ESH Community

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated effective as good. At this assessment the rating has remained good.

This meant people were supported and treated with dignity and respect; and involved as partners in their care.

People consistently received care that was compassionate, respectful and recovery focused. Staff were empathic and non‑judgemental, and people told us this helped them feel understood, supported and treated with dignity throughout detoxification and recovery.

People were fully involved in their care and treatment, with families and carers appropriately involved where consent was given, which was reflected in the care records we reviewed. The service also demonstrated a strong commitment to sustaining recovery by maintaining contact and offering support after discharge, including for people who chose not to take up the full aftercare programme.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

Staff consistently demonstrated a deep understanding of people’s emotional and psychological needs, particularly during detoxification and early recovery, and responded in a calm, reassuring and non‑judgemental way.

We spoke with 4 people using the service and 2 relatives. All feedback was highly positive. People described staff as “excellent”, “brilliant”, “very kind” and “understanding”, and told us staff were “always available when you are struggling”. Over the last 6 months, we reviewed feedback from 6 post‑treatment questionnaires, 3 recent online reviews and written compliments, which consistently praised the compassion, patience and emotional support provided. People told us the service “changed my life” and that they were “treated with respect throughout my stay”.

Staff provided clear information, advice and emotional reassurance at the time people most needed it, including during withdrawal and periods of distress. For example, staff described how they immediately responded when a person became distressed by offering one‑to‑one support in a private space, escalating concerns to senior staff and, where appropriate, facilitating contact with family to reduce anxiety. Several people and relatives confirmed staff continued to offer advice and support after discharge, including follow‑up contact and guidance, even where people chose not to engage in the full aftercare programme.

Exceptional practice was evident where staff went beyond expected care to protect people’s dignity and wellbeing. This included supporting a person who was in significant distress to secure an appropriate onward placement in another city, ensuring continuity of emotional support throughout the process. Staff told us that when a person was unable to attend a close family member’s funeral in person, they took proactive steps to support them emotionally by arranging a video call so the person could feel connected at the time of the service. Staff also explained how they incorporated personal and meaningful details into this support, including sharing the family member’s favourite flowers, to acknowledge the significance of the loss and show compassion in a way that was respectful and dignified.

Staff also used their lived experience of recovery to build trust, offer hope and provide meaningful reassurance, which people and relatives told us helped them feel understood and less alone during difficult moments.

We observed staff interacting with people in a warm, respectful and attentive manner, taking time to listen to people. Staff consistently spoke about people thoughtfully and compassionately during handovers and discussions and demonstrated optimism about people’s recovery journeys. Staff knew people well and took account of individual preferences, backgrounds and circumstances when sharing information and making decisions.

Privacy and confidentiality were always maintained. Staff clearly understood when information should be shared to protect people’s safety and when it should not. Staff told us, and 1 relative confirmed, that the content of one‑to‑one counselling sessions was not shared with families and that “what is said in the session stays in the session”. The relative told us they valued and supported this approach, describing it as respectful and professional. Staff said they felt confident to raise concerns about any disrespectful, discriminatory or abusive behaviour without fear of negative consequences.

The provider always treated people as individuals and involved them in decisions about their care, treatment and recovery. Care planning was person centred and recovery focused, and reflected people’s individual needs and circumstances, with people actively involved in setting goals and reviewing progress. Staff supported people to understand the programme and expectations from the outset, including the residents’ agreement, recovery approach and therapeutic activities, and ensured this was discussed during pre‑admission and on arrival.

People’s records showed that assessments were personalised and reflected people’s strengths, risks and recovery goals. Staff assessed people’s individual needs during pre‑admission to determine whether they could safely meet those needs. For example, where people had specific learning needs such as dyslexia, staff recorded this in care records and put personalised support in place. Staff told us these needs were clearly highlighted so all staff understood how best to support the individual. Care plans were reviewed regularly, including at 7‑day review points and during weekly one‑to‑one sessions, with changes agreed and signed by the person.

Staff understood people’s individual circumstances and adapted support, accordingly, including providing emotional reassurance during difficult periods and adjusting how information was shared. Staff said people were offered choices about therapeutic approaches, activities and aftercare planning, including engagement in 12‑step recovery, in‑house meetings, weekly one‑to‑one sessions, yoga, spiritual reflection sessions and mobility‑appropriate activities where needed.

The service took steps to make information accessible. Staff told us information leaflets were made available in languages spoken by people using the service. People’s individual dietary needs were well understood and managed. Staff told us people were offered a choice of food to meet dietary requirements, including allergies and intolerances. Handover information included key details such as the number of residents, dietary requirements and any allergies. Allergen‑specific utensils were available to minimise risk and ensure people could eat safely and with dignity.

