TLC Rehab

Ratings - Residential substance misuse services

• Overall

  Inadequate

• Safe

  Inadequate

• Effective

  Requires improvement

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Inadequate

Our view of the service

Assessment Summary

Date of assessment: 23 April to 2 May 2025

TLC Rehab is a residential substance misuse rehabilitation service. It offered alcohol detoxification (detox), opiate detox, benzodiazepines (benzo) detox and residential substance misuse rehabilitation. The service had capacity for 10 clients. The accommodation was mixed-sex. There were 7 clients on the first day of this assessment inspection and 1 new admission on the second day.

We conducted this unannounced comprehensive assessment due to the service being newly registered. TLC Rehab was the only registered location for the provider and was for self-funding clients.

The overall rating for this service is inadequate. During this inspection we found 30 breaches of regulation. These breaches were found across all five domains. We took enforcement action and asked the provider for an action plan and immediate assurances around how they will ensure these breaches are met.

Action we have taken

We found multiple concerns during the inspection and 29 breaches of regulation. These breaches were found across all five domains.

• The provider must ensure that there are clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support, and that they act on information about risk, performance and outcomes.
• The provider must ensure that clear inclusion and exclusion criteria is in place and followed.
• The provider must ensure that comprehensive initial assessments of the client are carried out in a timely manner at admission or soon after.
• The provider must ensure that they carry out appropriate recruitment and induction processes for permanent staff and that these are evidenced in staff files.
• The provider must ensure all bank and agency staff have personnel files at the service to ensure that appropriate recruitment checks and training requirements have been completed, can be monitored and updated as required.
• The provider must ensure that staff receive training appropriate for this service type, at a level that is appropriate to their role. This includes training in safeguarding adults and children.
• The provider must ensure that staff have completed medicines training, at a level appropriate to their role and they are deemed competent to carry out this role.
• The provider must ensure that staff receive competency assessments appropriate to their role, in a timely manner, and that the provider has clear oversight of this.
• The provider must ensure that key policies and procedures are in place and have been read and understood by all staff.
• The provider must ensure they document, investigate, and mitigate medicines incidents and have oversight of this.
• The provider must ensure that the service is compliant with the Fire Safety Order 2005.
• The provider must ensure that clients have comprehensive risk assessments in place, with appropriate support in place to mitigate any risks.
• The provider must ensure that all information on previous admissions is recorded.
• The provider must ensure that the service has assessments, policies and processes in place to manage and mitigate risks around mixed sex accommodation and sexual safety.
• The provider must ensure that the environment is regularly reviewed, to identify and manage ligature risks, in the event that a client does express self-harm or suicidal ideation when at the service.
• The provider must ensure that clients who present with self-harm or suicidal ideation, are referred to appropriate services.
• The provider must ensure that clients have appropriate care plans in place, which detail recovery, harm reduction and goals.
• The provider must ensure that every incident is recorded, investigated and that proportionate action is taken in response to any failure identified in the incident.
• The provider must ensure that clients have discharge and aftercare plans in place, that are co-produced.
• The provider must ensure that staff receive supervision and appraisal appropriate to their role, in a timely manner and that they have clear oversight of this.
• The provider must ensure that all restrictions are detailed in the client's treatment agreement.
• The provider must ensure that all notifications required, are made to CQC without delay.
• The provider must ensure that their standard operating procedure is up to date and reflects the current model of care and core staff team, delivered at the service.
• The provider must ensure that staff receive food hygiene and food safety training, at a level appropriate to their role.
• The provider must improve the offering of food, to ensure it is of good quality, healthy and varied; and that clients are included in the menu planning and preparing of meals where risks allow.
• The provider must consider how clients can be supported to life healthy lives, by providing more opportunities for physical exercise.
• The provider must ensure the service has clear outcomes measures to ascertain successful treatment.
• The provider must ensure that staff receive and keep up to date with training on the Mental Capacity Act, at a level appropriate to their role.
• The provider must consider alternative hand sanitisers, that are alcohol free.

People's experience of this service

People's experience

During this inspection, we spoke with 7 clients. Feedback from clients was mostly positive. Clients said that staff were approachable, caring, professional and interested in their well-being. Clients told us that staff were always visibly present throughout the service.

Clients told us that the internal environment was clean, well-decorated and maintained, and homely. However, they told us that the outside space felt bare and underdeveloped, although most clients noted that the garden had very recently been improved by a professional gardener. Clients told us they could lock their bedroom doors from the inside, but not from the outside. However, clients said that staff kept their valuables securely at the nurse's station.

