Pines is a residential care home for up to seven young people and adults with autism and severe learning difficulties, often accompanied by complex needs. The accommodation is on two levels and there is access to a garden area and outside space.

At our last inspection we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring, that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found systems and processes were in place to keep people safe. Staff understood their responsibilities for safeguarding people they cared for and assessed risks to their health and safety. Measures were in place to reduce these risks and people were supported to stay safe, whilst not unnecessarily restricting their freedom. Incidents and accidents were reported and the management team completed a detailed analysis and investigation to reduce the risk of similar incidents happening again. All incidents were reviewed on a weekly basis by a multi-disciplinary team.

Medicines were managed effectively and safely. The premises and environment was well maintained and the required safety checks were completed. Infection prevention and control was effectively managed.

Staff received appropriate training for their role and they were supported to further develop their knowledge and skills. People’s needs were assessed and care was delivered in line with national guidance. Care plans contained detailed information about each person’s individual support and their preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

Although most people were unable to fully express themselves verbally, they clearly enjoyed living at the home and appeared to be relaxed and happy. Staff had developed caring relationships with people and treated them with kindness and respect. People felt able to express themselves in a safe and supportive environment.

People continued to receive care that was responsive to their individual needs. Staff had a detailed knowledge of the people they cared for and were able to recognise subtle cues from people that enabled them to respond effectively to their needs and wishes. People led full and active lives. They engaged in a wide range of activities based on their personal choices. People were treated equally, without discrimination and information was presented to them in a way they could understand.

The registered manager and deputy manager provided good leadership and support to staff. The provider had put processes in place to support the manager and staff. The views of staff, people using the service and relatives were actively sought and listened to. Quality audits and governance processes were in place to enable continuous improvement in the quality of the service provided and to ensure that learning was shared.

Further information is in the detailed findings below.

We performed this unannounced inspection on 23 September 2015. Cambian Pines is run and managed by Cambian Learning Disabilities Midlands Limited. Cambian Pines is a care home which provides residential care for up to seven people with autism and severe learning difficulties often accompanied by complex health needs. Nursing care is not provided at the service. On the day of our inspection six people were using the service.

The service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People were protected from the risk of abuse as staff had attended training to ensure they had good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager had shared information with the local authority when needed.

People received their medicines as prescribed and staff had received training to ensure medicines were managed safely.

People were supported by a sufficient number of suitably qualified staff. The provider had ensured appropriate recruitment checks were carried out on staff before they started work.

People were encouraged to make independent decisions. Staff were aware of legislation to protect people who lacked capacity and in these instances and decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health. Staff ensured that people’s health needs were effectively monitored.

Positive and caring relationships had been developed between people and staff. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times.

People were supported to report any concerns or complaints and they felt they would be taken seriously.

People who used the service, or their representatives, were encouraged to be involved in decisions about the service and systems were in place to monitor the quality of service provision.

The inspection team who carried out this inspection consisted of two inspectors to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our visit we reviewed all the information we had received from the provider. The inspection took place over one day and was undertaken by two inspectors. All the people who used the service had complex needs and required a high level of support. We used a number of different methods to help us understand their experiences when we undertook our visit. We spoke with a relative of a person who was residing at the home. We also spoke with two staff and the registered manager. We looked at some of the records held in the service including the support files for three people. We observed the support people that who used the service received from staff and carried out a tour of the building.

There was a registered manager in post who was available throughout our inspection.

Is the service safe?

We asked a relative of a person who was residing at the home if they felt people’s safety was promoted. They told us, “It’s absolutely safe. I can visit at any time and I have no concerns.” They also told us they felt confident in discussing any concerns or complaints with the management team and said, “We have very good communication and we are listened to. I feel confident in reporting any complaints.”

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise.

We found staff were able to obtain relevant qualifications pertinent to their roles and responsibilities at the home and systems were in place to ensure their annual refresher training remained in date.

Is the service effective?

Systems were in place to ensure that people’s individual support needs was delivered in such a way as to meet people’s individual requirements and preferences.

We found staff had a good understanding of people’s individual requirements which were documented in support plans that had been reviewed appropriately. A person’s relative told us they felt their relation’s needs were well understood and said, “All the staff have a really good understanding of my relative’s needs.”

Is the service caring?

Throughout the day of our inspection we observed staff were caring in their approach. They were addressing people in a respectful manner and created a calm and purposeful atmosphere. A person relative said, “There is a good mix of staff. I feel they are very caring."

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed prior to people gaining residency at the home. We also found an on-going review process was undertaken to ensure people’s changing needs and aspirations could be identified and addressed

Is the service well-led?

The registered manager was available throughout the day of our inspection. We found they were fully aware of what was expected of them and demonstrated enthusiasm and commitment in developing the quality of service provision.

A person’s relative told us they felt confident in discussing any areas of service provision with the registered manager and said they felt any concerns or complaints would be addressed to their satisfaction.

Staff also told us they felt supported by the registered manager. Comments included, “We receive positive reinforcement from our manager. It’s very motivating,” and, “Our manager is fantastic and very supportive.”

We found the registered manager was in the process of conducting a satisfaction survey so people residing at the home, their advocates and staff could make comments about the quality of the service provision. The registered manager told us that the purpose of the survey was to glean information which would be analysed and form part of the organisation's future business development plans.

The provider was responsible for a number of other homes that delivered additional regulated activities that were not provided at this home. They had prepared a set of policies and procedures to cover all of their services and we found these to be generic in nature. We found there were policies and procedures at the home that were not suitable to the location. For example the policy on administration of medication stated, “Any medicines discontinued by the prescriber must be crossed through and signed and dated by either the prescriber or a registered nurse.” However, this service did not employ any nurses.