The Progress Project

The Progress Project is a residential care home providing personal care to 17 people with a range of mental health needs at the time of the inspection. The home can support up to 18 people.

People’s experience of using this service and what we found

People told us they felt safe living at the home. They were protected from the risk of abuse and harm by staff who had been trained appropriately and knew what action to take if they had any concerns. Risks to people had been identified and assessed, with guidance for staff on how to support people, which was followed. Staffing levels were sufficient to meet people’s needs and people had support from staff when they needed it. New staff were recruited safely. Medicines were well managed. The home was clean and smelled fresh. People were encouraged to undertake housekeeping tasks which promoted their independence.

Before people came to live at the home, their needs were assessed, to ensure the home could provide the level of care and support they required. People were consulted when referrals were made. People’s care and support needs were continually reviewed and assessed, with a view to rehabilitation back into the community. People received care from suitably trained staff and were encouraged in decisions relating to their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to eat and drink in a healthy way and many were independent in food shopping and in the preparation of their meals. When people became unwell or needed support from a healthcare professionals, they were supported with appointments.

Staff were warm, kind and caring with people. People’s diverse needs were identified and catered for, so that care was delivered in a personalised way that met people’s preferences and encouraged their independence. People were treated with dignity and respect.

Care plans were detailed and reviewed with people. People had identified goals which helped in their rehabilitation journey. People were independent when accessing the community. They were encouraged to participate in physical exercise, educational opportunities and social interests in line with their preferences. Some people had voluntary or paid employment. People’s communication needs had been identified, so that staff communicated with them in a way that suited them. Complaints were managed in line with the provider’s policy.

People were happy living at the home and with the service they received. They and their relatives spoke positively about the home, and of the managers and staff. Feedback was obtained in a variety of ways, through surveys and at residents’ meetings. Professionals who had involvement with the service spoke highly of the home. The service worked in partnership with others to benefit people’s care. A robust system of audits monitored and measured the service and were effective in driving improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at this service was good (published 1 August 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Progress Project provides support and accommodation for up to 16 people with on-going mental health conditions, including dual diagnoses such as schizophrenia and substance misuse. The aim of the service is to provide personalised support to enable people to move out of the service and live independently in the community. There were 12 people living at the service at the time of our inspection (including one person who had been admitted to hospital). The Progress Project is situated in a large, detached house not far from Worthing town centre and seafront. Communal areas include a sitting room, dining room with kitchen area, a games room with pool table and a smaller sitting area and an outdoor patio area. All rooms are of single occupancy.

A registered manager was in post. 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 felt safe living at the service and their risks were identified and managed appropriately. Staff received guidance on how to support people safely and mitigate any risks. Premises were managed safely and equipment was serviced regularly. Staff had been trained to recognise the signs of potential abuse and knew what action to take if they had any concerns about people. Staffing levels were sufficient to meet people’s needs and safe recruitment practices were employed. Medicines were managed safely.

Staff had been trained in a range of areas relating to people’s care and support needs and in mental health conditions. They were encouraged to study for qualifications such as diplomas in health and social care. New staff followed the Care Certificate, a nationally recognised qualification. Staff had regular supervision meetings and attended team meetings. The service worked within the requirements of the Mental Capacity Act 2005 and associated legislation. People had sufficient to eat and drink and were encouraged to shop for their own food for their lunchtime meals. People had access to a range of healthcare professionals and services and staff supported people to attend their healthcare appointments where needed.

People were looked after by kind and caring staff and positive relationships had been developed. People were supported to express their views and to be involved in making decisions about their care. They were treated with dignity and respect by staff and had the privacy they needed.

Care was personalised to meet people’s needs. People met with their keyworkers on a regular basis and were involved in reviewing their care plans. Support was provided that aimed to develop people’s independence, with a view to them eventually living independently in the community. Care plans were detailed and provided information to staff on how to support people in a responsive way. People pursued their hobbies and interests and were encouraged in this by staff. Complaints were listened to and managed effectively.

Residents’ meetings took place on a monthly basis and people felt involved in developing the service. Any improvements identified would be listened to. Formal feedback was obtained from people and their relatives. Staff felt well supported and good management and leadership were evident at the service. A range of systems had been put in place to monitor and measure the quality of the care delivered.

The Progress Project provides support and accommodation for up to 16 people with on-going mental health conditions, including dual diagnosis such as schizophrenia and substance misuse. The aim of the service is to provide personalised support to enable people to move out of the service and live independently in the community. There were nine people living at the service at the time of our inspection. The low occupancy had been planned as building works were in progress affecting the availability of suitable rooms. The Progress Project is situated in a large, detached house not far from Worthing town centre and seafront. Communal areas include a sitting room, dining room with kitchen area, a games room with pool table and smaller sitting area and an outdoor patio area. All rooms are of single occupancy.

There was no registered manager in post. 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. The day to day management of the service was undertaken by an acting manager.

The level of cleanliness in some parts of the service was not satisfactory. Areas in a bathroom and wet room were dirty and in need of a thorough clean. Infection control audits had not identified these issues and information recorded was inaccurate.

Four incidents that had taken place between July 2015 and February 2016 relating to safeguarding issues had not been notified to the Commission, although the provider had taken appropriate action to ensure the safety of the people concerned.

People were protected from avoidable abuse and harm as staff had been trained in safeguarding adults at risk and knew what action to take. Risks to people had been identified and assessed and information was provided to staff on how to manage people’s risks. At the time of inspection, the premises were undergoing maintenance and refurbishment; this was due to be completed within six to eight weeks. There were sufficient numbers of staff on duty to keep people safe. New staff were recruited in line with robust recruitment practices. People’s medicines were managed safely. Some people had been assessed as being able to self-medicate and manage their own medicines.

