ESH Community

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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 effective as good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this. The provider ensured people received effective care and treatment by assessing and reviewing their physical, mental health and wellbeing needs on admission and throughout their stay. Assessments informed personalised detoxification, abstinence and recovery plans, which were reviewed regularly to reflect people’s progress and changing needs.

The service delivered evidence‑based detoxification and abstinence regimes and focused on supporting sustained recovery. People were encouraged and supported to engage with external recovery groups and meetings during their stay, helping them to build wider support networks and prepare for discharge. Ongoing aftercare and follow‑up arrangements supported people to maintain positive outcomes after leaving the service. Systems were in place to support consent and capacity, and care was reviewed regularly to reflect people’s progress and changing needs.

Technology was used effectively to support people’s safety and wellbeing, including systems that enabled staff to monitor people’s whereabouts and respond promptly to concerns. Staff worked closely together as a team and shared information effectively through handovers, team meetings and detailed records, which supported coordinated care and timely decision‑making.

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 used a structured pre‑admission and admission assessment process overseen by a consultant psychiatrist. Prospective residents completed referral, screening and pre‑admission risk assessments to confirm medical suitability. On admission, staff completed comprehensive physical and mental health assessments, including substance use history, capacity and consent, medicines reconciliation and risk assessment. These assessments informed individualised care and detoxification plans.

We reviewed 4 care records. Assessments were holistic and person‑centred, with clear links between identified needs, risks and planned interventions. Care plans and risk assessments were recorded electronically, with hard‑copies in place, and were reviewed frequently, including daily during detoxification and weekly thereafter.

Staff assessed people’s physical health before treatment started, including blood pressure, height and weight, and requested GP information and blood tests where needed. During detoxification, staff monitored physical observations daily and escalated concerns promptly to the consultant psychiatrist or external health services.

The service took a holistic approach to assessment and responded promptly to people’s emotional and communication needs. For example, staff provided immediate support to a person who became distressed during a telephone conversation with a family member. Staff stayed with the person, offered reassurance and spoke with the family member, who later said they felt reassured about the care being provided.

People and relatives said they were involved in assessment discussions and understood their treatment options. Staff used assessment information effectively to guide care and promote wellbeing.

The service planned and delivered people’s care and treatment with them, taking account of what mattered to them. Care and treatment were provided in line with legislation and current evidence‑based guidance and standards. Staff understood their roles and responsibilities under relevant legislation and applied these appropriately in practice.

The service delivered medically monitored detoxification using individualised treatment regimens prescribed and overseen by a consultant psychiatrist. Medicines were available on admission and adjusted according to people’s clinical needs. Staff used recognised withdrawal assessment tools, including the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA‑Ar). Staff used this alongside regular physical observations and sedation monitoring to support safe and effective treatment.

The team worked with people to reduce health and social problems related to mental health and addiction. This included completing baseline physical health checks such as blood pressure, height and weight, and arranging blood tests before treatment commenced. The doctor reviewed people’s current medicines with their GP and completed assessments of mental health needs and social circumstances to inform care planning.

The doctor undertook regular reviews of people’s physical health and worked with GPs to ensure people had good access to physical healthcare, including referral to specialist services where required.

The service provided a structured therapeutic programme, including individual counselling, group therapy, recovery education and 12‑step‑based support. Staff also signposted people to additional psychosocial support, such as family therapy, where this was appropriate. On the day of inspection, inspectors observed a morning group session attended by 4 current residents and a former resident. The session was well facilitated, inclusive and recovery focused, with active peer support and clear therapeutic intent.

The team included, or had access to, the range of professionals needed to meet people’s needs. This included a doctor and therapist. Staff were experienced, qualified and had the skills and knowledge required to support the patient group. New staff received an appropriate induction to prepare them for their roles.

Staff at all levels had opportunities to learn and develop, and poor performance was managed appropriately. Staff received operational supervision every 3 months and an annual appraisal. Supervision records showed that staff discussed patient support, wellbeing, training and development. Managers identified learning needs and supported staff development, including completion of vocational qualifications. At the time of the inspection, 3 staff had completed National Vocational Qualification (NVQ) level 5, with 1 staff member working towards completion to support progression into a leadership role. Four staff had completed NVQ level 3, with 2 staff progressing through their training. Staff also received specialist training relevant to their roles, including naloxone overdose response, acupuncture, bereavement support and detoxification symptoms and medicines.

