Pirton Grange Specialist Services

Pirton Grange Specialist Services is registered to provide accommodation, nursing care and rehabilitation services for up to 38 people who may have support needs owing to mental health, learning disabilities or autistic spectrum disorders, Huntington's disease, dementia and neurological conditions. At the time of the inspection there were 27 people living at the home. Care was provided to adults in a wide range of ages.

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

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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.

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 people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The registered manager and staff made an effort to ensure people were involved in their care.

Right Care: Care was person centred and people’s individuality was treated with dignity and respect. The provider acknowledged the service size was not ideal to people whose primary need was their learning disability as the service was too large to fully meet the requirements of Right Care, Right Support and Right Culture. The provider was in the process of reviewing it’s suitability for learning disability provision.

Right Culture: The provider was constantly evolving and improving the service to ensure staff had the values and attitudes to maximise people’s lives.

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 Requires Improvement (published 30 September 2022) and there were breaches of regulation. 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.

Why we inspected

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, Effective and Well-led which contain those requirements.

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.

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 requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pirton Grange Specialist Services 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.

About the service

Pirton Grange Specialist Services is registered to provide accommodation, nursing care and rehabilitation services for up to 38 people who may have support needs owing to mental health, learning disabilities or autistic spectrum disorders, Huntington’s disease, dementia and neurological conditions. At the time of the inspection there were 32 people living at the home.

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

At this inspection we found some of the governance systems had been improved since the last inspection. However, the oversight and governance were not yet effective and established because the provider’s systems had not identified concerns we found on this inspection. The registered manager was unaware of the scale of gaps in the recording of people’s clinical observations or of the environmental risks found during inspection.

People did not always have risks to their health and welfare effectively managed. Identified risks to people’s safety was not always communicated to the staff responsible for providing care and support and did not always ensure safe delivery of care.

People were exposed to environmental risks and COSHH (Control of Substances Hazardous to Health) were not always safely stored. Areas where building work was taking place were accessible to people living at the home.

Some people did not have fire doors that closed properly. This left people at risk in the event of a fire.

People’s care plans were not always clear to enable staff to identify needs and risk. Information in different areas of the home contained details of care needs that conflicted with the information in people’s care records. For example, information about the amount of thickener needed in a person’s drink was different in the food preparation area to what was in their care file.

There were sufficient staff to meet people’s needs, however due to ongoing recruitment challenges there was a high use of agency staff. The use of agency staff increased the risk of staff not knowing people’s individual needs or the systems to accurately record people’s needs. The provider had measures in place so that where possible agency staff were consistent and had experience of the home and the people that lived there.

Feedback from people that lived there, and their relatives was largely positive. We found staff to be kind and attentive when supporting people with their care needs.

Staff observed and followed infection control procedures in line with national guidance for reducing the spread of 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 supported this practice.

Right Support

People did not always receive care and support in an environment that was safe or well maintained. Staff communicated with people in a way that met their needs. People had access to specialist healthcare when needed.

Right Care

People’s care, treatment and support plans did not always accurately reflect their range of needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People felt able to speak up and be listened to. There was use of agency staff through the service, and the registered manager took steps to ensure where possible consistency of staff was achieved.

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 requires improvement (published 9 December 2021) and there were breaches of regulation 12 and regulation 17. The last rating for this service was requires improvement (published 9 December 2021). At this inspection there were breaches of regulation 12 and regulation 17 and we served the provider a warning notice to improve. At this inspection some improvement had been made, however regulation 12 and regulation 17 was not met and some areas of the warning notice not complied with.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at 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.

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 unchanged at requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We held a meeting with the provider after this inspection to clearly identify what still needed to be done to improve their quality assurance systems. The provider will submit an action plan identifying what actions will be taken to make the improvements and the relevant timescales. This will be sent to the Commission so we can closely monitor the improvements being made. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Pirton Grange Specialist Services is registered to provide accommodation, nursing care and rehabilitation services for up to 58 people who may have support needs owing to mental health, learning disabilities or autistic spectrum disorders, Huntington’s disease, dementia and neurological conditions. At the time of the inspection there were 30 people living at the home.

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

People did not always have risks to their safety managed effectively. Risks were not clearly identified for staff to follow. Important information about people’s health conditions was not communicated effectively to staff for staff to ensure care was delivered safely.

