The Lighthouse

We rated The Lighthouse as requires improvement because:

• The provider’s governance systems for assessment, monitoring and mitigating risk in the service were not fully effective. We identified issues relating to the environment, risk assessment of clients, staffing checks and sharing learning with staff following incidents. The provider had not completed an action from our 2018 inspection relating to ligature assessment. Managers did not fully investigate incidents and share lessons learned with staff. Additionally, we could not find evidence that the provider had notified the CQC of an incident. The provider’s admission and exclusion criteria did not show how they had fully considered the Equality Act 2010 .
• Staff had not updated four out of six clients’ risk assessments we checked. Staff had not thoroughly assessed three clients’ alcohol dependence and severity in line with National Institute for Health and Care Excellence CG115 alcohol assessment guidance before treatment started. Staff did not develop a specific risk management plan for clients identified as being at risk that included a plan for unexpected exit from treatment.
• The provider’s recruitment checks did not effectively demonstrate that they were consistently checking that staff were experienced, competent, and had the right skills and knowledge to meet clients’ needs. The provider had not ensured that 50% of eligible staff had received an annual appraisal.
• Staff could not describe how treatments and care for clients were based on national guidance and best practice such as National Institute for Health and Care Excellence. The provider did not have audits or outcome measures to demonstrate that the treatment and therapy programme was effective.
• The provider did not have a robust plan in place for household waste collection as due to bank holidays, the contractor had not collected it. Staff were not always recording cleaning and food hygiene checks.
• The provider’s staff shift rota did not clearly show the number of staff on shift.
• The provider did not provide staff or clients with alarms to call for assistance in an emergency.

However:

• Staff treated clients with compassion and kindness. They respected clients’ privacy and dignity. Clients we spoke with were overall, satisfied with the service provided and said they had opportunities to give feedback on the service.
• Staff said they were proud of their work and the support they gave and received. There was good staff morale. Staff felt respected, supported and valued. Staff had received regular monthly supervision.
• The provider had acted since our last inspection to ensure that clients’ bedroom doors had locks to maintain their privacy, that they had a risk assessment for mixed sex accommodation. They had systems in place for the safe storage and recording of medications.
• The provider had appointed a new manager to improve the running of the service. They had started to review the provider’s systems, policies, procedures and protocols to update them and make them easier for staff to follow.
• The consultant psychiatrist assessed the mental and physical health of clients on admission. Staff offered clients person centred and integrative counselling and therapy such as cognitive behavioural therapy. Staff supported and encouraged clients to live healthier lives though yoga sessions and opportunities to attend a local gym. The provider offered clients a free aftercare service, usually up to eight weeks. This included groups and telephone support.