The Pleasance

The Pleasance is a residential care home providing accommodation and personal care for 15 people. At the time of inspection there were 13 people using the service. The Pleasance has 5 houses on 1 site. Each house has individual flats with communal living space and enclosed gardens. People with learning disabilities and autistic people use the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service demonstrated they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The provider had made improvements that were required after our last inspection. The care environment was safe, clean and secure. People were involved in planning their care and activities. Care was person-centred and people were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People received care and support that was person-centred and promoted their dignity, privacy and human rights. Staff had received training to keep people safe and they knew how to report any concerns about care. People were happy with the care they received. One person told us, “I am very happy with the care that I receive and [member of staff] always wants to help me.”

Right Culture

People led confident, inclusive and empowered lives because of the ethos, values, attitudes and behaviours of leaders and care staff. The service listened to people about their views of care and support and worked with the staff team to make changes and improvements. Staff knew the people they supported and they were open and honest in conversations about how they delivered care. The management team had a clear vision for the continued development of the service.

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

Rating at last inspection and update

The last rating for this service was inadequate following an inspection on 13 December 2022. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service was aware that it would be in Special Measures following the last inspection on 13 December 2023 and had implemented an action plan to make the required improvements. CQC issued a supplementary report on 9 May 2023 which confirmed the details of the breaches of regulation and the action that was taken.

During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 13 December 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Pleasance on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Pleasance is a residential care home providing accommodation and personal care to 12 people at the time of the inspection. The service can support up to 15 people. The Pleasance has 5 houses on 1 site each having individual flats with communal living space and enclosed gardens. People with learning disabilities and autistic people use the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

The provider failed to have safe and robust systems in place when incidents and accidents occurred. Risk management was poor and failed to identify and address all known risks. Staff were not provided with enough clear guidance to support people safely. 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 supported this practice.

Right Care:

People did not experience continuity and consistency of care from a staff team that knew them well. We found that at times, people were left unsupported which compromised their wellbeing. Staff interacted with people with warmth and respect.

Right Culture:

There was a lack of consistent and effective oversight from the provider and the registered manager regarding quality assurance. Risks were not always reduced to ensure people were safe. The registered manager had not consistently submitted notifications to the Care Quality Commission or made referrals to the local authority and police in respect of all reportable incidents.

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

Rating at last inspection and update

The last rating for this service was good (published 01 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service since the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report. Following the inspection, the provider evidenced they had taken action to mitigate some of the risks we identified on this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Pleasance on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safety, safeguarding, governance, staff training and the environment at this inspection.

Follow up

We met with the provider following the inspection. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Pleasance is a ‘care home’. 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.

The Pleasance has five houses on one site and provides accommodation and care for up to 15 people with learning disabilities or autistic spectrum disorders. At the time of the inspection there were 12 people living at the home, with three people on home leave.

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.” Registering the Right Support CQC policy

There was a registered manager in place for the service. A registered manager is a person who has registered with CQC 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.

Our last inspection at The Pleasance took place in February 2016. The home was rated as Good. At this inspection we found the service remained overall ‘Good’ but the well led domain had deteriorated to ‘Requires Improvement’.

People told us they felt safe living at the home.

The registered provider had systems in place to manage risks and safeguarding matters. However, there were gaps in this system. The risk to one person had not been fully thought out and an incident which should have been reported to the safeguarding authority had not been. However other action had been taken to safeguard the person.

We found staff received training in the safeguarding of vulnerable adults and staff spoken with understood their responsibilities in this area. There was information available throughout the service to inform staff, people using the service and their relatives about safeguarding procedures and what action to take if they suspected abuse.

We found accidents and incidents were recorded appropriately. However, the registered manager did not have an established system in place to learn from them, so they were less likely to happen again.

Records for the administration of medicines were not fully completed by staff. In the main medicines were safely stored, however, the storage of controlled drugs did not comply with the ‘Safe custody regulations 1973.’

There were appropriate numbers of staff employed to meet people’s needs and provide a personalised service.

People enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

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.

Staff were receiving regular training and supervision so they were skilled and competent to carry out their role.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

People living at The Pleasance and their relatives told us staff were caring. We saw people had their privacy and dignity respected.

We saw and heard positive interactions between people and staff throughout the inspection. Staff clearly knew people well and provided a personalised service.

Support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

People commented positively about the support and friendliness of the managers and were complimentary of the staff.

Audits and quality assessments were not wholly effective in identifying shortfalls within the service and records were not always complete.

Further information is in the detailed findings below.

The Pleasance Care Home is located on the edge of Edlington, with local facilities, shops and transport links close by. It has five houses on one site and provides accommodation and care for up to 15 people with learning disabilities or autistic spectrum disorders.

