Ark House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm. The service was safe, clean and well furnished, offering multiple spaces for therapeutic sessions, meetings and mealtimes. The service had enough staff to keep people safe and provide therapeutic sessions to promote recovery. Staff completed daily bedroom checks with clients and assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely record and store medicines. The service managed patient safety incidents well and had systems in place to record incidents and both staff and clients knew how, when and who to raise concerns to.

This service scored 81 (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 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported incidents appropriately. Lessons were learnt to continually identify and embed good practice and discussed through team meetings and directors’ meetings.

We reviewed incidents that occurred over a 3 month period prior to inspection. We found that all incidents were recorded appropriately, actioned and outcome, with referrals to safeguarding and the local authority where necessary. Incidents were discussed within team meetings and recorded within minutes. Incidents related to client issues and medication were most prominent. Client issues included leaving early (self-discharging) and disagreements between clients. Medication incidents included medication counts being incorrect or issues between pharmacy and Ark House in accessing medication, although there was evidence of these issues being resolved with immediate effect. There was evidence that the service demonstrated duty of candour where appropriate.

The incident reports were completed in line with Ark Houses policies and procedures and demonstrated that all staff knew how to report, record and escalate issues within the service. Learning and improvement opportunities were circulated by senior leaders to the wider team. There were no serious incidents reported within the last 12 months.

We scored the service as 4. This means the evidence showed an exceptional standard. The service always worked with clients and community healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services. The service’s referral and admission processes ensured all essential information about the client was received to determine if the client’s needs could safely be met, and staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care and good outcomes.

We reviewed 9 clients care records who were in treatment or recently discharged. There was evidence all clients had an admission assessment which included risk assessments which were updated to reflect any incidents, ligature risk assessments where appropriate, care plans which were holistic and person centred to their recovery, crisis contingency plans and consent forms. There was monthly oversight of risk assessments by staff, and all care plans were reviewed with clients during 1:1 sessions.

Pre-admission assessments were completed by the senior leadership team to ensure clients’ needs could be met within the service safely. Ark House also provided potential clients with information regarding the service to ensure it met their needs. Where clients self-discharged or their stay was terminated, contingency plans were outlined including informing next of kin, ensuring services in the person’s local area were made aware and hotels or bed and breakfast accommodation was provided to ensure safety overnight.

Following successful completion of the treatment programme, clients were able to return to Ark House for follow up support and to attend groups which were charity funded. Ark House also noted this was beneficial to clients still in treatment to see how people had progressed back into the community. Many of the ex-clients have gone on to volunteer within the service. We also spoke with an external provider who refers into Ark House and they told us the communication, referral process and shared learning was excellent.

We scored the service as 4. The evidence showed an excellent standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately which was reflected in the local authorities’ responses to Ark House.

All staff had mandatory safeguarding training for both children and adults. The compliance rate for this was 100% at time of inspection. There was a safeguarding lead in place, and a review of incidents evidenced referrals to the local authority safeguarding teams. There were posters within the service that supported people in recognising signs of abuse and how to raise concerns.

Ark House also completed referrals to the local mental health team when client’s mental health had deteriorated, or concerns were raised. We spoke with 10 members of staff who were able to describe the safeguarding process. One member of staff told us that, “Safeguarding is a constant and the vulnerabilities of clients”. Staff attend the counsellors’ meeting weekly and safeguarding is an agenda item, and this includes ex-clients and duty of care for these individuals. 6 months ago an issue flagged with an ex-client and a safeguarding referral was made for this individual.

Blanket restrictions that were in place were appropriate for the service type and there was a list of prohibited items. There was a restrictions register in place for the service which was regularly reviewed. This included items which were risk assessed as being unsafe for the environment/client group. Restrictions were regularly reviewed to maximise independence, based on risk reviews and environmental checks. Some clients told us they felt it was very strict, however also explained that the service needed to be this way to ensure the safety and ongoing recovery of all clients.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks in a holistic and person- centred way. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided support to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The service does not utilise any form of restraint.

We revied 9 risk assessments as part of this inspection. All care records reviewed evidenced collaborative approaches to risk with clients, which were reviewed in 1:1 sessions with counsellors. Risks were thought of holistically and included mental health, physical health, finances and risks upon discharge. All records were signed and dated by clients upon review. All records were up to date.

There were signed consent forms which clients agree to contracts under Ark House rules. Clients were supported to understand expectations and a client handbook which provided useful information about the service, treatment programme and expectations was available. Ark House ensured that all information was accessible in different languages and communication styles to suite individual need. We spoke to a volunteer whose first language was not English. They told us how Ark House ensured that their communication needs were met throughout their treatment as a client and about the ongoing support they receive as a volunteer.

