The inspection took place on 5 December 2018 and was unannounced. The previous inspection took place on 6 and 10 May 2016 when the service was rated as ‘Good.’

Shore House is registered to provide care and accommodation for up to 20 people who have needs associated with mental health and/or alcohol and substance misuse. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service aims to assist individuals with mental health needs in their recovery and move on to more independent living opportunities. The service accepts referrals for people who are already living in the community, as well as people who are inpatients at the time of referral. The service has been jointly commissioned by Brighton and Hove NHS and Clinical Commissioning Group (CCG) and Brighton and Hove local authority.

The service is situated on the sea front in the centre of Brighton and is near a range of facilities. Accommodation consists of 20 independent living units. Four of these were self- contained flats with a kitchen, bathroom and bedroom. Four flats had a bedroom and kitchen and the remainder did not have a bathroom or kitchen. There were several communal lounges and kitchens for people to use.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We have made two recommendations in the report regarding ongoing monitoring and assessment of risks to people.

Radiators were not covered or assessments carried out to ensure people were protected from hot surface temperatures. Risks to people were assessed but these were not always recorded. This included people’s ability to safely prepare and cook food as well as any risks of fire where people smoked in their rooms. We have made a recommendation about this.

People’s needs were assessed before they moved into the service. Staff also attended multi - agency planning meetings called the Care Programme Approach (CPA), which are coordinated by the referring mental health services. We noted copies of the CPA meeting decisions were not held with people’s care records so the provider would have all relevant information about people’s needs. We have made a recommendation about this.

People said they felt safe at the home. Support workers had a good awareness of the principles and procedures for safeguarding people in their care.

Sufficient numbers of support workers were employed to ensure people got the support they needed.

Medicines were safely managed.

There were systems to review people’s care and when incidents or accidents had occurred.

Support workers well trained in the methods used by the service to support people to develop their independence and recovery from mental illness and substance misuse, which was a system called the Outcome Star. This assessed people’s abilities to live independently and to progress to being more independent. Staff said they felt supported in their work. People said the support workers were helpful and supported them to be develop their independence. There were arrangements in place to support people to maintain and develop skills in meal preparation. The provider and support workers worked with local health care services to ensure people go the right health care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The ethos of the service was focussed on promoting people’s rights to live independently and to treat people equally irrespective of their needs or disability. People described the support workers as c

We inspected Shore House on 6th and 10th May 2016. The service provides accommodation for up to twenty people who have their own rooms with a licence agreement with access to communal lounge, kitchen and dining areas. The service provided support for people with mental health issues some of whom had physical health issues and substance misuse issue. The service has staff on site 24 hours a day. The aim of the service was to provide care and support for up to 18 months with a view to people moving on to more independent accommodation. The service used the Outcome Star which is a tool that measures and supports progress for people towards self-reliance or other goals.

The registered manager was on maternity leave and the deputy manager was acting up in to the role of manager. The senior manager was taking on the responsibilities of a registered manager in whilst the permanent registered manager was away. The senior manager had notified us of these changes. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 service is run.

People told us they felt safe and were happy with the care and support they received at Shore House. One person told us, “I do feel safe here, and I do think there are enough staff here”. People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. People were supported to manage their medicines safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

We saw people were supported by staff that knew them well, gave them individual attention and provided additional assistance as and when required. Staff received training to support them with their role on a continuous basis to ensure they could meet people’s needs effectively. Training was available that specifically addressed the needs of people at Shore House such as training in dual diagnoses.

Staff and the manager were knowledgeable about the Mental Capacity Act 2005. They were aware this legislation protected the rights of people who lacked capacity to make decisions about their care and welfare.

The staff team were responsive to people’s social needs and supported people to maintain and foster interests and relationships that were important to them. People were central to the practices involved in the planning and reviews of their support and guided by the Outcomes Star. People were encouraged to be as independent as possible and to plan to move to a more independent living arrangement where suitable. A staff member told us “I think the thing we do particularly well is how person centred we are, we don’t take a blanket approach to anything”.

