The Pines is registered to provide accommodation with personal care for up to five people with physical and learning disabilities. At the time of our visit five people lived at the service.

At out last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by sufficient, skilled staff to meet their needs and robust recruitment processes were in place to ensure only suitable staff were employed. Staff were aware of their responsibilities in safeguarding people from abuse. Risks to people’s safety were identified and control measures implemented to keep people safe. People received their medicines safely and in line with prescription guidelines. Accidents and incidents were reviewed and action taken to prevent them happening again. The provider had developed a contingency plan to ensure that people’s care would continue in the event of an emergency.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received support from staff who knew them well and positive relationships had developed. Staff treated people with kindness and were aware of their preferences. People’s religious and cultural needs were respected and staff demonstrated a good understanding of people’s communication styles.

The service worked closely with healthcare professionals to ensure that people’s healthcare needs were met. People had access to nutritious food of their choosing. People’s care records were person centred and completed in detail. Care plans were regularly reviewed and updated to ensure staff had up to date guidance regarding people’s care. People had access to a range of individual activities in line with their interests.

Staff received on-going training and induction to support them in their roles. Staff received regular supervision and told us they felt supported by the registered manager. Systems were in place to monitor the quality of the service provided and ensure continuous development. There was a complaints policy in place and reltives told us they would feel comfortable in raising concerns. The service worked proactively with other agencies and shared best practice through their attendance at registered managers meetings.

The Pines is registered to provide accommodation with personal care for up to five people with physical and learning disabilities. At the time of our visit four people lived here.

Care and support are provided on one level. Communal areas include a large lounge and separate dining area. Extensive adaptations have been made to the home to meet people’s needs, such as smooth flooring and wide corridors to aid with people’s mobility. This has been done without losing the character and homely feel of the home.

The inspection took place on 20 October 2015 and was unannounced. At our previous inspection in November 2013 we had not identified any concerns at the home.

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.

Staff were very good at meeting the needs of the people that live there. People, who all had very high physical and mental health support needs, were really encouraged to do as much as they could to remain independent, and be involved in their care and support. There was positive feedback about the home and caring nature of staff from people’s relatives. A relative said the service was, “Very caring, very holistic.”

Staff showed an good level of care and kindness to people. A relative said, “It’s not like they’re just doing a job, they’re looking after them as people. They really do care.” The staff were seen to be very kind and caring to people and treated them with dignity and respect. Every action staff carried out showed this. This was seen in so many ways during the day of our inspection. Examples such as the way that staff knew people as individuals and spoke to them, and giving them information about their care, down to small gestures such as pausing a DVD when people had their lunch so they could carry on watching when they returned, showed a high level of compassion and respect for people.

People were safe at The Pines. The home had been well maintained and was clean and tidy. Regular maintenance and improvements were made to the building to ensure it met the needs of the people who lived there. Adjustments had been made to the environment to better suit the needs of individuals. Wide doorways and level flooring made it easier for people to move around.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were seen to seek peoples consent, and give good clear explanations about choices and decisions that needed to be made. Staff really took their time to talk to people to make sure they were doing what people wanted.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Staff’s understanding of their roles and responsibilities within the DoLS was good. Applications were very detailed and each instance where someone’s freedom may be being restricted had been identified by the registered manager, and included in the DoLS.

There were enough staff to meet the needs of the people. An assessment of people’s needs had been completed by the registered manager and staffing levels were set to match them. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff had a good understanding of protecting people from abuse, and knew how to report it should they suspect it had taken place.

The training and induction processes for staff was good. Staff were up to date on their training, and their knowledge of people’s medical conditions, as well as cultural needs was excellent. Staff had regular one to one meetings with their manager, and were able to discuss their performance, training needs, and any concerns they may have. Staff told us they felt very supported by the management, and they loved working here. One said, “The manager is supporting and caring. It’s a happy and relaxed working environment and we can take our time to care for people.”

