We do not currently rate independent standalone substance misuse services.

• We found that each client had a current risk assessment and these were reviewed each week or when an incident occurred. 
• Staff were aware of the risk assessments and told us they had a better understanding of the clients they were supporting.

We do not currently rate independent standalone, substance misuse services.

• Following our inspection in November 2015 and September 2016, we found areas of good practice for effective, caring, responsive and well led. Since these inspections, we have received no information that would cause us to re-inspect these key questions.

• During this most recent inspection, we found that the service had addressed most of the issues needed to improve safe following the November 2015 and September 2016 inspections.

Ark House was now meeting Regulations 13, 15 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

However:

• The service needed to improve their records relating to identified risks to give assurances that all staff knew how to manage or minimise individual client risks. This meant they were not compliant with regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of risk management.

We do not currently rate independent standalone substance misuse services.

• We found there was a renewal plan in place for the fabric of the building and the soft furnishings such as bedding. The plan needed to be updated and actions to replace or repair the building or soft furnishings should be acted on in timelier manner.

• Clients were aware of their responsibilities in keeping their laundry up to date and cleaning done, this was part of their recovery plan.

We do not currently rate substance misuse services.

We found:

• Staff did not manage risk effectively. Although staff identified some risks on admission, clients did not have risk management plans or have their risks reviewed regularly. Staff communicated risks verbally and recorded very limited detail in handover notes.
• Staff did not have safeguarding training and did not know how to raise a safeguarding alert.
• The service had no formal processes in place to record incidents. This meant that they were unable to identify patterns, effectively investigate or ensure that staff learnt and shared lessons. Staff did not fully understand what constituted an incident.

However, we found Ark House to be effective, caring, responsive and well led because:

• Clients received assessments before their admission, identifying any areas that might compromise the effectiveness of the treatment provided by Ark House.

• Clients and staff were clear on the steps they needed to take to make progress with treatment. Care plans were individual and detailed in workbooks that staff and clients reviewed on a weekly basis.
• Staff established a therapeutic relationship with clients and involved them in their care. A therapeutic relationship is a working relationship between a worker and a client, which is built on mutual trust and respect with the aim of bringing about beneficial change.
• Staff treated clients with respect and kindness and supported them throughout their stay with the service.
• Staff provided aftercare following a client’s discharge from the service.
• The facilities were welcoming and comfortable.
• The service provided clients with a full structured programme of care, therapy and activities.
• Staff felt supported and involved in the service. Morale was good and staff found their work rewarding while reinforcing their own recovery. All staff had previously experienced difficulties with drugs or alcohol.
• The service and all staff understood the 12-step approach and used this effectively to treat clients.