Ark House

On this page

• 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 as good. At this assessment the rating has changed to outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People told us the service was exceptional and distinctive.

There were processes and pathways in place to ensure effective admission, treatment and discharge.. Clients had consistent access to effective therapy sessions, both individual and group. Staff supported clients to maintain their physical health by liaising with GP’s, pharmacy and community teams. There were regular activities which enhanced client’s socialisation, and encouraged routine and built confidence. Staff also engaged clients and families in creating individual plans to support them throughout their recovery journey.

Clients were assessed prior to admission to Ark House and received comprehensive mental health and risk assessments on, or soon after admission to the service.

Client outcomes were consistently good or exceeded their own expectations and feedback from client’s and their families confirmed this. We spoke to 9 clients and 5 family members of clients using the service or who had been recently discharged. Staff supported clients in a person-centred way and included them as partners in their care and treatment, encouraging independence and recovery. Staff worked exceptionally well as a team to deliver therapies, care and support. Staff had good knowledge of issues that could impact recovery and how to support the clients within the service.

Clients were able to access a wide range of support, including GP’s, pharmacists, counsellors, recovery support workers, wellbeing officer and community mental health teams. Staff supported clients to access physical healthcare specialists at local hospitals and services where needed.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. The service had a clear referral criteria in place and only accepted clients who had completed a detox programme prior to referral. Ark House had clear guidelines for emergency admissions which stated a client must have been without substance use 24 hours prior to arrival.

We reviewed 9 care plans. The plans evidenced initial assessments, mental health risk assessments and physical health needs. Care records were recovery orientated and reviewed weekly with clients,. Staff told us that more time was being invested in life skills, involving clients in developing new methods of recovery support materials to support the 12-step programme.

Staff and clients told us that the way Ark House delivered the 12-step programme provided clear lessons and treatment plans. Staff and clients told us from step 4 onwards, the support became more unique to the person and that more 1:1 time was offered to support spiritual goals. Counsellors completed consistent and timely checks with clients, monitored attendance at group sessions and 1-1 sessions and facilitated morning mediation where clients give their daily mood scores.

Assessments and care plans were created by the counsellors with clients for their individual clients. Staff gave an example of individual with diabetes and the bespoke care planning they undertook to help manage their physical health needs. Ark House also provided clients with a well-being officer who gave support to clients around external issues impacting their recovery. This included assistance with council tax, benefits and universal credit. There were assessments in place to ascertain support and level of benefit and ability to work. Staff also told us that clients who have difficulties with reading or writing could access additional support such as utilising an MP3 player for group sessions.

Discharge planning was co-ordinated by counsellors who updated the team in handovers, to ensure all staff could support personal recovery planning and determine short and long- term goals to support the client with re-entering community. Staff supported clients to attend self-help groups, acquiring sponsors and providing flyers for clients with QR codes for access to online meetings.

We scored the service as 4. The evidence showed an exceptional standard. The service always 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. They worked to develop evidence-based good practice and standards.

The service ensured clients were supported in understanding the 12-step treatment programme during their stay at Ark House. Staff supported clients with a ‘Client Handbook’ to support their understanding, and the principles of both group and individual therapy sessions. Clients had access to therapeutic activities within the service which promoted inclusivity and life skills. Clients took part in morning meetings to reflect on their recovery journey, how their mood was and any goals they had identified.

We observed a group session, which was attended by 18 clients. Clients were able to enter and leave as they needed to attend other appointments or sessions. The session consisted of a group session leader (counsellor) and was a fully interactive session based on finding solutions to problems. Observation showed that clients appeared to be involved and invested in the session and clients had notetaking booklets and copies of the Alcoholics Anonymous (AA) workbook to support the material being taught. Feedback from clients and staff was that sessions were recovery focussed, interactive, aided their recovery and they found them insightful and inspiring

Ark House utilised findings from the Cochrane reporting for the 12-step programme. A Cochrane review is a systematic review that attempts to identify, appraise and synthesize evidence to answer a specific research question. Researchers conducting systematic reviews use explicit, systematic methods aimed at minimizing bias, to produce reliable findings to inform decision-making. The service identified that the programme reflected benefits around client’s psychological and physical health. The service collected data from admission, first counselling session and clients’ discharge reports.

