Archived: Piper House

Below is a summary of what we found. The summary describes what people using the service and their relatives told us, the records we looked at and what staff we spoke with told us. We also reviewed other documentary evidence during the inspection.

If you would like to see the evidence that supports our summary then please read the full report.

Is the service safe?

Piper House is a supported living project with twelve independent self-contained flats. It offers 24 hour support to people with varying levels of physical ability, complex needs and/or learning disabilities.

The manager told us that support plans were developed with people and their relatives in collaboration with staff at Piper House and health and social care professionals. We reviewed five support plans during our visit. We saw that the provider had completed relevant risk assessments and that these had been incorporated into people's support plans. Risk assessments looked at areas such as moving and handling, continence, mobility, money handling, abuse and exploitation. However none of the support plans we looked at had been signed by people who used the service and/or family members. The manager told us that plans needed to be approved by people who used the service, family members and the relevant clinicians before being signed. We have asked the manager to update us when all support plans have been agreed and signed by the relevant parties.

The relevant staff were aware of the policies and procedures relating to the Mental Capacity Act (2005). We saw there was evidence best interest decision meetings had taken place and this process involved people who used the service, relevant health and social care professionals, senior staff at Piper House and family members.

There were measures in place to deal with foreseeable emergencies. We saw from the staff training matrix that most staff had completed classroom and/or e-learning training in the administration of medicines. There were suitable guidelines and policies in place regarding the administration of emergency medicines and the manager told us there was always an appointed first aider on duty and a minimum of two trained staff who were able to administer medicines.

Staff responded to potential safeguarding issues and had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The service had a safeguarding policy dated May 2011. Staff were able to give examples of different types of abuse and knew what to do if they suspected or witnessed abuse which included reporting the matter to senior staff and notifying safeguarding teams. We saw from the service's safeguarding records that not all safeguarding matters had been reported to the Care Quality Commission.

Is the service effective?

Staff we spoke with had completed an induction which covered core training in subjects such as safeguarding, moving and handling techniques, first aid and medicines administration. New staff also shadowed more experience staff before they began working directly with people. One relative told us that 'more training' was required and that they didn't think 'Look Ahead was geared towards learning disability.'

We saw records that showed staff were supervised on a regular basis. The service organised staff team meetings on a monthly basis. Staff we spoke with told us they could talk to the manager about any concerns they may have at any time. Relatives of people who used the service told us that the service was 'becoming more effective.' Staff told us 'we want the same thing' and 'we are a good team.' Most of the staff we spoke with told us they felt supported in their roles and received adequate supervision.

Is the service caring?

Staff we spoke with understood people's care and support needs and were aware of how to protect people's privacy and dignity. Staff were responsible for completing daily logs and monitoring the care, health and well-being of people who used the service. One person who used the service told us that the "staff are kind' and relatives we spoke with confirmed that staff were 'very pleasant' and 'staff are trying their best in very difficult circumstances.' One relative we spoke with told us 'staff try to be caring.' We saw staff interacting well with people, asking them how they were and what their plans were for the day.

Most of the people living at Piper House attended colleges and day centres during the week. Staff told us that they went out with people, took them for walks, for coffee and to church and that there was 'freedom for people to do what they want to do.' One person who used the service told us that they 'would like to go out more often' and we saw from the minutes of a customer meeting that people had also requested more day trips, parties, games and other activities. One family member told us that shortages of staff meant that people weren't always able to get out, particularly at the weekends.

Is the service responsive?

There was information about how to make a complaint and to whom. This information was not however available in easy read format. Relatives told us staff 'deal with complaints immediately.' One person who used the service told us "I'm happy here' and 'if I'm upset I can come and tell the manager.'

The service held a series of monthly meetings where it actively sought feedback from people who used the service, family/carers and staff. We looked at the minutes of a range of meetings and saw that people who used the service had requested more activities and highlighted ongoing maintenance issues. The manager told us that family members had requested their own entrance fob keys and that this had been arranged.

Is the service well-led?

The service did not have a registered manager in post. The manager who was currently responsible for the day to day running of the service told us they were in the process of applying to become the registered manager. The manager was supported by a newly appointed team leader, support staff and agency staff. Family members we spoke with told us 'they [the manager and the team leader] seem to be working well together.'

Staff we spoke with told us 'it's been up and down, as a team we need to work together more closely, things are taking shape.' Relatives told us that the service was now 'much, much better than it was.' One family member we spoke with told us 'staff are under enormous pressure' and are 'trying to do things better."

People told us that they had their care needs met by 'very, very, very good and kind' staff. We observed respectful and positive interactions. However information about the arrangements to meet people's needs and the service details was not provided in an accessible format.

The provider did not have appropriate arrangements in place to detail how it planned to meet people's needs. Staff were directed by outdated documents from services where people had previously lived. The provider had no system in place to appropriately plan the delivery of people's care.

There were not always adequate arrangements to keep people safe in the event of an emergency. Staff had not consistently adhered to the provider guidance about the management of people's medicines.

Relationships between staff and people who use the service were positive and relaxed. There were sufficiently robust recruitment processes that helped ensure people were supported by staff that were adequately skilled for their role and proper checks had been undertaken before they were offered a post in the service.

However once in post there were inadequate systems in place to ensure staff were properly supported, supervised and trained for their role. Since the service opened in June 2013 there has been no registered manager in post and the service has been supported by a series of temporary operational directors.

Piper House was a newly registered service with a new building, new staff team and new service users. All of these issues meant that the service was at a very critical period, we were concerned to note that there was an overwhelming absence of effective monitoring by the provider. At the time of our visit this was a role that appeared to be undertaken by the commissioning authority.