Pear Tree House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated outstanding.This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The person was at the heart of the care they received. Care and the environment had been built around their needs. We saw the person was in control of their life and care was delivered around them. For example, the person dictated where they spent time in their home, how their day was planned and what happened next.

Without exception, care plans and risk assessments were individualised and detailed. They were specific to the person’s needs, considered their history, preferences, likes and dislikes and ensured all aspects of care and support were considered. Records also reflected their aspirations and goals for the future. Care planning involved the person and those who were important to them and promoted their choices.

Staff worked with the person and their family in a person-centred way to ensure events were assessed, planned and individual. For example, when planning a holiday with the person, they chose a period when the weather was likely to be warmer, enabling the person to take part in the activities they enjoyed. They considered that environmental changes could cause anxiety and when booking, they looked for accommodation that was like previous stays to provide consistency and reassurance. They also ensured that local amenities were available and accessible, particularly a fish and chip shop, as this was an important and familiar part of the holiday experience for the person.

The provider had a developed a relaxed atmosphere where the person could live a meaningful life at their own pace, although routine provided structure for them, there were no set times they needed to get up or have meals. This was controlled by the person, their emotions and at their own pace. Some routine was incorporated into the person’s care. For example, they had a favourite take away meal on a Friday evening. The person accessed community activities based on their likes and dislikes and chose what they wanted to do.

Staff acted as advocates for the person and ensured they were involved with their care. They demonstrated a deep detailed understanding of the person. They could tell us their likes and dislikes, their preferred way of doing things and detail how they could express how they were feeling. Staff spent time with the person to understand then, their wishes, needs and aspirations. They were encouraged to live a fulfilled life by trying out new things at a pace which suited them, sometimes this was over significant periods of time.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The person received support from professionals who understood their diverse health and care needs. They had access to occupational therapists, speech and language therapy (SALT), dietitians, community specialists and social workers. Staff were able to give examples of how they worked with a variety of different professionals to develop individual plans of care for the person. Although some plans involved taking very small steps for the person and at slow paces, staff ensured they continued with these as they believed in the long-term outcome that could be achieved.

Continuity and consistency for the person had begun at the start of their transition into the home. The individual robust transition plan that had been developed and implemented for this person meant care was joined up, flexible and offered continuity. This level of care and support had then continued for this person into their everyday life.

The continuity the staff team provided had exceptional outcomes for people. The staff team, which had been recruited specifically for the individual had been supported by the provider to develop positive relationships with the person. Most staff had been present from day 1 of the transition of the person into the home. Without exception each member of the management team and staff team knew the person very well.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual need. Staff had worked creatively with the person to ensure they received information in a format they could understand. There were individual communication plans in place for the person which detailed the specifics of how they communicated. For example, the person used key sounds to describe certain words, plans for the person listed these sounds and the meanings of them. When new sounds or forms of communication were made, staff worked closely with the person and their families to understand the meaning of these. We saw staff respond to the person using the language they had created, which the person responded to positively.

Within the home there was an accessible communication box which was individual to the person. It had pictures they could access at any time if they wished to express an emotion or request something they wanted. The pictures were unique to the person and showed them participating in the activity. For example, there were pictures of them completing household tasks. Staff worked closely with the person and professionals to develop this communication aid which was unique to them. When specific pictures did not work or were not being used effectively, they were changed or adapted to enable more positive outcomes.

There was a range of accessible information available for the person should they require it. This was in relation to their care and support, policies and procedures within the home and meetings they had participated in. All information was available in an easy read format for the person and freely available.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

Both the person and those important to them were at the centre of the care they received and without exception they were listened to. A relative told us, “From day 1 I have been involved every step of the way.” Relatives, staff and professionals were given the opportunity to complete 6 monthly surveys about the care and support, to ensure their views were captured. All the information received was positive. However the registered manager was still able to tell us how they used this information to drive improvements throughout the home if needed.

The person was really listened to, not just through their voice but through their interactions and actions. The home monitored how the person reacted and engaged with new activities, with health appointments, with changes to staff teams and to everyday tasks they completed in their home. This way they could capture the experiences of the person; they could review this information and make an evidence based informed decision about what was needed and if any changes were required to how care was delivered.

Staff were aware of how the person chose to communicate and were continually monitoring them and their interactions to see if there were any changes which may show they were unhappy with something. One staff member said, “If [the person] is quiet or not themselves it may mean they are unwell. If we try something new with [the person] and they do not engage with us how they usually do when they are doing something, it might mean they are not happy about it. It’s the person’s way of complaining.”

The person and those important to them were supported to raise concerns and share where improvements were needed. A relative told us, “I absolutely know how to complain or raise concerns if needed. I have never had to, we have ongoing conversations all the time about how things are working, so I am sure we would address anything straight away.” Staff regularly communicated with relatives, either in the home or by telephone or video. Staff compiled photo books and stories for the person when they had new experiences such as holidays or completed everyday tasks such as housework so they could revisit these experiences with them and share them with those that were important to them. They gifted family members picture books of activities so family members felt involved with people’s experiences and outcomes.

The provider monitored compliments and complaints. There had been no recent complaints at the service. The registered manager was able to explain the action they would take if concerns were raised and told us this was in line with the complaints procedure that was in place. They told us how they would use this information as learning to the service and where possible make changes to people’s care which would have a positive impact.

All policies had been adapted and presented in easy read formats so people could access and view these if they wished.

The person had access to an advocate if needed. The service promoted advocacy and had easy read information available for the person. Staff gave examples of when people may need advocacy services or support.

The provider was exceptional at ensuring people could access the care, support andtreatment they needed when they needed it.

The person had robust plans in place which guided staff to support the person to access the right care and support when they needed it. The person was encouraged to attend medical appointments in person, however where this was not always possible, robust guidance and action was taken to ensure the appointment went ahead in an environment that suited the individual. If for any reason the person on the day chose to not attend appointments this was respected by staff and adaptations made to ensure these appointments and reviews still went ahead, for example as a video call as an alternative. The person was also provided with the correct levels of support needed for activities, appointments and interventions to go ahead and the provider ensured contingency plans were in place should they be needed.

Relatives and professionals spoke positively about the difference moving into Pear Tree House had made to the person’s life. A relative told us, “I can’t believe where we were and where we are, every barrier has been overcome.” A professional said, “For [person] this has been the longest placement in the community. The provider clearly understands their needs and wishes. This has enabled [person] to go on holidays and introduce new items to their home. [Person’s]quality of life has improved.”

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff considered discrimination and inequality that the person living in the home may face. They tailored the person’s care to consider barriers they may face to ensure positive outcomes. For example, when planning a holiday for the person, they considered factors such as avoiding school holidays to help avoid busier periods, as crowded environments may present triggers that could prevent the person from fully enjoying their holiday.

Staff had received training and were able to demonstrate the action they would take if the person they supported experienced discrimination or inequalities. Staff felt confident to challenge such concerns while maintaining their professional integrity. They understood the challenges people may face and the importance of not always being accepting of such issues.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The registered manager confirmed they were not supporting anyone who was currently receiving end of life care; however, they were aware of action to take if needed. They told us they would ensure people and those important to them were involved with all aspects of decision making and consider people’s individual needs and preferences. The provider had adopted a multi-disciplinary approach when introducing these plans and were working alongside professionals and families whilst these were developed.