About the service:

Pegasus care home provided personal and nursing care to eight people with a learning disability at the time of the inspection. The service was also providing support to a further 15 people with a learning disability with personal care within the community who lived in supported living accommodation.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service was meeting the principles of this policy.

People’s experience of using this service:

People received safe and effective care. Staff received training and had the skills to support people with meeting their needs. People were protected from the risk of abuse and risks to safety were assessed and managed to keep them safe.

People were supported by kind and caring staff who knew them well and understood their preferences. People’s dignity was respected and their privacy protected. People were encouraged to make decisions and choices for themselves and were encouraged to be independent.

People were supported to follow their interests and were involved in planning their care and support.

People had their views sought about the care they received and they were listened to. There were systems in place to monitor the quality of care and these were effective in identifying improvements.

The registered manager encouraged a positive culture and understood their responsibilities. Learning and partnership were encouraged and promoted to improve people’s quality of life.

The service met the characteristics of Good in all areas; more information is available in the full report below.

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 the service was rated Good (report published 9 October 2015).

Why we inspected: This was a scheduled inspection based on previous rating.

We last inspected this service on 16 July 2013. At that time we found that peoples care records had not always been signed by the person or their representative. We also found that records were not always in place to support people who had behaviours that might challenge. We found that referrals for manual handling assessments had not been made and that risk assessments had not been reviewed. At this inspection we found that these issues had not been adequately addressed.

On the day of our inspection there were five people who lived at the home. The home had spaces for six people to live there and another six people to have respite there. Nobody was on respite care at the time of our inspection. We talked with the manager and looked in detail at the care records for three people. We observed how people were being cared for in the home and sat with two people in the lounge area. We visited on a weekday and we spoke with two relatives. We talked with three staff members and spoke with one professional who had regular contact with the home. We looked at three staff files, and three records of people who lived at the home.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

Staff understood their role in safeguarding the people they supported. There were enough staff on duty to meet the needs of people who lived at the home. The manager had a good understanding of issues around safeguarding and their role in protecting people. Staff understood how to safeguard people they supported. There were policies and procedures in place to make sure that unsafe practice would be identified and people would be protected.

We saw people were cared for in an environment that was safe and clean. One relative told us, “He’s clean and he’s well looked after and he seems happy.”

The Care Quality Commission monitors the operation of the Deprivation of Liberty safeguards (DoLs) and the Mental Capacity Act 2005, which applies to care homes. The manager had an understanding of these safeguards which ensured people’s rights and choices were protected.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. Staff had been provided with up to date training in a range of topics including first aid and food hygiene. Care plans were linked to people’s individual needs, for example, in relation to nutrition. Staff had a good understanding of people’s care and support needs and knew them well. The service worked well with other agencies and services to make sure people received their care safely and effectively. One staff member told us, “Everybody is really helpful, I’ve done loads of training.”

Is the service caring?

Relatives told us staff were caring and kind. Staff told us they were clear about their roles and responsibilities to respect people’s privacy and dignity. We saw that staff were polite and attentive to people and understood their needs and preferences.

We saw the staff and manager were patient and gave encouragement when supporting people. All the staff we spoke with expressed kindness towards the people they supported. A member of staff told us, “There’s a lot of empathy here with the clients, I’d have my relative move in here.”

Is the service responsive?

We spoke with the manager who told us she involved other professionals in people’s care when their needs changed. This was so people’s care could continue to be provided safely and appropriately. A community nurse told us, “I’ve always been very happy with them. They are always amenable to any suggestions from us.” People who lived at the home and their relatives were involved and their choices were acted upon. A member of staff told us, “There’s a really good personal relationship with people, staff go the extra mile.”

Is the service well-led?

The manager was aware of their responsibilities in meeting the essential standards of quality and safety. Staff felt well supported and records we reviewed confirmed that staff were appropriately trained and supported to carry out their role safely. Staff told us they were clear about their roles and responsibilities. There was a clear structure of supervision responsibilities within the staff team. Staff felt supported to do a good job. A relative told us, “The owner is absolutely brilliant, always really helpful.”

There were seven people living there on the day of the inspection. We spoke with four people living there, five members of staff and the manager.

Arrangements in place to manage risks to people and support people who may present difficult to manage behaviour, had not always been consistent or effective. This placed people at risk of harm.

People had been given their medicines as they had been prescribed by their doctor to ensure their health and wellbeing.

Arrangements were in place so staff received the support they needed to carry out their role.

A staff training analysis had been completed and was in the process of being implemented so that staff would be suitably trained to meet people’s needs.

There were sufficient numbers of staff to meet people’s needs.

There were systems in place to monitor the service that people received.

We found evidence that the provider has developed systems for identifying the needs of the people who use this service in a person centred way. Staff are subject to the correct employment checks and references. We found that staff have not been supported through regular supervision and essential training. There are systems in place to check support plans and risk assessments but none to collate the feelings or experiences from the people who use the service.

The inspection took place on the 9 and 13 July 2015 and was unannounced.

Pegasus Care Home is registered to provide accommodation and support to 12 people with a learning disability, a mental health condition, physical disability, and sensory impairment. A further four people are supported with personal care within the community who lived in a supported living complex.

There was a registered manager in post responsible for the home and the services delivered within the community. 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.

We found concerns in July 2014 with the standard of records which were not robust enough to meet regulation 20. We asked the provider to send us an action plan outlining how they would make improvements and we considered this when carrying out this inspection. We found that sufficient action had been taken to improve the standard of records to meet the requirements.

While people told us they felt safe, we found that staff competency was not being checked to ensure they were able to administer medicines safely.

Concerns were raised as to there not being sufficient staff working at weekends when there was an increase in people on the respite service. Whilst we saw no evidence of this the manager confirmed they would implement a staffing tool to ensure they had the right levels of staff working to meet people’s needs.

The staff we spoke with told us they were able to get the support they needed to be able to enable them to support people appropriately.

We saw people’s consent being sought before support was given.

Staff we spoke with while they had an understanding of the MCA they had not all had training. It was clear that while training was available not all staff had completed the MCA training and DoLS training. Where concerns were identified that people were at risk of being restricted the provider had sought advice and authorisation from the local authority.

People and relatives we spoke with told us that staff were caring, nice and friendly.

People told us their independence, privacy and dignity was respected and we saw evidence to confirm this.

We saw that people were able to go to work, take part in social interests and live their lives how they wanted to. Staff we spoke with were able to demonstrate a good understanding of people’s needs and their likes and dislikes.

People and relatives we spoke with told us they knew how to complain, but advised that they had no complaints.

The provider had a system in place to monitor the quality of the service people received and we were told by people and relatives that a questionnaire was received and completed by them.