We inspected Sackville Gardens on the 25 November 2015. Sackville Gardens is a mental health care home which can accommodate up to five people. On the day of our inspection, five people were living at the home. The age range of people varied from 20 – 60 years old. People required support with their mental health needs, this included supporting people with eating disorders and anxiety. Support was also needed in relation to diabetes and physical health care needs.

Sackville Gardens belongs to the provider Brighton Housing Trust and falls under the ‘Archway Project’. The ‘Archway Project’ is part of the accommodation strategy for Brighton and Hove City Council for people with mental health needs. It helps bridge the gap between hospital and community and forms part of the pathway to help people move towards more independent living. The provider operates two registered care homes and three supported living units.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

The ethos of person centred care was at the forefront of Sackville Gardens, innovative ways of involving people were used so that people felt consulted, empowered, listened to and valued. Staff demonstrated flexibility and found creative ways to enable people to live as full a life as possible.

The provider, management team and staff were dedicated and committed to placing people first and ensuring they had the best quality of life possible. Staff engaged with people to promote meaningful activities and reduce any risk of social isolation. Engagement with the local community was encouraged by the provider and staff were actively involved in building further links with the community and encouraging people to engage with other services outside of the service.

The delivery of care at Sackville Gardens was built on the promotion of mental health recovery. Supporting people to move forward, increase independence and improve independent living skills. People spoke highly of living at Sackville Gardens and clearly recognised and understood the ethos of the service. One person told us, “They are supporting me so I can move on.” Another person told us, “I never would have thought I would have a period this long of being well and not hurting myself. That’s because I feel safe here and comfortable.”

The management team demonstrated how they had sustained some outstanding practices, development and improvement at the service. The leadership sought out creative ways to provide a personalised service and had achieved positive results through involving people. Client steering groups and focus groups had been organised. These provided a forum for people to be actively involved in the design and running of the service. The service was part of Psychologically Informed Environment (PIE) pilot and recognised the impact of the environment on people. The positive impact of this approach meant the some people had started to engage more with staff and their own recovery. Client steering groups and focus groups had been organised. These provided a forum for people to be actively involved in the design and running of the service.

The registered manager and staff team demonstrated passion and commitment to providing the best possible mental health care and promoting opportunities for people so they could live as full a life as possible. There was an established management team that was transparent in their approach and strove to achieve excellence.

Co-production (developing the service in an equal and reciprocal relationship between staff and people) was at the heart of the service. The provider, management team and staff involved people with the overall running of the service, from staff induction, policies, procedures and budgets. People spoke highly of continually being involved and felt their voice was heard.

Staff were highly motivated and achieved positive results through working closely with other agencies. One professional told us, “They are very good at liaising with me at an early stage if they feel a client’s mental health is deteriorating which means we can then look at interventions. This often prevents a hospital admission or a severe deterioration in their mental health.” Staff commented that one of the key strengths of the service was their relationships with other professionals. One staff member told us how the psychiatrist visited the home on a weekly basis and promoted a less formal environment than people going to see them.

The recovery model was fully utilised and people were supported to achieve their individual goals. Staff also recognised when people’s mental health may be deteriorating and the signs and triggers to look for. People confirmed that staff had a good understanding of their needs and they felt confident in the skills of staff. One person told us, “They know the signs to look for when I’m unwell.”

There was a clear focus on making safeguarding personal which meant putting the person at centre of any safeguarding concerns. Risk assessments provided clear guidance to staff and harm minimisation was utilised to also keep people safe. People commented they were involved in designing their risk assessments. There were enough suitable staff to meet people’s needs and promote people’s safety and wellbeing. There were systems in place to protect people from the risks associated from medicines and staff were vigilant in monitoring and using these.

There was a strong emphasis on communication. Staff were creative in how they could support people and various forms of communication had been established. One person told us, “I write a note to staff or use my communication card to inform staff when I’m in a bad way.”

Mealtimes were seen as sociable events. People cooked for one another and staff also joined people for the evening meal. Innovative methods and positive staff relationships were used to encourage those who were reluctant or had difficulty in eating and drinking.

During our inspection we spoke with three people who used the service as well as four members of staff including the registered manager, two project workers and a bank project worker. We looked at surveys and records to help us understand the views of the people who used the service.

One person who used the service told us “I like it here, they are a great bunch of staff” another person we spoke with told us “I have only been here a couple of weeks and everyone is lovely and it is a clean house”.

Staff we spoke with liked working for Sackville Gardens. One person told us “we are a good team with a wealth of experience”. If staff needed support or development they felt management were approachable and helpful. Another person told us “it has a homely feel here and we work well as a team“.

We also looked at support plans, risk assessments, staff records and policies and procedures.

We looked at minutes of meetings that involved people and saw that people were able to make suggestions about the service, such as choice of food, and these were taken into account. The people we spoke to told us that staff listened to them and treated them with respect.

We observed staff assisting people in making choices and in offering choices, such as a choice of food. We saw detailed care plans and risk assessments and saw that people were helped to be involved in their care planning and in expressing their wishes. We read that plans had been put in place to involved external professionals in making major decisions for some people.

We read detailed and comprehensive care records, which included evidence of frequent multidisciplinary working with external teams and services. We read that people were referred to suitable specialist services where necessary. We read evidence of emergency interventions where this was needed.

We spoke to people, who told us that they felt safe in the service. Staff had received suitable training in protecting people from harm and were able to tell us what they would do if they had concerns.

We found that staff received regular support in terms of supervision and training suitable to their work. Staff told us that they felt properly supported and trained.

We read surveys and maintenance audits that showed that the provider had systems in place to monitor the quality of the provision of care.

People are involved in determining their treatment plans and feel listened to.

They feel safe and well supported, and that support plans and reviews have been helpful in improving their quality of life.

Survey comments sampled included “I like the people here and staff are friendly, food is good”.