All staff were supported in delivering therapies and care to clients through regular supervision and appraisals. At the time of inspection, 100% of staff had received their bi-monthly supervision and annual appraisals. The supervision policy also reflected opportunities for ad-hoc supervisions where needed.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

We observed two morning handover meetings. Handover started with a reading related to substance abstinence and staff discussed what the meaning of the reading was. Staff spoke of their own personal relationship to recovery and gave a mood rating, which clients also share during their own morning meeting. Staff checked in with each other and their emotional well-being. The staff team discussed new admissions including mental health risk assessment. Staff discussed any issues or requests that had been raised from clients, and the staff team discussed the service user guides.

The team discussed medications, including liaising with the local GP and pharmacy to ensure client medications were ordered, clients knew when they would need to be collected and any appointments that clients might require support to attend. Staff discussed group therapy work and how they are presenting to clients. Staff nominated a new house leader, a client further on in recovery to take on more responsibilities, ensure other clients are awake to attend sessions and be a voice for the client community within the house.

Staff demonstrated good knowledge of individual clients, where they were in their recovery and individual needs and goals. Care plans were discussed during meetings and any incidents that had arisen were also reviewed.

Care records evidenced referrals to GPs, nutritionist and community mental health teams. There was evidence of multi-agency working between Ark House and community substance misuse services, including involvement in community client groups for addiction support. Feedback from leaders evidenced a positive shift towards learning and sharing between organisations, charities and support groups which helped develop further links for clients entering the service or being discharged into the community with relevant support links.

We spoke with external providers who told us about good working relationships and ongoing learning around why people might leave services early before treatment has concluded.

We scored the service as 4. The evidence showed an exceptional standard. The service always supported people to manage their health and wellbeing to fully 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 had an excellent understanding of what clients needed in order to support their recovery journey and live healthier lifestyles. Staff encouraged clients to have structure, routine and purpose to their days in order to support this. Client and family feedback received evidenced that the rules of the house supported this, and that both clients and family not only understood the rationale for the strict routines in place but agreed with this. Clients told us that the structure of the service and therapies was in keeping with the 12-step recovery programme and also provided life skills with regards to socialising, attending appointments, taking responsibility for managing medication, GP appointments and physical health.

The service employed two chefs who offered a wide range of variety in meals. Meal options catered for clients within the service, ensuring healthy options were available and any specific dietary needs were met. Clients were given the opportunity to give feedback on this. Overall, feedback was very positive about the food available.

Clients were supported to make appointments, attend hospital or GP appointments and collect medication from the pharmacy. Staff promoted client’s physical health and encouraged activity, physical exercise and access to outdoor areas for fresh air. Ark House had made refurbishments to the garden area, with decking, seating and an allocated smoking area for clients who smoked.

Local hotels in the area had provided gym memberships and passes to help people using the service to maintain a healthy lifestyle, engage with the local community and build links. The service encouraged and supported people to utilise these passes in the community.

We scored the service as 3. The evidence showed a very good standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Ark House utilised a range of audits to monitor outcomes and assess efficacy. Senior leaders were responsible for reviewing the audits of care records, staff supervision, appraisals and staff surveys. We reviewed staff file audits to ensure oversight of staff governance. Staff surveys were completed to look at areas of improvement within the service, alongside client feedback. The outcomes of feedback and surveys were discussed during governance meetings and staff meetings, where appropriate.

Leaders ensured technology was accessible for staff in order to access records, notes and information effectively. There were processes in place for documenting client 1:1’s and sessions. Ark House had created a purpose-built system which contained relevant documents, risk assessments and care plans specific to the client group.

Leaders were completing outreach sessions with other providers of substance misuse rehabilitation services to share learning and to improve outcomes. Leaders told us lessons learned from previous inspections had positively influenced the service to make connections with local and national service providers.

The service utilised recognised assessment tools within risk assessments and safeguarding referrals. Monthly team meetings were designated to discuss specific topics and review how the service was improving, implementing and monitoring outcomes.

We scored the service as 3. The evidence showed a good standard. The service always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centered care and treatment.

Staff took all practical steps to enable clients to make their own decisions and providing information for clients to make informed decisions around their treatment. This included care planning, sharing information and participating in group therapies. We saw evidence within care documents and care plans that clients were informed, involved and supported in their journey. Clients signed and dated consent forms upon admission and during 1:1 sessions with counsellors.

Where some clients requested to leave treatment early, staff attempted to reassure and encourage people to remain in treatment. Where this was not possible, staff sought consent to inform next of kin or arrange temporary accommodation if the client wished to leave overnight. Staff respected confidentiality and all staff received mandatory training in GDPR (General Data Protection Regulation).