Archived: Pinetops

Updated 4 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors on the first day and one inspector on the following day.

Service and service type

Pinetops is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Pinetops is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced on the first day and we told the provider we would be returning the following day. Inspection activity started on 15 September 2022 and ended with a feedback session on 10 October 2022.

What we did before the inspection

We reviewed the provider’s monthly action plan updates which had been shared with us. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

People who used the service were not able to speak with us about their care and so we observed care and support being provided. We spoke with two relatives, the provider, the regional operations manager and the manager. We also spoke with seven care staff including two night staff and three agency staff . We received feedback from the local authority quality monitoring team and the fire officer reported their findings to us.

We reviewed a range of records. This included three people’s care plans, three sets of medication records, one staff recruitment file and other records relating to the quality and safety of the service.

Updated 4 May 2023

About the service

Pinetops is a residential care home providing personal care to up to six people with a learning disability and/or autistic people. The service had three people living there at the time of the inspection visit. Pinetops has communal living areas and each person has their own bedroom, two of which are upstairs.

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:

The model of care and setting did not maximise people’s choice, control and independence.

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 did not support this practice. Where people’s freedoms to make choices had been restricted, these decisions were not appropriately reviewed and alternatives considered.

People were not fully involved in deciding how they wanted to be supported. The provider identified people’s interests, goals and aspirations but their choices were not always respected. Staff were not always aware of people’s goals and aspirations and the assessed risks associated with these. Staff did not receive the training and support they needed to make sure they could meet people’s complex needs. This meant people were not supported to increase their independence and ensure a good quality of life, in line with their stated goals.

The management of risks, including those posed by the environment, was not robust and had been raised at our previous inspection in October 2021. Recording and monitoring of known risks was not always accurate and staff knowledge of risk was not comprehensive.

Right Care:

Care needed to be more person-centred to promote people’s dignity, privacy and human rights. Staff did not always use age appropriate language. Care routines did not always ensure people’s dignity was promoted.

There were usually enough staff but often these were agency staff or inexperienced staff who did not know people well. This limited people’s opportunities to access the community and follow their own interests.

Staff had been trained in safeguarding people from abuse but the provider had not ensured safeguarding concerns were always reported and fully investigated.

Right Culture:

The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives. The provider did not have systems in place to support people to lead their best lives. Audits of care delivery and the monitoring of safety were poor. This placed people at risk of receiving unsafe care and treatment. Care did not meet people’s complex needs and the provider did not have oversight of the failings of the service.

The values of the service, as set out in its policies and procedures, were not evident in practice. People led restricted lives and were not supported to develop and grow their skills and independence.

The provider did not ensure staff had the training, skills and experience they needed to deliver the care people needed. Staff were demotivated and the culture of the service was not inclusive and progressive. Action plans and monthly updates shared with the Care Quality Commission (CQC) did not drive improvement and did not demonstrate a cohesive culture.

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 inadequate (published 21 January 2022.) Conditions were imposed on the provider’s registration and they submitted monthly improvement plans documenting how they were bringing about improvements. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 19 and 26 October 2021. Breaches of legal requirements were found. We imposed additional conditions on the provider’s registration and required them to send us a monthly action plan documenting actions taken to improve safe care and treatment and good governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to consent, safe care and treatment, safeguarding, good governance and ensuring there were enough skilled and experienced staff.

Full information about CQC’s regulatory response to the serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.