People were supported to involve families and others where they wished. Feedback from 2 relatives confirmed communication was open, transparent and respectful, and that families felt welcomed and appropriately involved, with consent. throughout the person’s stay. Relatives told us the service took time to explain treatment, aftercare and expectations clearly. There were regular opportunities for people to influence how the service was delivered, including weekly community meetings, where people could raise issues and suggest improvements. Records showed concerns raised had been listened to and addressed.

People were involved in decisions about admission, length of stay, participation in therapy and aftercare arrangements, and were supported to make informed choices throughout their time at the service. Staff explained how consent was checked throughout the person’s stay, and people were clear they could leave the service if they chose. Records showed consent was revisited where needed, including during detoxification and changes in care.

We spoke with 4 people using the service. People described feeling motivated to remain engaged with treatment and valued the structured programme. One person told us they had left two previous rehabilitation services but felt this service was “much better” and that they had stayed on the programme. Another person said they had developed a clearer understanding of how to move forward and highlighted the importance of peer support and aftercare in sustaining recovery.

People told us they understood the rules of the service, including the structured recovery programme, and felt these were explained clearly and applied fairly. We observed that people were encouraged to take responsibility for aspects of daily living, such as participation in communal activities and engagement with the recovery programme, which supported independence and wellbeing.

People were supported to maintain relationships and networks that were important to them within agreed boundaries, and confidentiality was consistently respected.

Staff informed and involved families and carers appropriately, with the person’s consent.

Relatives told us the service actively promoted independence by encouraging people to take ownership of their recovery plans. One relative explained how staff supported their family member to share learning and action plans themselves, rather than staff communicating directly with relatives, which helped build confidence, responsibility and longer‑term independence.

People had access to a range of activities and opportunities to engage with the local community to promote independence, health and wellbeing. These included structured therapeutic activities, group work, recovery meetings and physical activities such as walks and yoga, which people could engage with according to their preferences and stage of recovery.

Staff demonstrated strong awareness of early signs of distress, anxiety, physical unwellness, withdrawal or deterioration and took timely action to provide reassurance, one‑to‑one support and appropriate escalation where required.

As outlined earlier in this report, staff gave clear examples of responding immediately when people became homesick, distressed or anxious. People told us staff “do not leave you struggling on your own” and are “always there when you need them”.

Records reviewed, including minutes from weekly community meetings, the compliments log, and 4 complaints logged by residents in the last 6 months, showed that staff responded promptly to concerns raised by people. These included environmental and comfort‑related issues, such as maintenance matters, all of which had been addressed and resolved without delay.

Relatives also described instances where staff provided immediate reassurance when they were worried about their family member, including prompt communication and confirmation that support was in place.

Staff described clear processes for escalating concerns to senior staff or clinical leads without delay and for facilitating contact with families where this helped reduce anxiety, with the person’s consent.

People’s needs, views, wishes and comfort were a clear priority, and staff anticipated these to avoid preventable discomfort, concern or distress.

Staff were alert to changes in people’s presentation and took time to observe, communicate and engage people in discussions about their immediate needs. Staff responded in ways that respected people’s wishes while maintaining safety, including offering additional one‑to‑one support, modifying activities and escalating concerns where appropriate.

Staff quickly recognised when people needed urgent support and used appropriate tools and technology to assist. For example, staff used recognised withdrawal assessment tools and monitoring systems during detoxification to identify early signs of deterioration and respond promptly. Where risks reduced, staff adjusted monitoring, accordingly, ensuring support remained proportionate and person centred.

Staff told us they felt respected, listened to, supported and valued by senior leaders, who were visible, accessible and approachable. Staff spoke positively about working for the service and said they felt proud to be part of the team. Staff had access to support for their own physical and emotional wellbeing. Staff could access therapeutic or counselling support when required.

Staff told us they had regular supervision and appraisal, which provided opportunities to reflect on practice, raise concerns and discuss development needs. Appraisals included conversations about career development and how this could be supported.

Staff told us there was a clear focus on progression and succession planning, with senior staff being supported to develop the skills and experience required for future leadership roles, including progression towards registered manager responsibilities.

Staff said they felt encouraged to develop within their roles and that leaders took an active interest in their professional growth. The provider supported staff development and professional confidence through access to training and qualifications relevant to their roles. Records showed staff were supported to undertake National Vocational Qualifications (NVQs), with 3 staff having completed NVQ Level 5, 4 staff having completed NVQ Level 3, and additional staff currently working towards these qualifications.

Staff feedback reviewed through supervision and appraisal processes showed positive morale, strong engagement with people using the service and confidence in delivering recovery‑focused care.

Staff achievements and contributions were consistently recognised. Records from team meetings showed staff were praised for their work and success, including recognition of high‑quality practice and learning achievements.

Staff felt able to raise concerns and were confident that leaders listened and acted on feedback.