This inspection took place on 19 September 2017 and was announced. We gave the provider 24 hours’ notice as the service is small and we needed to be sure someone would be at home. The Pines is a service that provides personal care and accommodation for up to 12 people who have a learning disability and who may be living with autism. On the day of the inspection, there were 11 people living at the service.

There was a registered manager in post at the time of our inspection however they were away from work and not available to meet with us. 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.

At our last inspection in June 2016 we rated The Pines ‘Requires Improvement’ in caring and responsive and as a result ‘Requires Improvement’ overall. This was because we were concerned that staff practices were not consistently good and staff did not always act in a way which fully promoted people's independence and rights. We were also concerned at our last inspection that the range of activities for people was limited by a number of factors including staffing levels, transportation and the range of different needs people had which was not conducive to individualised care. We found at this inspection that improvements had been made to these areas however we concerned about the environment. There was damaged paintwork, stained carpets and the lighting needed enhancing.

Staff were recruited safely and received an induction when they first started working at the service. People were supported by sufficient staff who knew them well. Senior staff were requesting to review the number of support hours with the local authority.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and to help keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

All medicines were administered by staff who were trained to do so. We identified some issue with record keeping around medicines however were assured by additional records in place that people were having their medicines has the prescribed intended.

Staff had received training and supervision and were able to describe how they worked with people to meet their needs.

Support files were personalised to reflect people's personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people's care to ensure they received the care and treatment which was right for them.

People received a service that was caring. Staff knew people's needs well and were responsive and supportive. Staff treated people with dignity and respect. People were offered a range of activities both at the service and in the local community. Staff sought to gain people's views.

Staff understood the need to support people to remain as independent as possible. Some people were able to go out unaccompanied by staff. Support plans showed that this had been risk assessed and systems had been put in place to enable them to contact the service if needed.

Good leadership was in place that provided staff with the necessary support and training to make sure people received good quality care. The management team assessed and monitored the quality of the service. A number of audits that had taken place. This ensured the service continued to be monitored and improvements were made when they were identified.

The inspection took place over two different dates the 10th and 12 February 2016 to meet with as many people as possible using the service. The first day was unannounced but the second day was agreed with the registered manager.

The service provided accommodation for up to twelve people and was divided into three separate living quarters to give people further independence according to their needs. Adults had a diagnosis of learning disability, mental health needs or both and were supported in accordance with their needs.

There was a registered manager in post who had been in post in excess of three years.

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 service provided accommodation which was designed to accommodate differing needs including those who were more able and those who needed more assistance. Each part of the accommodation was self- sufficient other than the laundry which was shared. Despite this set up it was not clear how staff were always meeting people’s needs effectively around their individualised needs and according to their wishes and abilities.

Medication administration was carried out by staff who were sufficiently supported to ensure they had the right competencies and skills.

Risks to people’s safety were documented and as far as possible effectively managed.

Staff recruitment was robust and there was good support in place for staff. Their training was up to date but limited access to more specialist in-depth training around mental health and learning disability training meant we could not be assured that staff had the necessary skills and sufficient understanding of individuals.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberties. The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People were supported to eat and drink sufficient to their needs and staff worked hard to ensure people received the health care they needed and staff monitored people’s health and acted accordingly.

Staff interactions with people were not always as positive as they could be and staff were not seen to promote people’s independence as fully as they might. Some people did not seem to have sufficient interaction or opportunity to participate in a fuller life as possible. Other people who could be more independent were not given the fullest opportunity.

People were consulted about their care and support. Regular reviews and an effective complaints procedure meant gaps in service provision could be identified and rectified.

Support plans were sufficiently detailed but did not always give specific guidance for staff to follow. Support plans were kept under review.

The service was well led with robust audits and quality assurance systems. Staff felt well supported and records were up to date. However the experiences of people using the service could be improved upon.

During our inspection a number of people were at home and were being supported by staff with daily living skills and craft work. Other people were out at the cinema club and work placements. People had a range of regular activities they attended and some people were able to access them independently. We spoke with four people using the service and observed the interactions between them and staff throughout the day. We met with one relative and spoke with two staff. We looked at records relating to the management of the service, care records and records relating to the administration of medication. We found this to be a well-planned and well managed service. Accommodation was appropriate to people’s needs and facilitated people’s independence. People were encouraged to do as much for themselves as possible and received help from staff when required.

One person told us “The staff are nice, I like living here.” They told us what they did during the day and evening and what support was provided to them. Another person told us how staff supported them with their health care needs and how their diet was monitored to ensure it was appropriate. One person showed us their jewellery making and what charts they completed which were in place to monitor how their needs were being met. This meant people's needs were being met

During this inspection our pharmacist inspector looked at the safety of medicine management at the service. We conducted an audit of medicines and found people living at the service were protected by the arrangements in place.

We spoke with four people who said they liked living in the service. Two people told us they were very happy with their room. One person said, “I chose the colours for my room.” Another person said, “I choose my own meals and go shopping for food.”

We saw that staff encouraged people to take part in self care, in activities, and to undertake tasks that they were able to manage.

There was good awareness of safeguarding vulnerable adults from abuse. Posters were displayed with information for staff and people living in the service on how to deal with suspected abuse. One person told us, “I feel safe here.”

We saw that staff were trained to provide care appropriate to the needs of people living at the service. There were systems to monitor safety and the quality of service.