We carried out a review of the data available to us about Piper House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Piper House, you can give feedback on this service.
Piper House is a purpose built, supported housing service comprising 12 self-contained studio flats. People may access a communal reception and seating area on the ground floor of the premises. Flats situated on upper floors are accessed by stairs and a lift. Ground floor flats open out onto a garden available to all tenants.
People living at Piper House have a range of complex needs including learning and physical disabilities, autistic spectrum conditions, epilepsy and behaviours that may challenge services. The service is staffed 24 hours a day and is registered to provide support to people with personal care needs. At the time of this inspection the service was supporting nine people.
People's experience of using this service
The provider had systems in place to monitor the quality of people's care and support. Although the monitoring systems now better enabled the provider to identify and address areas for improvement in recent months, we could not yet be confident these improvements were firmly embedded within daily practice and sustainable.
Safe recruitment processes were being adhered to in order to make sure staff were suitable for their roles and responsibilities. Some relatives thought the staffing levels were insufficient at night-time and were concerned that not enough senior staff were available at the premises at the weekends.
Risks to people's health, safety and welfare were identified and addressed. Staff understood policies and procedures to keep people safe. Medicines were safely managed.
People and their relatives were involved in the care planning process. Care plans were detailed and person-centred and were kept under review. They reflected people's healthcare needs and people were supported to meet their healthcare needs.
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 to eat a balanced and appealing diet.
The provider had suitable safeguarding and whistleblowing policies and procedures in place and staff were advised about how to identify and promptly report any concerns they may have.
People were supported to engage in community activities and take part in their hobbies and interests. People were encouraged to give their views and be as independent as possible.
Staff completed a range of training which included training to meet the healthcare needs of people who used the service.
We have made a recommendation about the provider reviewing staffing levels and skill mix for night-time and weekend shifts.
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.
This was a focused inspection that considered whether people were provided with a service that was safe, effective and well-led. Based on our reviews of key questions Safe, Effective and Well-led the service was able to demonstrate how they were meeting the underpinning principles of Right Support, right care and right culture. People were encouraged to make meaningful choices, develop their independence and lead fulfilling lives. People’s care and support plans were produced in a person-centred way which considered their individual needs, wishes and views. Staff were familiar with people’s unique personalities and favoured routines.
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 improvement (report published 7 December 2019).
Why we inspected
We carried out an unannounced inspection of this service on 10, 14, 15 and 16 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
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 of Safe, Effective and Well-Led which contain those requirements.
This inspection was prompted in part due to concerns received from an anonymous source in relation to the safety and quality of the care and support provided to people living at Piper House. These concerns included the safety of night-time care, the standard of cleanliness in the premises, weekend and night-time cover by management staff and the choice of social activities for people who use the service. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.
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.
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Piper House is a purpose built, supported housing service consisting of 12 self-contained studio flats. People have access to a shared reception/seating area on the ground floor of the building. Flats located on upper floors are accessed by stairs and a lift. Ground floor flats open out onto a communal garden area.
People living at Piper House have a range of complex needs including learning and physical disabilities, autistic spectrum conditions, epilepsy and behaviours that may challenge services. The service is staffed 24 hours a day and is registered to provide support to people with personal care needs. At the time of this inspection the service was supporting 10 young adults.
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's experience of using this service:
People and their relatives were involved in the care planning process. Although care plans were detailed and person-centred, they were not always being reviewed and updated to reflect people’s current and changing healthcare needs. Some of the care plans we viewed contained inaccurate and/or out of date information.
Risks to people’s health, safety and well-being were assessed and planned for. However, not all members of staff were aware of the policies and procedures in place to ensure people were safely evacuated from the building in the event of an emergency.
Medicines were not always being managed safely. We noted an administration error in relation to one person’s medicines which had not been identified through the provider’s checks and control procedures.
Staff supported people to access appropriate healthcare services. However, systems in place to document and monitor people’s health and well-being were not always being completed in full. It was not always clear whether people’s health conditions were being treated and monitored appropriately.
Staff completed training in food hygiene and supported people with food shopping and meal preparation. We noted that one person was not always being provided with healthy and nutritionally balanced meals.
People trusted the staff working with them and staff supported people in a kind and caring manner.
The provider had appropriate safeguarding and whistleblowing policies and procedures in place and staff were informed about how to recognise and report any concerns they may have.
Staff supported people to be as independent as they wished and had a good understanding of people's personal preferences.
People were supported to follow their interests and participate in leisure, learning and social activities.
Staff were mindful of people's privacy and endeavoured to maintain people’s dignity by respecting their personal boundaries.
Safe recruitment processes were being followed to ensure staff were suitable for their roles.
Staff completed a range of training. However, not all staff had completed epilepsy training despite staff supporting people with this condition and recommendations made by a visiting healthcare professional.
The provider had systems in place to monitor the quality of the care provided and an improvement action plan was in place. However, at the time of our inspection, the premises were in need of renovation. Delays to repairs and ongoing issues with the water supply, lifts and equipment were having a negative impact on people’s health, safety and well-being. Quality monitoring systems were not always effective and had not identified all of the shortfalls we found during this inspection.
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 (report published 4 May 2017).
Why we inspected:
This inspection was part of a scheduled plan based on our last rating of the service.
In March 2019, CQC received notification of an unexpected death within the service. The circumstances of this incident were discussed with a local authority safeguarding lead and the registered manager at the time of the event. We sought further information during this inspection in relation to these concerns and will request a full update once the investigation report has been completed to consider whether any further action is required.
Enforcement:
We identified breaches of the regulations in relation to safe care and treatment and governance 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Piper House is a purpose built, supported housing service consisting of 12 self-contained, one bedroom wheelchair accessible flats. People have access to a shared reception/seating area and laundry facilities on the ground floor of the building. Flats located on upper floors are accessed by stairs and a lift. Ground floor flats open out onto a communal garden area.
People living at Piper House have a range of complex needs including learning and/or physical disabilities, autistic spectrum conditions, epilepsy and behaviours that may challenge services. The service is staffed 24 hours a day and is registered to provide support to people with personal care needs. At the time of this inspection the service was providing support to 11adults.
The service had a registered manager in post who divided his time between this and another service run by the same provider. 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’s written risk assessments covered a range of issues including road safety, exploitation and abuse from others, self-neglect and financial management. Risk assessments had been reviewed in line with the provider’s policies and procedures. People were protected from the risk of potential abuse because the provider operated systems for recording these matters.
Where possible, people were involved in decisions about their care and how their needs would be met. Staff developed caring relationships with people using the service and treated people with kindness, compassion. People were being supported to maintain their hobbies and interests
Staff supported people to attend healthcare appointments and liaised with people’s GP and other healthcare professionals as required to meet people’s needs. Medicines were managed and administered safely.
Staff recruitment procedures were in place and were being followed to ensure suitable staff were employed by the service. Staff received the appropriate training to equip them with the skills, knowledge and experience to carry out their duties effectively and with confidence and demonstrated a good understanding of people’s individual needs and wishes and how to meet them.
People’s individual preferences were respected in relation to food and drink choices and people were supported to prepare their own meals where this was possible
The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. The registered manager understood when a DoLS application should be made and how to submit one.
Monthly and weekly audits were carried out across various aspects of the service; these included the administration of medicines, care records and health and safety checks.