Pear Tree House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.This is the first assessment for this newly registered service. This key question has been rated outstanding.This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

The person’s transition into the service was exceptional. Staff had worked with the individual for several months, supporting them daily in their previous environment. They did this while they developed a bespoke individual service and environment to meet their needs. There was a detailed and robust transition plan in place which adopted a multi-disciplinary approach and involved a variety of supporting professionals including a psychiatrist and community nurses. The transition plan looked at the holistic needs of the person and considered how risks, their wellbeing, and their health and psychological needs could be managed during this time. The transition plan was continually reviewed, adapted and developed, with family and professionals, to ensure a safe transition for the person into their new home. The plan was set at the person’s pace meaning the plan and the person could adapt at the different stages and was guided by the person’s individual needs.

In addition, due to the risks associated with the transition into the new environment, the staff team had developed innovative ways to familiarise the person with this. As the person could not leave their previous location, staff developed a video of the new home to familiarise the person with. Staff identified the persons relative as a safe and secure figure in their life and worked alongside their relation who completed a voice over for the video which offered reassurances and a calm association with their new environment. Staff spoke positively about this and felt this was a positive step which had ensured the transition had been successful. Staff felt proud to be part of the transition for this person. One staff member said, “It worked perfectly, having everything in place and planned for, this really helped us as staff and the individual in adapting.” A professional told us, “Transitions have been well-coordinated, with clear planning, detailed risk management, and close involvement from all professionals and families.” They also commented, “The service takes time to understand each person’s history, needs, and potential triggers to ensure a gentle, paced and supportive transition”.

The person’s care plans and risk assessments were robust, detailed and individual to their needs. They were based on the person’s original assessments. However, care plans and risk assessments were adapted and developed with family members and by observing the person in their current environments. The person’s care was regularly reviewed to ensure it was up to date.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

The registered manager was aware of and implemented the right support, right care, and right culture guidance. Staff were well trained and confirmed they were provided with excellent support and training to meet the needs of the people they supported effectively. Staff were aware of national guidance and recommended approaches, and they were focused on delivering individualised person-centered care for the person.

There was an ongoing schedule of training which was regularly reviewed and updated dependent on the changing needs of the person. This included Oliver McGowan training (this is the government’s preferred and recommended training for learning disability and autism), Positive Behaviour Support and physical intervention training which had been specifically adapted to meet the needs of the person supported. This meant the person received care that was tailored to their individual needs and delivered consistently to them by a staff team who were trained to do so.

The person was at the forefront of their care and the decisions they made, including what their daily routines looked like. Staff promoted the person’s independence and ensured they made choices and held full control of their life. They had the opportunity to access the community as part of their routines and there was a clear emphasis on developing a good quality of life for the person.

The provider understood and followed the principles of STOMP (stopping over medication of people with learning disability, autism or both) They ensured the person and those important to them were involved with regular medication reviews with professionals. The registered manager and staff were able to demonstrate the positive impact these reviews and actions had on the person’s behaviours and overall quality of life. The registered manager told us how the staff team worked with professionals to reduce and change various medicines for the person. They were also able to demonstrate the reduction in the use of ‘as required medicines’, physical interventions and a general reduction in incidents They told us they felt this had a positive impact on the person’s life. One staff member told us, “[Person] is just more alert now and more aware and responsive to us.” Another staff member told us, “I was 1 of the first people to meet [Person]. I wouldn’t believe it if you had told me the impact we have had on their life. They are just a different person to then, so aware, happy, alert, just totally different.”

There was also a system in place which used evidence-based tools to assess the person’s needs. A variety of assessment tools were available if needed to ensure their needs were identified and met. Staff were aware of these outcomes to ensure they delivered the correct care.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

We saw staff worked together collectively to deliver effective care to the person. They had developed strong professional relationships. There were regular reviews and team meetings as well as daily handovers, where the person’s needs were discussed.

Staff were able to freely share ideas, were encouraged to make suggestions and openly raise concerns if needed. As staff knew people exceptionally well, they could quickly identify any changes for people and work together to act. For example, they were able to recognise changes in the person’s mood, so they could redirect or intervene before this became problematic for this person. Information was constantly identified and shared by staff about the person to ensure they used the most up to date information. The staff team had been empowered by the registered manager and had been given the autonomy to make changes or seek support from other professionals if needed.

