Archived: Pentire

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Pentire provides care and accommodation for up to three people who have autistic spectrum disorders. At the time of the inspection three people were living at the service.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. 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 manager told us they were in the process of applying to CQC to become the registered manager.

People were protected from the risk of abuse because staff had received training in this area and were knowledgeable about the potential signs of abuse. Staff and people told us they would not hesitate to report any concerns and were confident these would be acted on by senior management. Staff knew where to report concerns outside of the organisation. People told us they trusted staff and felt safe at Pentire.

Incidents were recorded in a timely manner and there were systems in place to help ensure they were seen by members of Spectrum’s behavioural team. This meant any trends or patterns could be identified and action taken quickly to address any issues.

There were a range of risk assessments in place to protect people from identified risk. Guidance for staff was clear and detailed. Staff demonstrated an understanding of how to support people in order to help them avoid becoming anxious or distressed. There were enough staff available to meet people’s individual needs.

Care plans were up to date and were regularly reviewed. Key workers had responsibility for overseeing individuals care plans. People took part in meaningful activities which met their individual needs and preferences.

Staff described the service as “happy” and people told us they were well supported. Staff morale was positive and there was a shared approach to care and support which focused on people’s individual needs. There were systems in place to ensure staff communicated together to share relevant information about people’s changing needs. Staff, people and a relative told us they considered the service to be well organised.

At this focused inspection we found the registered provider was now meeting the requirements of the regulations.

We inspected Pentire on 18 May 2016, the inspection was announced. The service was last inspected in July 2014, we had no concerns at that time.

Pentire provides care and accommodation for up to three people who have autistic spectrum disorders. It is part of the Spectrum group which offers care and support to people with autistic spectrum disorders living in Cornwall. At the time of the inspection three people were living at the service. Two people had bedrooms and their own living areas in the main house and a shared kitchen area. The third person lived in a self-contained annexe attached to the main house.

There was a registered manager in post. 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.

One person had raised a safeguarding concern with staff. There had been a delay between the concern being raised and CQC and the local authority being alerted. Action taken to protect people from the risk of abuse had not been carried out in a timely manner.

We had received concerns in relation to staffing levels. The rotas and other evidence showed that over the three weeks before the inspection visit there had been two occasions when staffing levels had been below the hours commissioned by each person’s Local Authority, as being the hours of staff support necessary to meet the person’s needs. However these had been for relatively short periods and staff did not believe it had impacted on people’s opportunities to take part in activities. People told us they were able to ask staff for support when they needed it and did not have to wait.

Several members of staff had recently left the service which meant most of the staff were new to the service. Staff displayed an enthusiastic approach to their work and told us they were keen to work together to ensure people were supported well. Most of the staff had experience of working for Spectrum in other units. Recruitment practices helped ensure staff working at the service were fit and appropriate to work in the care sector.

Care plans did not consistently describe how to support people when they became anxious or distressed. There was not always clear guidance for staff to follow to enable them to alleviate people’s anxieties and protect others from any associated risk.

People, where appropriate, were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate.

Staff were supported by a system of regular supervision and training. New staff were required to complete a house and corporate induction. They also had to undertake the Care Certificate within their first 12 weeks of employment if new to the role.

Staff recognised the importance of family relationships and friendships. People were encouraged and supported to develop and maintain social networks.

The layout of the building was organised in a way which meant people were able to spend private time alone if they wished. There were also shared areas within the house where people could socialize with each other. For example, on the day of the inspection two people chose to share a meal together.

People had access to a range of activities. There was gym equipment available within a shared area of the building and we observed one person using this. People took part in various activities in the community including paid and voluntary work. This can help people to develop confidence and contribute to their self-esteem.

Care plans contained details about how people wanted to be supported and in depth information regarding their behavioural needs. Some of the information was out of date or referred to incidents which had taken place many years ago.

People were confident about raising any concerns they had with staff. There was a satisfactory complaints procedure in place.

The registered manager and deputy manager had a good understanding of the day to day running of the service. There were clear lines of responsibility and accountability within the service which were understood by all. Quality assurance systems were in place to help ensure the safety and effectiveness of the service.

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

We observed staff interact with people who used the service in a kind and calm manner. We saw staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care records and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

People were protected from abuse Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights

Staff said they had received sufficient training to enable them to carry out their roles competently and felt there was sufficient staff on duty.

People who used the service, their representatives, and staff were asked for their views about their care and treatment and they were acted on.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed that they went out frequently and saw healthcare professionals when they needed to.

Staff said they had received sufficient training and support to enable them to carry out their roles competently and felt there was sufficient staff on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.