We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

A registered manager was in post who was supported by a Board of Trustees. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Yeldall Manor provides residential psychosocial treatment for up to 24 men recovering from drug and alcohol addiction. People stayed at Yeldall Manor for six months to a year. At the time of our inspection 19 men were using the service. Psychosocial treatments include certain forms of psychotherapy (often called talk therapy) and therapeutic social and work activities.

The service had a Christian ethos and people told us this created shared values and a sense of community. This was understood by all the staff and people we spoke with. Though people agreed to attend Christian led activities when they entered the programme, they were free to practice different religions as well. People took part in a structured work programme as part of their recovery. They told us this supported them to remain occupied, feel useful and develop new skills. We received overwhelming evidence from social workers, people and staff that people’s needs had been met and positive outcomes achieved.

The service provided a highly structured treatment and work programme. People were assigned an addictions counsellor as their key worker who supported them to plan and review their treatment goals. People received a treatment programme that addressed their medical, social, psychological and spiritual needs in line with national quality standards. Though the programme was structured and strictly implemented people told us they set their own recovery goals with the support of their counsellors.

However, the information in people’s recovery plans did not always reflect all the support provided to ensure people had a comprehensive record of all their treatment activity and how they would be supported to reach their recovery goals. The absence of a comprehensive recovery plan detailing people’s treatment and progress meant people’s needs and preferences might be overlooked. It might not be clear to people which needs would be addressed in the psycho-social treatment. Relevant agencies might not be involved when required or some people may have to extend their stay because their recovery plans had not been reviewed and their treatment adjusted as their needs changed.

People and their social workers praised the staff and the positive outcomes people achieved through the treatment programme. People consistently told us they had received care at Yeldall Manor from thoughtful, kind and sensitive staff. They told us Yeldall Manor felt like home. Staff were appropriately trained and supported to undertake their roles effectively. Staff we spoke with were passionate about the work they did and celebrated people’s achievements.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People at the home were able to consent to their treatment and the restrictive house rules. They could leave the programme when they chose.

The provider worked with local GP’s who had sufficient knowledge and experience in detoxification treatment to be able to oversee people’s detoxification safely. People were supported to manage the physical and mental symptoms of detoxification.

People told us they felt safe at Yeldall Manor and did not experience discrimination, harassment or bullying from staff or other people living in the home. People were treated with respect and trusted that the provider and other people on the programme would keep their information confidential. The provider ensured that people could raise safety concerns and complaints. People were satisfied that the registered manager would take action to resolve their concerns.

People and staff told us they received clear direction from the registered manager and understood their role and responsibilities in the service. The Board of Trustees supported the register manager to manage the service through regular meetings and ensuring resources were available as needed.

The provider remained informed of developments in addictions treatment and used this information to improve the quality of the service. The registered manager listened to people’s views and had acted on their feedback to make changes to improve the quality of the service. The registered manager worked closely with the Board of Trustees to monitor any risks to the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with told us they felt involved in their treatment. One person told us “I get to discuss issues with my counsellor.” Another person told us “I definitely feel supported in my recovery.” People told us they felt respected by staff. People were provided with an outlet to discuss issues and concerns. One person told us “We have house meetings and residents meetings.” This demonstrated people were involved and participated in the service and their treatment.

Admission assessments were comprehensive and explored people’s histories and expectations of treatment. Input was sought from outside agencies to feed into people’s recovery plans. Risk assessments identified possible risk and how to reduce risk.

The provider had an effective system in place to ensure pre-employment checks were undertaken for potential staff. The provider had an effective system in place to ensure complaints were dealt with to a satisfactory standard.

As part of our inspection, we spoke with people who used the service. We talked with six people, from a total of twelve residents, all of whom told us that they had received information prior to admission.

Some people we spoke to had applied to Yeldall Manor because it offered a therapeutic programme that included resettlement and provided longer term support and the opportunity to relocate. One person said “It’s a really good place”. Another person described the programme as “very personalised”.

People told us that were able to approach staff with any questions they had regarding the programme and their treatment, and they were involved in the delivery of their care and treatment. People told us that they felt safe at the service and would be able to speak to staff about incidents of abuse or harm.

People who used the service told us that there were enough staff to meet their needs. Staff members we spoke to confirmed this.

