Pine Lodge

Pine Lodge provides respite accommodation and support for up to a three people at a time, with a learning disability, autistic spectrum disorder and physical healthcare needs. At the time of our inspection one person was staying at the service.

The service consisted of one bungalow, with three bedrooms one with an ensuite shower room, communal lounges and bath and shower rooms and shared kitchen and garden facilities.

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 staying at Pine Lodge participated in activities and maintained attendance at college, day services and community hubs. Staff were skilled and received specialist training, they showed empathy, kindness and compassion and placed value on their caring roles and involvement in people’s lives. People had their care and support needs met by sufficient numbers of staff.

People were offered a choice of meals and staff monitored people assessed to be at risk of poor food and fluid intake. Staff understood the needs of people requiring specialist diets and cooked food tailored to individual needs. The care provided was flexible to meet people’s needs and preferences. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good working relationships with healthcare professionals and incorporated advice and best practice guidance into the care provided. The service worked in partnership with people and encouraged feedback. Staff told us they enjoyed working at Pine Lodge and spoke highly of the support and encouragement provided by the management team.

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.

The care environment was clean and comfortable throughout, however, we identified some environmental and equipment risks, but the registered manager put measures in place immediately after the inspection to address and mitigate these.

The service had governance processes in place and completed internal quality checks and audits, however these had not independently identified some of the points found during the inspection. The management team was responsive to feedback and guidance provided and implemented measures to prevent reoccurrence.

Rating at last inspection

The last rating for this service was Good (published 20 October 2016).

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.

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

There was a registered manager in post. 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 were supported by staff who understood safeguarding procedures and were able to recognise the signs of potential abuse.

Risks to people had been thoroughly assessed and plans were put in place to manage these risks. At the same time people were supported to live their lives without unnecessary restrictions.

Robust recruitment procedures had been employed to ensure that staff were suitable to work with people who used the service. There were sufficient numbers of staff deployed to provide care safely. The service ensured that people with particularly complex needs were supported by staff who had the skills to meet those needs. Staff received comprehensive training to enable them to meet people’s needs.

People were given support to take their medicines as prescribed. People’s nutritional needs were met and they were supported to access appropriate healthcare services if they needed it.

People were supported by staff who showed respect and cared for them as individuals whilst maintaining their dignity. People were encouraged to make their own decisions where possible and their consent was sought appropriately.

People and those important to them were involved in planning of their care, how it was delivered and their independence was promoted. People’s care was delivered in the way they wished, by staff who were knowledgeable about their needs.

People who used the service and staff who supported them were able to express their views on the service. People were supported to make complaints and were confident that these would be heard and acted upon. The service maintained good communication with people who used the service and their families.

The management team maintained a good overview of the service and had systems in place to monitor the safety and quality of the service. Staff were supported by the management and felt valued by the organisation.

This is a summary of our findings. If you would like to see further evidence supporting this summary please read the full report.

Is the service safe?

We looked at the care records for both of the people staying in Pine Lodge and saw that where people were unable to make certain decisions for themselves, these were made in their 'best interests' with the involvement of appropriate people such as their next of kin or representative.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, a member of staff we spoke with told us that they had been trained to understand when an application should be made. This member of staff also advised us that neither of the people currently staying in Pine Lodge was subject to any restriction, as defined by the provider's Deprivation of Liberty Safeguards (DoLS) policy.

Two people were staying in Pine Lodge during this inspection and each person needed high levels of support in respect of maintaining their health and wellbeing. For example, one person needed 'gastrostomy tube feeding'. We saw from this person's records that they were supported appropriately to ensure that they received sufficient nourishment and hydration.

A member of staff explained to us that the night shift was usually covered by a member of waking night staff plus a 'sleep-in' member of staff. They told us that the waking night staff operated a telephone 'buddy system' with another service that was also run by the provider. This was to ensure that the waking night staff's safety and wellbeing was monitored while they were lone working.

Is the service effective?

For both people staying in Pine Lodge we saw that the care records and daily reports maintained by the service were up to date, contained accurate and relevantly detailed information and were regularly reviewed. There were detailed risk assessments in place that covered most aspects of people's daily life and each of these had been completed specifically for the individual they referred to. All the risk assessments we looked at were up to date and had been reviewed appropriately.

A member of staff we spoke with told us that the service was very focussed on meeting people's needs. They explained that on a few occasions it had been necessary to refuse some admissions, where it was identified that the service may not be able to meet a person's needs appropriately.

Is the service caring?

One person we spoke with told us that, although it was short notice, they were offered the choice of staying in Pine Lodge and that they had agreed to this. This person also told us, 'The staff are all really good here, they always ask what I want and never make me do anything I don't want to'

We observed staff asking this person's consent for various things during our inspection. For example, whether they would like to speak with us and whether it was alright for us to look at their support plan.

When we asked about the care they were receiving, one person told us, 'I've been very impressed with the support here. Particularly [staff name]; they supported me very well last week, when it was very hard'

Our observations throughout the duration of our inspection showed staff to be friendly, caring and professional, whilst interacting naturally with people in the course of their duties.

Is the service responsive?

Our observations of one person with higher support needs showed that, although staff were unable to obtain verbal consent, they were very responsive to the person's body language and used gestures and objects when interacting with them. This assured us that staff respected the person's individual methods of communication, giving consent and making certain decisions for themselves.

Although people did not live in Pine Lodge on a permanent basis, we noted that advice and intervention was sought, as necessary, from relevant healthcare professionals such as the district nurse, GP and Community Psychiatric Nurse.

We noted that, if people did not wish to eat in the dining room, their choices would be respected and they were able to have their meals in other areas such as the quiet lounge or their own rooms. One person we spoke with told us, 'I like having my meals in the dining room but I know I can eat somewhere else if I want to'.

We noted from the minutes of the staff meetings that feedback forms in respect of compliments and complaints were being sent out. It was stated that a form should be sent home for completion after a person's first stay in Pine lodge. For people who stayed in Pine Lodge for 28 days or less, two forms should be sent home during the year and four forms a year should be sent home for people staying in Pine Lodge for more than 28 days.

This meant the provider could monitor the quality of the service provided for people and take account of complaints and comments to improve the service.

One person we spoke with who was staying in Pine Lodge told us that they knew how to make a complaint if they needed to. They also said that they could talk to any of the staff if they were unhappy about anything. They told us, 'I can talk to the staff about anything. If I need something sorting out, I know they'll do it for me'

Is the service well led?

When we asked how the staff treated people, one person we spoke with said: 'Excellent. They're all very nice. I see [the manager] sometimes; she's very nice and makes me laugh. [staff name], who's here today is really brilliant, I don't know where I'd be without them'

During a discussion, one member of staff confirmed that they had completed an induction when they first started working in the service. They also told us that they had regular one-to-one time for supervisions, got on well with other staff and felt well supported by their manager or other seniors.

This member of staff also told us that they were 'very happy' in their work, felt confident and knew most of the people well that they supported.

We saw that staff meetings were being held regularly and looked at the minutes of the meetings held in February and March 2014. These showed that discussions and updates were given and received by staff in respect of any improvements required in the service, particularly with regard to the delivery of care, equipment, and shift planning.