TLC Rehab

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• 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 requires improvement. At this assessment the rating has remained requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 4 care and treatment records and found that comprehensive assessments of substance use had not been completed for every client. In 3 records staff had not explored clients’ previous treatment history. There was no evidence of assessing any of the clients’ blood borne virus (BBV) status. For 2 clients admitted for alcohol treatment, there was no evidence of relevant blood tests such as liver function tests being obtained prior to admission, despite one of these clients reporting that they had liver cirrhosis. For one client, staff had made an initial assessment of their needs, but had not identified or acted upon the impact of their inappropriate behaviour on other clients. Several clients told us it made them uncomfortable and impacted their own experience of the service, but this had not been managed appropriately by the service.

The service used a global risk stratification tool for client risk assessments, rating the risk as low, medium or high overall and assigning the frequency of review accordingly. This included individuals who were at risk of suicide or deliberate self-harm. This was not in line with national guidance, which advises not to use risk stratification to predict future suicide or the repetition of self-harm.

The admission policy stipulated the criteria for when clients must be assessed face-to-face prior to admission. In 1 care record it was not clear if the client had been assessed remotely or face-to-face because staff recorded both options in the assessment form. There was limited evidence of a full physical health assessment on admission in the care records we viewed.

Since our last inspection in July 2025, we saw improvement in staff considering whether the service could safely meet a person’s needs. The service had declined a number of referrals due to recognising they could not safely meet those clients’ needs. The service referred clients to more appropriate care where possible. For example, 2 people were referred to the emergency department at a local acute hospital. However, during our assessment, we saw 2 clients had still been admitted to the service despite meeting its exclusion criteria. This remained an area for the service to address.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service offered care and treatment interventions suitable for the client group. These were medically assisted detoxification treatment for alcohol, opiates and non-opiates, and psychosocial interventions which included group and individual therapy. The interventions were those recommended by guidance from the National Institute for Health and Care Excellence (NICE).

Feedback from most clients about the one-to-one therapy sessions was very positive. They described staff delivering these and impact of the sessions as ‘amazing’. However, 3 clients said the difference in therapeutic style of the staff delivering group work caused some confusion and lack of consistency across the groups and one-to-one sessions. Managers we spoke with acknowledged the limitations of the current therapy programme and told us about plans to improve it.

The service had now developed and implemented a range of clinical audits. These included audits of care records, admissions, incidents, concerns and complaints, health and safety compliance, food safety, discharge planning, medical equipment and medicine management. These audits identified actions that were linked to an action plan and marked as completed in the audits we looked at. The service had commissioned a full service audit in November 2025. However, due to the ongoing lack of clinical leadership, there were limitations to how the service could use the results of clinical audits to measure and improve the effectiveness of the treatments it provided.

In most care records we viewed, there was limited evidence of regular medical and prescribing reviews.

Whilst internal meetings had improved, some were still not taking place regularly or with the correct attendees.

The service held daily flash meetings and monthly team meetings, although monthly meetings had not taken place every month due to the recent high staff turnover. We observed a flash meeting where staff discussed and shared information about each client effectively. There were also managerial and clinical governance meetings. Managers explained that the previous plan to hold fortnightly meetings had not worked due to the relatively small team size. Meetings were now minuted and minutes were available to staff on a shared drive.

The doctors working for the service did not routinely attend team meetings. This limited information sharing and discussions about patient care and clinical decisions.

The service did not regularly work with external teams or organisations.

Whilst clients were offered healthy food and some activities, the service did not always actively support people to live healthier lives, or where possible, reduce their future needs for care and support.

Sessions that were on an activity timetable were not taking place regularly. This included a weekly yoga class and a daily walking group. Clients told us the yoga teacher had not attended in several weeks and the daily walk did not take place. They said this would be valued. Clients and some staff said that the physical exercise on offer was limited and thought that clients would benefit from more physical activity.

The care records we reviewed showed that limited harm reduction advice was provided to clients. Staff did not check clients’ blood borne virus (BBV) status and did not always request relevant blood tests for clients whose liver may have been damaged by alcohol use.

The service did not offer clear smoking cessation schemes. The rules and procedures around staff smoking were not clearly available for staff or clients. We were told that 2 clients had increased their smoking or started smoking whilst at the service. The service did not have a clear policy for staff smoking at the workplace, including where this could or could not take place.

The service had a large garden that clients could access at any time. There was seating available for people who wanted to spend time outside.

The service offered a table tennis table in the garden for clients to use. A staff member recently organised a weekly running club for clients who wished to join in. Clients who had attended gave very positive feedback about the benefits.

The service employed a chef to prepare fresh food on site. Clients’ feedback about the chef was extremely positive. The chef recently started making ginger energy shots for clients to support their health and wellbeing. The chef planned healthy meals and adapted these to the needs and preferences of clients.

The service routinely used outcome measures to monitor people’s progress.

We reviewed 4 care and treatment records and saw evidence that staff used recognised rating scales, such as the Alcohol use disorders identification test consumption (AUDIT-C) and the Severity of Alcohol Dependence Questionnaire (SADQ).

The service had now started monitoring client outcomes. We viewed a quarterly audit of outcome measures including the World Health Organisation Wellbeing Index (WHO-5), the generalised anxiety disorder assessment (GAD-7), depression assessment (PHQ-9), length of stay and treatment goals. The service had identified an area for improvement which was to ensure higher compliance with completing outcome measures on discharge.

A lack of clinical leadership limited the service’s ability to use data from outcome measures to monitor treatments and drive continuous improvement.

Whilst the service had trained staff to apply the Mental Capacity Act, there were concerns about its use in practice in the service.

In the care records we reviewed, we saw evidence that staff had assessed clients’ mental capacity and documented consent, confidentiality, and information sharing.

Compliance with Mental Capacity Act training was 80%. However, only 60% of staff had completed training in consent for health and social care.

One client was assessed as having the capacity to decide on admission to the service, but their capacity to make other ongoing specific decisions was queried by some staff. We heard concerns from staff and other clients that the needs of this client exceeded those that the service was able to support safely. We raised this as an area for the service to address immediately during our assessment.