Staff had completed training in a range of essential areas and were able to undertake additional training as needed to meet people’s needs. New staff followed the Care Certificate, a universally recognised qualification. Staff had supervision meetings with their manager, although some staff had not always received supervision every four to six weeks in line with the provider’s policy. However, the acting manager was readily available and handover meetings between shifts were an opportunity for staff to discuss any ongoing issues relating to people’s care and support. Staff meetings were held usually every three months. Consent to care and treatment was sought by staff in line with legislation and guidance. People were free to come and go as they pleased. They had sufficient to eat and drink and were supported to maintain a healthy lifestyle. A range of healthcare professionals and services were available to people. People had furnished and personalised their rooms according to their preferences.

People were supported by kind and caring staff who knew them well and understood how to meet their mental health needs. People spoke highly of the care and support they received from staff and were involved in decisions about their care and treatment. They were treated with dignity and respect and had the privacy they needed at the time they wanted it. Relatives and friends could visit freely.

Care plans were extremely detailed in the information recorded about people, their personal histories and backgrounds, their likes and dislikes and their mental health conditions. Staff knew how to support people in a personalised way to achieve a set of planned goals towards independent living. People were encouraged to go out into the community and to pursue activities that were of interest to them such as sports, college or work. Complaints were managed appropriately and to the satisfaction of the complainants.

People were involved in developing the service and house meetings were organised to enable them to express their views and to feedback about the service. The culture of the service was described as, “A nice warm, friendly environment” that supported and nurtured people. Staff felt the service was managed well and respected the acting manager. A range of systems was in place to measure the quality of the care delivered, although this had not been effective in identifying some areas of concern which we found at the time of inspection. However, in the main, audits had identified other areas concern which had been acted upon.

We found two breaches relating to the Health and Social Care Act (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of this report.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

The Progress Project provides support and accommodation for up to 16 people with on-going mental health concerns including substance misuse. On the day of our inspection 10 people were living at the home. We looked at documentation such as care plans, policies and procedures, training records, staff records, surveys and quality and audits. We spoke with four people using the service, the manager, deputy manager, and two members of staff.

Is the service safe?

The service was safe because the provider had undertaken a detailed assessment and completed a personal profile for each person. People's needs assessment addressed areas of mental health, mobility, communication, personal relationships, risks and physical health. The plans had been checked and updated regularly to reflect the level of support or care required.

There were effective recruitment and selection processes in place. We looked at records for four staff members who worked at The Progress Project. This included proof of identity, a completed Disclosure and Barring Service (DBS) check and satisfactory evidence of conduct in previous employment concerned with the provision of health or social care.

Staffing levels were consistent and adequate to meet people's needs and ensure staff safety. Staff had received appropriate training in the relevant policies and guidance surrounding the detention of people under the MHA.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The service was effective because the provider operated a key worker system that allowed people to build positive relationships with their key workers. This enabled both parties to be constructive in regard to their expectations, goals and meeting their needs as part of the rehabilitation programme.

Key workers prepared support plans with each person to ensure their individual goals were identified. This supported people to take control of their own recovery and plans for their future.

Is the service caring?

The service was caring because people's needs assessment addressed areas of mental health, mobility, communication, personal relationships, risks and physical health. The plans had been checked and updated regularly to reflect the level of support or care required.

People living at the home told us: 'Staff are good; they understand and are always willing to listen to me'.

Is the service responsive?

The service was responsive. People living at The Progress Project were supported by staff whe were responive to peoples needs to live independently in preparing and submitting their curriculum vitae (CV) to prospective employers as a step to gaining full time employment and independence.

Is the service well led?

The service was well led. The service had not had the consistency of a registered manager however the manager was going through the registration process to become the registered manager at The Progress Project with The Care Quality Commission.

There were processes in place to record and respond to complaints. The manager told us that any complaint would be investigated and responded to in a timely manner.

A system of staff supervisions and appraisals was in place, which included providing staff with feedback. Although the manager was unable to show us any records of appraisals taking place we were shown diary appointments to demonstrate that these were due to take place for all staff during June and July 2014.

Supervision meetings were used to review what had been learned from training courses, job roles and objectives, staff wellbeing and future development, and the needs of people using the service.

We spoke with people who lived at The Progress Project. People told us that they felt safe and well cared for. They said that staff were kind and supportive of them. However, people felt their personal progress had slowed and felt affected by staffing changes and lack of specialist support.

We found that although people's needs were assessed and recorded, their care was not always delivered in line with this. Although people wished to increase their independence, the care they received did not accomplish this. People told us they felt unprepared to transition into the community.

We found that there were not always enough suitably qualified staff to meet people's needs safely and appropriately. There was a lack of qualified staff such as Registered Mental Health Nurse (RMN), Occupational Therapists (OTs) and activities coordinators to support people's recovery.

We found that staff had not received appropriate training to understand the needs of people with mental health and substance misuse issues. Therefore staff were unprepared to deal with mental illness and challenging behaviours. Staff were ill-equipped to empower people's independence and coping skills.

People were supported by staff who were experienced, skilled and knowledgeable. Staff had completed mandatory training but training records indicated that most staff training was not up to date. However, the provider had a plan in place for updating and reviewing training for all staff.

The provider had various methods for ensuring the quality of their service. This included obtaining feedback from people, visitors and staff. People's views and feedback were considered in the on-going improvement of the home.