People who used the service and staff were asked for their views about care and treatment and these were acted upon. There were a variety of mechanisms in place to achieve this which included, weekly residents meetings, daily staff meeting feedback questionnaires from people at set points during their treatment. These showed good levels of satisfaction.

As part of our inspection, an expert by experience accompanied us on our visit to speak with people who used the service.

We spoke with five people, who all told us they received information prior to admission.

People told us that were able to approach staff with any questions they had regarding the programme and their treatment, and they were involved in the delivery of their care and treatment.

The majority of people told us that they were treated with dignity and respect and that activities they were offered were appropriate to the stages of their recovery.

Everyone we spoke with was very complementary about the staff.

People told us that they had plenty of opportunities to get involved in having their say about how the service was run.

They also told us that they were confident that if they reported any problems, they would be dealt with promptly and effectively.

We do not currently rate independent standalone substance misuse services.

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

• Since our previous inspection, there had been some improvements to medicine management processes but there were still gaps in process and policy around the prescribing and administration of medicines that did not fully assure us that clients would always be kept safe from harm. There were gaps in medicine charts with no explanation recorded. Since our previous inspection the service stocked take-home naloxone medicine but staff were not trained to advise the client in its safe use.

• Staff training was not always adequate to enable them to carry out their roles safely. Staff competency was not regularly reviewed in respect of medicine administration or in the completion of withdrawal assessment and measuring tools in line with provider policy. We saw evidence of tools used to assess withdrawal symptoms not being used in line with clinical guidelines.

• Since our previous inspection, client care records remained separate and did not cross-reference each other. However, the provider had made progress in addressing this and had a test site in place for a new electronic case management system.

• Since our previous inspection staff now completed risk assessments after admission, however, these did not always reflect health or risk information contained in the pre-admission risk assessment. Care plans did not consistently reflect physical health needs.

• Prescribing doctors completed a medical assessment on admission for detoxification clients only, but this was not holistic and did not include questions on safeguarding, mental health, capacity, social care needs or a full injecting history. The service received a lot of key information pre-admission from GPs and other relevant health, probation and social care bodies.

• There was no multi-disciplinary team meeting in which all staff could review and discuss patient care.

• The service had not audited infection control, prescribing, medicine charts or care records. Yeldall Manor commissioned external quality inspections and sought to drive improvement based on these recommendations.

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

• Clients told us the care they received was exceptional and gave them opportunities to rebuild their lives. The programme included a wide range of employment training and volunteering opportunites in the local community and through small business enterprises on the same site. Clients completing the programme also had access to move-on accommodation.

• Peer support was included in the structure of the programme. Clients were assigned another client to help them settle into the programme and there were opportunities to make changes to the service through community meetings.

• The service was part a group of independent rehabilitation centres where clients could be placed as an alternative to Yeldall Manor if the placement broke down.

• Yeldall Manor fundraised and offered a bursary to financially support clients.

• Outcomes for clients were good. In the 12 months prior to our inspection, 16 of 17 clients had successfully completed detox treatment with the 17th client undergoing detoxification treatment at the time of the inspection.

• There was a clear exclusion criteria and the service did not accept clients that would not benefit from the ethos of the service or where staff could not ensure a safe environment.

• Since our previous inspection, Yeldall had instigated quarterly governance meetings and two new posts had been developed to recruit two staff members to focus on governance, policies and audits.

• Staff felt happy working at Yeldall and felt there had been a recent improvement in their feeling able to give feedback and input into service development.

• Storage and disposal of medicines was well-managed and doctors prescribed and managed detoxification medicine safely and followed national guidance. Since our previous inspection the service had processes in place to report, record, act on or monitor significant events, incidents and near misses in relation to medicines.

• The service ensured that all clients accessed physical health care via a local GP practice and a sexual health nurse visited the service regularly to provide blood borne virus testing and treatment.

• Since our previous inspection the service had set up policies and an internal system to record any incidents or safeguarding concerns. Staff understood when and how to report incidents or safeguarding concerns.

• Staff provided a range of care and treatment interventions suitable for the patient group. These included medicines and detox treatment, therapeutic interventions, mutual aid access and opportunities for training and employment. These followed guidance from the National Institute for Health and Care Excellence.

• Staff received regular supervision with 100% of staff having a named supervisor. Staff were able to access specialist training courses in addiction. Mandatory training attendance was good overall. All staff were trained in first aid and received Safeguarding and Mental Capacity Act training via a local authority.