Clients told us activities were discussed as part of the care and treatment provided at the service. Clients told us about activities they were involved in, including therapeutic groups such as walk and talk, client-led yoga, and a nutrition group. However, most clients told us that exercise opportunities and physical activities were lacking on-site and off-site, and without these, they were sometimes feeling bored and physically idle throughout their care and treatment at the service. Clients also told us that activity preferences they raised during assessment were not supported as discussed. For example, one client told us that they raised their interest in swimming during the admission procedure but were yet to hear how this would be supported.

Clients told us that the admission procedure was calm and reassuring, in which they all received welcome packs, a meeting with the doctor on the first day, and a second meeting a few days later. Most clients told us how senior leaders were also involved with admission and were understanding and supportive throughout the process. Clients told us they were allowed to access their phone and laptops during their stay, but not during therapeutic sessions. Clients recognised this was different than other rehabilitation services.

Clients told us that there was sometimes a weekly house meeting, but this was very inconsistent and did not follow a standing agenda. We did not find any evidence of a weekly house or community meeting, and senior leaders told us that they did not take place due to client preferences.

Clients were less positive about the food in the service, stating it was repetitive with minimal choices, poor quality on the weekends, concerns around the undercooking of meat and a high quantity of food waste. Clients told us to mitigate this, they were ordering a lot of takeaways, and one client had been making a cooked breakfast for all clients, once a week at the weekend. Clients told us that a regular community meeting would provide them with a space to discuss the food and drink offered at the service and discuss any concerns.

Throughout our inspection, we saw positive interactions between staff and clients. Staff members were observed to be compassionate, approachable and proactive in offering support. Observed group sessions were delivered with clarity and confidence and facilitators encouraged natural and open engagement from clients. Clients told us they were provided with accessible and topic specific handouts following sessions.

However, while the people we spoke with expressed that they were happy with their care, our assessment found that multiple elements of care and treatment at the service did not meet the expected standards. This will be discussed throughout the report.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

The service did not admit clients under the Mental Health Act 1983. All clients were self-funded.

Although the service did not admit clients under the Mental Health Act 1983, many people in residential substance misuse services have co-occurring mental health conditions (dual diagnosis) or mental health needs, where referral for assessment under the Mental Health Act may be required. Staff did not have appropriate training and knowledge on how to support a client whose mental health was deteriorating in order to refer the person to crisis mental health services if needed.

Senior leaders told us they weren't aware of advocacy support available, and the service did not display information on advocacy services. However, clients could access this information through their client information pack that is provided as part of their admission.

Mental Capacity Act

Most staff had a limited knowledge and understanding of the Mental Capacity Act 2005. The service employed 13 members of staff, and only 2 of these staff had received training in the Mental Capacity Act 2005. There was no date of completion for both staff, so we were unable to check whether this was within date. The provider had booked 8 members of staff onto this training, but the date for this was not documented. Additionally, the Registered Manager and Nominated Individual had not completed or been booked to receive this training. Clients who access residential substance misuse services can have fluctuating or impaired capacity when under the influence of substances. Staff working in substance misuse services should have received training in the Mental Capacity Act 2005 to ensure they have appropriate knowledge to undertake mental capacity assessments for clients who may have impaired capacity and will need to consent to a variety of decisions, including consent to detoxification, substitute prescribing, unplanned exits from treatment and sharing of information.

The provider had a policy on the Mental Capacity Act. However, we found no evidence that staff were aware of the policy and had access to it. The policy had a read and sign sheet at the front of the policy, which no members of staff had signed.

The service did not have arrangements in place to monitor adherence to the Mental Capacity Act. There were no audits in regard to application of the Mental Capacity Act and no evidence of lessons learned.

In the 7 care records we reviewed, staff recorded capacity to consent to treatment & sharing of information. This was completed comprehensively and all had client's electronic signatures.

Key Question Summaries

This was the first assessment for this newly registered service. We found multiple concerns during the assessment across all five domains. We informed the provider of our serious concerns during and immediately after this assessment. We sent a letter of intent (notice of CQC's intention to take urgent action) to the provider about our concerns in relation to; the model of care, inclusion and exclusion criteria, outcomes measures, discharge planning, safeguarding, risk management of clients, policies and procedures, incidents and complaints, safe staffing, security of premises, fire safety, governance and the directors. The provider sent us an action plan to address our concerns, and to provide assurances of how the risks identified have already been removed or are immediately being removed within a certain timeframe.

We have also taken other enforcement action concerning breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served a warning notice around the safe management of medicines.