We rated Shardale St Annes as requires improvement because:

• Risks identified through assessments were not formulated into individual risk management plans that provided guidance for staff.
• Recovery plans were limited in detail. They did not set out clearly what clients needed to do to complete the recovery programme or how they were progressing through the recovery programme.
• Essential information about clients’ individual risk and progress through recovery was discussed and contained in handover notes but was not always transferred to clients’ individual records following discussions.
• There was no date for review of therapeutic interventions.
• The policy that provided guidance for staff working alone did not set out how the risks of working alone would be mitigated.
• The provider’s monitoring systems had not identified the issues we found in care and treatment records.

However:

• The provider had developed a recovery programme based on seven core values and incorporating a disciplinary scaling process. The model focused on developing communication, resilience and personal responsibility within a supportive community environment.
• There was an aftercare support programme that clients could access following completion of the recovery programme, to maintain their recovery and develop their peer support networks in the community.
• Clients who were senior members of the community had roles of responsibility such as gatekeeper, safeguarder and community leader. The provider gave clients training and guidance in these roles so they could carry them out effectively.
• Staff provided a range of care and treatment interventions suitable for the client group, delivered in line with national guidance and best practice.
• The provider had a clear definition of recovery that all staff shared and understood. There was a clear sense of common purpose based on shared values. Staff were positive and proud about their work.
• Managers had access to information about the performance of the service that supported their management role. Clients and carers could give feedback on the service they received.

We do not currently rate independent standalone substance misuse services.

This was a focused inspection relating to issues identified at a previous inspection.

We issued a requirement notice following a comprehensive inspection in February 2016 relating to one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in relation to regulation 5 (fit and proper persons: directors).

At this inspection, we assessed whether the service provider had made improvements to their arrangements for checking that the directors were fit and proper, which we identified in the requirement notice. We found that the provider had made the improvements and met the requirement notice.

At the last inspection in February 2016, we also found areas that the provider should take steps to improve. These were:

• The provider should ensure that all staff are aware of and understand the principles of the duty of candour.
• The provider should ensure that staff receive training so they understand the Mental Capacity Act.

At this inspection we were assured by looking at records and speaking with the staff on duty that the provider had taken steps to ensure that these areas had been addressed.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The environment was clean, well maintained, welcoming and comfortable.
• There were sufficient staff to deliver the treatment programme.
• Risk assessments were comprehensive and staff reviewed them regularly.
• Clients were involved in decisions about their care and the service. There were agreed house rules and a behavioural code of conduct.
• Staff demonstrated understanding of procedures for safeguarding clients from abuse. The managers acted as safeguarding leads.
• Staff had completed core skills training to their required level.
• Staff carried out assessments before clients were admitted to ensure that the service could meet the individuals’ needs.
• Care plans were recovery focused. In the records we reviewed it was clear what clients’ goals were and how they would achieve them. The provider reviewed the care plans regularly throughout a client’s stay.
• Care and treatment was underpinned by best practice. Clients had access to psychosocial therapies, group sessions and individual one to one sessions with a counsellor. Staff supported clients to engage with other recovery communities.

• 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.

• Staff established therapeutic relationships with clients and involved them in their care.

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

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

• Clients were involved in the running of the house. They were allocated trusted roles, such as community leaders, head of house, gatekeeper and safeguarder. Every month, the clients chose who should be allocated these roles, depending on the level of motivation they had shown in completing the programme.

• 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 and ongoing appraisals of their work performance from their manager, providing support and professional development so they were able to carry out their duties.
• 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.

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

• There were no effective systems and processes to ensure that all directors were, and continued to be, fit, and that no appointments met any of the unfitness criteria set out in Schedule 4 of Regulation 5 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• There was a whistle blowing policy. Staff were aware of this and understood it. However, the policy did not cover the duty of candour and we were not assured through speaking with staff that they understood the principles of the duty of candour.