We carried out an unannounced comprehensive inspection at Pendarves on 4 August 2018. The previous inspection took place on 7 and 12 June 2017. At that time, we had concerns about the cleanliness of some areas of the service. Staff did not have guidance on how they should support people when they were reluctant to keep their environment clean or would not agree to staff assisting them with this. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met the outstanding legal requirement from the last inspection.

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall. At the time of the inspection four people were living at the service. The service was based in a large semi-detached house set within its own gardens.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Services are required to notify CQC of various events and incidents to enable us to effectively monitor the service. This includes any incident which is reported to, or investigated by, the police. We identified that we had not been notified of two incidents following which the police had been called. This has resulted in the well-le section of this report being rated as ‘requires improvement.’

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The accommodation was arranged to allow people independence and privacy. The building was subdivided into three flats. Two people lived in self-contained flats and two people shared a flat. Each had an en-suite bedroom and shared a kitchen and lounge.

People had choice about how and where they spent their time. Staffing was arranged to enable people to take part in activities and access the local community according to their preferences. Staff encouraged people to be independent in all areas of their lives. When people’s choices impacted on their health and well-being staff and members of Spectrum’s senior management team considered their capacity to make these decisions. Where people were found to lack capacity to make specific decisions these were made in their best interest in line with the legislation and principles of the Mental Capacity Act.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. The previous registered manager left in June 2017. 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 previous manager had left the service following a long period of absence. There was a new manager in post who had only been appointed the day before the inspection. They had registered to complete relevant training and were intending to apply to CQC for registration.

The new manager had been working at the service as deputy manager for three months and had built up an understanding of the service and people’s needs. People and staff were positive about the new appointment. Comments included; “He listens, if I’ve made a decision he seems to support my thoughts” and “The new manager is an improvement.”

There was a stable and experienced staff team in place. They were supported by a system of

We inspected Pendarves on the 7 and 12 June 2017, the inspection was unannounced. The service was last inspected in February 2016. At that time the service was found to be good over all but required improvement in relation to our question in the service safe. A breach of the regulation was identified as the services recruitment processes were not sufficiently robust to ensure people safety.

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection four people were living at the service. The service was based in a large semi-detached house set within its own gardens. The building was subdivided into three flats. Two people lived in self-contained flats on the ground floor and two people had en-suite bedrooms and shared kitchen and lounge on the first floor of the building.

The service is required to have a registered manager. At the time of the inspection there was no registered manager in post. The previous registered manager had recently left the service and a new manager had been appointed two weeks prior to the inspection.

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 were informed by the provider’s operations director that the new manager would be applying to be registered with the commission.

Recruitment practices had significantly improved since our previous inspection. All staff were now interviewed face to face and all necessary checks, including disclosure and barring service check and reference checks had been completed.

Prior to this inspection we received information of concern about the cleanliness of the service and the support people received to maintain their environment. The service did not have effective infection control procedures in place and there was a lack of formalised cleaning schedules. During our inspection we visited each person in the own rooms / flats and found the reported concerns were justified. Some rooms were cluttered but tidy while others had obviously not been recently cleaned. One person refused to let us see their en-suite bathroom which staff reported was a particular area of concern. Staff said “I would say, without a doubt, I think people are safe. Hygiene is a question mark but safe, definitely.” This was a breach of the regulations. You can see what action we told the provided to take at the back of the full version of the report.

The providers routine quality assurance processes had failed to identify the issues in relation to the support people received to maintain the quality of their environment. Once staff and relatives reported these concerns, the provider had acted promptly and appropriately to address the issues. A a result a number of significant changes were being made at the service. New carpets had been installed in communal areas, the gardens had been tidied up and on the first day of our inspection a commercial cleaning service visited to quote for the completion of a deep clean of the service.

People’s care plans were generally detailed and informative. However, they did not provide staff with sufficient guidance on how meet people’s needs in the event that they repeatedly declined support with personal care or to manage the cleanliness of their environment.

People told us they felt safe and happy at Pendarves and one person commented, “I am safe, if I felt threatened or anything like that I will let Spectrum know.” Staff understood their role in protecting people from avoidable harm and when asked, were able to explain how they responded if they be

We inspected Pendarves on 11 February 2016, the inspection was unannounced. The service was last inspected in February 2014, we had no concerns at that time.

Pendarves provides care and accommodation for up to four people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. Pendarves is part of the Spectrum group which provide services to people living with autism in Cornwall. 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.

Recruitment practices were not robust enough to ensure staff working in the service were suitable to work in the care sector. We identified a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The premises were well maintained and had been adapted to meet people’s individual needs and preferences. Two people had self-contained flats with their own kitchen and living area. The other two people had large en-suite rooms and shared a kitchen and living area.

