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Inspection Summary


Overall summary & rating

Good

Updated 14 March 2019

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.
Inspection areas

Safe

Requires improvement

Updated 14 March 2019

We rated safe as requires improvement because:

  • Crisis plans were not filed with client’s care records nor uploaded onto the provider’s shared electronic database. We found them in the staff office, sitting in a pile on a staff member’s desk. This meant that staff would not be able to access the information needed to support a client if their mental health deteriorated or if they relapsed.
  • Although staff regularly reviewed risk management plans, they had not been documented as reviewed, signed or dated. Risk management plans did not identify those at risk of unexpected exit from treatment.
  • Information held on each client in their records was not always up to date, and there was information missing, such as some information about diet and nutrition, mental health and self harm. Not all documentation was stored in the same place.
  • There were recording errors and medication charts did not clearly show whether medication was prescribed regularly or as required. Staff were not recording when a dose of medication was missed or refused. Staff were relying on clients to ensure their babies and children took their medication as prescribed. There were examples of babies missing vitamins but the medication record did not show if this had been refused. The provider had recently changed systems to address the increase in medication errors and was arranging training for staff.
  • Managers were not auditing medication systems and processes regularly or effectively.

However:

  • The environment was safe, clean, well-equipped and well-furnished. Staff risk assessed any ligature anchor points and had a clear admissions policy that screened out potential clients at high risk.
  • The provider had enough staff to keep people safe from avoidable harm.
  • Managers provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect clients from abuse and the provider worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply safeguarding principles.
  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave clients honest information and suitable support.

Effective

Good

Updated 14 March 2019

We rated effective as good because:

  • Staff provided a range of treatment and care for clients based on national guidance and best practice. For example, staff offered therapy on domestic violence, eye movement desensitisation and reprocessing (EMDR), cognitive behavioural therapy (CBT), mindfulness, self- esteem, and ‘you and me, mum’ (a facilitation programme developed by Women’s Aid). Staff supported clients with their physical health and encouraged them to live healthier lives.
  • Managers made sure they had staff with a range of skills and qualifications needed to provide high quality care. They supported staff with appraisals and opportunities to update and further develop their skills.
  • Staff worked effectively with other agencies to ensure clients received holistic care and support.
  • Staff supported clients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005.

However:

  • Client assessments were often hand written and did not follow the providers pro forma document. Care records had information missing as sections were stored in different places.

Caring

Outstanding

Updated 14 March 2019

We rated caring as outstanding because:

  • Staff were highly motivated and treated clients with compassion and kindness. They respected clients’ privacy and dignity, and went the extra mile to support their individual needs.
  • Stakeholders praised the friendly and welcoming manner of the staff team, the caring, compassionate environment of the service and the prompt and effective organisation of support by the team. Stakeholders said that the passion for the work the team delivered was very apparent and their work was emotional and inspiring.
  • Staff empowered clients to understand and manage their own care and treatment by working in partnership with them in their care planning.
  • Staff encouraged all of the clients to support and understand individual’s religious and cultural needs.
  • Staff supported clients to have a voice and realise their potential, such as speaking at events, singing at a celebration and speaking to journalists during the filming of a documentary. Clients were enthusiastic about their inclusion and involvement in the development of the service. Clients were involved in interviews to recruit staff and volunteers.
  • The provider had an innovative approach to supporting clients to maintain and get the most out of their therapy sessions by providing tailored childcare in an onsite nursery. This meant clients could rest assured that their child was being safely cared for by qualified staff whilst they concentrated on their recovery sessions.
  • Staff maintained confidentiality of information about clients. Staff were aware who clients had agreed to have their information shared with. For example, clients would often not want information shared with their ex-partners.

Responsive

Outstanding

Updated 14 March 2019

We rated responsive as outstanding because:

  • Clients could access the service within 48 hours if they needed urgent support.
  • The provider demonstrated innovative approaches to implement responsive aftercare and involved other organisations and linked services, such as the sunflower women’s centre to ensure continuity of care. Staff offered telephone and Skype counselling if clients moved out of area after completing treatment. Some clients told us that they relocated to Plymouth just so they could keep their aftercare support going through Trevi house.
  • Clients and their children had their own bedrooms where they could keep personal belongings safely. There were quiet areas for privacy and where clients could be independent of staff. Night staff observed babies every hour throughout the night to check they were asleep in their cot or if the mother needed any support.
  • Staff supported clients with activities outside the service, such as work, education and building family relationships.
  • The provider had a proactive approach to understanding the needs of a very vulnerable group of people. The provider location was covert and had a PO Box address so victims of domestic abuse felt safe. Therapy sessions were specific to the client group and mothers were able to attend therapy knowing their babies were being looked after in a safe environment by qualified nursery staff. Staff ensured that clients had access to peer support and cultural support.
  • Clients had access to good quality food that met specific needs such as for those who were vegetarian or coeliac. Clients could make hot and cold drinks and snacks when they wanted.
  • Staff treated concerns and complaints seriously, investigated them and learned lessons from the results. Lessons learnt were shared with all staff. Clients were involved in the review of complaints, such as the use of mobile phones.

Well-led

Good

Updated 14 March 2019

We rated well-led as good because:

  • Managers had the right skills and abilities to ensure the service provided high-quality sustainable care. Managers were visible in the service and approachable for clients and staff. Trustees attended staff meetings and were well known by the staff and clients.
  • The provider had a vision for what it wanted to achieve and workable plans to turn it into action. The plans were developed with involvement from staff, clients, and key groups representing the local community.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff described people working collectively and never on their own. Morale was high and the staff group felt positive and satisfied. Staff were proud to work for the provider.
  • Managers used a service improvement plan to continually improve the quality of its services. Managers regularly submitted plans to the board of trustees to review. Learning from incidents and complaints was shared regularly via the service’s newsletter and via staff meeting minutes.
  • The management team had addressed communication issues within the team by working on a project called ‘project hymn sheet’, which ensured staff were being consistent with what they said and did. Managers also addressed this via their staff wellbeing strategy and the staff newsletter.
  • The provider encouraged learning and demonstrated their involvement in innovative practice, such as developing their outreach service, carrying out a cost benefit analysis of the ‘Trevi pound’, working on research with two universities, and tendering services with Pause. Pause is a national charity working to improve outcomes for vulnerable women and aims to reduce the number of children going into care.

However:

  • Managers were not auditing medication administration records and care plans. We saw errors in both areas that had not been picked up by the management team.
Checks on specific services

Substance misuse services

Good

Updated 14 March 2019

See overall summary.