Archived: Pendarves

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall. At the time of the inspection three people were living at the service. The service was based in a large semi-detached house in a residential area of Camborne.

People's experience of using this service and what we found

Pendarves had been through a period of unsettled management. The new manager had been promoted into their position two months before our visit. Whilst staff had felt the impact of these changes and did not feel supported by the provider organisation, they told us they continued to be part of a strong team.

People were supported by a manager and stable staff team who knew them well and were committed to ensuring high quality, person centred care. There were usually sufficient staff to achieve this and staffing had not fallen below levels deemed safe by the provider.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

• Two people shared communal space and another person lived in their own flat. Their support was designed to enable them to live the lives they chose. People were supported to develop and maintain their independence

Right care:

• The support people received was person centred. Staff promoted people’s dignity and treated them respectfully. They understood people’s needs and provided security and encouragement.

Right culture:

• The staff at Pendarves were committed to ensuring people were leading the lives they wanted. The staff team were open with each other and willing to challenge and be challenged to achieve this goal. People were treated with dignity, respect and care.

Staff described their responsibilities in relation to safeguarding with confidence. People told us they felt safe.

Medicines were managed safely. People received their medicines when needed and appropriate records had been completed. People had access to healthcare professionals.

Risks to individuals and the environment were managed effectively and people’s views informed their risk management plans. There were systems in place to record, monitor and review accidents and incidents to reduce future risks.

Staff development was supported through induction, support and guidance from colleagues and the manager, and training relevant to the needs of the people they cared for was provided.

Infection control procedures and measures were in place to protect people from infection control risks associated with COVID-19.

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

People's care and support needs were assessed and reviewed. People worked with their keyworkers, and the staff communicated effectively with each other, to ensure care plans remained relevant and ensured consistency.

There were systems in place to monitor and improve the quality and safety of the service provided to people. People and staff contributed to these systems within the home. People told us they knew how to raise concerns and complaints, and staff explained they encouraged this. No complaints had been made in the year before our visit.

The manager and staff team were open and transparent and acted on feedback given, and queries raised, throughout the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was Good. (Published August 2018)

Why we inspected

The inspection was prompted in part due to concerns in relation to staffing levels across the organisation. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall. At the time of the inspection four people were living at the service. The service was based in a large semi-detached house set within its own gardens.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Services are required to notify CQC of various events and incidents to enable us to effectively monitor the service. This includes any incident which is reported to, or investigated by, the police. We identified that we had not been notified of two incidents following which the police had been called. This has resulted in the well-le section of this report being rated as ‘requires improvement.’

The care service has 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. The accommodation was arranged to allow people independence and privacy. The building was subdivided into three flats. Two people lived in self-contained flats and two people shared a flat. Each had an en-suite bedroom and shared a kitchen and lounge.

People had choice about how and where they spent their time. Staffing was arranged to enable people to take part in activities and access the local community according to their preferences. Staff encouraged people to be independent in all areas of their lives. When people’s choices impacted on their health and well-being staff and members of Spectrum’s senior management team considered their capacity to make these decisions. Where people were found to lack capacity to make specific decisions these were made in their best interest in line with the legislation and principles of the Mental Capacity Act.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The previous registered manager left in June 2017. 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 previous manager had left the service following a long period of absence. There was a new manager in post who had only been appointed the day before the inspection. They had registered to complete relevant training and were intending to apply to CQC for registration.

The new manager had been working at the service as deputy manager for three months and had built up an understanding of the service and people’s needs. People and staff were positive about the new appointment. Comments included; “He listens, if I’ve made a decision he seems to support my thoughts” and “The new manager is an improvement.”

There was a stable and experienced staff team in place. They were supported by a system of regular training, supervision, appraisals and staff meetings. Staff told us they worked well together as a team and had a shared set of values which focused on doing things ‘with’ people rather than ‘for’ people.

Care plans were detailed and informative. Staff recorded information about how people spent their time and their health and emotional well-being on a computerised system. This could be accessed by the senior management team as necessary.

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection four people were living at the service. The service was based in a large semi-detached house set within its own gardens. The building was subdivided into three flats. Two people lived in self-contained flats on the ground floor and two people had en-suite bedrooms and shared kitchen and lounge on the first floor of the building.

The service is required to have a registered manager. At the time of the inspection there was no registered manager in post. The previous registered manager had recently left the service and a new manager had been appointed two weeks prior to the 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. We were informed by the provider’s operations director that the new manager would be applying to be registered with the commission.

Recruitment practices had significantly improved since our previous inspection. All staff were now interviewed face to face and all necessary checks, including disclosure and barring service check and reference checks had been completed.

Prior to this inspection we received information of concern about the cleanliness of the service and the support people received to maintain their environment. The service did not have effective infection control procedures in place and there was a lack of formalised cleaning schedules. During our inspection we visited each person in the own rooms / flats and found the reported concerns were justified. Some rooms were cluttered but tidy while others had obviously not been recently cleaned. One person refused to let us see their en-suite bathroom which staff reported was a particular area of concern. Staff said “I would say, without a doubt, I think people are safe. Hygiene is a question mark but safe, definitely.” This was a breach of the regulations. You can see what action we told the provided to take at the back of the full version of the report.

The providers routine quality assurance processes had failed to identify the issues in relation to the support people received to maintain the quality of their environment. Once staff and relatives reported these concerns, the provider had acted promptly and appropriately to address the issues. A a result a number of significant changes were being made at the service. New carpets had been installed in communal areas, the gardens had been tidied up and on the first day of our inspection a commercial cleaning service visited to quote for the completion of a deep clean of the service.

