The Pines Residential Home

We found the following examples of good practice.

Visitors were checked on arrival for proof of vaccination where it was applicable. The provider kept themselves informed about changes in best practice guidance and adapted their practice accordingly. For example, following changes to visiting guidance the provider revised their practice to support people to maintain relationships with those close to them.

We saw there was a plentiful supply of PPE throughout the buildings and staff were observed wearing it appropriately at all times. The provider acted on advice from infection prevention and control (IPC) leads from partner agencies. For example, following a recent IPC visit the provider revised their use of PPE and removed any unnecessary equipment.

The provider kept themselves, and staff, up to date with advice and guidance about best practice in care homes. For example, everyone we spoke with knew about the changes to visiting and testing.

Risk assessments were in place for people and staff regarding individual risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations unless exempt.

The Pines Residential Home is a care home providing personal care to up to 13 people who have a learning disability. At the time of the inspection 12 people were using the service. The Pines Residential Home is made up of three separate units; The Pines can accommodate seven people; The Unit supports up to four people and there are two individual flats known as The Cones.

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.

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

People were protected from the risk of abuse because the provider’s systems ensured staff were suitable to work with people. People told us they felt safe and risks to people’s safety and well-being were assessed and monitored. There were sufficient numbers of staff to meet people’s needs in a safe way.

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. Staff always asked for people’s consent before helping them.

People had their needs assessed and were supported by staff who had the skills and experience to meet their needs. Staff monitored people’s health and well-being and worked with other professionals to make sure they received the care and treatment they needed. People’s nutritional needs were assessed, and they received food and drink which met their needs and preferences.

People were supported by kind and caring staff who ensured they were involved in decisions about their care. People were treated with respect and their right to privacy was understood and respected by staff. People were supported to remain as independent as possible.

People received a service which met their needs and preferences. There were opportunities for social stimulation and people could see their friends and family whenever they wanted. People were treated as individuals and chose how they spent their time. People and their relatives felt confident and comfortable to discuss any concerns with staff.

The home was well-led and there were effective systems in place to monitor and improve the quality of the service people received. Staff were well supported and motivated. This led to a happy and inclusive environment for people to live in. The service worked in partnership with other professionals to achieve good outcomes for 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 requires improvement. (Report published 21 March 2019) and there were two breaches of our regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of our regulations.

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 service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

What life is like for people using this service:

In the ‘unit’ section of the home, there were not always enough staff to meet people’s needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The service did not always notify CQC of events, incidents or accidents that they were required to by law. This was a breach of Regulation 18 of the Care Quality Commission (Registration) regulations 2009.

Staff did not feel that the registered manager spent enough time at the service.

People told us that they were happy living at The Pines and referred to it as home.

People received personalised care and support that promoted independence. People were given choices and were encouraged to have control over their lives.

People had access to the community and attended clubs and social groups. There were activities available for people who spent most of their time within the service.

Staff received appropriate training to ensure they could meet people’s needs in a caring and kind way.

Staff understood what was important to people and supported people to achieve their goals.

People were protected from the risk of abuse and medicines were mostly managed safely.

More information is in the full report.

Rating at last inspection:

At our last inspection in June 2016 (report published 9 September 2016) the service was rated as Good in all five key questions. At this inspection we found that the key questions of Safe and Well-Led are now rated Requires Improvement and the overall rating has therefore changed to Requires Improvement.

Why we inspected:

This was a planned inspection based on the date and the overall rating of the last inspection.

Enforcement:

You can see what action the provider needs to take at the end of our report.

Follow up:

We will ask the provider for an action plan to address the breaches of regulation. We will continue to monitor the service through the information we receive.

The Pines Residential Home offers accommodation for up to eleven people with learning disabilities or autistic spectrum disorders. There were eleven people living at the home at the time of our inspection. The home consists of two units, The Pines House where six people lived, and The Pines Unit where three people lived in the main house and two people lived in individual flats.

The service was previously inspected on 24 April 2014 and met all standards considered at the time.

A registered manager was in post at the time of our visit. 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 registered manager and director were also the proprietors of the home.

People were supported to be safe by a staff team who knew them well. Staff knew what actions to take if they had concerns for people’s safety or well-being. People were supported to recognise when they were at risk of being unsafe and assisted to make their own decisions on how they managed the risks. People were supported to take their medicines so they would remain well.

People were supported by staff who valued and listened to them. People's choices were acted upon by staff who went the extra mile to support them to live a fulfilled life and cared for them in a way they preferred. This was because the service used the principles of the Mental Capacity Act (MCA) well to develop the confidence of people to make their own decisions. People were supported to enjoy a range of food and drinks so they maintained a balanced diet. People were enabled to prepare their own meals if they wished. Access to health services and specialists was arranged as required so people were able to remain physically and mentally well.

People were supported to enjoy a rich and active social life and were treated with dignity, kindness and compassion at all times. The staff team understood each person’s individual preferences, diversities and needs. People were encouraged and supported to achieve their full potential, undertake further education and develop their skills. They were enabled to make their own choices about what they did each day. There was a positive approach to people's chosen pastimes with a focus on working with the person to ensure they could achieve what they wanted. As a result, people had a high self-esteem.

People enjoyed close and caring relationships with the staff team. The atmosphere throughout the home was happy and open. People were confident to express their thoughts and ideas at all times. Where required, intensive support for people was provided in a discreet and compassionate manner by staff. Care provided was individual to each person's requirements. It was planned and reviewed with people and their families. People and relatives knew how to raise concerns and complaints and were confident that staff would take action if this happened.

People and families enjoyed close relationships with the registered manager and director of the service. The unit managers in the home enjoyed trusting relationships with the people, their families and the staff. The whole senior team worked well together to ensure the staff team knew what was expected of them. Checks were undertaken on the quality of the care and support provided for people. Opportunities were taken to develop the service as a result of these checks. The registered manager and director showed that they were committed to continuous development of the service.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Risks to people had been identified, assessed and kept under review. Staff had undertaken training important to their role including manual handling and fire training in order to care for people safely.

Appropriate arrangements were in place to manage medicines. This meant that people were protected against the risks associated with medication.

Is the service caring?

Staff interactions were supportive and respectful. We observed a relaxed, yet respectful atmosphere in the service. All five people spoken with told us they were happy living at the service and felt safe. One person told us, 'It's nice up here, I like it here'. Another person told us, 'I can't think of anything that I am unhappy with'.

Is the service responsive?

The service responded to people's changing needs. People had access to support and advice from a team of health and social care specialists.

People's views about care and treatment were acted upon. People using the service were involved in decisions relating to food and activities. People told us they felt listened to and respected.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the service met their needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

People were protected from the risks of inadequate nutrition and dehydration. People were provided with a choice of suitable and nutritious food and drink, which was freshly prepared in the service. Special diets were catered for including diabetic, vegetarian and soft diets.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. Satisfaction surveys had been completed by people who used the service and feedback gained was positive.

Staff felt part of a good team and that they were well supported.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'They are very nice' and another said 'They take care of me'.

The provider had developed a system whereby they can monitor how well the home is meeting the needs of the people who live there.