Archived: Pinetops

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.

Pinetops is a residential care home providing personal and nursing care for up to six people with a learning disability, autistic people, or people with mental and/or physical healthcare support needs. The service had three people living there at the time of the inspection visit. The service comprised of a converted Dorma bungalow, with two bedrooms upstairs, four downstairs with shared communal spaces and shower room.

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

People’s safety and well-being was not being maintained. People were not accessing meaningful activities either onsite or in the community. Concerns regarding the safe management of people’s medicines were identified. People were not being protected from risks associated with infection, prevention and control, including COVID-19. There were not always sufficient numbers of skilled staff to safely meet people’s assessed needs, placing people at risk. The provider had not got good oversight of the care provided to people, in the absence of a registered manager.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well-led, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This was impacting on the standards of care, levels of meaningful activities including integration within the local community, and protection from harm.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence. People were included in decisions about their care and support, but staffing issues meant that they were not always able to achieve their goals. Some of people’s specific support needs were not always clearly identified and met.

Right care and right culture:

• Records indicated that work needed to be completed to ensure that all staff understood the ethos, culture and values that underpinned the service. The language in care plans and staff records was not always inclusive and respectful. The provider’s oversight of this issue was poor. Some individual staff were observed to treat people who used the service with respect in a way that upheld their dignity.

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, (the report was published on 30 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about lack of provider level oversight of the service in the absence of a manager registered with CQC, and the impact this was having on the standards of care provided. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to protecting people from harm, safe care and treatment, staffing levels and the governance and oversight of the service, at this inspection.

Full information about CQC’s regulatory response to the more 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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

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.

People’s experience of using this service:

¿ People’s relatives were positive about Pinetops. Comments included, ”I am very impressed. [Person] is getting good care and is very happy,” and, “I am quite happy with the care that [person] receives.”

¿ People were protected from avoidable harm and abuse.

¿ Risk assessments were in place to ensure people and the environment they lived in was safe.

¿ People received their medicines when they needed them.

¿ Staff were recruited safely and staffing levels were sufficient to meet people’s needs.

¿ Staff were knowledgeable and were kind, caring and patient.

¿ 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's health was well managed and there were links with other services to ensure that their individual health needs were met.

¿ People were treated with dignity and respect.

¿ Staff knew people well and had developed meaningful relationships with them. Support was provided in a person-centred way based on people’s preferences.

¿ People were supported to have choice in their daily lives, however people were not always supported in the least restrictive way.

¿ People could take part in a range of activities which promoted their wellbeing.

¿ Quality assurance processes were in place and actions were taken to address any issues identified.

¿ The service was run well by a registered manager who was held in high regard by people, their relatives and staff.

¿ The registered manager had good oversight of the service.

Rating at last inspection: Good (report published 19 September 2016)

Why we inspected: This was a planned inspection based on the previous rating.

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

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

The inspection took place on the 10 August 2016 and was announced.

Pinetops provided care for up to six people. The home supported people who had a range of learning disabilities.

There is another home next door called Greenacres. This is owned by the same provider and has the same registered manager. As a result there are similarities with both homes in terms of the management and the administration of the services. We inspected these services during the same week.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Throughout this report the registered manager will be referred to as the manager.

People benefited from being supported by staff who were safely recruited, well trained and who felt supported in their work by their colleagues and by the manager. There was consistently enough staff to safely meet people’s individual needs.

Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Medicines were administered safely and adherence to best practice was consistently applied. People received their medicines on time, safely and in the manner the prescriber intended. The service regularly audited the administration of medicines. Medicines were stored securely.

Staff knew and understood the needs of people living at Pinetops.

Staff received yearly appraisals. Staff also had regular supervisions. The manager and team leader observed practice and were involved in the daily running of the service.

Staff told us they were happy working at Pinetops. They assisted people with kindness and compassion. People’s dignity and privacy was maintained and respected. People were treated as individuals.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was depriving some people of their liberty in order to provide necessary care and to keep them safe. The service had made applications for authorisation to the local authority DoLS team. The service was working within the principles of the MCA.

The manager’s understanding about mental capacity and the staff’s understanding about DoLS was variable. When we raised this with the manager, they put a plan in place to address this.

People’s care plans contained important, relevant and detailed information to assist staff in meeting people’s individual needs. People had been involved in making decisions around the care they received. People’s needs had been reviewed. People’s care was person centred.

People were supported to maintain good health and wellbeing. The service reacted proactively to changes in people’s health and social care needs.

The service had links with the local community and the manager planned to develop this further.

The service encouraged people to maintain relationships with people who were important to them. There were planned activities on a daily basis to support people to maintain their interests and fulfil their goals.

There was a positive, open culture and a welcoming and friendly atmosphere at Pinetops. There were systems in place to monitor the quality of the service. Although there appeared to be delays at the provider level (New Boundaries) for some of the improvements to the garden, the manager and staff wanted to make.

We noted that some people were not able to make more complex decisions about their care. Where this was the case there were clear indications that decisions were taken in a way that represented their best interests. The new manager had plans to improve how care plans were developed and increase opportunities for people to communicate if they were unable to do this verbally.

People's needs were assessed and care was delivered in a way that met their needs safely. People had access to other professionals to help keep them well. Staff were able to give us detailed information about people's health and welfare and showed they understood how to meet people's needs. This included how they supported people to have enough fluids and to eat well.

Medicines were managed and administered safely so that people were protected, as far as possible, from risks associated with these.

Most people would need assistance to make complaints. However, there was a system for dealing with these. Our discussions with staff showed that they were aware of the importance of responding to and resolving informal complaints promptly. We observed that people living at Pinetops interacted freely with staff and showed no signs of being ill at ease. One person said they had no concerns but were confident staff would "...sort it out..." if they did.

At the time of our inspection two people had gone out with their cooking club for a Christmas meal. We were told that both people often liked to spend time cooking in the home's kitchen.

One person's care records showed that they regularly undertook activities, which they said they enjoyed such as bowling, going to the cinema and going out for a coffee and a walk.

We saw that people's individual rooms had been decorated and furnished in accordance with their choices and that people were able to have their personal possessions around them.

We met and spoke with one person while they were relaxing and watching a film in their room. This person told us they were happy and liked their room. When asked, they also told us they liked having their personal collections of DVDs and other items, which they said the staff helped them to dust and clean.

At the time of our inspection, we saw that there were enough members of staff on duty to keep people safe and meet their care and welfare needs.

There were a number of systems in place to assess and monitor the quality of service provided.