Archived: Pennine View

Pennine View is a residential care home providing accommodation and personal care for up to 2 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 2 people using the service.

The service also provides care and support to people living in 4 supported living settings, so they can live as independently as possible. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. At the time of our inspection there were 6 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People’s medicines were not always managed safely, and people were not always supported by staff who had received relevant and good quality training in positive behaviour support, human rights and all restrictive interventions.

People were mostly 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. However, records relating to consent and capacity needed improving and we have made a recommendation about this.

People living at the home each had unique and complex health needs and staff mostly knew people and understood risks to people. Staff provided kind, caring, person-centred care and support. Staff communicated with people in ways that met their needs.

Right Care:

People's needs were assessed and developed into a support plan. Further work was underway to ensure support plans contained detailed information to enable people to receive appropriate care and support that was responsive to their needs. The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards although records needed to be improved.

There were sufficient staff deployed to meet people's needs and wishes. People received person-centred care that promoted people's dignity, privacy and human rights. Staff recognised and responded to changes to individual's needs. We saw staff treated people with kindness and patience. People had access to meaningful activities and support plans were person centred.

Right Culture:

Governance arrangements were not as effective or reliable as they should be. Further improvement was needed in the quality assurance processes to identify shortfalls and to drive improvement. Support plans and risk assessments relating to people's health needs and the environment were completed but needed more person-centred information to help protect the health and welfare of people who used the service. Relatives and staff gave us mixed feedback about the culture at the service.

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

Rating at last inspection

The last rating for this service was good (published 3 February 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about a closed culture, staff training and management. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pennine View on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 4 breaches in relation to safe care and treatment, medicines management, staff training and oversite and governance at this inspection.

We have made a recommendation about the review of fire safety procedures and the management of records relating to consent and capacity.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Pennine View is a bungalow that provides accommodation and care as a residential care home for two people with learning disabilities. The registered manager also oversees staff who support people in supported living; these services are registered separately.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Systems, processes and practices safeguarded people from abuse. Risks were assessed and managed so people were supported safely and their freedom respected. Sufficient levels of staff were available to support people safely and to meet their needs. Medicines were administered safely. People were protected from infection. Lessons learnt were discussed at staff team meetings.

Peoples needs and choices were assessed and they were provided with support that met these needs and choices. Staff were trained and knowledgeable about the people they support. People were supported to eat and drink and maintain a balanced diet. Staff worked as a team with regular handovers, health professional advice was sought when appropriate. People’s preferences were considered in the design and decoration of the home. Consent to care had been considered and appropriate legislation followed and documented. 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 treated with kindness, respect and compassion. Records showed the emotional support people needed and received. People views were considered and people made choices where they were able to do so. People’s privacy and dignity were respected and their independence encouraged.

People received very personalised care responsive which was responsive to their needs. Concerns and complaints were recorded and improvements considered, however complaints were minimal.

The management of the provider had recently changed and staff were clear about the ethos of the new provider. Staff spoke about an open and inclusive culture in the service and all were focused on providing the best outcomes for people. A governance framework was in place, and audits had recently taken place. Staff were clear about their responsibilities. Staff and families were engaged in the service. The action plan from the last CQC inspection had been implemented. People accessed the community and staff worked with other professionals and voluntary organisations.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 January 2019).

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.

Pennine View is a bungalow that provided accommodation care for two people with learning disabilities. The registered manager also oversees staff who support four people that live in supported living in two housing association owned bungalows.

What life is like for people using this service:

Our last inspection took place in June 2016 when the service was rated good. At this inspection we found that the service had declined and was rated requires improvement.

The provider had arrangements in place for managing people’s medicines. However, we identified some concerns regarding the stock and review of people’s medicines, therefore, medicines were not always managed in a safe way. We have made a recommendation that medicine management is addressed so that people receive their medicines in a safe way.

Staff recruitment files we looked at did not always reflect that the recruitment process had been followed in line with the providers policy.

The provider had systems in place to ensure the service was operating to the provider’s standard and that policies and procedures were being adhered to. However, we found audits had not identified the concerns we highlighted as part of this inspection, therefore they were not always effective.

We have made a recommendation that the provider ensures that a robust system is in place for auditing the service.

The provider had systems in place to safeguard people from abuse. Risks associated with people’s care and support had been identified and were appropriately managed to keep people safe. Staff we spoke with told us there were always enough staff available to ensure people’s needs were met in a timely and person-centred way.

Staff received appropriate training which gave them the knowledge to complete their roles and responsibilities. Staff told us they felt supported by the management team. However, we looked at staff files and found staff did not always receive structured support sessions in line with the providers policy.

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.

People were supported to maintain a balanced diet which met their needs and took account of their preferences. People had access to healthcare professionals as required.

We spent time observing staff interacting with people who used the service and found they were kind and caring. Staff offered appropriate support in line with people’s assessed needs. Staff ensured that people’s privacy and dignity were maintained.

People received personalised care which took in to consideration their preferences and choices. People were supported to maintain community links and be involved in a range of social activities.

The provider had a complaints procedure in place and people were given opportunities to raise concerns.

Further information is in the detailed findings below.

Rating at last inspection:

Good (Report published 27/07/2016)

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

Pennine View is a bungalow that provided care for two people with learning disabilities. The registered manager also oversees staff who support four people that live in two housing associated owned bungalows. These bungalows provide accommodation for one person and accommodation for three people. They are staffed at all times.

The registered manager has been in post since 2014. 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.

At the time of the inspection we met both people who lived at the home and three of the people who were supported by staff in their own accommodation. The two people who lived at Pennine View had very limited verbal communication so we observed how staff interacted with them. We saw staff could pick up on the smallest change in their behaviour and could readily interpret what the people were indicating they wanted.

The people who used the supported living accommodation told us that they were very happy with the service and found it met their needs. They told us all about the improvements they had made when interacting with others and the communication skills they had learnt. We found that there was a lot of humour and jovial interactions between the people and staff. The people felt able to freely discuss any concern and ask questions about everyday matters.

We had a very warm and lively discussion about the life of maggots and how maggots were used in the fishing expeditions people enjoyed. We also discussed the holidays people went on and how they were taking action to improve their daily living skills.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed and were adept at using deescalating techniques.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities and autism spectrum disorders.

Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The staff we spoke with understood the requirements of this Act and were ensuring that where appropriate this legislation was used.

Staff shared with us a range of information about how they as a team worked very closely with people to make sure the service enabled each person to reach their potential.

People and the staff we spoke with told us that there were enough staff to meet individuals needs. We found there were sufficient staff on duty to meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered manager had an effective system in place for dealing with people’s concerns and complaints. We found that people felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety, relevant infection control procedures were followed by the staff at the home. We found that action was taken to minimise known risks.

The registered manager had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that people were supported to make day to day decisions, for example, what to have for breakfast, with assistance from staff.

Staff knew people living at Pennine View very well and were able to interpret their non verbal and verbal communication in order to assess mood, behaviours and wellbeing.

Since the last inspection the whistle blowing procedure displayed in the main lounge had been updated to explain how and where people, staff and advocates could go to whistle blow if they were concerned about the possibility of abuse happening at the service.

People were now protected against the risks associated with medicines because the provider had improved the arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people received.