People received regular assessments of their needs and any identified risks. Records were maintained in relation to people’s healthcare, for example when people were supported with making or attending GP appointments.

People told us that staff were kind and caring. One person told us about staff “I really like it here, staff are really helpful and really sympathetic”. We observed staff treating people with dignity and respect and involving them in their care.

The service was well led and had good leadership and direction from the manager and senior manager. Staff felt fully supported by the managers to undertake their roles. A person centred culture was promoted and embedded. There were robust quality assurance systems in place to ensure a high quality of care and support was provided.

Our inspection team was made up of one adult social care inspector and a pharmacist . We set out to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. We spoke with the registered manager, four care staff and nine people who lived at the project. During the inspection we looked at various records and documentation to confirm our findings. These included care plans, risk assessments and policies and procedures.

If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Care plans and risk assessments had been developed and were reviewed on a regular basis. Risk assessments covered areas of risk such as suicide, self-neglect, aggression and alcohol consumption. Risk assessments looked at the likelihood of the risk and what methods of staff interaction worked best for the person. Signs and symptoms of relapse were recorded along with triggers for certain behaviours.

The project provided care and support in a safe environment. Weekly and daily checks were completed as part of the project’s health and safety framework. Weekly fire alarm tests took place and firefighting equipment was maintained to a safe standard.

The internal and external environment was monitored and reviewed. All windows had window restrictors in place and these were checked daily. People were allowed to smoke in their rooms but not in communal areas. People assessed at high risk of smoking related accidents were checked upon daily to reduce any risk of fire related accidents.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act (MCA) 2005. We found Shore House to be meeting the requirements of the DoLS. Staff had a basic understanding of DoLS and MCA. We saw that people’s movement was not restricted and people could freely come and go as they pleased.

People told us they received their medication on time. The project supported people to regain their independence with medication administration. Workshops were run on self-medicating and people were enabled to self-medicate.

Is it effective?

People told us they were happy with the care and support they received. The project used the outcome star to help people set goals in areas of their life such as motivation, social contacts and tenancy. People met with their keyworker at least once a week to discuss their goals and plans for moving on.

Staff received the training required to safely deliver care and support. Staff had received training on equality and diversity, mental health, safeguarding vulnerable adults and managing difficult situations.

Shore House was committed to delivering high quality training and support to all staff members. Staff received regular supervisions and staff meetings. These enabled staff to discuss any practice issues, concerns and discuss ideas on the running of the project.

Is it caring?

People were involved in their care plans. Care plans were regularly discussed with people and people were promoted to make their views known on the delivery of care and support.

Observations of staff interaction saw that staff clearly knew people living at the project and had built rapports with people.

With permission, we sat in on a house meeting. During this meeting, people provided us with feedback on what it was like to live at Shore House. People told us staff respected their privacy and dignity and they felt safe and secure. People also commented they felt supported.

Is it responsive?

People’s needs had been fully assessed before they moved into Shore House. This demonstrated that the project was confident it had the skills and time to meet the needs of the person and enabled them to move onto more independent living.

Where people’s mental health needs had deteriorated, Shore House acted appropriately, seeking advice and contacting relevant health care professionals. Records demonstrated that Shore House monitored people’s health and wellbeing on a regular basis. Where required, measures were implemented to maintain the person’s health and wellbeing.

Is it well-led?

Staff had a clear understanding of why they were there and what their roles and responsibilities were. Staff were supported by a management team and the registered manager demonstrated strong leadership skills.

Shore House had a quality assurance systems intended to monitor and improve the project. The project submitted a quarterly report to the Clinical Commissioning Group (CCG). A service development plan was in place. The project regularly sought feedback from staff and people about the running of the project and what could be improved.

Recruitment practices were safe. Before staff worked unsupervised in the home, a Disclosure and Barring check (DBS) had taken place. This meant staff had no record of misconduct or crimes that could affect their suitability to work with vulnerable adults.