All inspections: Cocoon Residential Rehab

Cocoon Residential Rehab is a 9- bedded residential substance misuse service based in Hemel Hempstead. At the time of our inspection the provider name was changing from Drug Link to Cocoon Support Limited and the service name was changing from Oxygen Recovery to Cocoon Residential Rehab.

The service provides detoxification and rehabilitation for both males and females. Cocoon Residential Rehab provides medically monitored detoxification and therapeutic interventions to support people in their recovery.

Cocoon Residential Rehab is registered with Care Quality Commission to provide:

Treatment of disease, disorder or injury.
Accommodation for persons who require treatment for substance misuse.

We carried out an unannounced inspection on 12 May 2026. At the time of inspection there was a registered manager in post. We previously inspected the service in 2022 and rated the service as good. There were no breaches at the last inspection. However, the provider were told they should ensure that staff and volunteers receive regular supervision, infection prevention and control risk posed by the toilet in the clinic room should be rectified and leaders should ensure staff are up to date with mandatory training.

At this inspection we rated the service as requires improvement. Following inspection on 12 May 2026, the CQC sent a Letter of Intent to the service. This meant we considered using potential enforcement action. We asked the service to send an urgent action plan of how they would improve patient safety. Following review of the action plan, a warning notice was served on the provider. This was due breaches of regulations 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We also found 3 breaches that did not require immediate action. This included a breach of regulation 9 (person centred care), regulation 18 (staffing) and regulation 20 (duty of candour).

Mental Health Act and Mental Capacity Act Compliance

People had mental capacity assessed at assessment. We found staff had requested a mental capacity assessment for a person that was due to be discharged from treatment.

Cocoon Residential Rehab is a 9- bedded residential substance misuse service based in Hemel Hempstead. At the time of our inspection the provider name was changing from Drug Link to Cocoon Support Limited and the service name was changing from Oxygen Recovery to Cocoon Residential Rehab.

The service provides detoxification and rehabilitation for both males and females. Cocoon Residential Rehab provides medically monitored detoxification and therapeutic interventions to support people in their recovery.

Cocoon Residential Rehab is registered with Care Quality Commission to provide:

Treatment of disease, disorder or injury.
Accommodation for persons who require treatment for substance misuse.

We carried out an unannounced inspection on 12 May 2026. At the time of inspection there was a registered manager in post. We previously inspected the service in 2022 and rated the service as good. There were no breaches at the last inspection. However, the provider were told they should ensure that staff and volunteers receive regular supervision, infection prevention and control risk posed by the toilet in the clinic room should be rectified and leaders should ensure staff are up to date with mandatory training.

At this inspection we rated the service as requires improvement. Following inspection on 12 May 2026, the CQC sent a Letter of Intent to the service. This meant we considered using potential enforcement action. We asked the service to send an urgent action plan of how they would improve patient safety. Following review of the action plan, a warning notice was served on the provider. This was due breaches of regulations 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We also found 3 breaches that did not require immediate action. This included a breach of regulation 9 (person centred care), regulation 18 (staffing) and regulation 20 (duty of candour).

Mental Health Act and Mental Capacity Act Compliance

People had mental capacity assessed at assessment. We found staff had requested a mental capacity assessment for a person that was due to be discharged from treatment.

Oxygen is a nine-bedded residential drug and/or alcohol, medically monitored detoxification and rehabilitation facility based in Hemel Hempstead, Hertfordshire. Oxygen provides ongoing abstinence-based treatment, which includes group therapy, individual counselling and support in life skills.

Our rating of this location stayed the same. We rated it as good because:

The service provided safe care. The premises where clients were seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training and appraisal. Staff worked well together as a multidisciplinary team and relevant services outside the organisation.
Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
The service was well led, and the governance processes ensured that its procedures ran smoothly.

However:

There was a toilet that was used for urine testing in a side room attached to the clinic room. There was medical equipment stored in boxes in the room and there was not a cubicle around the toilet. This meant there was a potential infection prevention and control issue.
Staff did not receive regular management supervision in line with the service policy. We reviewed the supervision records of 7 staff for the past year. We found that 5 staff had not received 6 supervisions a year, as per the service policy.

We rated Oxygen as good because:

• Rooms and furnishings in areas accessed by clients were clean and well maintained.

• The service was fully staffed at the time of inspection. Staff absences were planned for in advance and were managed effectively.

• All clients had an initial risk assessment, risk assessments were comprehensive and regularly updated.

• The service had a clear medicines management process in place, all medication was stored appropriately. Medication was audited regularly.