People’s care plans were generally detailed and informative. However, they did not provide staff with sufficient guidance on how meet people’s needs in the event that they repeatedly declined support with personal care or to manage the cleanliness of their environment.

People told us they felt safe and happy at Pendarves and one person commented, “I am safe, if I felt threatened or anything like that I will let Spectrum know.” Staff understood their role in protecting people from avoidable harm and when asked, were able to explain how they responded if they became concerned about people’s safety.

The new manager and staff had a good understanding of the requirements of The Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. Where restrictive practices where in place, these had been regularly reviewed and were appropriately reduced where possible.

Staff knew people well and cared for the people they supported. One staff member told us, “Fundamentally we are here for these gentlemen. Everything has to be done to the best for their care. I sound like a manual but I really believe it” while another commented, “I feel I have made a positive impact on people lives. I really enjoy that.”

Staff respected people’s privacy and choices. People were involved in decision making and the planning of activities. Records showed people were regularly supported to engage in a variety of activities in the local community and one person was supported to maintain paid employment. People told us, “I get to choose what to do. You can go where you want because you have individual staff” and “I can go out in the evening if I want. I was out last night and the night before.”

Following the registered manager’s resignation the provider had taken prompt action and a new manager for the service had been appointed. Staff told us they felt well supported and records showed they had received regular supervision. The new manager was having a positive impact and staff told us, “[The new manager] is excellent. New ethos and new vision. It has moved forward in a lot of areas and pretty quickly” and “It is well led. [The new manager] is a great manager who is good at supporting staff and very big on dignity and duty of care.” The new manager told us they had been well supported by the provider’s senior manager and commented, “I am being supported very, very well. I am being offered support from everywhere. All my emails were responded to yesterday (Sunday).”

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. Pendarves is part of the Spectrum group which provide services to people living with autism in Cornwall. 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.

Recruitment practices were not robust enough to ensure staff working in the service were suitable to work in the care sector. We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The premises were well maintained and had been adapted to meet people’s individual needs and preferences. Two people had self-contained flats with their own kitchen and living area. The other two people had large en-suite rooms and shared a kitchen and living area.

People were able to access the local community and amenities easily as the town centre was within walking distance. Some people went out independently for walks or to go shopping. There were systems in place to ensure people were able to contact staff for support, guidance or reassurance if they needed it. Risk assessments were personalised and relevant to the individual’s needs. The deputy manager described them as; “The scaffolding to support people and hold them up.”

Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager. Other training identified as necessary for the service was updated regularly. Staff received supervision and appraisals. New employees were required to complete a thorough induction which incorporated training, familiarisation with policies and procedures and shadowing more experienced staff. The induction process had been updated to include the Care Certificate.

The provider acted in accordance with the requirements laid out in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). People were able to make every day decisions such as how and where they spent their time and what they ate. Staff recognised and respected people’s rights.

Care plans were personalised, detailed and updated regularly. They contained information about people’s likes and dislikes as well as information regarding their health needs. Staff were aware of people’s preferences and how they wished to be supported. There was an emphasis on supporting people to be independent and make choices about how they wanted to lead their lives.

There were effective quality assurance systems in place to monitor the standards of the care provided.

We saw staff interact with people who used the service in a kind and calm manner and responded to a person's request for assistance promptly.

We saw staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service had a care plan which outlined the person's care needs. We looked at two care plans and staff told us they had been updated and guided, directed and informed staff in how to manage all aspects of a person's care. We noted that the care plans had been shared with the person's relevant commissioner and they had also agreed to the content of the care plan.

Due to the substantial environmental changes to Pendarves we reviewed the environment. People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staff told us the minimum staffing levels were adhered to at all times.

We saw staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service had a care plan which outlined the person's care needs. We looked at one person's care plan and staff told us it had been updated and now guided, directed and informed staff in how to manage all aspects of a person's care. We looked at the care plan and saw it had been reviewed and did inform direct and guide staff in what caring interventions were needed to ensure that staff approached people in a consistent manner when providing care. The care plans identified that when a person presented behaviours that challenged staff were given direction in how to provide support to the person and to other people who may be witness to the incident.

Staff told us the minimum staffing levels were adhered to at all times. The registered manager told us since the last inspection the waking night staff member had ceased with the agreement of the person who used the service and commissioner.

People who used the service had a care plan which outlined the persons care needs. Behavioural plans were implemented to manage particularly challenging behaviours. Staff told us the behavioural plans did not direct them in how to manage peoples presenting behaviours effectively and to ensure that other people living in the home were protected from the impact of such display of behaviours.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home.

Systems for safeguarding people from abuse were satisfactory. Legal safeguards, which protected people who were unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.

Pendarves minimum staffing levels were present during the day. Rotas and other records evidenced that the assessed minimum number of staff were not consistently on duty at night.

The provider identified risks and issues but action plans may not always be monitored to ensure that improvements are made to people's safety and welfare.

Appropriate records were maintained and overall, we found these were up to date.

In many ways people were well supported by staff. We saw that people had the opportunity to take part in a range of activities that were of particular interest to them. There was considerable information about each person's needs and the best ways to support them. However, there was a lack of clear concise guidance about managing particular issues, and there was no evidence of risk assessments to ensure that people were safe if they needed to be physically restrained. There were no adequate systems to record and monitor incidents, and therefore to learn from what had happened.

We found that there were sufficient staff, who were given training to do their job, and that they were supported by their manager, and the organisation.

We were worried that concerns raised by people who either lived or worked in the home were not dealt with in a timely manner. Whilst we found that there were systems in place to monitor the quality of the service, but these were not always effective.