Cocoon Residential 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

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 as good. At this assessment the rating has changed to requires improvement.

We found a breach of regulation 12 in relation to safe care and treatment. Risk assessments were not completed in a timely manner on admission and risk management plans were not completed. People in treatment did not always have care plans in place. Prescriber appointments were online and people did not see a prescriber face to face during their time in treatment. Rating scales used to monitor risk of withdrawal were not used in line with policy. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

However, people had completed consent to treatment on admission. There was a group and activity timetable in place.

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.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Managers did not ensure comprehensive risk assessments were completed in a timely manner on admission or that risk assessments were regularly updated. We reviewed 2 care records onsite and 3 after inspection. We found that risk assessments were not updated on admission, after the pre-admission risk assessment. One risk assessment we reviewed was blank and had not been updated during treatment. We reviewed another risk assessment and found the risk management plan was blank. Failure to assess, review and develop a risk management plan means that person centred care and risk management was not in place and puts people at risk of avoidable harm. Following our inspection, leaders ensured all risk assessments were reviewed.

Managers did not have oversight of care planning. In the care records we reviewed, we found care plans were not present and up to date. A person we spoke to told us they did not have a care plan in place. Following our inspection, we requested all care plans and all people in treatment had a care plan in place.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care and treatment did not always meet people’s needs. Cocoon Residential Rehab was a medically monitored facility and people were assessed online on admission by a GP with Specialist Interest in Addiction. People were not seen face-to-face by a prescriber during their treatment and there were no nurses on site. We raised concerns with the provider about lack of face-to-face prescriber appointments and clinical oversight. The provider implemented an action plan and processes were reviewed to include escalation to a face-to-face prescriber appointments, where remote prescribing did not assure clinical safety. This included concerns around withdrawal or overdose risk.

People told us that there was a silent approach to therapy, where they sat in silence when people didn’t talk. People told us this made them feel uncomfortable and did not feel beneficial.

There was a group and activity timetable. This included National Institute for Health and Care Excellence (NICE) recognised treatment interventions, such as group therapy, relapse prevention and cocaine or narcotics anonymous. Staff told us that morning group sessions were unstructured therapy sessions and afternoon sessions were cognitive behavioural therapy (CBT) based treatment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Leaders did not ensure appropriate meetings were held for the service. There limited was evidence of meetings being held, where risk could be discussed across a multi-disciplinary team. We reviewed clinical meeting minutes for February and May 2026. Attendance to these meetings was low with only 2 members of staff attending. The meeting agenda included referrals, admission, client review, safeguarding and health and safety. There was only evidence that clients in treatment had been discussed. There was no evidence of referrals, new admissions or safeguarding were reviewed. It was unclear how any concerns relating to referrals, new admissions and safeguarding were safely managed and shared with the wider team.

We reviewed a full team meeting for April 2026. The team meeting agenda included staff training, staffing updates, works to the property and annual leave. However, meeting minutes were brief and there was only evidence of a mock CQC inspection being discussed.

We reviewed handover meeting minutes and found identified risks were not always documented. Handover meeting minutes for 1 person in treatment had no identified risks and no action plan to reduce risk. Therefore, it was not clear how information about risk and mitigation was shared between staff. However, other people in treatment had risks identified and an action plan in place. For example, where a person was diagnosed with epilepsy, the risk management plan included confirming medication doses, creating a seizure management plan and staff to be briefed on what to do if a seizure occurred. It was not clear if these actions had been completed.

Staff updated other services when people were discharged from treatment. We found detailed discharge reports had been sent to some external agencies, such as funders.

We scored the service as 2. The evidence showed some shortfalls. The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We did not always see evidence of people being supported to live healthier lives. In care records we reviewed we did not see evidence of people being supported with blood borne virus (BBV) testing or smoking cessation. One person told us they did not feel supported with accessing a GP appointment, which took 7 weeks to arrange.

People told us activities were limited at the weekends and sessions, such as meditation or acupuncture were not available. People also told us that access to the gym was limited to half an hour, which also included time to get changed.

However, people we spoke with told us there were sessions available, such as art groups, daily walks and yoga. People also told us they were supported with food shopping by a senior peer.

The service were part of a condom distribution service.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to support people in their recovery, however they were not always used as per policy. For example, the services alcohol detox policy stated that Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) should be completed 3 times per day for the duration of detox. CIWA-Ar is a ten-item scale used to assess withdrawal from alcohol. In care records we reviewed, we found CIWA-Ar was not always completed 3 times per day during detox. Close monitoring of CIWA-AR during detox can help identify alcohol withdrawal and ensure safe care and treatment.

Staff used Alcohol Use Disorder Identification Test (AUDIT) to identify an alcohol use disorder and Severity of Alcohol Dependence Questionnaire (SADQ) to determine the severity of dependence.

There were no people receiving an opiate detox at the time of our assessment. Staff told us that tools such as Clinical Opiate Withdrawal Scale (COWS) would be used to monitor withdrawal for people having an opiate detox.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

In care records we reviewed we found that people had given consent to treatment. We also found that a capacity assessment had been completed. This ensured people could make their own decisions about treatment.