Archived: Clouds House

Updated 20 December 2018

Clouds house is located in Wiltshire and provides residential treatment for people with addictions, including alcohol and drug dependency to clients across the country. Clouds House provides medical detoxification and a therapeutic recovery programme based on the 12 step model. The service is located in one building and is set across four floors. Therapy, activity and communal rooms are located on the ground floor. The medical centre is located on the first floor. The service can accommodate 38 clients and provides separate bedrooms for male and female clients across the first and second floors. Clouds House is registered by the Care Quality Commission to provide the following regulated activities

Accommodation for persons who require treatment for substance misuse

Treatment of disease, disorder or injury

The service has a registered manager and nominated individual. Our last inspection took place on 4 April 2018. This was a focused inspection to find out whether Clouds House had made improvements to meet the requirement notices issued following our last comprehensive inspection in October 2016. We found that the service had met all the requirements.

Updated 20 December 2018

We rated Clouds House as good because:

• Staff provided safe detox and treatment for clients based on national guidance and best practice. Pre-admission assessments used by the service were high quality and included questions which assessed current substance use, risk of blood borne viruses and physical health needs. Staff used the pre-admission assessment to develop risk assessments, on admission, to guide development of individually tailored detox medication regimes. Staff regularly reviewed the effects of medication on each client’s physical health and used nationally recognised tools, including the Clinical Institute Withdrawal Assessment for alcohol scale and the Subjective Opiate Withdrawal Scale.

• Recovery treatment was provided based on the 12 step model. The environment was fit for purpose and there were adequate rooms to provide psychosocial therapies, activities, and safe detox. All areas were safe, clean, well-equipped, well furnished and well maintained. The design, layout, and furnishings of the service supported clients’ privacy and dignity.
• Staff were skilled, competent and knowledgable in meeting the needs of people who used the service. The service provided training in key skills to all staff and made sure everyone completed it. The service had ensured all registered nursing staff had completed part 1 of the Royal College of General Practitioners certificate in the management of drug misuse and the clinical lead had completed part 2. Psychosocial therapies were provided by qualified counsellors and psychotherapists. Staff had completed monthly topical training on substance misuse subjects. Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
• Clients were positive about the service and staff treated clients with compassion and kindness. They respected privacy and dignity, and supported their individual needs. Staff involved clients in decisions about their care, treatment and changes to the service.
• Staff supported clients to make decisions on their care for themselves. They understood the service policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly when appropriate.
• The service treated concerns and complaints, and client safety incidents seriously. The service provided a variety of forums for clients and staff to give feedback on the service and raise any concerns or complaints. There were systems in place to record, review and discuss complaints and incidents and there was evidence of improvement in response to this. The service monitored service risk through a local and corporate risk register which staff could contribute to. Changes to the service were discussed with clients and staff.
• Leaders within the service were visible and approachable for both clients and staff. Staff morale was high and the staff team felt respected and valued. The nursing team and counselling team worked well together and were supported by their managers.

However:

• Staff did not always complete all sections of risk management and care plans. Staff did not regularly review risks and progress within care plans. Six out of seven care records did not have risk assessments completed for the ‘aftercare’ section of the management plans. Risk assessments and care plans had only been reviewed in one care record of the seven reviewed.
• Although staff were managing the risks, documentation of the ligature point risks and plans to mitigate the risks were incomplete (a ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation). The checklists database for care records, which staff were expected to complete, was not up to date. Although clinical care record audits were being completed monthly, these had highlighted issues with reviews of care plans for three consecutive months without significant improvement or an action plan being developed.
• Some of the blanket restrictions used did not include a clear rationale for their use in the consent paperwork. This included, restricted times to watch television, and set bedtimes without access to other areas of the building. The service did not have a plan or policy in place for reducing restrictive practice.

Updated 20 December 2018

Clouds House provides medical detoxification and a therapeutic recovery programme based on the 12 step model.