Most of the staff team had been recruited at the transitional period of the person’s placement. Staff had been specifically recruited for this individual and because of this, had consistently worked together for a long period of time. Relatives and professionals praised how staff worked together and alongside the service to achieve positive outcomes for the person. A relative told us, “They all work together they are such a good bunch.” A professional also confirmed, “The service has excellent relationship-building with individuals and professionals. There is a strong focus on positive behaviour support. Good communication and clear documentation. It’s a culture that promotes dignity, respect, and autonomy.”

All staff were knowledgeable about the person and shared with us what made them an effective team. One staff member said, “The staff team are like a family, we included the managers in that.” Another staff member said, “We have to keep communicating and trust each other, we have to keep getting this right.”

Managers and staff proactively identified and actioned changes to the person’s care. Where needed specialist advice was sought from professionals to ensure the care and treatment the person received was tailored to their individual needs. Professionals were able to share example of what the individual had achieved. This included, reduced incidents or behaviours of concern, greater community access, improved emotional stability and stronger routines and independence.

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider was committed to working with the person, their family and health professionals to ensure positive outcomes were achieved for the person. The person was encouraged to attend health checks and routine appointments as a preventative measure in managing and maintaining their health. Where the person needed to be supported in their own environment, the staff team had collaboratively and at the pace of the person worked with health professionals to develop relationships and programmes to ensure their health needs could be met. For example, the person now engaged in regular visits from a health professional which had previously not taken place. Staff had identified the impact the specific health need was having on the persons health and worked alongside them, their family and professionals in the development of a plan to address this.

The person was supported to make choices regarding their nutrition and hydration. They were encouraged, with staff support, to go into the kitchen and select the items they would like, where previously during the transition period the home was advised this would be high risk and the person should not be encouraged to enter the kitchen area. At times, the person had declined to eat meals cooked within the home and had instead chosen prepared meals which they previously had all the time. At the time of the inspection, the person ate a variety of foods, including home-cooked meals, prepared meals, and meals purchased and consumed within community food establishments. Staff members continued to promote choice, independence, and the maintenance of a balanced diet in line with the person’s preferences.

Staff observed any changes in how the person presented and any changes to their emotional state. They used this as an indication there may be a change in the person’s wellbeing or health. Care plans and risk assessments detailed what these changes may mean for the person and the appropriate action to take during these times. The unique relationship staff had developed with the person meant that changes were detected early as staff knew how they presented.

The person had a hospital passport that detailed their needs including their communication style, mobility and health needs, along with their risks and presentation during periods of emotional distress. Staff told us they were aware of this passport and would take it to hospital with the person if needed.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Without doubt, the outcomes achieved for the person were exceptional. This included a reduction in the use of ‘as required’ medicines, physical interventions, and periods of emotional distress. There was also improved relationships and contact with family members, including relationships that had not previously not been in place. The person completed daily activities which had been incorporated into routines, such as emptying the dishwasher and bed making. They accessed the community to participate in activities of their choosing, such as visiting cathedrals, walks and holidays.

The person’s journeys were tracked and staff worked collaboratively with them and those important to them to celebrate their journey with the use of pictures. These books mapped milestones the person had achieved, such as trips to the beach, making their own bed without prompts and engaging with health interventions. Goals and aspirations for the future were also identified as part of this process. Goals included, increasing social interaction with others and an increased involvement in daily activities. The books identified the positive impact these events had on the person’s life including increased contact with a family member, a reduction in the frequency and intensity of incidents and an increase in meaningful activities in and out of the home.

Regular review of care, audits, reflective practices and goal setting ensured the person’s outcomes were consistently monitored. The management and staff team were always striving to improve the service and make things better for the person. They supported the person to try new experiences.

There was an emphasis on how the person could be supported to maintain and develop new skills.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Capacity assessments and best interest decisions were in place when needed to ensure the Mental Capacity Act was applied. Staff were able to demonstrate an understanding in this area including the importance of gaining consent from the person. They had also received training in this area and were aware of the processes to follow.