Quality assurance processes had been effective at improving the home for the people who lived there. Regular audits were completed around the home by staff and visiting senior managers. Items identified as requiring action had been completed within the timescales set by the provider. The registered manager had a clear plan for how the home was going to further improve, such as introducing cutting edge equipment and processes to further improve people’s experiences at the home.

People, their relatives, staff and others (such as GP’s commissioners and health care professionals) had the opportunity to be involved in how the home was managed. Regular feedback was sought to check that the home was meeting people’s needs. All of the feedback we received, or read, was very positive about the staff and home.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a high level of detail for staff to reference if they needed to know what support was required. People and relatives (due to peoples communication needs) were involved in the review and generation of these plans. People received the care and support as detailed in their care plans.

People were supported to maintain good health as they had access to relevant health care professionals when they needed them.

People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of medicines. Staff really involved people in taking their medicines; one person was seen to help prepare the thickened water they needed to have to help them swallow their tablets, or helping to count out the tablets. Clear explanations were given to people about what the medicines were for, so they could make an informed choice about whether to take them or not.

People had access to activities that met their needs. They had access to the local community and could attend a variety of activities and clubs. More individualised activity plans were being developed with people by the staff, so that people’s dreams and new interests could be supported.

People had enough to eat and drink, and received support from staff where a need had been identified. Specialist diets to meet medical, religious or cultural needs were provided. People were involved in what they ate, and they had a good variety and choice of food and drink.

People and relatives knew how to make a complaint. The complaint policy was in an easy to read format using pictures and clear language so people would be able to understand it. No formal complaints had been received since our last inspection.

The Pines had four people living there. On the day of our visit one person was at the home. Staff told us that two of the people were attending day services and the other person was assisting staff with the food shopping and returned later in the day. One individual told us they were “happy” and that the staff were “alright”. Due to the nature of the individual’s physical and learning disabilities people’s communication skills were limited.

We looked around the home which was clean, comfortably furnished and free from unpleasant odours. All the bedrooms were single occupancy with one room having an ensuite bathroom. We saw that bedrooms were personalised with photographs, music systems, CD’s and pictures. The home also had a sensory room. Staff told us that most of the individuals enjoyed listening to music due to their limited sight and one person enjoyed watching films in their room.

We also spoke with three staff. We spent time observing how staff interacted and supported people. We saw staff treated people in a sensitive, respectful and professional manner and involved individuals in the running of the home.

Care plans were person centred and covered all aspects of individual’s care and were reviewed on a regular basis. The documentation showed that the home worked closely with health care professionals and the day services that individuals attended. This ensured that individual’s had continuity in their care.

During our visit to The Pines we were able to speak to people using the service, their relatives and staff, in addition to reviewing documentation relevant to the outcomes inspected.The information collected from these different mechanisms, when combined with our observation of the care and support provided, enabled us to conclude that the services both respected and involved the people who were using them.

At The Pines we found a programme of care that clearly supported individual's (or others acting on their behalf) with their needs, from the point at which they were referred to the service. This care programme ensured that people who used the service were protected from the risk of abuse.

All the evidence collected about staffing demonstrated that there were enough qualified, skilled and experienced staff to meet people’s needs and staff were positive about the training they had received and the usefulness of this in their role.

From the evidence collated it was also clear that people who used the service, their relatives and staff were asked for their views about their care and treatment and they were acted upon. In addition there was a clear system in place to assess and monitor the quality of the service provided which included audits against the CQC outcomes.

People who live at this service have special communication needs. Of the five people using the service one person used limited speech as a method of communication. Opportunity to speak with this person was minimal as they were out of the home for the majority of the visit. On their return they were tired and resting in their room watching a music channel on their personal large plasma television. We were introduced to this person who was informed by the registered manager of the purpose of the visit. The manager supported them to express their views about the home. They told us they were happy but their wheelchair was uncomfortable. A referral had been made for another wheelchair assessment.