TLC Rehab

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

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. This key question has been rated requirements improvement. This meant the effectiveness of people's care, treatment and support did not always achieve good outcomes or was inconsistent. We found breaches of regulation in relation to this key question.

The service did not carry out risk assessments in a timely manner, and some key information was missing. Staff compliance with training related to substance misuse services was very low. Staff provided some care and treatment interventions suitable to the needs of most clients. However, the service did not provide enough opportunities for physical exercise. The service carried out some audits, but these were not always completed correctly or in a timely manner. Team meetings and shift handovers did not always share comprehensive information or indicate appropriate actions that needed to be taken by the service to support risks. The team did not have effective working relationships with other relevant teams outside the organisation, for example, the local authority. Although the service used recognised rating scales, the outcome of these tools was not used to form recovery care plans for any of the clients. The service did not have clear outcome measures to ascertain successful treatment. Staff recorded capacity to consent to treatment and sharing of information for all clients.

We have not awarded this service a score for Effective.

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

The service did not maximise the effectiveness of people's care and treatment by assessing and reviewing their health, care, wellbeing and communication needs in good time.

We reviewed the care records for all 7 clients' residing at the service. Staff completed a variety of risk assessments for all clients. However, for one client who had been at the service for 12 weeks, they only had a mental health assessment on file two months after admission.

Assessments included an overall risk assessment, drug/alcohol assessment, physical health assessment and mental health assessment. All clients had brief plans around unexpected exits, motivation to change, harm reduction advice, recovery and aftercare. We saw key pieces of information missing from multiple assessments which could have resulted in avoidable harm. For example, from one clients risk assessment, there was no information about why risk had increased and what the plan was to address the risk. One client was identified as alcohol dependant, however there was minimal information on their alcohol history and no documents were found in their alcohol section. Where one client had past suicidal thoughts, there was limited information about this, no evidence that this client had been referred for specialist mental health support or how his current mental health was being supported in their care plans.

Not all staff had received training in working in substance misuse services. Four of 12 staff had completed e-learning in alcohol and drugs and only 2 of 12 staff had completed a variety of substance misuse sessions, and all other staff were only booked on, but no dates were documented. The remaining staff had not received any specialist training. This meant there was a risk that staff were not adequately trained to meet the needs of the clients. The service has been operating for nearly 7 months, and thus appropriate training has not been offered in a timely manner.

Staff assessed client's core physical health needs on admission, and this was reviewed throughout their stay. This included an assessment of temperature, pulse, blood pressure, weight, a breathalyser and urine test. If any further physical assessment or tests were required, clients needed to access a walk-in centre, or A&E department, or register temporarily with a local GP. Electrocardiograms (ECGs) were not conducted by the service. There were no clients who were prescribed methadone, as the service would usually prescriber buprenorphine. If an ECG was needed, the service stated they would take the client to the hospital.

The service completed some audits of care records. This included weekly audits on detox records and therapy records. We could see that the new governance manager had ideas on future audit systems, but they were very new to the service, and this was in the early stages, and not yet embedded.

The service did not always plan and deliver people's care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided some care and treatment interventions suitable for most of the clients. The care and treatment interventions that TLC Rehab offered were medically monitored pharmacological detox regimes for alcohol, opiate and benzodiazepines addictions, group based psychosocial interventions based around the 12-step principles and one-to-one counselling. These interventions were those recommended by guidance from the National Institute for Health and Care Excellence. However, whilst the service conducted multiple assessments around admission, all clients had very brief plans around motivation to change, harm reduction advice, recovery and aftercare. Clients were not offered routine screening for blood borne viruses, which NICE guidelines state that services should focus on.

The service aimed to deliver a programme that was more personalised than a generic 12-step programme. Staff said that the therapy team were still working on what this will include. We did not see evidence of co-ordinated care or collaboration with mental health services for this client or useful care and treatment interventions.

The service provided some therapeutic activities such as a walk and talk group, nutrition group and a client led yoga group. However, there was a blanket restriction for all clients on kitchen access. All clients were low risk, and the service hoped to focus on rehabilitation and support with life skills, and a restriction on kitchen access did not seem to support this model of care. Additionally, clients did not have access to opportunities for regular physical exercise. Clients told us that they thought this was provided at the service, as discussed at admission, but they had little opportunity to engage in physical exercise.

