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RNID Action on Hearing Loss Pippin House Good


Inspection carried out on 3 April 2018

During a routine inspection

Pippin House is a residential care home providing accommodation and support for up to eight younger adults with learning disabilities (including autistic spectrum disorder) and/or mental health needs, living with a hearing impairment. At the time of the inspection, seven people were living at the home. Accommodation is provided over three floors with each person having their own bedroom and bathroom. People share a communal lounge, dining room, conservatory, kitchen and laundry room. The home is surrounded by pleasant landscaped gardens.

At our last inspection in November 2015, we rated the home as good in all five key questions. At this inspection in April 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. We found support within the home has continued to improve and there was evidence of very good practice, particularly in supporting people’s independence and managing their health care needs.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People continued to receive safe care that met their needs and expectations. The home had a strong emphasis on promoting people’s independence and involvement in decision making. People told us they enjoyed living at Pippin House and staff told us they were proud to work there.

During the inspection, people were busy going about their day to day activities and were keen to show us around the home and tell us what they did. This included gardening, both at the home and in the community, learning new skills such as hairdressing, as well as attending vocational courses and undertaking voluntary work.

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 supported this practice. Improvements since the previous inspection included supporting people to manage their medicines and finances. Information was presented in pictorial format to support people’s decision making, with each person involved in developing their own support plans and risk assessments.

Relatives told us the home provided an excellent level of support. Their comments included, “Nothing is ever too much trouble for the staff”, “I can't praise the staff enough” and “With the love and dedication from the excellent staff team he has grown in all areas of his life. It is such a relief to a family when their loved ones are in such a special place as Pippin House. To watch the way [name] has grown and progressed over the last few years is nothing short of amazing.”

Importance was placed upon supporting people with their healthcare needs and understanding the need for regular healthcare checks. The staff ensured there were no barriers to people receiving the healthcare support they required.

Staff were safely recruited and continued to receive the training and support they required for their role. Staff told us they felt listened to and they felt their team work had improved since the appointment of the new registered manager. Professional guidance was sought when necessary, for example with supporting people whose behaviour might place themselves and others at risk of harm. Advice was followed and support given in line with good practice. The communication between the home and professionals was good.

People, relatives, staff and healthcare professionals told us the home was well managed and gave us very good feedback about the registered manager’s attitude towards involving them in the running of the home.

There were systems in place to monitor and check that the quality of the service provided met with the aims of the organisation. Senior managers from The Royal National Institute for Deaf People regularly attended the home to me

Inspection carried out on 02 November 2015

During a routine inspection

This inspection was unannounced and took place on 02 November 2015. At our last inspection in November 2013 the home was meeting the regulations at that time.

Pippin House is a care home run by the charity Action on Hearing Loss (RNID). The home can accommodate up to eight people. All of the seven people living in the home at the time of the inspection were profoundly deaf, but are in residential care due to a range of learning disabilities (including autistic spectrum disorder) and/or mental health problems.

The home had a registered manager, who had been in post since the home opened in 2000. 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.

All of the people living at Pippin House knew each other well. Some of them had been living together at another home prior to moving in and the others joined them when the home opened. They benefitted from being supported by a stable staff team, many of whom had, like the registered manager, been working at the home since 2000. On the day of the inspection people were happy, relaxed and engaged in meaningful social and leisure activities. Staff were attentive and available to support people with their chosen activities. Staff spoke with people in a friendly and respectful manner.

People told us they enjoyed living at Pippin House and felt safe. One person told us, “I feel safe, I can live the life I want and I am supported to manage any risks.” Another person said “I have everything I need clock, light, computer, office desk everything.” People were supported to explore new experiences, gain new skills and to increase their independence. Each person had a care and support plan which they had contributed to writing. These plans were personalised and gave staff important information about their likes, dislikes and preferences. They detailed how and when staff should provide support in day to day activities as well as during times when people might need additional support. For example, when anxious or agitated, some people may display behaviour that placed themselves or others at risk of harm. The plans described under what circumstances this may occur and how staff should respond. Should a person require a physical restraint to protect them or others, this needed to be described in more detail to ensure this was managed safely and consistently.

Risks to people’s safety in and out of the home were clearly identified and people were involved in exploring these risks and identifying how to overcome them. People’s medicines were managed safely and they received these as prescribed. People used the local healthcare facilities such as GPs and dentists as well as receiving support from specialist services such as the community learning disability service.

People took part in a wide range of community based activities throughout the week, including exercise classes, swimming, and visiting local places in interest. Work opportunities were also explored for people. For example, one person had a job in a local charity shop and they told us how much they enjoyed this.

The home had adopted the ‘Total Communication’ approach to involving and communicating with people. This approach enhanced people’s ability to be involved in making decisions about their lives and explore their ambitions for the future.

A social care professional told us “staff respond to each person as a unique individual and I am always impressed by their truly person-centred approach”.

