The inspection took place on 1 and 2 February 2018. It was unannounced.

Peartree House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and looked at both during this inspection.

Peartree House specialises in the rehabilitation of people recovering from an acquired brain injury. It can accommodate up to 46 people in an adapted listed building with annexe accommodation for people with greater independence. At the time of the inspection there were 35 people living in the home and annexe with a further two people supported in their own homes.

There was a registered manager in post. A registered manager is a person who has registered with us 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 provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to store and administer medicines safely, and to manage the risk of infection. There was a culture that encouraged learning from experience.

People’s assessments, rehabilitation and care plans were based on appropriate professional standards and guidance. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of and put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses. The provider had adapted the home to accommodate people recovering from brain injury.

Care workers had developed caring relationships with people they supported. People were encouraged and supported to take part in decisions about their care and support and their views were listened to. Staff actively respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. People were able to take part in leisure activities which reflected their interests. People were kept aware of the provider’s complaints procedure, and the provider dealt with complaints in a professional manner.

The home had a warm, welcoming atmosphere. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

At the time of our inspection there were 36 people using the service. We spoke with six of them individually and others in two informal groups. They told us they were satisfied with the care and treatment they received. They were positive about the staff and manager, and told us they felt safe. One said they “wouldn’t want to live anywhere else”. Another described the service as “brilliant”. They confirmed they were happy with the standards of cleanliness and that the food provided was adequate and prepared according to their needs.

We found that people’s care and treatment were based on assessments by the multidisciplinary team and were planned to deliver effective goal-based rehabilitation. Support and treatment were effective and responsive, and provided in a caring manner. People were protected from the risk of poor nutrition and hydration. There were robust procedures in place to protect people from the risk of the spread of infection.

The provider had effective recruitment procedures and made the necessary checks before employees started work. Complaints were taken seriously and responded to appropriately.

We spoke with five out of 36 people using the service. They told us that Peartree House was a “very good home” with staff who “knew what they were doing”. They confirmed that staff ensured they had their consent before delivering care or treatment. They said they were involved in their own assessments and care plans, and that care and treatment were provided according to their plans. One person said they were “not too happy” at being there, but their accommodation did permit them some independence. Others said that they were “very impressed” and that the staff were “brilliant, I can’t fault them.”

We found that people’s consent was obtained if people were able to consent. If they were not, appropriate steps were taken to ensure decisions were made in people’s best interests. People's needs were assessed thoroughly and detailed plans were developed which formed the basis of the care and treatment they received. People were protected from the risks associated with medicines. There were sufficient numbers of skilled staff who were supported by the management to provide the care, support and treatment required. The service kept detailed and accurate records which were kept securely.

People told us that Peartree was clean and the staff friendly and caring. Now and again there will be a problem but anything they had referred to the management had been dealt with fairly quickly.

We were told that they had attended the residents meeting and liked to have an agenda. They felt able to raise issues at these meetings but couldn’t think of any issues they had raised.

One person told us that they could go out whenever they wanted to and had just returned from the shops where they had gone in their electric wheelchair.

This inspection took place on 16 & 19 October 2015 and was unannounced. Peartree House provides accommodation and care for up to 46 people specialising in the rehabilitation of people with an acquired brain injury. At the time of our inspection there were 36 people living at the home. Accommodation is provided in either the main building or in three smaller buildings where people were supported to be more independent. The Centre provides both long-term care and active rehabilitation, and aims to enable clients to maximise their skills and abilities.

The home has a registered manager who has been registered since December 2011. 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.

Risk assessments had been completed for the environment and safety checks were conducted regularly of gas and electrical equipment. People had individualised evacuation plans in their care folders. However, an emergency grab bag was not available at reception, with people’s individualised evacuation plans. This meant that in an emergency they could not be accessed easily and presented a potential risk to people.

There were enough staff to meet people’s needs. Relevant recruitment checks were conducted before staff started working at Peartree house to make sure they were of good character and had the necessary skills. Staff told us they received regular supervision and support where they could discuss their training and development needs, but records showed they had not recently been completed.

People felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. People were supported to receive their medicines safely from suitably trained staff.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

People received varied and nutritious meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day. However, people did not always have their fluid intakes recorded appropriately.

People were cared for with kindness, compassion and sensitivity. We observed positive interactions between people and staff. Support was provided in accordance with people’s wishes.

People and their families (where appropriate) were involved in assessing, planning and agreeing the care and support they received. People were encouraged to remain as independent as possible. Their privacy and dignity was protected.

Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a wide range of activities tailored to their specific interests. ‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service.

People liked living at the home and felt it was well-led. There was an open and transparent culture within the home. There were appropriate management arrangements in place and staff told us they were encouraged to talk to the manager about any concerns. Regular audits of the service were carried out to assess and monitor the quality of the service.