We rated Brevin home care as good because:

• The service had made improvements since the previous inspection in 2017. At the current inspection we found that the service had ensured that all patients had received comprehensive assessments by experienced staff. Since the last inspection, the service had stopped providing alcohol detoxification treatment. The service had recruited nurses, developed a bank system and a log of staff that were available to ensure that patients received care and treatment when they needed it. The service was completing appropriate checks on staff before they commenced employment to ensure they were qualified and suitable to work safely with patients in their own homes. Staff were no longer working excessive hours.
• At the previous inspection we found that the service did not have a safeguarding children’s policy. In this inspection the service had an up-to-date children’s policy that was easily accessible to all staff. Safeguarding was integral to the teams’ daily practice. Care records demonstrated that staff clearly recorded safeguarding decisions and made appropriate safeguarding referrals where necessary. Staff were aware of who to contact about safeguarding concerns within the team.

• At the previous inspection we noted that different parts of patients’ records were stored in different places. In this inspection the service had one electronic system with all aspects of a patients’ assessment and care. This was easily accessible to all staff that through a secure log in system.

• Staff actively engaged with GPs, social services as well as other care organisations, if necessary. This ensured staff could plan, develop and deliver the service to meet the needs of the patients. This included liaison with GPs to ensure physical health checks had been completed.

• Staff received regular managerial supervision to provide support and monitor the effectiveness of the service.

• The service had introduced governance systems that included audits to monitor quality of care.

• The service was well-led by the senior leadership team. Staff had access to information they needed to provide safe care and high-quality treatment to patients.

However:

• Although the service had an appropriate appraisal policy, non-medical staff had not received appraisals in the past 12 months. Staff appraisals were affected by the high turnover of staff and registered managers.

• Although staff had care plans for each patient, the quality of care plans varied as some were not personalised according to patient needs. Staff did not always actively promote the needs of all patients, including those with a protected characteristic. Staff did not always include patients’ religion, physical health, ethnicity and sexual orientation into their care planning.

• The service did not always ensure that discussions and decisions about patient care were always documented.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• Clients were positive regarding staff in the service. They felt listened to, understood, supported and safe.

• Clients were prescribed medicines in accordance with National Institute of Health and Care Excellence (NICE) guidance.

• Validated tools were used for the assessment and monitoring of clients undertaking alcohol detoxification.

• There were appropriate incident reporting procedures. Staff knew the types of incidents to report and changes were made following incidents.

• The service had a complaints system and clients knew how to complain. Staff knew how to deal with complaints and there was learning from complaints.

• The service had working links with a number of other professionals. These included a nutritionist, physiotherapist and a sleep specialist.

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

• Staff worked excessive hours without a day off. In some cases, a nurse would remain at the client’s home for seven days without a day off. Nursing staff had not had individual supervision since early 2016.

• A nurse had not undertaken mandatory training and a doctor had undertaken one type of mandatory training.

• There was no record that clients received a medical review during alcohol detoxification.

• Some staff working in the service did not have appropriate pre-employment checks.

• Clients’ care plans were not always specific and detailed.