Peter's Place

About the service

Peter’s Place is a 'care home' providing personal and nursing care to 13 people at the time of the inspection. The service can support up to 13 people. Each person has their own bedroom and ensuite, some of which have a shower facility. In addition, people can access shared living areas including a sensory room, a spa bathroom, a shower room, dining areas and a lounge. A garden is at the rear of the property which is accessible to people living at Peter’s Place and their visitors.

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

Right Culture:

A quality assurance system was in place however, this had not addressed all shortfalls identified at this inspection. The provider told us they had developed a new quality assurance system which was planned to be implemented at the service.

Relatives were involved in the care planning and review process. The provider promoted engagement with external professionals where required to ensure people had care which was tailored to their needs.

Right Support:

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. Staff understood the value and importance of providing care which was dignified and respectful. One staff member said, "Staff are caring and work together as a team putting people first."

People were supported in a safe and clean environment. People were encouraged to personalise their rooms. A wheelchair accessible lift was in place to enable all people living at the service access to shared living areas.

Staff had received training and applied their skills and knowledge to provide safe care. Medicines were administered by trained staff.

The activity co-ordinator was passionate about their role and motivated people to access activities of their choice. People were supported by the staff team to access the community and pursue personal interests.

Right Care:

Staff had received training on how to recognise and report abuse. People received care which was kind and caring. People were supported by skilled staff who knew them well and were aware of people’s needs and preferences.

There were enough appropriately skilled staff to support people safely. Staff were aware of how people communicated and supported them to make decisions and choices.

People’s care plans and risk assessments provided guidance and information to support people safely, providing strategies for staff to de-escalate distressing situations for people.

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 11 April 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• The provider had purchased additional computer tablets to promote people’s well-being and maintain contact with relatives. Staff had supported people to create a celebration DVD which was shared with relatives at Christmas.

• Staff were knowledgeable of processes and systems in place relating to infection prevention and control.

• A decontamination unit had been purchased by the provider at the beginning of the COVID-19 pandemic. This was used regularly in all rooms of the home to enhance the deep cleaning process.

The service was a large home, bigger than most domestic style properties. Peter’s Place was registered to support up to 13 people. There were 13 people with learning and physical disabilities using the service at the time of the inspection.

People’s experience of using this service:

Peter’s Place was larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by staff approach to ensure each person was treated as an individual with personal preferences being at the forefront of care. This is known as person centred practice.

Due to these person centred practices 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.

The provider had a good understanding of registering for the right support and trying to ensure that people’s needs could still be met in a way that focuses on meeting their preferences and wishes.

Peter’s Place provided good care and responded positively to people’s wishes and preferences.

Staff treated people very well and communicated using a variety of methods such as speech, sound, touch, gestures and objects. This meant they met the various communication needs of each person.

Staff spoke respectfully when talking to people. Staff upheld people’s dignity and privacy in the way they treated them.

Risk assessments and care plans in place in people’s care files and were updated regularly.

People were supported to have the most choice and control of their lives and staff supported them in the least restrictive way possible. However, the records in the service did not reflect this practice. Information about who could legally make decisions on behalf of people unable to consent for themselves was inaccurate. We spoke to the registered manager about this and they agreed to review the files.

Systems for managing medicines were robust. However, staff did not always complete the records and medicines audits conducted or reviewed by the registered manager did not pick up the concerns highlighted during the inspection. We discussed this with the registered manager.

The registered manager completed a range of audits such as care files, health and safety, medicines, and internal quality audits. However, as with the medicines, these audits did not pick up other areas noted by the inspector during the site visit.

The human resources manager conducted robust recruitment processes including criminal checks and past employment history to ensure the staff are safe and suitable for the role. Staffing levels were good and appropriate to meet the needs of the people receiving care.

Care files had a certain amount of out of date information in the file and risk assessments signposted to other documents. This could cause confusion for staff to know what people’s current needs were.

Staff skills and knowledge of people’s preferences and needs were very good. Staff received regular training and supervision as well as on the job mentoring.

People had good access to healthcare as needed and staff had a good understanding of how people’s health and sensory needs affected their responsiveness and ability.

Staff and relatives gave very positive feedback about the management team, senior management and human resources staff. Staff told us they were happy to work at Peter’s Place.

Peter’s Place met the characteristics of good in most key areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection Peter’s Place was rated good in all five key areas of safe, effective, caring, responsive and well-led (The report was published on 05 April 2016).

Why we inspected: This was a planned, comprehensive inspection based on the rating at the previous inspection. This inspection was unannounced.

Follow up: We will continue to monitor the service and revisit areas found for improvement at our next inspection.

Peter’s Place provides nursing care and support for up to 13 people with a physical and learning disability. There were 13 people living at the service on the day of the inspection.

The service did not have a registered manager, but a manager was in place who was going through the registration process. 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 felt safe living at the service. Staff had been provided with training to recognise signs of potential abuse and how to promote people’s safety.

Processes were in place to manage identifiable risks within the service and to ensure people’s freedom was not restricted unnecessarily.

The provider carried out recruitment checks on new staff to make sure they were suitable to work at the service.

Systems were in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with the appropriate training to meet people’s assessed needs. There was a supervision framework and appraisal system in place to support staff with their personal and professional development.

Staff worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed. Where people were unable to make decisions about their care and support, mental capacity assessments had been undertaken.

People were provided with adequate amounts of food and drink and to maintain a balanced diet. If required, people were supported by staff to access healthcare facilities.

Positive and caring relationships had been developed between people and staff. There were processes in place to enable people to express their views about their care and support needs.

Staff had a good understanding of the needs of the people they were supporting and how to ensure their privacy and dignity were promoted.

People’s needs were assessed prior to them moving into the service. This ensured that the care they received was appropriate to their needs.

A complaints procedure had been developed to inform people on how to raise concerns about the service if they needed to.

There were quality assurance systems in place to monitor the quality of the care provided and to drive continuous improvements.

Is the service safe?

The person we spoke with told us they felt safe. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. Registered nurses administered medicines safely and these were stored in a locked cabinet. We saw that the provider took appropriate steps to deal with any incidents of abuse and to minimise the risk of abuse.

Is the service effective?

People were provided with appropriate care and treatment, and their needs had been met. Staff received training to support people with various care needs. Some of the people had complex needs which meant they were not able to understand their care plans. However, we saw multi-disciplinary involvement in assessing people's needs and appropriate treatment was provided to meet their needs.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. They were able to communicate effectively with people with limited verbal communication. The staff obtained people's consent before any care or treatment was provided. One person said, "Staff are good."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals were made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to access a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

We spoke with one person and their relative about their experience of living at the home and the care and support they were offered. They told us they were happy living at the home, felt safe in the environment and with the care they were given. The person said, "It's nice living here." Their relative told us, "The staff are kind and the care is good."

Some of the people who lived at this home were unable to express their views directly because of complex communication problems. Therefore we observed engagement between them and staff. It was evident that staff interacted positively with people and respected individual needs and abilities. We saw that people were offered choices as to how they spent their free time. Care plans were person centred, with risk factors being appropriately assessed.

We observed evidence of effective record keeping and robust recruitment processes. We were given free access to all information we required as part of this inspection.

At the time of our visit, eight residents were out doing activities either at the day centre, or with staff: one person was on holiday with care staff. We found staff providing care and support were very knowledgeable about each person's needs.

One person who was able to communicate was interacting well with staff prior to leaving for a shopping trip.

We spoke with someone visiting the home who told us how happy they were with the care and support given to their relative and also themselves by all staff at Peter's Place, and said they 'couldn't wish for better'.