Pennine Camphill Community

Pennine Camphill Community is a specialist residential college, providing education, personal care and living accommodation for up to 28 people. The service supports people who have a learning disability and/or autism. At the time of our inspection 6 students were living at 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.

This was a targeted inspection that considered the safety of people using the service. Based on our inspection of risk, staffing and safeguarding, we found that one area of risk was not identified and assessed. Whilst we found action was taken to mitigate immediate risks to people, no specific risk assessment or care plan was in place to guide staff about how to safely support people. Following our inspection, action was taken to address this.

The service had designated safeguarding leads. However, we found several incidents of which had not been reported to the local authority or CQC. Staff 'normalised' behaviours of concerns and senior staff did not always identify incidents which required reporting to external agencies.

Incidents were monitored in house through a therapy team, safeguarding team and the care manager. Staff understood their roles in relation to safeguarding and told us they felt comfortable to report concerns. Staff had reported safeguarding concerns to the senior team; however, incidents were not reported externally by the leadership team. People were supported by enough staff and where people required dedicated 1:1 this was provided. People told us they felt safe, and staff told us people were safe and there were enough staff to safely support people.

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 inadequate (published 03 April 2023).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the safety of people using the service. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We were assured during this inspection that people were protected from the risk of harm from this concern. However, we have identified concerns in relation to records and reporting incidents to external agencies. Please see the safe sections of this full report.

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.

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

Enforcement

We have identified breaches in relation to safeguarding at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pennine Camphill Community is an education disability service providing accommodation and personal care for up to 28 people. The service provides support to people who have a learning disability and autistic people. At the time of our inspection there were 20 people using the service, some of whom were accessing respite care.

The service had 1 house divided in to 4 corridors. There was a lounge, kitchen and dining area and a communal room. Each bedroom had an en-suite facility. The service had a sleep-in facility for staff.

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 were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s independence was not always promoted, and we observed staff not seeking consent and imposing restrictions on people. People’s support needs and risks associated with their care were not always appropriately managed to ensure safe care could be provided.

Right Care:

People did not always receive person-centred care and their care plans did not show they were encouraged to make decisions about the support they received. Systems and processes were not effective in ensuring people were protected from the risk of abuse and staffing was not always provided in line with people’s needs. Staff did not always have the appropriate training to meet the needs of people. People’s medicines were not always safely managed. Recruitment was safely managed.

Right Culture:

Feedback from people, relatives and staff was mostly positive about the care received. However, we found the culture of the service did not reflect a positive and empowering ethos. The service worked in partnership with other health and social care professionals to seek advice on providing effective care, although we found this was not always recorded. The service was not using governance processes effectively to learn lessons or improve the service. A new management structure had been recently implemented to address the culture of the service and governance oversight. Staff told us they felt supported in their roles.

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

Rating at last inspection and update

The last rating for this service was good (published 7 April 2020). The overall rating for the service has changed from good to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report. The registered manager and head of care were responsive to the concerns found by us and took action to mitigate immediate risks to people during the inspection. They told us they would address wider concerns after the inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, risks associated with people’s care, staffing levels, safeguarding concerns and staff training. A decision was made for us to inspect and examine those risks.

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.

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

Enforcement

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, safeguarding, good governance and staffing. We issued warning notices against the registered manager relating to the breaches of regulation 9 and 11. The registered manager did not submit an appeal or representations against the warning notices.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Pennine Camphill Community provides accommodation and personal care for up to 28 students with learning disabilities, some of whom are living with autism. It is a specialist residential college of further education. Accommodation is provided in four individually staffed houses. At the time of our inspection, seven students were using the service accommodated in two houses.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Students and their relatives felt the service was safe. A relative told us, “It’s a fabulous set up.” Another relative said, “From [Person’s] point of view they really enjoy being at Camphill [referring to Pennine Camphill Community]. They look forward to going back when they’ve been away or been home.” Risk assessments were in place and showed what action had been taken to mitigate identified risks. The management of medicines was safe and administered by staff who were assessed as competent. Feedback about the meals was positive. Students were protected from the risk of infection.

Care plans were up to date and detailed what care and support students wanted and needed. New staff received an induction. Staff training and supervision was up to date. Staff received the input of other healthcare professionals where needed. Students 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. A relative told us, “They enable the students to grow their confidence and they treat them with such respect. It’s a beacon and a good example of best practice.”

Care planning was extremely person-centred and students were encouraged to retain their independence. Relatives felt involved in making decisions regarding the student’s care needs. Students were encouraged and supported to become more independent by learning life skills.

Students were supported by a regular staff team who knew them well. Social activities met student’s individual needs and enabled students to live as full a life as possible.

