We do not currently rate independent standalone substance misuse services.

• During our comprehensive inspection in April 2016, we found Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 were not being met.

• During this most recent focused inspection in February 2017, we found that the services had addressed the issues that had caused us to issue two requirement notices following the April 2016 inspection.

• Littledale Hall Therapeutic Community was now meeting Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At this inspection, we found:

• The provider had introduced a new policy and procedure in relation to medicines management. Audits had been implemented in relation to medicines management and risk assessments were in place for clients who were able to self-administer medicines.

• A ligature policy and audit had been completed.

• Systems and processes had been established and operated to maintain an accurate and complete contemporaneous record in respect of each client.
• All staff had received training on the Mental Capacity Act and the Deprivation of Liberty Safeguards.

And this means that the provider was no longer in breach of regulations.

People who received treatment and care from Littledale Hall were very positive about their experience. Comments we received included:

"It is amazing, it has given me my life back, my kids and my family.”

“I have learned loads about addiction and how to keep safe.”

“I have the best chance, and have been offered a place in the flats.”

“With the support of the Hall and the staff I am able to give something back. I am applying for voluntary work and college; and am being helped to set up these connections.”

“It is a community and run like a community. It is the safest place I`ve felt in a long time. Staff support you.”

It`s been brilliant for me. It`s been hard but I’ve got good relationships with staff.”

We looked at the arrangements for the prevention and control of infection in Littledale Hall. We saw that bathrooms, toilet areas and bedrooms were kept clean and tidy and to a good standard.

As part of our inspection we checked how medicines were being handled. Overall we found that there were safe systems in place to manage and administer medication that help protect the health and wellbeing of people.

We saw there were safe recruitment procedures in place to ensure people were protected and supported by staff with the skills and experiences to meet their needs. Our discussions with a range of staff confirmed they felt well supported in their roles.

Although the house was a listed building and was very old it was clear that a programme of work was underway to upgrade and improve the home. We saw evidence of redecoration taking place.

There were a range of audits and systems in place to monitor the quality of the service being provided.

People using the service that we spoke with all said that staff were respectful. One said, “The staff are great, even though the structure is sometimes difficult, we are always respected as individuals with our own personalities.”

The service had developed and maintained relationships with a number of professional agencies. This ensured that people’s physical, spiritual, developmental, educational and social needs were met. The service had endeavoured to forge these relationships for people’s ongoing needs as they moved into aftercare and beyond.

We saw that people living in the community were able to personalise around their bed. This had however left some rooms in need of redecoration. We were told that bedrooms were redecorated within a cycle of redecoration which had been paused to assess the damp and condensation issues.

People we spoke with on the day of the inspection all said that staff were excellent. One said, “There is a massive element of care around everything they do.” Another said, “They save lives.”

We saw policies and procedures for records management and data protection. We saw these being followed on the day of the inspection. The employee handbook detailed safeguards the provider took to keep, staff, people living in the community, volunteers and visitors safe. This included information around confidentiality and whistle blowing.

We spoke with three residents who were very positive about the treatment programme they were undertaking and about the staff at Littledale Hall. Recent resident feedback forms all reflected positively on the experience the individual had undergone. Many residents felt that their life was fundamentally changed for the better, their self esteem and confidence had grown, and their ability to cope with life, responsibilities and seeing themselves as a valued member of society had improved beyond all measure. This they felt was all down to the treatment and support they had received at Littledale Hall.

Comments from residents included:

"There is no them and us here we are all us (residents and staff)."

"We are well supported and cared for."

"Because you are able to get to know each other you get to know when someone is not feeling ok and you are able to support them through that period."

"All the staff go out of their way for you here."

We found the following issues that the provider needs to improve:

• The audits of medicines management arrangements were not sufficiently robust or recorded to ensure that the gaps in the medicines administration charts were identified and addressed. Staff were not always following the medicines policy the provider had in place. Where clients wanted to self-administer medicines staff were not risk assessing them.  Adequate checks to confirm what medicines clients were currently prescribed when they arrived at the service were not in place. Individual medicines records were not clearly presented and medicine records we looked at showed that doses of medicine were frequently missed.

• The provider must ensure a ligature environmental audit is completed. This is to ensure that all that is reasonably practicable to mitigate any ligature risks is in place to ensure the premises are safe to use for their intended purpose.

• The provider must complete and maintain contemporaneous record for each individual client.

• Staff did not have a full understanding of their responsibilities to work within the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards.

• Staff did not review the appropriateness of all blanket restriction practices in place for all clients at all stages of treatment. The restrictions were not individually risk assessed or reviewed throughout the course of the clients’ treatment and the appropriateness of these was applied to all clients without applying any level of trust and or privacy as they progressed and neared completion of their programme.

We found the following areas of good practice:

• The environment was clean, well maintained, welcoming and comfortable. Staff carried out assessments before clients were admitted to ensure that the service could meet the individuals’ needs. Care plans and risk assessment were in place and were recovery focused. The provider reviewed the care plans regularly throughout a client’s stay.

• The therapies provided were underpinned by best practice. Clients had access to psychosocial therapies, group sessions and individual one to one sessions with a counsellor. Staff worked with clients to help them develop the skills they needed to sustain their recovery and maintain their independence when they returned to the community providing access to aftercare facilities to support them in their recovery.

• Staff treated clients with respect and kindness and supported them throughout their stay.

• All clients had full involvement with their treatment during their stay. They made decisions about their treatment during sessions with their keyworker.

• There was a structured programme of care, therapy and activities. Discharge planning included an aftercare package to support clients following rehabilitation.

• Staff had regular supervision, support and on going appraisals of their work performance from their managers.

• Staff we spoke with were highly motivated in their work and told us they felt supported by senior management. There was an open and transparent culture. Staff told us they felt comfortable raising any concerns or issues.

• There was an appropriate governance structure in place.