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 concerns that we found in April 2025 had not been sufficiently addressed and remained in place.

The service did not always ensure assessments, including risk assessments, were completed and updated in a timely manner, and some key information was missing. Staff compliance with training related to substance misuse services was very low. The service did not use audits effectively and had not created or implemented several audits, as indicated in their action plan. The service did not have clear outcome measures to ascertain successful treatment and did not regularly analyse outcome data.

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.

In April 2025 we identified several issues relating to the assessment of need. These issues were in the timeliness of assessments on admission, including risk, physical health and mental health assessments. We saw examples of missing information from assessments which could have resulted in avoidable harm. Not all staff had received training in working in substance misuse services. There was a lack of embedded audit that could be used to identify areas of improvement. The service planned to address this by making the admission policy and decision making around admission more robust, auditing admissions to ensure necessary paperwork was present, and assessing competencies and training needs. During this assessment, we found these actions had not taken place. The admission policy remained unclear about the process to follow when a patient met the exclusion criteria and stated the registered manager could make a final decision about admission, although they did not have the appropriate clinic training and competencies to do this. We saw records of 5 clients who had been admitted without their GP summary being available, and some went on to have hospital admissions due to physical health deterioration. The service had not created or implemented any audits around admission paperwork and practice. Staff had not received training in supporting people receiving care for substance misuse. Only 2 of 4 staff involved in admissions had their competencies around admissions assessed.

There was limited or no record of multidisciplinary team discussion around admissions, including those with complex needs.

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.

Staff used the NEWS2 scoring system to monitor clients’ physical health regularly.

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 Drug misuse and dependence: UK guidelines on clinical management and National Institute for Health and Care Excellence. The documentation around the model of care had been updated to indicate that a doctor was not on site at all times.

The service provided individual and group therapeutic intervention as well as therapeutic activities such as a walk and talk group, nutrition group and a client led yoga group. The lead therapist who had devised the therapeutic programme and led on delivering it was leaving the service in the two weeks after the inspection and the service did not have a clear plan in place to minimise disruption to clients and ensure continuation of care.

In the 9 care records we looked at, 3 clients did not have evidence of care plans. Good practice indicates that care plans are important to outline how staff can support clients to have safe and effective care. Care plans can identify agreed upon goals, include a person's strengths and should be developed jointly with them. Without a care plan, the service cannot demonstrate how they are identifying and meeting the needs of individual clients. For 2 clients, these care plans were created 6 days after their admission, which meant staff would not have a clear and consistent plan of support before this time.

Clients were not offered routine screening for blood borne viruses, which NICE guidelines state that services should focus on. The service did not offer routine pregnancy tests for clients who may need one.

At the inspection in April 2025, we identified 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. During this inspection, we saw there had been no change to this, and no evidence of consideration of this by the service.

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.

At the April 2025 inspection, we identified that staff participated in some audits, but these were not completed correctly, routinely or in a timely manner. During this inspection, there was no evidence that this had been addressed. There were no audits available.

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, or peer support workers, which would support holistic rehabilitation.

The service held monthly team meetings and fortnightly therapy team meetings. Staff also had a daily handover meeting when shifts changed. At the assessment in April 2025, we found that meeting minutes did not contain sufficient information for staff to read, understand, make any improvements, or to check back that actions had been made. Handover minutes did not make clear how identified risks and actions were updated on patient care records or assigned to staff to ensure they took place.

During this assessment, we found no consistent improvement to minutes, including handovers. The action plan outlined that the registered manager would hold two team meetings per week, to discuss any changes to existing policies and practice. We saw evidence of only three meetings taking place between 29 April and 8 July 2025.

The service aimed to provide facilities and activities to support people to live healthier lives. There was a large garden for clients to use, and this had a table tennis table available. One of the therapists also led a weekly yoga session. There was a walk and talk group for clients to participate in, and staff said they would risk assess if someone was able to go out jogging. Therapy staff said they asked about activities that people enjoyed and tried to support them to continue to access these.

The service contracted services of a nutritionist, who could come to the service once a week.

The service did not provide information about the other ways it could have supported clients to live healthier loves. For example, through participation in smoking cessation schemes, managing cardiovascular risks, or national screenings for cancer.

The service had an outcomes policy in place, although this did not have a date of creation or commencement. There was no evidence available that this had been shared with staff to ensure they were aware of the policy.

Although staff used a range of recognised rating scales to assess and record the severity of clients’ conditions at admission and at different times during their treatment, this was not done consistently. We saw that staff used tools including the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to assess and monitor the severity of alcohol withdrawal symptoms, the Severity of Alcohol Dependence Questionnaire (SADQ), to assess the severity of psychological and physical dependence on alcohol and the Recovery Assessment Scale with 41 items (RAS-41), to measure progress in recovery. We also saw that staff used the Malnutrition Universal Screening Tool (MUST) to assess if clients were malnourished or at risk of malnutrition.

The service did not use data from outcome measures well, in order to monitor successful treatment and drive service development and improvement.

Following the April 2025 assessment, the service action plan outlined that the leadership staff would create and implement a weekly outcomes audit, as well as include this as a topic in a monthly governance audit. During this inspection, there was no evidence that this audit documentation had been created, and no evidence that any audits had been carried out.

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

Staff recorded capacity to consent to treatment and sharing of information for all 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.

In our April 2025 assessment, we found the service had multiple blanket restrictions in place which were not clearly documented in the client’s treatment agreement. During this inspection, there was no evidence that the service had put in place actions it had outlined to address this. There was no signage to detail the restrictions in place or explanations to why, and we could not see evidence that restrictions or prohibited items were discussed with clients during their admission.