People were able to access the local community and amenities easily as the town centre was within walking distance. Some people went out independently for walks or to go shopping. There were systems in place to ensure people were able to contact staff for support, guidance or reassurance if they needed it. Risk assessments were personalised and relevant to the individual’s needs. The deputy manager described them as; “The scaffolding to support people and hold them up.”

Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the registered manager. Other training identified as necessary for the service was updated regularly. Staff received supervision and appraisals. New employees were required to complete a thorough induction which incorporated training, familiarisation with policies and procedures and shadowing more experienced staff. The induction process had been updated to include the Care Certificate.

The provider acted in accordance with the requirements laid out in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). People were able to make every day decisions such as how and where they spent their time and what they ate. Staff recognised and respected people’s rights.

Care plans were personalised, detailed and updated regularly. They contained information about people’s likes and dislikes as well as information regarding their health needs. Staff were aware of people’s preferences and how they wished to be supported. There was an emphasis on supporting people to be independent and make choices about how they wanted to lead their lives.

There were effective quality assurance systems in place to monitor the standards of the care provided.

We met with two people who lived at Pendarves. One person told us they were pleased with the environmental changes that had been made to the home. The other person told us that they had “mixed feelings” about the changes as they were unsure where items were now kept. However they told us they were pleased with the new living arrangements in the home.

We saw staff interact with people who used the service in a kind and calm manner and responded to a person’s request for assistance promptly.

We saw staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service had a care plan which outlined the person’s care needs. We looked at two care plans and staff told us they had been updated and guided, directed and informed staff in how to manage all aspects of a person’s care. We noted that the care plans had been shared with the person’s relevant commissioner and they had also agreed to the content of the care plan.

Due to the substantial environmental changes to Pendarves we reviewed the environment. People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Staff told us the minimum staffing levels were adhered to at all times.

We met with one person who lived at Pendarves who told us they were pleased with the environmental changes being made to the home and were aware why these changes had been proposed. We saw staff interact with one person who used the service in a kind and calm manner and responded to another person when they phoned for support in an appropriate manner. Due to the building works being in progress the people who lived at Pendarves had chosen to go on various outings/ activities during the day.

We saw staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service had a care plan which outlined the person’s care needs. We looked at one person’s care plan and staff told us it had been updated and now guided, directed and informed staff in how to manage all aspects of a person’s care. We looked at the care plan and saw it had been reviewed and did inform direct and guide staff in what caring interventions were needed to ensure that staff approached people in a consistent manner when providing care. The care plans identified that when a person presented behaviours that challenged staff were given direction in how to provide support to the person and to other people who may be witness to the incident.

Staff told us the minimum staffing levels were adhered to at all times. The registered manager told us since the last inspection the waking night staff member had ceased with the agreement of the person who used the service and commissioner.

We met with one person who lived at Pendarves who told us they were satisfied with the care they received and could not think of any improvements needed. We saw staff interact with one person who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

People who used the service had a care plan which outlined the persons care needs. Behavioural plans were implemented to manage particularly challenging behaviours. Staff told us the behavioural plans did not direct them in how to manage peoples presenting behaviours effectively and to ensure that other people living in the home were protected from the impact of such display of behaviours.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home.

Systems for safeguarding people from abuse were satisfactory. Legal safeguards, which protected people who were unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights.

Pendarves minimum staffing levels were present during the day. Rotas and other records evidenced that the assessed minimum number of staff were not consistently on duty at night.

The provider identified risks and issues but action plans may not always be monitored to ensure that improvements are made to people's safety and welfare.

Appropriate records were maintained and overall, we found these were up to date.

We spoke to three of the people who use the service. The people we spoke with all said they were happy living in the home. People said they liked the staff and found them helpful. People said the food was to a good standard, and there was enough to eat and drink. Everyone said they were happy with their accommodation. People said they were happy with the activities that are provided.

We found that since our last visit to Pendarves in March 2012, there had been improvements in the decoration and furnishing of the house.

In many ways people were well supported by staff. We saw that people had the opportunity to take part in a range of activities that were of particular interest to them. There was considerable information about each person’s needs and the best ways to support them. However, there was a lack of clear concise guidance about managing particular issues, and there was no evidence of risk assessments to ensure that people were safe if they needed to be physically restrained. There were no adequate systems to record and monitor incidents, and therefore to learn from what had happened.

We found that there were sufficient staff, who were given training to do their job, and that they were supported by their manager, and the organisation.

We were worried that concerns raised by people who either lived or worked in the home were not dealt with in a timely manner. Whilst we found that there were systems in place to monitor the quality of the service, but these were not always effective.