Clients' physical healthcare was managed by their GP. Staff assessed client's core physical health needs on admission, and this was reviewed throughout their stay. This included an assessment of temperature, pulse, blood pressure, weight, a breathalyser and urine test. If any further physical assessment or tests were required, clients needed to access a walk-in centre, or A&E department, or register temporarily with a local GP. For one client, we found that staff had responded slowly to their physical health needs around venous ulcers, which had resulted in a deterioration of this issue. The client stated there was a lack of staff and unclear procedures, which led to a delay and caused the client pain and complications.

Staff assessed clients' needs for food and drink and for specialist nutrition and hydration. We saw evidence that staff used the Malnutrition Universal Screening Tool (MUST), to assess if clients were malnourished or at risk of malnutrition. Where malnutrition was identified we saw that staff had documented to provide the client with high calorie and high protein shakes.

Staff participated in some audits, and quality improvement initiatives, however they were not completed correctly, routinely or in a timely manner. For example, the monthly medicines audit had only been completed once, despite the service being open for 8 months. The weekly health and safety audit stated that all fire equipment was in working order, however no checks had been completed on any fire safety systems or equipment since the service registered in September 2024. The service also carried out audits on one client file week, but this was also not completed regularly.

Although the team included or had access to most specialists required to meet the needs of clients in the service, clients did not have access to occupational therapists, social workers, dieticians, or peer support workers, which would support holistic rehabilitation. A doctor was used as and when required and was not part of the core staff team. Nurses provided 24/7 care, and other professions such as counsellors and health care assistants made up the staff team.

The service did not work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

The service held monthly team meetings and fortnightly therapy team meetings. We reviewed the last three-monthly team meeting minutes. The meeting had a standing agenda with items such as incident reporting, concerns, complaints and compliments, learning from audits and policy discussion. However, the information noted throughout was basic and did not contain sufficient information for staff to read, understand, make any improvements, or to check back that these actions had been made.

Staff shared information about clients at handover meetings within the team (for example, shift to shift), using a template specific to the service. When reviewing a recent handover note, it was not clear how identified risks and actions were updated on patient care records or assigned to staff to ensure they took place. For one patient, they had been expressing suicidal ideations in their daily journals, but there were no clear actions that had been taken by the service to support and manage this.

The team did not have effective working relationships with other relevant teams outside the organisation (for example, local authority social services). We did not see any evidence that the service had any communication with the local authority and had made no safeguarding referrals to the local authority since they registered as a service in September 2024.

Staff did not always direct clients to other services when appropriate and, if required, supported them to access those services. For example, we saw one client who was not receiving a detox regime or attending the psychosocial group sessions. They did not meet the inclusion criteria for the service, and the service did not support him to access a service that was more appropriate to meeting his mental health needs. However, one client told us that the service supported him to treat a swallowing difficulty.

The service did not always support people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported clients to live healthier lives. For example, there was a daily walk and talk group, and nutrition group. However, clients noted that there were not enough opportunities for physical exercise, specifically on-site gym equipment or supported access to a gym off site. Clients also noted that they were not involved with cooking their meals and had restricted kitchen access despite being low risk in a kitchen environment. There was multiple client complaints noted about poor quality and poor variety of food, and that clients were mitigating this by buying takeaways.

Additionally, we saw no evidence of the service supporting clients through participation in smoking cessation schemes, managing cardiovascular risks, or national screenings for cancer.

We saw evidence that staff had supported clients to access physical health care, including attending accident and emergency, however we also saw evidence where there were delays in this, which led to a deterioration in the client’s health. Additionally, one client had venous ulcers, and we saw no evidence that the staff supported the client to procure appropriate dressings, or to see an appropriate specialist.

The service did not routinely monitor people’s care and treatment to continuously improve it.

Staff used recognised rating scales to assess and record the severity of clients’ conditions at admission. For example, staff used the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to assess and monitor the severity of alcohol withdrawal symptoms and used the Severity of Alcohol Dependence Questionnaire (SADQ), to assess the severity of psychological and physical dependence on alcohol. We also saw that staff used MUST to assess if clients were malnourished or at risk of malnutrition. However, the outcome of these tools didn’t translate into any recovery plans of care for any of the clients at the service.

The service did not have clear outcome measures to ascertain successful treatment. Clients were privately funded, and it was unclear why some clients who completed treatment, returned to the service the following week. One client had been at the service for 12 weeks, with no clear evidence of why they remained at the service for treatment.

The service did not always tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff recorded capacity to consent to treatment sharing of information for all 7 clients residing at the service. This was completed comprehensively and all had client’s electronic signatures. There were no capacity assessments on file, as all clients were presumed to capacity.

The service had multiple blanket restrictions in place, which were not clearly documented in the client’s treatment agreement, including restricted kitchen access.