Staff were well trained and had the skills and knowledge to support people with learning disabilities and a hearing impairment: all staff were trained in British Sign Language. They were enthusiastic and respectful towards the people they supported. They said the home was well managed and they received regular supervisions and appraisals. Communication was effective between the management and staff team with daily handover meetings and regular staff meetings.

Safe recruitment procedures were in place and appropriate checks had been undertaken before staff started work. People were involved in interviewing and choosing new staff.

The registered manager and staff were able to demonstrate an understanding of Mental Capacity Act 2005 (MCA) and under what circumstances a ‘best interest’ meeting would be required. A ‘best interest’ decision is made by others who know the person well when the person does not have the capacity to make their own decisions about their care and treatment. We saw were required capacity assessments and best interests decisions had been recorded in people’s files for some decisions.

People told us they were able to choose what they wanted to eat and drink and they were involved in planning menus and shopping. People had pictorial menus and recipes with step by step guides for preparing the meals they had chosen. People used local cafés, pubs and restaurants and used photographs of food and drinks to indicate what they wished to order.

All those spoken with knew the home’s complaint policy and this was displayed using pictures and symbols people could understand. When a concern had been rasied, the actions taken to resolve the issue were clearly recorded. There were effective quality assurance systems in place to monitor the service and drive improvements. The home was accredited with a number of initiates to ensure services and support were personalised and community-based. The home was also accredited with staff development and management organisations for which the home had to continually provide evidence of its learning and development. The registered manager and the people living in the home told us of the planned extension to provide more living space. People had been involved in the planning process and were looking forward to the changes.

Inspection carried out on 28 November 2013

During a routine inspection

We spoke with six of the seven people who lived at the home. We also spoke with five care workers including the manager. We were accompanied by two specialists who could communicate with people using British Sign Language. Through this means of communication, people told us they were very positive about their lives at Pippin House.

People had been involved in making decisions about their lives at the home. This had been achieved through a key worker system, regular meetings, surveys and questionnaires.

People�s health and welfare needs had been met. One person told us care workers supported them and gave them choices about how to spend their time. People in the home displayed behaviours which indicated they were happy and relaxed in the company of care workers.

There were opportunities for people who lived at the home to undertake work placements and leisure activities. We saw that people were supported to access these.

Care workers had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

Staff had been employed following successful background checks and references being obtained. People who lived at the home had been involved in the recruitment and selection of staff.

Regular feedback had been sought on the quality of care. One relative had written �A very homely environment which is very welcoming. Staff are committed to residents. There is no better environment for my brother.�

Inspection carried out on 14 December 2012

During a routine inspection

People living at Pippin House had their privacy protected, choice and control over their lives and choice regarding their bedroom furnishing and decoration.

People had also been involved in the running of the home. This was achieved by attending regular meetings and use of questionnaires.

People had their health and welfare needs met. One person we spoke with said they were happy and did not want to leave. Other people in the home were unable to speak to us in depth but displayed behaviours which indicated they were happy and relaxed in the company of staff.

There were many opportunities for people living at the home to be able to access work placements and leisure activities. We saw that they were supported to access these.

There was a robust recruitment procedure and effective training programme in place. This meant that staff were only employed following appropriate pre employment checks, induction and training.

The home was organised and well managed. There was an ethos of continual improvement and attitude of person centred focus. Records were well maintained at Pippin House. Staff saw them as working documents which reflected the care and support people received.

Inspection carried out on 20 February 2012

During a routine inspection

We took an expert by experience to the home with us when we visited the home on Monday 20 February 2012. The expert by experience accompanied us because of their ability to communicate with people at the home using British Sign Language (BSL).

We spoke with four people at the home. Everyone we spoke with was happy, did not want to live anywhere else and said they would like to stay at Pippin House as long as possible. People indicated that they had choice and control over their lives and were able to be involved in planning their care.

There was a variety and choice of daily life skills, recreational and leisure activities on offer which suited the character and preferences of people. People also told us that the manager and staff helped them access work placements, work experiences and activities.

People appreciated the support they received from staff. The level of support needed varied according to the persons abilities and was described in the person�s care plan. We saw that people set themselves goals to achieve with staff support.

People appeared relaxed around the staff and told us they felt safe in their home environment. People told us that when they had concerns they went to the staff for reassurance.

People we spoke with spoke highly of the staff and appreciated the support they received. There was some dissatisfaction with the quality and effectiveness of sign language and communication used by new staff. People said that the staff who had worked at Pippin House for many years had a good understanding of BSL and were either good or fluent. People also told us they relied on the manager for relaying information in BSL and were happy with this.

The people living at the home knew how to raise concerns and were offered opportunities to give feedback. We saw evidence that this feedback was listened to and acted upon.

Reports under our old system of regulation (including those from before CQC was created)