Peoples’ medicines were not always managed safely. People did not always get the support needed to take medicines safely. Clear action was not always taken to reduce errors or risks associated with people’s medicines.

There was no registered manager in post. The clinical manager told us that improvements had been made to the systems, policies and procedures following a recent Coroner’s inquest. However, we found improvement was still needed to address recommendations made after the inquiry. There were gaps in recording, no oversight of clinical risks and no effective management of agency staff, particularly agency nurses who were required to manage the shift.

There were sufficient staff to meet people’s needs, however there was not always a consistent staff team who had up to date knowledge of peoples’ current needs.

Relatives told us that care staff were attentive to the needs of their loved ones. They could raise concerns and felt confident that anything raised would be addressed.

People were cared for by staff who attended training relevant to their roles. The agency staff also had opportunity to access the same training as permanent staff.

People lived in an environment that was clean and well maintained.

Staff observed and followed infection control procedures in line with national guidance for reducing the spread of 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 supported this practice.

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 Good (published 3 December 2019).

Why we inspected

Prior to our visit, we received concerns in relation to the management of peoples’ nursing needs and the management and governance of the service. This was following a Coroner’s inquest which identified some shortfalls with the quality of clinical care provided. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of people’s risks and the management and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Pirton Grange Specialist Services is registered to provide accommodation, nursing care and rehabilitation services for up to 58 people who may have support needs owing to mental health, learning disabilities or autistic spectrum disorders and dementia. Services are also provided for older people, people detained under The Mental Health Act, people with physical disabilities, sensory impairment and younger adults. At the time of the inspection there were 35 people living at the home.

Pirton Grange Specialist Services had two separate areas of the home. In one area there were facilities for eight people needing support with mental health or learning disabilities. In the other area there were facilities for thirty people needing nursing support spread over two floors.

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

People were cared for by staff who knew how to keep them safe and protect them from avoidable harm. Sufficient, knowledgeable staff were available to meet people's needs. Staff followed infection control and prevention procedures. People received their medicines regularly and systems were in place for the safe management. Incidents and accidents were investigated, and actions were taken to prevent recurrence.

People's needs were assessed, and care was planned and meet legislation and good practice guidance. Care was delivered by staff who were well trained and knowledgeable about people's needs and wishes. People enjoyed their meal time experiences. 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.

People were supported by staff who were caring. The atmosphere within the home was welcoming and friendly and staff were considerate towards people they cared for. People and their relatives were involved and supported in decision making. People's privacy was respected, and their dignity maintained.

People were supported by staff who cared for them as individuals and had the information and understood how to meet people’s needs. People had some interesting things to do and support to improve their well-being. Complaints were investigated, and outcomes agreed with on-going communication, and improvements made when needed.

The registered manager and her management team were open, approachable and focussed on providing quality care. Systems were in place to monitor the quality of care provided. The management team and staff were passionate about person centred care and people and staff felt valued and well supported. The management team promoted links with community health and social care teams to improve people’s well-being.

The service applied where possible the principles and values Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 good (published 31 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

This inspection took place on 16 February 2017 and was unannounced.

A registered manager was not 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 2008 and associated Regulations about how the service is run. However, the provider had appointed a manager who was in the process of applying to become a registered manager with the Care Quality Commission.

At the last comprehensive inspection on 28 November 2014, we asked the provider to take action to put in place suitable arrangements for obtaining and acting in accordance with the consent of services users in relation to the care and treatment provided for them.

We completed a focused inspection on 4 November 2015 to make sure the improvements required had been made. We found the effectiveness of the service had been improved and action had been taken to meet the legal requirements in respect of obtaining and acting in accordance with people’s consent in relation to the care and treatment provided for them. We could not improve the rating as a result of the inspection on 4 November 2015, as we needed to make sure the improvements made were sustained.

At this inspection we found the improvements required had been sustained.

People told us the staff who cared for them understood their safety needs. Staff cared for people in ways which promoted their safety, based on people’s individual risks. Staff knew what action to take to protect people from the risk of potential abuse. There were enough staff employed to care for people so they received care promptly and their safety and well-being needs were met. Where people wanted assistance to take their medicines this was given by staff who knew how to do this safely.

