Clouds House

Clouds House is a residential substance misuse and addiction service offering detoxication and a therapeutic recovery programme.

We rated Clouds House as good because:

• The service provided a safe medically assisted detoxification and therapeutic recovery programme for clients with substance and alcohol dependency. The environment was clean and fit for purpose. Staff routinely carried out environmental assessments. Staff and clients were able to call for assistance if needed.
• The service had enough staff to safely meet clients’ needs. Staff managed referrals well to ensure clients were suitable for admission. Staff had appropriate skills, knowledge and experience to provide the right care and treatment.
• Care plans were recovery-orientated and reflected the assessed needs of the client. Staff provided a range of clinical and therapeutic interventions suitable to the needs of clients that were informed by best practice guidance. Staff used a range of evidence-based assessments tools and outcome measures to support their practice.
• Staff assessed and managed risk well. The service had clearly defined and embedded processes in place to keep people safe. Staff had training on how to recognise and report abuse. The service had clear and robust policies in place for safeguarding adults and children.
• Staff worked well together as a multidisciplinary team and with relevant services outside the organisation to provide good handovers of care and treatment for clients. Staff told us that they felt supported in their role. The service manager was visible and approachable. Managers ensured that staff received supervision and annual appraisals.
• Staff treated clients with compassion and kindness and respected their privacy and dignity. Clients were fully involved in choices regarding their care and treatment. Clients told us they felt supported and well prepared in terms of understanding the 12-step model of recovery ethos.
• Staff planned and managed discharge well and ensured unexpected exits from treatment were managed safely. The service helped to identify alternative pathways for people whose needs it could not meet.
• The service provided a variety of forums for clients and staff to give feedback on the service and raise any concerns or complaints. The service monitored operational risk through a local risk register which staff could contribute to.

However:

• There was a lack of clinical oversight with regards to the review process, actions taken, and lessons learned from medication incidents. A recent external pharmacy quarterly report highlighted a lack of evidence of actions being undertaken for areas identified as a concern. The checklist in relation to medicines due to expire in 3 months was unclear in terms of what the dates were referencing, and the entries had not been signed off.
• The service did not have a controlled drug policy specific to residential accommodation (prison and community only) and the generic policy pre-dated the external pharmacy contract. Clinical staff were working from the Adverse Incident Policy dated September 2020 and were unaware of the revised policy dated April 2022.
• Some clinical staff reported a lack of clarity around the day to day, weekly or monthly oversight of the service and that some clinical information was not shared with the wider clinical team. The concern meant that there was a lack of clinical governance with regards, for example, the timely completion of clinical audits.
• The equipment checklist did not include the ECG machine or scales to monitor height and weight, therefore we were not assured staff were regularly checking the equipment was in working order before use.
• The main clinic room was multifunctional and being used as a staff room. Clients received medicines alongside staff working or eating in the room. This meant that there was a risk of a confidentiality breach whilst receiving their medication and a lack of client privacy and dignity if staff not involved in medication administration were present.