PIPS Office Also known as Positive Individual Proactive Support Limited

PIPS Office is a supported living and outreach service providing personal care to adults with learning disabilities, mental health needs and autistic people. People lived in their own accommodation in multiple locations across Teesside, County Durham and North Yorkshire.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of our inspection, the service supported 25 people with personal care.

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

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.

Right Support:

People’s medicines were not always safely managed. Medicine records were not always accurate and clear guidance was not always in place to help staff support people to take their medicines safely.

Staff supported people to have the maximum possible independence, choice and control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

The provider used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them. People were supported by staff who were recruited safely and who had appropriate inductions.

Right Care:

Systems to safeguard people from the risk of abuse were in place. However, areas of oversight needed to be more robust, to ensure the provider was doing all they could to identify and deal with concerns at the earliest stage possible. We have made a recommendation about this.

People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. People told us they were happy and liked the staff teams supporting them. People we visited appeared settled, relaxed and comfortable.

Right Culture:

Governance processes were not always effective in identifying issues and driving improvement. Quality assurance audits were not always comprehensive enough or had not always been completed accurately.

The management team was visible in the service, approachable and took a genuine interest in what people, staff, family, advocates and other professionals had to say. Positive improvements had been observed in people’s quality of life and staff were passionate and enthusiastic about person-centred support.

The provider sought and encouraged feedback from staff, people supported and relatives. The provider and staff worked well with other professionals. The provider was responsive to the inspection feedback and put actions in place immediately.

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

Rating at last inspection and update

The last rating for this service was good (published 27 March 2020).

At the last inspection we recommended that the provider seeks further support and guidance from a reputable source, about effective systems to monitor the service. At this inspection we found effective systems were still not in place to ensure robust and consistent oversight of the service.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of the support provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 good to requires improvement based on the findings of this inspection.

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

The provider has taken immediate action to mitigate the risks identified.

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

Enforcement and Recommendations

We have identified breaches in relation to the safe management of medicines and oversight at this inspection.

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

We have made a recommendation about reviewing safeguarding procedures and processes to ensure they are robust.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

PIPS Office is based in Stokesley and provides supported living services to people in the Middlesbrough, Hartlepool, Durham, Stockton and East Cleveland areas. At the time of this inspection the service was providing support to 37 children and young adults, most of whom had autism and/or learning disabilities.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were safe. Risks to people were assessed and regularly reviewed and positive risk taking was promoted. Staff followed guidance from other professionals to ensure people’s safety was maintained whilst allowing people to develop skills.

Staff had received appropriate support and training and any safeguarding concerns had been appropriately managed. Accidents and incidents were thoroughly recorded, although regular reviews of trends were not always recorded. The provider took action to address this.

People were encouraged to follow a healthy diet and attend health reviews. Medicines were appropriately administered, and the effectiveness recorded. Regular meetings took place with other professionals to monitor the progress people were making. Though records did not always clearly reflect this. The provider took action to address this.

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 at the centre of the service and their views listened to and acted upon. People had been encouraged to be part of a ‘driving up quality’ group which focused on areas people wanted to see improved.

Support was provided to allow people to attend a range of activities. Information was presented to people in a way they could understand. Care plans contained person-centred information that focused on each individual.

Systems to monitor the quality and safety of the service were in place and were effective. These required further development to ensure the registered manager had consistent oversight of all supported living services. We have made a recommendation about this.

The service applied the principles and values of 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. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection

The last rating for this service was good (published 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

PIPS Office registered with CQC in May 2016 and this was the first inspection of the service. The service is based in Stokesley and provides supported living services to people in the Middlesbrough, Hartlepool, East Cleveland and York areas. At the time of this inspection the service was providing support to 15 people, most of whom had autism and/or learning disabilities. The nominated individual and registered manager where present throughout the inspection.

The service had a registered manager. 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.

Recruitment procedures had been followed to ensure staff were safe to work and did not pose a potential risk to people who used the service. Interviews were recorded and records showed that the provider ensured new staff were suitable for the role before an offer of employment was made.

Medicines were managed and stored safely. When people required their medicines to be administered by staff, appropriate documentation and risk assessments were in place. Medicines records contacted accurate information which reflected people’s current medicine needs. Records showed that medicines had been administered as prescribed.

A safeguarding policy was in place to protect people from the risk of harm. All staff we spoke with were aware of the procedure to follow if they suspected abuse was taking place. Safeguarding concerns had been managed appropriately.

Risk assessments had been developed and were in place for people who needed them. The service promoted positive risk taking and risk assessments recorded how this was to be managed safely. People were not restricted and their independence was promoted. Risk assessments had been regularly updated to reflect people’s current needs.

People told us they trusted staff and felt part of the service. They were able to transition to the service over a period of time which helped people to build relationships with staff before they began receiving support.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005. Staff were aware of the procedure to follow if they suspected a person lacked capacity to make decisions.

There was a process for completing and recording staff supervisions and competency assessments. Systems in place ensured staff received the training and experience they required to carry out their roles. They completed an induction process with the provider and shadowed more experienced staff until they built relationships with people. A range of training was provided to ensure staff were able to effectively carry out their roles.

Some people were supported by staff with meal preparation and where possible people’s independence was promoted in this area. Records and people confirmed that they were given choice and were able to make independent decisions about what they had to eat and drink.

People were supported by a regular team of staff who knew their likes, dislikes and preferences. Staff had the knowledge of people’s personal histories and medical conditions and had been involved in implementing and developing support plans to meet people’s needs. Support plans were reviewed on a monthly basis to ensure they continued to meet people’s needs.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. Professionals were kept updated regarding people’s progress or any concerns that had been identified. People were clear about how they could get access to their own GP and other professionals and staff at the service arranged this for them where needed. People and relatives told us they were always treated with dignity and respect.

People usually consented to their care and support from staff by verbally agreeing to it and when appropriate best interests decisions had been made and were recorded. People we spoke with confirmed they had input in the support planning and had access to their care records. Information on advocacy services was available.

The provider had an effective system in place for responding to people’s concerns and complaints and easy read formats of the complaints procedure were given to people when they joined the service. People said they would talk to the manager or staff if they were unhappy or had any concerns.

Staff told us they felt supported by the management. They said the management team were approachable and they felt confident that they would deal with any issues raised. Staff were kept informed about the operation of the service through regular staff meetings and other forms of communication. They were given the opportunity to suggest areas for improvement.

The management team carried out a number of quality assurance checks to monitor and improve the standards of the service. Information was analysed and the findings shared with staff during staff meetings.

The manager had a good understanding of their role and responsibilities and had extensive experience of working with people with autism and learning disabilities. They understood when notifications were required to be submitted to CQC. Notifications are changes, events or incidents the registered provider is legally obliged to tell us about within the required timescales.