People benefited from receiving support from staff with the knowledge and skills to care for them and staff recognised people’s rights. People enjoyed their mealtime experiences, and had enough to eat and drink to remain well. Staff took action to support people if they required medical assistance, and advice provided by health professionals was followed. As a result, people were supported to maintain their physical and mental health.

Caring relationships had been built between people and staff. People and their relatives were positive about the staff that supported them. Staff worked in ways which made people feel valued and included and recognised them as individuals. Staff took time to chat to people and show interest in how they spent their time. People were encouraged to make their own day to day decisions about their care. Where people needed support to do this this was given by staff. People were offered reassurance from staff in the ways they preferred when they were anxious. People’s right to privacy was taken into account in the way staff cared for them and they were encouraged to further develop their independence.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. People were confident they would receive the care they needed from staff as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

Positive comments were received about the way the home was managed and people and staff were encouraged to make suggestions for developing care further. Staff knew how they were expected to care for people. The manager and provider checked the quality of the care provided and people and their relatives were encouraged to give feedback on the care they received, so improvements would be driven through and people would continue to enjoy living at the home.

This inspection was completed by one inspector. On the day of our inspection we found that 28 people lived at Pirton Grange. Due to their complex needs or health conditions, we were not able to speak with all of the people who used the service. We observed their experiences to inform our inspection. We spoke with four people who used the service, the registered manager, deputy manager, two nursing staff and four care staff.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. One person told us, "I feel safe here and I feel sure everyone here is safe." Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy. We found some safeguarding alerts had been made for people and the appropriate action taken by the provider. However, we found evidence that not all incidents had been identified and reported for safeguarding. The registered manager was unclear about why this had happened but reassured us that appropriate action had been taken to ensure people's safety.

People were not always asked for their consent to care and treatment and where people did not have the capacity to give consent, the provider had not acted in line with legal requirements.

People had not always been cared for and supported in line with their individual care plan and risk assessment. This meant that people's welfare and safety was not always protected.

The deputy manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Systems were not in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found people had been deprived of their liberty without appropriate authority and safeguards.

Is the service effective?

People were not included in the planning of their care. We found that care plans and risk assessments were not followed by care staff. This meant people were not receiving effective care that met their needs.

Although regular staff training took place, we found training was not always effective. Staff were not supported to effectively carry out their role.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient with people. One person told us, "The staff are very good to me."

People’s preferences, interests and diverse needs had been recorded, however care was not always provided in accordance with people’s wishes.

Is the service responsive?

People were not given the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service however the provider had not acted on comments that people made.

Is the service well led?

The provider had risk management systems in place. We found the provider did not check that risks were managed effectively.

The provider sought the views of people who used the service and staff. Records seen by us indicated that people were not asked about all aspects of the service and their views were not acted on.

Staff told us they were not clear about their roles and responsibilities. Staff told us they did not feel supported by managers.

We found that staff had an understanding of the needs of people who used the service. We found that care and support was planned and delivered in a safe way, which met people's individual care needs. One person who used the service told us, "This is my home and I love it."

We found that people's dietary needs were met and that people had a good choice about what they ate. We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

People we spoke with were positive about the care they received. People told us that staff had the right training and that their knowledge and skills were adequate. One person told us, "They have helped me so much. I'm a different person now."

We found that systems were in place to effectively deal with complaints. The provider monitored the quality of the service and had made improvements where needed.

We found that the provider did not have systems in place to gain the consent to care and treatment of people who used the service.

The three care files that we reviewed indicated that arrangements had been made to support people in receiving their health and care needs. We saw recordings that confirmed that staff had actively promoted people's health and well-being. From

discussions held with three staff we found that people were well supported in receiving care needs that suited their individual preferences and lifestyle.

People were encouraged and supported to do things for themselves and were given choices. One person told us, "I can go out if I want to."

We found that systems were in place to keep people safe. Staff had received training in safeguarding people and knew how to respond to concerns.

We saw that staff were supported in carrying out their roles effectively. This was because there were systems in place for staff to attend appropriate training courses. Senior staff regularly monitored staff practices to ensure that appropriate care was being provided.

People told us they knew how to make a complaint but that they had not needed to.