We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• We found the environment at the Lighthouse to be clean, safe and well maintained, and that there was adequate staffing for the service. Staff recruitment was based on the number of clients admitted to the Lighthouse, and extra staff from the provider could be accessed if needed. All clients had risk management plans in place. Environmental health checks, fire safety checks and legionella risk assessments were in place and up to date. There were enough staff to ensure that activities were not cancelled. Medication was monitored and dispensed safely. A safeguarding policy was in place, but no alerts had been raised in the 12 months prior to the inspection.

• The Lighthouse had clear and comprehensive admission criteria. Care plans were seen to be holistic, person centred and considered the views of clients. Clients were given a full assessment prior to admission, in conjunction with the assessments of referring agencies. Consideration was clearly given as to whether the service could manage existing physical health problems. An unannounced medication audit was carried out in July 2016 by the pharmacy used by the Lighthouse, issues that were identified were dealt with. Staff appraisals were taking place.

• Both clients we spoke to told us that the staff were caring, approachable and were always available to speak to if they needed further support. Most of the staff had personal experience of substance misuse issues, and this led to an understanding of client issues. Staff were caring and respectful and their interactions were person-centred, friendly, and recovery focused. Relatives and carers were also offered support by the service, as well as in their local area.

• Lighthouse staff maintained close links with care coordinators and care managers to ensure all services were planned, developed and delivered in accordance with the referral recommendations. The Lighthouse directed clients towards a variety of services that it could not provide, but this was only done in partnership with the referral body or their representative. The Lighthouse had a full range of rooms and equipment to ensure care needs were met. Activities available at the Lighthouse included swimming, a cycling group a gardening group, woodcraft, and cooking and baking. There had been no formal complaints in the 12 months prior to the inspection.

• The Lighthouse aimed to offer practical and goal-focussed support to clients, with access to services that would promote independence, give choices about the way services were delivered, maximise privacy and dignity, and safeguard welfare. This aim was evident in staff attitudes and behaviour. Staff sickness was monitored, at the time of the inspection there was only one staff member on long-term sickness. There were no bullying or harassment cases reported at the Lighthouse for the 12 months prior to the inspection. There was a whistleblowing policy in the employee handbook and staff were aware of it.

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

• Diversity and equality training figures were less than 75%, as were manual handling practical, and effective behaviour management.

• Key performance indicators were not fully utilised to gauge the performance of the service, although the impact on the service was not noticeable at the time of inspection.

We are placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We rated Lighthouse as inadequate because:

• Managers had not ensured that the building that accommodated the clients was safe. Staff did not risk assess the environment in relation to risks to clients, especially in relation to managing a mixed sex environment. Staff had not identified repairs that required to be made to the building to keep clients safe.
• Staff did not follow basic procedures to protect clients from risk. The service did not have a system for checking clients as they entered or left the building. This meant that, if there was a fire, staff would have no way of knowing who was still in the building. Managers had not ensured that staff had all the training required for their role, in relation to drug misuse, overdose awareness and how to administer emergency medicine. Records did not contain the completed documentation to keep clients safe. In the records we reviewed we found staff had not completed fully, physical identity forms and health action plans. This meant staff would not have the necessary information to share if a client went missing or to meet their healthcare needs. They did not have any risk management plans in the records we reviewed.
• The governance arrangements for the service were not effective. The service could not be assured that the oversight was in place to provide high quality services and keep clients safe. Lighthouse did not have a system to identify the number of staff required for each shift. There was no way of knowing if the service was under or over staffed. There was no system to monitor the compliance with health and safety checks of the environment. Policies did not comply with legislation and there was no system to review the policies and ensure they were relevant to the client group. There were policies from three different services in use. The provision of the therapy in relation to addictive behaviours was not being provided as marketed in the services literature and information to commissioners and clients.
• The registered manager was not following policies in relation to Duty of Candour, complaints and CCTV. The risk register did not capture current risks to the service in relation to governance and how staff would mitigate risks.
• Lighthouse breached Regulations 12 Safe care and treatment and 17 Good Governance of the Health and Social Care Act 2008, we have issued warning notices for these breaches. Lighthouse also breached Regulation 18 Staffing of the Health and Social Care Act 2018, we will issue a requirement notice in relation to this.

However:

• Feedback from clients, carers and care coordinators was positive. Clients were supported and encouraged to participate in activities within the local community.
• Staff received a comprehensive induction, regular supervision and annual appraisal.
• Staff worked in a person-centred way. They demonstrated an understanding of equality and diversity issues and working with clients belonging to vulnerable groups. Staff had developed a therapeutic programme tailored to the needs of clients with a dual diagnosis of substance misuse and mental health needs.