Pinecroft and Bristol Outreach

Pinecroft provides accommodation and personal care for four people. There were four people living at the home at the time of the inspection.

In addition, the service provides personal care as part of an outreach service to people in their own homes. This service was situated in a separate self-sufficient office in the back garden of Pinecroft. It provides a service to older adults and young adults who have a diagnosis of autism.

Not everyone using Bristol Outreach Service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection no one was receiving the regulated activity of personal care.

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:

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.

Pinecroft provided people with a homely environment that was safe, clean and well-maintained. People were able to personalise their bedrooms. They had been consulted on the décor of the home. Checks were completed on the environment to ensure it was safe.

Staff supported people with their medicines that promoted their independence.

There were enough staff that were skilled to meet people’s needs safely. This was kept under review. Staff recruitment and induction training processes promoted safety.

Right Care:

People led inclusive and empowered lives because of the values and the attitudes of the management and staff. People were supported to do the things they liked to do. People were encouraged and supported to gain life skills enabling them to move to more independent living.

People received care and support that was person-centred and promoted their dignity, privacy and human rights.

Staff understood how to protect people from poor care and abuse. Risks to people had been identified and clear plans of care were in place to keep people safe. People were supported with bespoke training in keeping safe and staying healthy.

Right Culture:

The registered manager and staff were clear about their roles and responsibilities in supporting autistic people. The ethos and the values were promoted within the service, with people setting clear goals based on their aspirations.

People received person-centred, individualised care because staff knew people and their needs well. There was an inclusive atmosphere in the home, people were fully engaged in the running of the home with regular meetings taking place. Their views were acted upon.

Staff worked well together as a team and sought advice and support from health and social care professionals when required. Feedback from professionals was positive and showed the staff worked in partnership to ensure positive outcomes for people.

Quality was everyone’s business. Staff and people and were involved in the quality audits with one person championing in this area in respect of health and safety and the fire checks.

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

Rating at last inspection

The last rating for this service was requires good (published 7 August 2018).

Why we inspected

We undertook this focused inspection due to the length of time since the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led.

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 remained good based on the findings of this 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pinecroft and Bristol Outreach 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.

In addition, the service provides personal care as part of an outreach service to people in their own homes. This service was situated in a separate self sufficient office in the back garden of Pinecroft. It provides a service to older adults and young adults who have a diagnosis of autism.

Not everyone using Bristol Outreach Service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection the Outreach service was supporting 18 people. However, only one person was receiving the regulated activity of personal care. The person’s package of care had started on the 6 June 2018 and was a temporary arrangement until the Outreach Office in Plymouth was registered.

There were two registered managers in post. One was responsible for Pinecroft and the other for the Bristol Outreach 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.

At our last inspection, we rated the service good. At this inspection we found the evidence had shown the service continues to be good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

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. This was the vision of the manager and staff working at Pinecroft. People were very much part of their local community and care was tailored to the person.

There was enough staff to support people living in Pinecroft and those receiving a service in the community and to respond to their changing needs. Some staff worked in both Pinecroft and the Outreach Service. This was seen as positive by the management of the service as some people had previously lived in Pinecroft and it offered them some consistency and familiar staff.

People were being supported and enabled to take more control over their lifestyle choices. People were being encouraged to shop and prepare their own meals, look after their own finances and take some responsibility for their medicines. This was in preparation should people chose to live more independently. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People received effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Pinecroft.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. The home provided a caring service to people. People were involved in decisions about the care and support they received. Staff were knowledgeable about the people they supported and committed to providing care that was tailored to the person. People were treated with kindness and compassion.

Both Pinecroft and the outreach service were well managed with a strong leadership team for the support workers. People’s feedback was valued and used to make changes to service provision.

The registered managers and provider had monitoring systems, which enabled them to identify good practices and areas of improvement. It was evident they strived to provide the best experience for people and care that was tailored to the person.

In addition the service provides personal care as part of an outreach service to people in their own homes. This service was situated in a separate self-sufficient office in the back garden of Pine Croft. At the time of the inspection they were supporting seven people however, none of these people were receiving assistance with personal care. The Care Quality Commission therefore did not inspect this part of the service as they were not carrying out any regulated activities.

There were two registered managers in post. One was responsible for Pine Croft and the other the Outreach 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.

People were receiving care that was responsive and effective. Care plans were in place that described how the person would like to be supported. This included the early warning signs that a person’s mental health was changing and how the person’s autism impacted on their day to day lives. The care plans were tailored to the person and provided staff with information to support the person effectively. People had been consulted about their care needs and their views sought about the service. People were supported to make decisions and take proportionate risks. Systems were in place to ensure that complaints and any concerns in respect of abuse were responded to.

Staff were caring, supportive and demonstrated a good understanding of their roles in supporting people with autism. Staff received training and support that was relevant to their roles. Systems were in place to ensure important information was shared amongst the team and other health and social care professionals to ensure a consistent approach to people’s care.

People had access to other health and social care professionals. Feedback received from visiting professionals was that they were made to feel welcome and were kept informed about any changes enabling them to adjust any treatment and support for the person. People confirmed they could access an advocacy service if they wanted. At the time both people had declined an advocate, saying they could speak out for themselves. Safe systems were in place to ensure people received their medicines as prescribed.

There was enough staff to support people both in the home and the community and to respond to their changing needs. Staff worked in both Pine Croft and the Outreach Service. This was seen as positive by the management of the service as some people had previously lived in Pine Croft and it offered them some consistency and familiar staff.

People were being supported and enabled to take more control over their lifestyle choices. People were being encouraged to shop and prepare their own meals, look after their own finances and take some responsibility for their medicines. This was in preparation should people chose to live more independently.

The service was well led. There were systems to monitor the quality and seek the views of people to improve the service.

The service was advised to review the name of the service as currently it does not acknowledge the service provided in the community, the Outreach Service.

The registered manager had recently been promoted within the organisation and was currently inducting the newly appointed manager. We were assisted throughout the inspection by both managers and support team. They were knowledgeable about people they supported and provided us with information about their experience and views about the quality of service provided. It was evident they enjoyed working in the home and supporting the people who lived there.

People experienced effective, appropriate care, and support that met their needs and was person centred. They were provided with a choice of suitable and nutritious food and drink. People lived in a suitable environment that was safe and promoted their well-being.People were made aware of how to express any concerns they had and were supported by staff when they needed assistance to do this.

We spoke with staff during our visit. We saw that they had developed good relationships with people and were knowledgeable about their individual care needs.

We looked at peoples' care files and saw that peoples' care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw through staff rotas that there had been sufficient staff to support people with their care needs and activities.

We looked at various records kept at the home including peoples' care plans, the records of how people were being kept safe and records of how staff were being trained to meet peoples' needs. It was evident that people had been empowered to make decisons about their care and had been supported in being independent.