The provider had a complaints procedure in place. Students and relatives knew how to make a complaint should the need arise. Relatives were regularly consulted and asked for feedback about the quality of the service. The principal was clear in their desire to provide person-centred and high-quality care to everyone who used the service. Most relatives told us they had regular contact and felt very supported by the frontline staff who directly supported the students. Relatives and staff felt the service was well-managed.

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 29 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 Camphill Community provides accommodation and personal care for up to 29 people with learning disabilities, some of whom are living with autism. It is a specialist residential college of further education and is situated on the outskirts of Wakefield. Accommodation is provided in five individually staffed houses. At the time of our inspection only two houses were accommodating students. The service is registered with CQC to provide accommodation and personal care as single package under one contractual agreement. CQC regulates both the living accommodation and the care provided, and both were looked at during this inspection.

At the time of this inspection there were 10 people using the service.

The service is required to have a registered manager. 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. There was a registered manager at the service.

People who used the service were referred to as students and this terminology is used throughout this report.

Students told us they felt safe at Pennine Camphill Community and relatives we spoke with appreciated the environment the service provided for students to be able to access the outdoors safely.

Safeguarding policies and procedures were in place but the service had not recognised some concerns as safeguarding issues and had not reported them appropriately. Risks assessments were in place but we found these were not always being used effectively. Positive risk taking was supported.

Some improvements were needed in the way medicines were managed and audited.

A health and safety group had recently been developed.

There were enough staff and volunteer co-workers to provide students with the support they needed and the provider had safe and effective recruitment and selection procedures in place.

Staff received training appropriate to their needs although evidence gathered during the inspection suggested staff would benefit from further training in MCA and DoLS.

Students were not always supported to have maximum choice and control of their lives and staff lacked an understanding of the principles of the Mental Capacity Act, consent issues and people’s right to make choices.

Students told us they enjoyed the food at the service although we did not see evidence of people being involved in menu planning. Some people followed restrictive diets although there was little evidence to support the reasons for this.

Students had confidence in staff and we saw caring, compassionate and friendly interactions between staff and students although language used by staff was not always respectful.

Although we saw evidence of some good practice, students’ privacy and dignity needs were not always fully considered.

Students were encouraged to develop their independence and we saw examples of this. However, lack of choice in some areas did not fully support this.

Some improvements were needed in relation to documentation and practice to demonstrate a fully person-centred approach. Some care records had been developed in a person-centred manner but lacked evidence of student involvement.

A complaints procedure was in place and easy read information was available to support students to express any concerns.

Students had opportunities to engage in activities and new experiences of their choice.

Some routines within the service restricted student’s opportunity to make lifestyle choices and there was little evidence of this being assessed on an individual basis.

People had confidence in the management team and they were open about their recognition of where improvements were needed. Some new systems had been introduced.

Systems for auditing the quality and safety of the service were not fully effective and the service had failed to make required notifications to the CQC of events within the service.

Systems were in place to support students transitioning between services.

We identified two breaches of regulations during the inspection. You can see what action we have told the provider to take at the back of the full version of this report.

Pennine Camphill Community provides accommodation and personal care for up to 29 people with learning disabilities, some of whom are living with autism. It is a specialist residential college of further education and is situated on the outskirts of Wakefield. At the time of this inspection there were 13 people using the service.

The service is required to have a registered manager. 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. There were three registered managers at the service.

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

There were enough staff and volunteer co-workers to provide a good level of interaction and the provider had effective recruitment and selection procedures in place.

Staff and volunteer co-workers had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who lived at Pennine Camphill Community. This ensured they had the knowledge and skills to support the people who lived there.

People’s capacity was always considered when decisions needed to be made.

People grew some of their own food and were supported to eat a balanced diet. Mealtimes were a social occasion in the houses.

Staff interacted with people in a caring, friendly, professional manner. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of personalised care plans and risk assessments. People and their representatives were involved in care planning and reviews. People engaged in educational, work and leisure activities which were person centred.

There had been no complaints at the service, but people told us they knew how to complain and told us staff were always approachable.

People received person centred individualised planning and support when moving between services.

The culture of the organisation was open and transparent. The managers were visible in the service and knew the needs of the people who used it.

The registered provider had an overview of the service. They audited and monitored the service to ensure the needs of the people were met and that the service provided was to a high standard.

We saw people were respected and involved in what took place in the setting. For example, staff were seen to include people in discussions about what they wanted to do and the activities in their day. People told us they liked being at Pennine Camphill Community. Staff told us they put each person at the centre of what they did.

We saw people were settled and happy. We observed people were involved in purposeful activities and they worked in small groups with other people and the staff responsible for their learning and well-being. We looked at two care records and saw these were detailed with information about people's individual needs.

We saw premises were well maintained, easily accessible and secure. People told us they knew what to do in an emergency, such as a fire drill.

We observed people enjoyed their meals and food was served in good quantities for people's needs, within a homely atmosphere.

We saw there were systems in place for assessing the quality of the provision.