The Pines provides accommodation and support for up to 13 people with learning difficulties. At the time of our inspection there were 13 people using the service. The home is divided into two separate parts, the house and the unit and there are two flats that are separate to the main building which are referred to as ‘the cones’. The people who are supported in both the unit and the cones have higher dependency needs than people who live in the house.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

What life is like for people using this service:

In the ‘unit’ section of the home, there were not always enough staff to meet people’s needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The service did not always notify CQC of events, incidents or accidents that they were required to by law. This was a breach of Regulation 18 of the Care Quality Commission (Registration) regulations 2009.

Staff did not feel that the registered manager spent enough time at the service.

People told us that they were happy living at The Pines and referred to it as home.

People received personalised care and support that promoted independence. People were given choices and were encouraged to have control over their lives.

People had access to the community and attended clubs and social groups. There were activities available for people who spent most of their time within the service.

Staff received appropriate training to ensure they could meet people’s needs in a caring and kind way.

Staff understood what was important to people and supported people to achieve their goals.

People were protected from the risk of abuse and medicines were mostly managed safely.

More information is in the full report.

Rating at last inspection:

At our last inspection in June 2016 (report published 9 September 2016) the service was rated as Good in all five key questions. At this inspection we found that the key questions of Safe and Well-Led are now rated Requires Improvement and the overall rating has therefore changed to Requires Improvement.

Why we inspected:

This was a planned inspection based on the date and the overall rating of the last inspection.

Enforcement:

You can see what action the provider needs to take at the end of our report.

Follow up:

We will ask the provider for an action plan to address the breaches of regulation. We will continue to monitor the service through the information we receive.

The inspection took place on 23 June 2016 and was unannounced.

The Pines Residential Home offers accommodation for up to eleven people with learning disabilities or autistic spectrum disorders. There were eleven people living at the home at the time of our inspection. The home consists of two units, The Pines House where six people lived, and The Pines Unit where three people lived in the main house and two people lived in individual flats.

The service was previously inspected on 24 April 2014 and met all standards considered at the time.

A registered manager was in post at the time of our visit. 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 registered manager and director were also the proprietors of the home.

People were supported to be safe by a staff team who knew them well. Staff knew what actions to take if they had concerns for people’s safety or well-being. People were supported to recognise when they were at risk of being unsafe and assisted to make their own decisions on how they managed the risks. People were supported to take their medicines so they would remain well.

People were supported by staff who valued and listened to them. People's choices were acted upon by staff who went the extra mile to support them to live a fulfilled life and cared for them in a way they preferred. This was because the service used the principles of the Mental Capacity Act (MCA) well to develop the confidence of people to make their own decisions. People were supported to enjoy a range of food and drinks so they maintained a balanced diet. People were enabled to prepare their own meals if they wished. Access to health services and specialists was arranged as required so people were able to remain physically and mentally well.

People were supported to enjoy a rich and active social life and were treated with dignity, kindness and compassion at all times. The staff team understood each person’s individual preferences, diversities and needs. People were encouraged and supported to achieve their full potential, undertake further education and develop their skills. They were enabled to make their own choices about what they did each day. There was a positive approach to people's chosen pastimes with a focus on working with the person to ensure they could achieve what they wanted. As a result, people had a high self-esteem.

People enjoyed close and caring relationships with the staff team. The atmosphere throughout the home was happy and open. People were confident to express their thoughts and ideas at all times. Where required, intensive support for people was provided in a discreet and compassionate manner by staff. Care provided was individual to each person's requirements. It was planned and reviewed with people and their families. People and relatives knew how to raise concerns and complaints and were confident that staff would take action if this happened.

People and families enjoyed close relationships with the registered manager and director of the service. The unit managers in the home enjoyed trusting relationships with the people, their families and the staff. The whole senior team worked well together to ensure the staff team knew what was expected of them. Checks were undertaken on the quality of the care and support provided for people. Opportunities were taken to develop the service as a result of these checks. The registered manager and director showed that they were committed to continuous development of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

Risks to people had been identified, assessed and kept under review. Staff had undertaken training important to their role including manual handling and fire training in order to care for people safely.

Appropriate arrangements were in place to manage medicines. This meant that people were protected against the risks associated with medication.

Is the service caring?

Staff interactions were supportive and respectful. We observed a relaxed, yet respectful atmosphere in the service. All five people spoken with told us they were happy living at the service and felt safe. One person told us, “It’s nice up here, I like it here”. Another person told us, “I can’t think of anything that I am unhappy with”.

Is the service responsive?

The service responded to people's changing needs. People had access to support and advice from a team of health and social care specialists.

People’s views about care and treatment were acted upon. People using the service were involved in decisions relating to food and activities. People told us they felt listened to and respected.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the service met their needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

People were protected from the risks of inadequate nutrition and dehydration. People were provided with a choice of suitable and nutritious food and drink, which was freshly prepared in the service. Special diets were catered for including diabetic, vegetarian and soft diets.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. Satisfaction surveys had been completed by people who used the service and feedback gained was positive.

Staff felt part of a good team and that they were well supported.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect. They told us staff talked with them about how they would like their support to be provided.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “They are very nice” and another said “They take care of me”.

The provider had developed a system whereby they can monitor how well the home is meeting the needs of the people who live there.