• Trained staff completed blood pressure checks, breathalysing, and urine drug screening at regular intervals.

• Staff reviewed and updated individual care plans regularly. Care plans were personalised, recovery orientated, holistic and looked at areas of strength. All clients we spoke with said they were involved in their care plan.

• Staff used recognised monitoring forms to record and assess client withdrawal, outcomes and strengths as recommended in drug misuse and dependence: UK guidelines on clinical management.

• All staff, including volunteers received a thorough induction, all eligible staff were being supervised and appraised. Staff had access to regular team meetings and daily handovers. Staff could access additional and specialist training to support them in their role.

• The service held weekly house meetings where clients were encouraged to raise any issues with staff. Staff welcomed feedback from clients using the comments box or weekly house meetings.

• Staff morale at the service was high. Staff told us that they felt valued and supported within their roles.

• We saw evidence of recruiting from within the service and internal promotion. Staff felt able to input into developments within the service.

However:

• The blood pressure machine had not been calibrated.

• Staff were not wearing their lanyard alarms in line with the providers lone-working policy.

• Toilets and bathrooms were mixed sex and not designated male or female. Risk assessments did not clearly indicate if the risk of being in mixed-sex accommodation had been considered and male and female bedrooms were located next to each other.

• Naloxone was stored in a locked cupboard within the clinic room and was not accessible immediately in an emergency.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

All clients had an initial risk assessment. Risk assessments were comprehensive and updated regularly and following incidents. Staff completed comprehensive admission assessments for each client.
The service manager completed environmental risk assessments, including ligature audits.
Key workers allocated weekly one-to-one time with clients. Staff documented interactions with clients in treatment records.
All staff had completed a comprehensive induction. Staff had access to specialist training.
Staff undertook physical health checks prior to client's starting detoxification, and regularly throughout. Clinical assessments, case notes and discharge summaries were comprehensive. Clients accessing treatment were temporarily registered with the local GP surgery and dentist for any healthcare needs.
Care plans were reviewed and updated weekly. Care plans were holistic, personalised, recovery orientated and looked at a client’s areas of strength.
Staff had access to weekly team meetings and clinical meetings and daily handovers.
Oxygen provided follow on support for clients who had completed their treatment programme. Clients who had completed treatment had the opportunity to live at move on housing and attend the service for additional support. All clients were contacted following discharge.
We observed staff interacting with clients in a kind, considerate and caring manner. Clients we spoke with told us staff were interested in their wellbeing and that staff were respectful, polite and compassionate. Clients felt involved in their care.
Families could be involved in treatment with client agreement.
The provider rarely cancelled appointments or groups due staff shortages or sickness.
We saw comfortable dining areas. Snacks and hot or cold drinks were available at all times. Clients were encouraged to take responsibility for therapeutic duties.
The service had not received any formal complaints since June 2015, clients we spoke with knew how to complain.
We saw thank you cards and letters displayed on the information board from clients who had successfully completed treatment.
Staff turnover and sickness levels were low. Staff morale at the service was high. Staff told us that they felt valued and rewarded for the job they did. We saw evidence of recruiting from within the service. Staff felt able to contribute to developments within the service.

However, we also found the following issues that the service provider needs to improve:

The clinic room temperature was not recorded. The fridge in the clinic room was used for staff lunches and not as a clinic room fridge, there was no medication that required refrigeration at the time of inspection. We saw disposable cups in the sink within the clinic room that were being reused. Staff could not confirm if they were used for giving clients medication or for urine testing.
The service had nine single bedrooms, all of which were unisex and risk assessments did not include the risk of shared sex accommodation. Bathrooms were not designated for males or females.
Only one member of staff was allocated to an overnight shift which both staff and clients felt was unsafe. Clients we spoke with said if there was an issue with the staff member they would need to exit the building to summon help as clients did not have access to phones or alarm systems.
Staff did not transport medication to other sites in lockable transportation bags.
The service did not have a standardised way of reporting incidents. We saw incidents reported on incidents templates, by email and on word documents.
Staff were not being supervised regularly in line with the provider’s supervision policy.
Clients felt the house rules, confidentiality and information sharing should be revisited a week after admission as there is a lot of information given to them on admission and they may have been under the influence of substances on admission.
There was a lack of 1:1 space available.

Cocoon Residential Rehab

All Inspections

During an assessment of Substance misuse services

During an assessment of the hospital overall

07 September 2022

During a routine inspection

15 August 2018

During a routine inspection

07 December 2016

During a routine inspection