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Reports


Inspection carried out on 5 December 2017

During a routine inspection

Pilton House is a ‘care home’ that provides accommodation for a maximum of 27 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were 27 people living at the service and one respite person visiting the service for the day. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Pilton House provides accommodation. Some bedrooms are on the ground floor where communal areas are also present. The remaining bedrooms are on the first floor which is served by a lift. Staff are present on both floors of the home at all times to ensure people’s needs are met.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 of Pilton House came into post in September 2017 however she had worked at the service for a number of years in a management position.

We carried out this unannounced inspection on 5 December 2017. At the last inspection, in September 2015, the service was rated Good. At this inspection we found the service remained Good.

On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People who were able to talk to us about their views of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people included, “It’s very well organised”, “All the staff are lovely” and “It’s all good” Relatives we spoke with told us they were “very pleased” with the care that their family member received. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People’s behaviour and body language showed that they felt cared for by staff. Staff said they were proud to work at Pilton House and told us “It’s the best and most supportive place I have worked” and “The people are lovely. It’s lovely here we [staff] work well as a team.”

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety. People said they felt safe at Pilton House.

The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained by a maintenance team who completed any faults in a timely manner. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Some people living at Pilton House were living with dementia and were independently mobile around the service. However, the service did not have clear pictorial signage to help people who need additional support recognising areas of the building such as their bedrooms, toilet and shower rooms. The registered manager had discussed signage with people at the service and they had stated that they did not want this in their home. Therefore the registered manager respected their wishes but placed signage on people’s bedroom areas if they requested this.

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Pilton House. Staff supported people to access appropriate healthcare services. Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

People were able to take part in a range of group and individual activities. Three activity coordinators were in post who arranged regular events for people.

There were safe arrangements in place for the administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicines which required stricter controls by law were stored correctly and records kept in line with relevant legislation.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.

Staff were supported by a system of induction training, one-to-one supervision and appraisals. The induction and on-going training of staff ensured they were effective in their role. Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them. People’s legal rights were understood and upheld.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example.

People and relatives all described the management of the home as open and approachable. Relatives told us, “I can talk to the manager or staff at any time.” There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Inspection carried out on 14 and 17 September 2015

During a routine inspection

An unannounced inspection was completed at this service on 11 and 14 September 2015. Pilton House Trust is registered to provider accommodation and support for up to 27 people. The service provides this support to older people and people living with dementia. It does not provide nursing care. At the time of this inspection there were 25 people living at the service.

A registered manager was in post but was about to de-register as she has taken over the role as fund raiser for the trust. The deputy manager had taken over the role as the manager, having day to day responsibility for the running of the service and it is her intention to apply to register with CQC shortly. 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 2014 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, applications had been made to the local authority in relation to people who lived at the service. The manager told us these were waiting to be approved.

People said they felt safe and well cared for. Staff knew people’s needs and preferences and had the right training and support to enable them to deliver care safely and effectively. Care and support was being well planned and any risks were identified and actions put in place to minimise these.

People were supported to eat and drink in a relaxed and unhurried way. Respect and dignity were upheld in the way staff worked with people. Staff were kind and compassionate towards people and their relatives.

Healthcare professionals said people’s healthcare needs were being well met and the staff team were proactive in seeking advice in a timely way to ensure this. One healthcare professional said ‘‘I have been very impressed with the way this service is working with the person to reduce their medication and ensure their emotional needs are met.’’

There were enough staff available to ensure people’s needs were being met in a timely way. People spoke highly about the staff group who supported them and we observed care and support being delivered in a kind and compassionate way. Relatives confirmed their views were considered and they were kept informed of any changes in people’s needs and wishes.

Recruitment processes were robust ensuring new staff were suitable to work with vulnerable people. New staff received a comprehensive induction to enable them to gain skills and confidence in working in the service and to understand individual’s needs.

Staff knew how to protect people from potential risk of harm and who they should report any concerns to. They also understood how to ensure people’s human rights were being considered and how to work in a way which respected people’s diversity. People were offered a range of activities and consideration was being given to how they could support people to access the local community more. This included having their own minibus to get people out to places of local interest.

The provider ensured the home was safe and audits were used to review the quality of care and support being provided, taking into consideration the views of people using the service and the staff working there. Any complaints or concerns were dealt with swiftly and comprehensively.

The ethos and culture of the service was to promote independence for as long as possible and ensure people were given choices in all aspects of their daily lives. Staff understood and promoted this ethos in the way they delivered care and supported people.