a complaint and felt that their concerns would be listened to. Clients attended weekly community meetings, where clients could talk about their week, express their views on the service and make suggestions for improvements.

The service collected and reviewed client feedback by asking clients to complete a satisfaction survey, which was an embedded QR link in their discharge letter. This had been added there to aim to improve return rates. Managers analysed any themes and trends from client feedback and shared this with the staff team in the monthly staff meeting. Clients gave us examples of where they had raised concerns, and these were listened to and actioned appropriately by the service. One person said that their initial welcome to the service could have been further improved and the service immediately addressed this and ensured that the welcome now included changes based on this feedback. 

The service made sure that people could access the care, support and treatment they needed when they needed it.

Waiting times for admission to the service were short. At the time of inspection, the average wait to be admitted was 1-2 weeks. There was no waiting list for the service. Clients gave positive feedback about not having to wait a long time to access the service.

The design, layout, and furnishings of the service supported clients’ treatment, privacy and dignity. Each client had their own bedroom during their stay and could keep their belongings safe. Clients could lock their bedroom doors if they wished. Clients and staff had access to a range of rooms to support care and treatment, including lounges, a dining area, kitchen spaces and meeting rooms that could be used for individual and group sessions or for seeing visitors. The service was close to the local acute hospital, so could access emergency services promptly if required.

The buildings within the service were not suitable for clients with mobility needs or wheelchair users. However, potential clients were directed to the provider’s Kent services when the service was unable to meet clients’ mobility needs.

Staff made reasonable adjustments for people, such as translating materials into other languages or arranging interpreters.

Staff were open and honest with clients and suggested a longer period of stay if they felt that clients required this for their recovery. One client told us that they stayed longer than anticipated to receive more therapy but felt that it was necessary as this aided them to achieve full sobriety from substances and alcohol.

There was adequate medical cover day and night. There were registered nurses on site 24/7, who could escalate concerns to a doctor where necessary. In an emergency or out of hours, staff would call NHS 111, accompany clients to the local hospital or call an ambulance.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The service admitted people from diverse religious and cultural backgrounds. Staff recognised the importance of supporting peoples’ cultural, social, and religious needs as part of their recovery and overall wellbeing. Staff worked proactively to ensure individuals were able to maintain and practise their faith, beliefs, and cultural identity whilst in treatment. Staff made adjustments to accommodate people with diverse needs. Information was also made available in various formats and languages upon request to ensure accessibility.

Outcome measures and client feedback were discussed with staff within weekly care planning sessions. These sessions provided a space for clients to reflect on their progress, raise any concerns and work collaboratively with their therapist and care team to review goals and adapt their treatment plan where needed. This process helped ensure that clients remain actively involved in their own recovery, and that care continued to evolve in a way that best supported their ongoing health and recovery needs.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff collected feedback from clients that used the service and staff listened to clients ongoing feedback in the weekly community meetings. Client feedback was also collated and reviewed in the quarterly governance meetings.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. The equality and diversity policy was also summarised in the client welcome pack.

Staff had completed 100% of their equality, diversity, inclusion and human rights training and 100% of their learning disability and autism training at the time of our visit.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff planned for each person’s discharge and return to their local area. Staff carefully planned client’s discharge with them and their families, carers and community mental health teams, if appropriate. Staff also liaised with referring agencies and local authorities if the client wished them to do so.

Staff began discharge planning at the point of admission with a plan in place for each person to ensure they had ongoing support once they had completed their detoxification and left the service. If the client consented, the doctor sent a copy of their discharge letter to their GP.

The service had also introduced an unscheduled discharge care plan to ensure that staff and residents agreed on what the next steps were if the client were to unexpectedly leave the service.

Staff supported clients to source recovery groups in their local area, so they could continue to access them when they left the service. One client commented that they were able to find their own sober support group in their local area after leaving the service.