Mount Carmel provides residential rehabilitation for people with serious alcohol addiction. The primary model of treatment is the 12-step programme.

We undertook this inspection to find out whether Mount Carmel had made improvements to their service since our last comprehensive inspection in August 2016. At that inspection, we found the service was not compliant with regulations regarding safe care and treatment, good governance, staffing and the employment of fit and proper persons.

We found the provider had made improvements in relation to health and safety. The service had appointed a senior member of staff as the lead for health and safety. The service had also instructed an experienced specialist contractor to conduct a full health and safety assessment and make recommendations. The service now stored knives and cleaning products safely. The service fitted locks to bedroom doors. This meant that clients could store medication securely in their own rooms. The service was reviewing the procedures for infection control. All volunteers who prepared meals for clients had a food hygiene certificate.

The service completed risk assessments for all clients. The service had introduced systems for reviewing the quality of record keeping and risk assessments.

During this inspection, we found staff were committed to making improvements and addressing the concerns raised in the previous report.

However, we found some areas which the provider needs to improve:

The service continues to only employ staff to be on the premises during the day. This meant that clients were left without support and supervision from staff for long periods of time. We concluded that the absence of staff heightened the risk of serious incidents occurring. The service had not assessed the risks these arrangements present.

We spoke with seven people using the service, two staff members and the deputy manager during this unannounced visit to Mount Carmel.

Comments about the service provided from the people using it included "a life saver, brilliant", "I feel totally supported", "fantastic", "really good, they've really helped me" and "there is no place like it, they've saved me". Individuals told us that "the staff go above and beyond here", "the staff will guide you", "they are brilliant" and "the staff always look out for you". One person told us that "they know, they'll approach you before you go to them" whilst another said "they know you as an individual".

Staff spoken to felt that morale was high within the service and said that they received the support and training to enable them to do their jobs well.

We did not speak to people using the service on this occasion because this was a follow up visit to look at the arrangements for managing medicines. Our inspection of December 2012 had found that appropriate arrangements were not fully in place to make sure that people were being protected against the risks associated with medicines.

We looked at the records kept for a number of individuals during this unannounced visit and saw that the service had made improvements to ensure that people were having their medicines in a safe way and at the times they needed them.

We spoke to seven people who use the service, three staff members and the manager during this unannounced visit to Mount Carmel.

Overall feedback about the service included 'can't say a bad word about it', 'they come from a caring place' and 'they are looking after me well'. One person said 'I would not be sitting here if it wasn't for them' and another individual said 'this is one of the best rehab's in England, they look after you for life here'.

All of the people spoken to said that they felt safe living at the service and were treated with dignity and respect. Feedback about the staff was very positive and comments included 'they all care', 'they are not judgemental' and 'the staff do a fantastic job'.

There were 13 people living at Mount Carmel at the time of our inspection. People who use the service are referred to as residents. We spoke to three residents individually, and to a group of four ex-residents, who were visiting the service. All were very positive about the changes to their lives since they had lived at Mount Carmel.

Comments included

“I didn’t have quality of life before. All my attitudes have changed”

“Without a doubt it’s the best thing I’ve ever done.”

“I’ve started to grow up”.

“I’m reborn"

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

• The provider had failed to identify significant risks within the premises and risks presented by and to clients. There was a lack of awareness of the need for rigorous risk assessments throughout the service. As a result of this, risks were not identified and steps were not being taken to mitigate any risks.

• The provider had not carried out an assessment to determine whether there were sufficient staff on duty at any time to meet the needs of clients and ensure they were safe at all times. The provider had not assessed the risks of arrangements for giving responsibilities to clients designated as house leaders. There were no records of the competency of house leaders being assessed.

• The provider did not have effective arrangements in place to assess, monitor and improve the quality and safety of services provided.

• The service did not have adequate arrangements in place to assess the risk of, prevent or to control the spread of infections. No action was taken to ensure the main fridge, storing clients’ food, was kept at the correct temperature after records showed the temperature was too high.

• The service had not carried out checks on people before they became volunteers at the service. Staff supervision records were kept at home by supervising staff. They were not available at the service and staff could not access their own records.

• Clients were not able to store their own medicines securely and make sure no one else could access them. Medicines administration records did not include a list of any allergies.

• Children were able to visit the premises without supervision or staff being present. There were no records kept of children visiting the premises. Staff had not received training in safeguarding children.

As a result of our serious concerns about the service we served a warning notice on the provider. We asked them to make urgent improvements to the service and take steps to protect clients from avoidable harm.

However, we also found the following areas of good practice:

• Current and former clients were overwhelmingly positive about the service. They told us that the service had transformed their lives, and that staff were professional and caring.

• Once someone had been a client at the service, Mount Carmel offered free after care for life.

• Treatment at the service was based on the well-established 12-step programme, along with acupuncture, meditation and yoga.

• The service provided joint counselling sessions in which two counsellors would facilitate conversations between clients and their partners.

• The staff team was skilled and experienced. Morale within the staff team was very positive and staff were motivated by the achievements of their clients.