The service took part in clinical audit, benchmarking and quality improvement activity. Managers used audit findings and feedback from people using the service to make improvements. For example, the service updated its “444 – Aftercare Support Options” document, which is provided to all residents and their families on discharge. Updates included adding various helpline details for families and clarifying people’s responsibility for booking their own second follow‑up counselling session.

People told us the programme was structured and meaningful, and that staff “knew what they were talking about” and supported them to understand their recovery. Observations and care records showed care was delivered consistently in line with assessed needs and recognised good practice.

The provider ensured staff and services worked together effectively to deliver coordinated care and treatment.

The service operated with a multidisciplinary approach, including a consultant psychiatrist, counsellor, operations management and support staff. Staff worked closely together through daily handovers, daily check‑ins, and regular team meetings. Inspectors reviewed 3 team meeting minutes from the last 3 months, which showed consistent discussion of residents’ progress, risks, medicines, admissions, discharge planning and follow‑up actions.

The service liaised with external professionals where required, including GPs, local authority, community substance misuse services and emergency services, to support continuity of care. Information was shared appropriately, with consent, to ensure people received joined‑up support during and after treatment.

Staff told us communication within the team was open and supportive, and that they felt able to escalate concerns promptly. Records showed clear evidence of shared decision‑making and coordinated responses to people’s needs.

The provider supported people to live healthier lives by promoting recovery, wellbeing and longer‑term health outcomes.

The service promoted healthy lifestyles through structured daily routines, therapeutic activities, and peer support. Activities included group therapy, counselling, physical activities and recovery skills sessions, healthy eating advice with flexibility to reflect people’s health and stage of recovery.

Aftercare and relapse prevention were integral to the service model. All residents were offered post‑discharge counselling and ongoing access to weekly support groups. The weekly aftercare sessions were well attended by former residents.

Families were supported separately through structured contact, shared discharge planning and access to aftercare and telephone support, alongside informal emotional support and guidance on how to support recovery, which families said gave them confidence to seek support and receive timely responses while maintaining confidentiality around therapeutic group work.

People and relatives consistently described positive changes in health, confidence and independence. Feedback indicated people felt better equipped to manage their recovery and maintain healthier lifestyles following discharge.

The service monitored outcomes and used information to improve the effectiveness of care and treatment.

Over the last 6 months, monitoring showed positive outcomes for most people who entered treatment. The majority were abstinent at follow‑up, with some people continuing in treatment at the time of review. In the last 12 months, 57 people used the service, with 91% successfully completing treatment. Early exits (9%) were managed safely with family involvement. No residents had returned to treatment within the last 12 months.

Staff used recognised rating scales, as outlined earlier in this report, to assess and record the severity of alcohol withdrawal and to monitor outcomes during detoxification.

Care records were audited weekly during placements and at discharge to ensure plans remained effective and reflective of progress. Staff routinely shared an exit questionnaire with people at the end of their treatment to gather feedback about their experience of the service and the care they received. This feedback was used to understand people’s views and to help the service monitor the effectiveness of treatment and identify areas for improvement. Quality improvement actions were identified and implemented, including strengthened follow‑up processes and improvements to admission facilities. Meeting minutes and audits showed learning was shared with staff and used to improve practice. People told us they felt supported beyond discharge and valued ongoing contact from the service.

The provider made sure people’s consent to care and treatment was obtained and respected. Care records showed clear evidence that staff sought consent for treatment and information sharing at admission and reviewed it throughout people’s stay. Where people’s capacity fluctuated, including during periods of withdrawal, staff understood how to reassess capacity and revisit consent as needed.

People we spoke with confirmed they had consented to treatment and said staff explained their care and treatment options clearly. Staff told us they checked consent on an ongoing basis and ensured people understood decisions about their care. Care plans reflected people’s consent and were signed where appropriate.

The service had clear processes to assess capacity and obtain informed consent before and during treatment, including for temporary monitoring arrangements during detoxification. These decisions were clearly documented in care records.

People told us they felt involved in decisions about their care and treatment, and records supported that consent was consistently sought and respected throughout their stay.