The service had a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

People told us they felt safe living at the home. Systems were in place to keep people safe and staff were knowledgeable about safeguarding vulnerable people.

Staff enabled people to follow their preferred interests and be as independent as possible. People told us they liked living at the home and felt staff met their needs and supported them appropriately.

There were enough skilled and experienced staff on duty to meet people’s needs and enable them to follow their hobbies and interests. The company’s recruitment system helped the employer make safe recruitment decisions when employing staff. We found new staff had received a structured induction and essential training at the beginning of their employment. This had been followed by refresher and specialist training to update and develop their knowledge and skills.

People received their medications in a safe and timely way from staff who had been trained to carry out this role.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required.

People were fully involved in choosing what they wanted to eat and drink. They told us they planned their own meals, went food shopping and helped prepare meals.

Care files reflected people’s needs and preferences, as well as any risks associated with their care. These provided staff with guidance about how to support people and keep them as safe as possible. Most support plans and risk assessments had been reviewed and updated regularly to ensure they were meeting each person’s needs. However, information in one file was out of date and monthly evaluations had not always been consistently recorded.

People participated in a varied programme of activities that was tailored around their individual interests and preferences. They told us they enjoyed the activities they took part in and said they were fully involved in deciding what they wanted to do.

The provider had a complaints policy to guide people on how to raise concerns. There was a structured system in place for recording the detail and outcome of any concerns raised.

People who used the services had been encouraged to share their views on the service provided at regular meetings and care reviews.

We found a system was in place to check if company policies had been followed and the premises were safe and well maintained, but it was not as comprehensive as it could have been.

Below is a summary of what we found. The summary is based on our observations, speaking with people who used the service, speaking with staff supporting them and looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were cared for and supported in line with their assessed needs. We spoke with people who used the service and they felt able to raise any concerns with the staff or the manager. People told us that the manager was approachable and made time for them.

The provider had systems in place to ensure the service was safely run. Audits were carried out by the registered manager.

Is the service effective?

People’s health and care needs were assessed and care plans were designed to meet the needs of people who used the service. People felt that they were involved in their care.

Each person had a key worker who was responsible for their care. They ensured the care plans were still relevant to meet people’s needs. The registered manager completed a care plan audit every month to ensure they reflected the person’s needs and were up to date.

Is the service caring?

We observed staff interacting with people who used the service and saw that they were caring and kind in their approach. Support plans included people’s interests, likes and dislikes. This ensured that people’s preferences were considered as part of their care and that life history had been used effectively.

We spoke with people who used the service who told us that they felt they were cared for appropriately. One person said, “I have a key worker and staff talk to me about my care and what I want to achieve.” Another person said, “I enjoy going to college.”

Is the service responsive?

Social interaction was based on people’s likes and dislikes and what they wanted to do. People were assisted to attend appointments where required.

We spoke with people who used the service who told us they felt able to discuss anything with the manager or the staff. One person said, “I can talk to the staff at any time.”

Is the service well-led?

We spoke with staff who were clear about their roles and responsibilities. They felt the manager was very supportive.

The provider had an effective recruitment system in place which ensured people were supported by skilled and experienced staff. Pre-employment questionnaires were carried out to ensure appropriate people were in post.

The manager sought the views of people in order to improve the service provided. House meetings took place on a regular basis and people felt able to contribute. There was a quality assurance system in place which was completed on an annual basis. The registered manager acted on suggestions made and discussed the outcome of the survey with people who used the service and their relatives.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One member of staff we spoke with told us: “We have a really good and supportive team who are focussed on delivering the best care we can.” A person who used the service told us: "I like it here, it's really nice and so are the staff."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member told us: "We have a wonderful staff team and very supportive management."

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. One person we spoke with told us: “I know how to complain and who to, staff listen to me when I am not happy.”

People we spoke with told us they were happy living at the Pleasance and they were independent and able to make decisions about their care and treatment.

Medication was administered safely to people. People were given appropriate support, to ensure they had taken their medication as prescribed.

We found people were cared for, and supported by, sufficient, suitably qualified, skilled and experienced staff. Staff demonstrated different methods of communicating with people to ensure their wishes and beliefs were respected.

People experienced care, treatment and support that met their needs and protected their rights. We saw several good examples of interactions between staff and people using the service. One person told us “staff are really nice here.” another person told us

“I like my flat a lot, I chose the wallpaper.”

People were cared for in a clean, hygienic environment. The standard of cleanliness observed throughout the premises was good.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were provided with a range of training opportunities to ensure that their skills and knowledge remained up to date and that they understood the needs of people they were supporting.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.