We also reviewed client feedback on the service. Clients provided positive feedback around support with medications and being able to write in a request book for specific activities such as support with banking. We reviewed 6 complaints made to the service. All appropriate actions were taken and governance oversight evidenced in meeting minutes. Complainants were thanked for feedback to improve the service. Ark House also displayed posters regarding local advocacy services and different contact methods available. The posters explained how advocacy worked, the benefits of this and staff supported clients to make referrals where required.

We completed a tour of the building with the service manager. The service consists of a large house with the ground floor being communal and for therapies, meals and utilities. The first and second floor were for bedrooms. The floors were separated for males and females. Bedrooms were large and often shared by two people as part of the recovery pathway which clients told us helped them greatly to discourage isolation and prevent loneliness. Bedroom spaces were shared by same gender clients and clients could personalise their bedspaces. Some clients had recovery orientated posters and notes from therapy sessions to reflect on during the evening. The service was well maintained and fit for purpose, with a newly renovated outdoor area for clients to take breaks for therapy sessions. All clients completed a risk assessment upon admission which included an assessment of their mental health, risk to self and this was reflected within care documents. Any potential ligature points were documented within the ligature risk assessments.

Any potential risks within the environment were recorded on the services risk register. The environment was also included within the business continuity planning- which had detailed guidance for staff in emergencies. There was a building risk assessment in place for the service which ensured relevant checks had been carried out. Staff all had access to technology to support their roles, including a service specific system created by Ark House for the ongoing oversight of risk reviews.

Some area’s of the building required redecoration and slight improvements, such as flaking privacy screens. Due to the age of the building, maintenance is an ongoing endeavour. At the time of the inspection, all maintenance records were up to date and checks completed.

We scored the service as 4. The evidence showed an exceptional standard. The service made sure there were enough skilled and experienced staff, who received thorough support, supervision and could access robust development opportunities. The staff worked together well to provide safe care that met people’s individual needs. The service was fully established with a team consisting of leadership, counsellors, support staff and regular volunteers who provided support and therapeutic interventions. Staff shifts were regular, providing consistency and structure to the treatment programme Ark House offers. The staffing provision also ensured that staff were available on a 24-hour basis, with an on-call manager designated to support the service 7 days a week.

Mandatory training for staff was 100% compliant at the time of inspection, with the exception of two new members of staff, who had training booked in. Mandatory training included first aid, fire safety, infection prevention control, safeguarding both children and adults, self-harm reduction, lone working and data protection. All mandatory training was relevant to the needs of the clients using the service and monitored by senior leaders through supervision and appraisals.

Ark House also provided staff with additional training and education to enhance skills. For example, two members of staff had received funding to be trained in family therapy, NVQ health and social care management, trauma counselling, motivational interviewing and counselling courses through local universities. Ark House also provided in- house training from a clinical psychologist to staff in 2023 and 2024.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was well maintained, tidy and clean. There is a member of maintenance staff available 5 days a week. The service used an external company to ensure the environment was cleaned thoroughly. Clients were encouraged to keep spaces tidy as part of their routine. There were Control of Substances Hazardous to Health (COSHH) risk assessments in place where appropriate, such as the utility room. Hand sanitisers were alcohol free and staff and clients knew where to access these. Staff completed fridge and room temperature checks where medication was stored and within the kitchen areas, in line with policy. The service has two chefs who had the relevant health and safety training in place for cooking, preparing and storing food.

All staff had completed mandatory training in infection prevention and control. There were measures in place for adverse events such as Covid-19 detailed within the business continuity plan.

We scored the service as 2. The evidence showed some short falls in standard. The service made sure that medicines and treatments were safe and met people’s needs. There was a medication lead in place who took responsibility for ensuring clients were supported in ordering and receiving medication from the pharmacy, and safe storage. As part of this inspection, we reviewed 17 medication records. As the service is not clinical, clients are expected to attend the office to request their medication. The medication was contained in a locked cupboard to ensure people were kept safe.

The medication lead would sign medication once the client had come to collect this. Staff prompted clients where needed in order to ensure clients received their medication. A review of incidents showed issues with medication counts, however these were evidenced to be rectified safely. A review of medication charts showed some missing signatures. Some signatures were left until the end of the day to give clients the opportunity to take medications when they preferred. Staff liaised with GP’s and pharmacists within local pharmacies to ensure clients had enough medication during their stay at Ark House and upon discharge from the service. Clients were supported to attend and arrange appointments with their GP for any issues with medication.