We carried out a review of the data available to us about The Piers 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 The Piers, you can give feedback on this service.
The Piers is a care home registered to provide accommodation and personal care for up to three people diagnosed with autistic spectrum disorders and learning disabilities. At the time of this inspection there were three people living at the home.
The service has been developed and designed in line with the values that underpin the 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 of them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using the service and what we found
People told us they were happy and comfortable living at The Piers. Our observations showed people liked the staff, who knew them well and provided their support and care with warmth, kindness, patience, respect and dignity.
We received positive feedback from relatives and health professionals about the service provided by the management team and staff at The Piers. Staff understood how to identify and report abuse and were well supported in their roles. Staff received regular team meetings, supervision and annual appraisals and completed a variety of training courses to enable them to carry out their roles competently.
Risks to people’s health, safety and well-being were assessed and management plans put in place to ensure risks were reduced as much as possible.
People were supported by safely recruited staff. There were enough appropriately trained and experienced staff to support people in ways that suited them. Communication styles and methods were tailored to individual people and staff supported people to understand the choices available to them.
People were supported and enabled 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.
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 service worked collaboratively with health care professionals to ensure people received the best care and support at all times. Staff were responsive to people’s changing support needs and adapted care and support according to their health needs.
Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training.
There was an open, honest and supportive culture within the home. Relatives and staff spoke positively of the registered manager and felt the service was well led. There were robust quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.
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 (published March 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.
The service does not have a registered manager. The previous manager left in September 2016. There was an acting manager in post who was responsible for The Piers and another home for one person in the local area. They were covering the post until a new registered manager could be appointed. The provider was actively recruiting for 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.
The Piers is a care home without nursing in Poole for up to three people with learning disabilities. At the time of the inspection two people were living at the home. The service also provided personal care and support to one person living the community six days a week during the day. There were not any plans to offer this service to any other people living the community.
Relatives told us they felt their family members were safe at The Piers. Staff knew how to recognise and respond to any signs of abuse.
Risks to people’s safety were assessed and managed to minimise risks. Staff followed any risk management plans in place for people. Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP. Staff knew when they should administer PRN ‘as needed’ medicines.
Staff knew people well and understood their needs and the way they communicated. People received care and support in a personalised way both at The Piers and in the community. Relatives told us people were very well supported by the staff.
Staff were encouraging, caring, and compassionate and they treated people with dignity and respect. People and staff had good relationships. People were supported to take part in activities both in The Piers and in the community. This included sensory activities.
People received the health, personal and social care support they needed. People’s health conditions were monitored to make sure they kept well.
Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff were recruited safely and people were involved in the recruitment of staff. There was a core of staff that knew people very well. There had been some changes in the staff team but this had not impacted on the people living at or that were supported by The Piers.
The culture within the service was personalised. Relatives and staff told us they had confidence in the acting manager. There were systems in place to monitor and drive improvements in the safety and quality of the service provided.
At the time of our inspection we were able to speak briefly with one person who uses the service. We also spoke with the manager and two staff.
Where people did not have the capacity to consent, decisions were made in consultation with people's representatives and health and social care professionals.
People experienced care and support that met their needs and protected their rights. Risks to people, staff and others were assessed and managed to ensure the safety of all parties.
There were systems in place to regularly check and monitor the quality of the service.
We spoke with people's relatives who told us 'staff 'give a lot more time than is paid for' and people 'go out a lot " so are part of the community.
We saw people had care and support plans but found evidence that the recording showed appropriate people had on most occasions not been consulted on decisions about the care and support This means that systems and safeguards that ensured people experienced appropriate care and support and to protect there human rights were not in place.
We found staff did not have the key training in some aspects of their roles. We spoke with the acting registered manager and two staff who told us they were not aware of their roles and responsibilities in relation to capacity and best interest decisions and this means people could be at risk of abuse or neglect. We found that there were no arrangements in place to deal with foreseeable emergencies although all staff did explain who they would contact first.
We spoke with the acting registered manager and two staff who told us that people were treated with respect and were supported to make choices during meal times and daily activities.