We rated The Lighthouse as requires improvement because:

• The provider’s governance systems for assessment, monitoring and mitigating risk in the service were not fully effective. We identified issues relating to the environment, risk assessment of clients, staffing checks and sharing learning with staff following incidents. The provider had not completed an action from our 2018 inspection relating to ligature assessment. Managers did not fully investigate incidents and share lessons learned with staff. Additionally, we could not find evidence that the provider had notified the CQC of an incident. The provider’s admission and exclusion criteria did not show how they had fully considered the Equality Act 2010 .
• Staff had not updated four out of six clients’ risk assessments we checked. Staff had not thoroughly assessed three clients’ alcohol dependence and severity in line with National Institute for Health and Care Excellence CG115 alcohol assessment guidance before treatment started. Staff did not develop a specific risk management plan for clients identified as being at risk that included a plan for unexpected exit from treatment.
• The provider’s recruitment checks did not effectively demonstrate that they were consistently checking that staff were experienced, competent, and had the right skills and knowledge to meet clients’ needs. The provider had not ensured that 50% of eligible staff had received an annual appraisal.
• Staff could not describe how treatments and care for clients were based on national guidance and best practice such as National Institute for Health and Care Excellence. The provider did not have audits or outcome measures to demonstrate that the treatment and therapy programme was effective.
• The provider did not have a robust plan in place for household waste collection as due to bank holidays, the contractor had not collected it. Staff were not always recording cleaning and food hygiene checks.
• The provider’s staff shift rota did not clearly show the number of staff on shift.
• The provider did not provide staff or clients with alarms to call for assistance in an emergency.

However:

• Staff treated clients with compassion and kindness. They respected clients’ privacy and dignity. Clients we spoke with were overall, satisfied with the service provided and said they had opportunities to give feedback on the service.
• Staff said they were proud of their work and the support they gave and received. There was good staff morale. Staff felt respected, supported and valued. Staff had received regular monthly supervision.
• The provider had acted since our last inspection to ensure that clients’ bedroom doors had locks to maintain their privacy, that they had a risk assessment for mixed sex accommodation. They had systems in place for the safe storage and recording of medications.
• The provider had appointed a new manager to improve the running of the service. They had started to review the provider’s systems, policies, procedures and protocols to update them and make them easier for staff to follow.
• The consultant psychiatrist assessed the mental and physical health of clients on admission. Staff offered clients person centred and integrative counselling and therapy such as cognitive behavioural therapy. Staff supported and encouraged clients to live healthier lives though yoga sessions and opportunities to attend a local gym. The provider offered clients a free aftercare service, usually up to eight weeks. This included groups and telephone support.

We do not currently rate independent standalone substance misuse services.

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

• There were ligature anchor points in the bedrooms, bathrooms and in communal areas. The service had completed a ligature risk assessment. However, it did not identify individual ligature anchor points or say how staff would mitigate identified risks.

• We had concerns regarding mixed-sex accommodation. Bedroom corridors contained a mixture of male and female bedrooms. There were no locks on the bedroom doors so clients could not lock the door to maintain their safety, privacy, and dignity.

• The service did not have an alarm call system in place. Staff did not carry personal alarms. Staff would be unable to summon assistance quickly if a client or staff required assistance.

• At the time of inspection managers were not appropriately reporting incidents to the Care Quality Commission.

• Storage and recording of medication was not appropriately managed.

• The service had exclusion criteria that stated they did not admit patients with complex mental health issues. However we found evidence that the service had admitted patients with these needs. The service was not equipped to deal with the risks that this posed. Managers had not fully considered all possibilities of how they would meet the needs of clients with disabilities or clients that did not speak English. The manager stated they would not offer a service to people with these additional needs and had not considered what alternative support they could access to enable them to meet individual needs of clients. Not all care plans were holistic and person centred.

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

• The service had enough staff to care for the number of clients. Staff knew and put into practice the service’s values. Mandatory training compliance was 100% for eligible staff.

• We found staff to be kind, caring, and respectful at all times and treated clients with dignity and respect and clients confirmed this.

• Clients told us that the food was of good quality and they had a choice of food and cultural dietary needs could be met. Clients had access to a seven day therapeutic activities timetable. Staff and clients were given opportunity to provide feedback that led to service improvements.