We rated Trevi House as good overall because:

• The environment was homely, clean and well maintained. Clients had access to facilities that promoted recovery, such as the purpose-built therapy room and the nursery where their children were looked after whilst they were in therapy. Clients had access to ‘move-on’ bedrooms in another building as part of a step-down process as their recovery progressed.
• Clients had access to a wide range of therapy and activities, based on national guidance and best practice. Staff supported clients with their physical health and encouraged them to live healthier lives. Clients were very positive about the staff working with them and the service that they received. Clients were able to see changes as a result of them complaining, such as being involved in a review of the use of mobile phones.
• The service had enough staff with the right skills and training to provide safe, effective, holistic, high quality care to the clients. Staff felt proud to work at the service and said they were valued and respected by their team. All staff had received an appraisal that identified training and qualifications they would need to further their careers.
• Staff had regular meetings where they discussed learning from incidents, complaints, service planning and development. Clients and staff said they felt very involved in the running of the service. Staff empowered clients to have a voice and realise their potential by involving them in presentations, celebrations and service promotion.
• Staff were highly motivated to empower clients to get the most out of their recovery. Staff went the extra mile to ensure clients were safe and supported. The provider demonstrated a proactive approach to understanding the needs of a very vulnerable group of people with complex needs, by keeping the location of the service covert and by providing services such as the nursery that were specific for their clients’ needs. Stakeholders said that the service and the staff team were inspiring.
• The provider demonstrated innovative approaches to working with other agencies to support appropriate discharge from the service and provide the most fitting aftercare for clients. Staff worked diligently with ex-clients and joint worked with another provider to successfully set up a women’s centre that focussed on continuing recovery after leaving the service. The provider had also successfully bid to secure a tender for the Pause project. Pause is a national service that identifies women who have had two or more children removed from their care. The team at Trevi House worked with Plymouth social care to look at women’s records and target women who met the criteria for this support. This project is due to start in February 2019.
• The provider was involved in innovative research and quality improvement programmes. Managers were campaigning about funding inequalities across local authorities, had completed a cost benefit analysis of the ‘Trevi pound’ (the Trevi Pound showed that by having clients in their care (represented as one pound), this saved the community two pounds) and were involved in research at two universities.

However:

• Information in care plans was not all stored in the same place. Staff used two systems to record information and as a result, information was missing from both locations. Crisis plans were not filed in clients’ care plans which meant that staff did not have access to essential information about how to support a client if they went into crisis. Information about unplanned exits was not recorded in clients’ care records.
• There were recording errors and medication charts did not clearly show whether medication was prescribed regularly or as required. The provider had recently changed systems to address the increase in medication errors and was arranging training for staff. Managers were not carrying out regular audits on medication and care records.

During our visit to Trevi house we spoke to three people in the treatment programme, two members of staff and reviewed four care files.

People told us "It's been good"; "There is always someone here to talk to"; " It's a safe environment"; "You are watched and observed, but it feels ok"; "You are treated like an adult"; "The groups are brilliant"; "Staff are brilliant, very supportive, you are kept real here."

The people we spoke with had received verbal and written information about the programme, had explanations about what was involved in the programme including the "house rules", and people understood they were able to change their minds if they wished to. People's consent was sought and their human rights respected.

People had an individual assessment and were involved in their care and treatment programmes. People had individual counselling and group work to help them achieve their treatment goals.

People were protected from abuse and told us that they felt safe at Trevi House. There were policies and guidance in place for staff to follow should the need arise.

Staff were skilled and supported. New staff had an induction and staff had access to formal and informal supervision.

There was a complaints policy in place and people felt safe to raise any complaints they might have.

Trevi House is registered with the Care Quality Commission (CQC) as a care home for the first stage treatment of alcohol and drug dependence for up to thirteen women, between the ages of 18 and 60. Children under the age of 8 years can be accommodated with their mother.

One woman told us, “It has been a privilege to stay here” and another said, “The support I have received has been outstanding”.

The welcoming booklet given to people states, “Trevi is a special place indeed, somewhere where the concept of family underpins everything we do”. This was in reference to Trevi House taking only women and their children for admission.

The women we spoke with all agreed that the treatment programmes were appropriate for them. Women said the group sessions were very good and they felt supported. Each women spoken with said they felt safe and were treated with dignity and respect by all the staff.

The women we asked knew how to make a complaint and how complaints were managed by the organisation.

We looked in detail at the treatment plans and care of two of the women who stayed at Trevi House. We spoke with staff about the treatment plans in place and about the treatment programme offered. We found these were individual and person-centred and included risk assessments.

Staff had undertaken training in the Safeguarding Vulnerable Adults as well as Safeguarding Vulnerable Children. This assisted the staff to take appropriate action if an issue was identified.

We do not currently rate independent standalone substance misuse services.

We found the following areas of good practice:

• The environment was visibly clean and well maintained. The provider carried out regular infection control audits.

• Since the previous inspection in 2014 medicines management had improved. There was a purpose built medicines and clinical room. Medicines were safely managed and stored. Staff were trained in medicines management and there was a medicines management lead who liaised with the pharmacist, non medical prescriber and GP.

• Risk management had improved since the previous inspection and individual risk assessments were robust and detailed. Staff were all aware of safeguarding procedures and knew how to escalate concerns. Incidents were recorded and there was an open culture of learning from incidents and flagging concerns. The provider fulfilled their duty of candour in relation to incidents and complaints. There was a culture of learning from complaints.

• The service had enough staff to care for the number of clients and their level of need. Care plans were holistic, recovery focused and individual.

• There were therapy groups that were relevant to the client group and safely managed. Groups were effective and safely managed. The provider offered psychological therapies that were recommended by the (NICE).

• Staff felt well supported and had facilitated group supervision and regular one to one supervision. There were some opportunities for external supervision and the manager received additional supervision from a nursing director of a local NHS provider.

• There were good training opportunities for staff and leadership opportunities for senior staff. Staff were up to date with mandatory training and all staff told us there were opportunities for additional development training. Staff were familiar with and trained in the Equality and Human Rights Act and safeguarding. There was a safeguarding lead that supported and advised the team.

• We received excellent feedback from clients, staff and other agencies that worked with the service, such as specialist midwifery, funders, and pharmacy. Clients told us that staff were always kind and respectful and always went out of their way to help. For example, staff continued to support clients when they had left the service. Without exception the service was described very positively.

• The service was well led and morale was high. Staff knew and put into practice the service’s values, and had contact with managers at all levels, including the board of trustees.

• There were many examples of innovative practice. The service hosted a regular garden party to thank partners for their support with developing outreach services to meet needs of clients who had been discharged.

• Partnership working was prioritised and the service had developed effective links with a range of partners. The service worked well with its partners and stakeholders.