Pirton Grange Specialist Services is registered to provide accommodation, nursing care and rehabilitation services for up to 58 people who may have support needs owing to mental health, learning disabilities or autistic spectrum disorders and dementia. Services are also provided for older people, people detained under The Mental Health Act, people with physical disabilities, sensory impairment and younger adults. There were 31 people living at the home at the time of our inspection.

This inspection took place on 16 February 2017 and was unannounced.

A registered manager was not 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 2008 and associated Regulations about how the service is run. However, the provider had appointed a manager who was in the process of applying to become a registered manager with the Care Quality Commission.

At the last comprehensive inspection on 28 November 2014, we asked the provider to take action to put in place suitable arrangements for obtaining and acting in accordance with the consent of services users in relation to the care and treatment provided for them.

We completed a focused inspection on 4 November 2015 to make sure the improvements required had been made. We found the effectiveness of the service had been improved and action had been taken to meet the legal requirements in respect of obtaining and acting in accordance with people’s consent in relation to the care and treatment provided for them. We could not improve the rating as a result of the inspection on 4 November 2015, as we needed to make sure the improvements made were sustained.

At this inspection we found the improvements required had been sustained.

People told us the staff who cared for them understood their safety needs. Staff cared for people in ways which promoted their safety, based on people’s individual risks. Staff knew what action to take to protect people from the risk of potential abuse. There were enough staff employed to care for people so they received care promptly and their safety and well-being needs were met. Where people wanted assistance to take their medicines this was given by staff who knew how to do this safely.

People benefited from receiving support from staff with the knowledge and skills to care for them and staff recognised people’s rights. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was followed. As a result, people were supported to maintain their physical and mental health.

Caring relationships had been built between people and staff. People and their relatives were positive about the staff that supported them. Staff worked in ways which made people feel valued and included and recognised them as individuals. Staff took time to chat to people and show interest in how they spent their time. People were encouraged to make their own day to day decisions about their care. Where people needed support to do this this was given by staff. People were offered reassurance from staff in the ways they preferred when they were anxious. People’s right to privacy was taken into account in the way staff cared for them and they were encouraged to further develop their independence.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. People were confident they would receive the care they needed from staff as their needs changed. People and their relatives understood how to raise any concerns or complaints about t

We completed an unannounced comprehensive inspection of this service on 28 November 2014. We found there was a breach in the legal requirements and regulation associated with the Health and Social Care Act 2008. The provider did not have suitable arrangements in place for obtaining and acting in accordance with the consent of people who lived at the home in relation to the care and treatment provided for them.

We undertook this focused inspection to check the provider now met the 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 Pirton Grange Specialist Services on our website at www.cqc.org.uk.

The provider is registered to provide accommodation and nursing care for up to 58 people who may have needs due to acquired brain injury, Huntingdon’s Disease, multiple schlorosis or Parkinsons Disease. There were 26 people living at the home at the time of our inspection.

A registered manager was not in post at the time of our inspection but we saw that the provider had made suitable arrangements through the appointment of an acting service manager while they recruited a new manager. The acting service manager told us once the manager had been recruited they would apply to become a registered manager. 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.

People were supported by staff who knew the importance of checking if people consented to the care. Staff knew the most effective way to communicate with individual people, and used this knowledge so that people were empowered to make their own decisions and choices. We saw staff gave people time to make their own decisions, and took into account people’s wishes when giving care. People told us staff respected the decisions they made about receiving care.

Where people were unable to consent to some areas of their care, staff had worked with other professionals and relatives so that decisions were made in the best interest of the person, by people who had the authority to do this.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made continue to be implemented.

This inspection took place on 28 November 2014 and was unannounced.

The provider was not meeting the requirements of the Health and Social Care Act 2008 at our last inspection on 23 July 2014. This inspection identified breaches in regulations relating to depriving people of their liberties, meeting people’s care needs and keeping people safe, staff training and support, and assessing the quality of the service provided. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that overall improvements had been made to the care people received, staff training and assessing the quality of the service provided. Although where people lacked mental capacity to consent to their care and support, the proper procedures had been followed to ensure decisions were made in people’s best interests but further improvements were needed to show that this was done consistently.

The provider of Pirton Grange Specialist Services is registered to provide accommodation and nursing care for up to 58 people who may have needs due to acquired brain injury, Huntingdon’s Disease, multiple sclerosis or Parkinson's Disease.

At the time of our inspection 27 people lived at the home. Pirton Grange comprises of two connecting buildings, the older grange and a new purpose built home and rooms were arranged over two floors.

A new manager has been appointed and they were in the process of applying to become the registered manager. 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.

Staff told us they had not received training to support them to understand the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This law sets out to support the rights of people who do not have the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We found there was an inconsistent approach in applying the MCA in order to support people’s rights when specific decisions needed to be made so that the right people were involved. This meant the required standards of the law that related to the MCA were not always being met to promote people’s best interests.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Where people had been assessed as needing their liberty restricted to keep them safe, referrals had been made to the local authority for their approval.

People and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and caring, and thoughtful towards people and treated them with dignity and respect when meeting their needs. We observed lots of chatter and laughter as staff supported people to do some fun and interesting things.

Staff knew how to identify harm and abuse and how to act to reduce the risk of harm to people which included unsafe staff practices. There were sufficient staff of the right skill mix available to meet people’s needs and safe and effective recruitment practices were followed.

People had their health care needs met and their medicine administered appropriately. Staff supported people to attend healthcare appointments and liaised with their doctor and other healthcare professionals as required to meet people’s needs.

Staff understood people’s care and support needs. We saw staff supported people with their eating and drinking so that they had the nourishment and hydration to meet their needs.

The manger understood their responsibilities and had made improvements to the service people received since our last inspection. There were effective management systems in place to monitor and improve the quality of service provided. Staff told us they felt able to talk with the manager if they had any concerns or opinions and they would be listened to.

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

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of our inspection. Their name appears because they were still the registered manager on our register at the time.

This inspection was completed by one inspector. On the day of our inspection we found that 28 people lived at Pirton Grange. Due to their complex needs or health conditions, we were not able to speak with all of the people who used the service. We observed their experiences to inform our inspection. We spoke with four people who used the service, the registered manager, deputy manager, two nursing staff and four care staff.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. One person told us, "I feel safe here and I feel sure everyone here is safe." Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy. We found some safeguarding alerts had been made for people and the appropriate action taken by the provider. However, we found evidence that not all incidents had been identified and reported for safeguarding. The registered manager was unclear about why this had happened but reassured us that appropriate action had been taken to ensure people's safety.

People were not always asked for their consent to care and treatment and where people did not have the capacity to give consent, the provider had not acted in line with legal requirements.

People had not always been cared for and supported in line with their individual care plan and risk assessment. This meant that people's welfare and safety was not always protected.

The deputy manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Systems were not in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found people had been deprived of their liberty without appropriate authority and safeguards.

Is the service effective?

People were not included in the planning of their care. We found that care plans and risk assessments were not followed by care staff. This meant people were not receiving effective care that met their needs.

Although regular staff training took place, we found training was not always effective. Staff were not supported to effectively carry out their role.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient with people. One person told us, "The staff are very good to me."

People’s preferences, interests and diverse needs had been recorded, however care was not always provided in accordance with people’s wishes.

Is the service responsive?

People were not given the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service however the provider had not acted on comments that people made.

Is the service well led?

The provider had risk management systems in place. We found the provider did not check that risks were managed effectively.

The provider sought the views of people who used the service and staff. Records seen by us indicated that people were not asked about all aspects of the service and their views were not acted on.

Staff told us they were not clear about their roles and responsibilities. Staff told us they did not feel supported by managers.

When we visited Pirton Grange we found that twenty five people used the service and we met and spoke with three of these people. We spoke with three relatives of people who used the service. We spoke with four members of staff who delivered care and the registered manager. We read the care records for six people who used the service. We read six care staff records.

We found that staff had an understanding of the needs of people who used the service. We found that care and support was planned and delivered in a safe way, which met people's individual care needs. One person who used the service told us, "This is my home and I love it."

We found that people's dietary needs were met and that people had a good choice about what they ate. We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

People we spoke with were positive about the care they received. People told us that staff had the right training and that their knowledge and skills were adequate. One person told us, "They have helped me so much. I'm a different person now."

We found that systems were in place to effectively deal with complaints. The provider monitored the quality of the service and had made improvements where needed.

We found that the provider did not have systems in place to gain the consent to care and treatment of people who used the service.

On the day of our inspection there were 25 people living in the home. Part of the premises had been closed temporarily for decorating. We spoke with three people who used the service. We observed how staff interacted with people to support them in making decisions about their care and lifestyles. We saw that staff respected the decisions that people made. We spoke with a person who said, "I like living here."

The three care files that we reviewed indicated that arrangements had been made to support people in receiving their health and care needs. We saw recordings that confirmed that staff had actively promoted people's health and well-being. From

discussions held with three staff we found that people were well supported in receiving care needs that suited their individual preferences and lifestyle.

People were encouraged and supported to do things for themselves and were given choices. One person told us, "I can go out if I want to."

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

We saw that staff were supported in carrying out their roles effectively. This was because there were systems in place for staff to attend appropriate training courses. Senior staff regularly monitored staff practices to ensure that appropriate care was being provided.

People told us they knew how to make a complaint but that they had not needed to.

People using this service told us they were happy with the care and treatment they received. They told us staff support them in ways they wanted. They said "the staff are very nice mostly" and "I am happy here". Other people showed us with a "thumbs up" sign that they were happy with the care at Pirton Grange.