About the service:

Pennine View is a bungalow that provided accommodation care for two people with learning disabilities. The registered manager also oversees staff who support four people that live in supported living in two housing association owned bungalows.

What life is like for people using this service:

Our last inspection took place in June 2016 when the service was rated good. At this inspection we found that the service had declined and was rated requires improvement.

The provider had arrangements in place for managing people’s medicines. However, we identified some concerns regarding the stock and review of people’s medicines, therefore, medicines were not always managed in a safe way. We have made a recommendation that medicine management is addressed so that people receive their medicines in a safe way.

Staff recruitment files we looked at did not always reflect that the recruitment process had been followed in line with the providers policy.

The provider had systems in place to ensure the service was operating to the provider’s standard and that policies and procedures were being adhered to. However, we found audits had not identified the concerns we highlighted as part of this inspection, therefore they were not always effective.

We have made a recommendation that the provider ensures that a robust system is in place for auditing the service.

The provider had systems in place to safeguard people from abuse. Risks associated with people’s care and support had been identified and were appropriately managed to keep people safe. Staff we spoke with told us there were always enough staff available to ensure people’s needs were met in a timely and person-centred way.

Staff received appropriate training which gave them the knowledge to complete their roles and responsibilities. Staff told us they felt supported by the management team. However, we looked at staff files and found staff did not always receive structured support sessions in line with the providers policy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain a balanced diet which met their needs and took account of their preferences. People had access to healthcare professionals as required.

We spent time observing staff interacting with people who used the service and found they were kind and caring. Staff offered appropriate support in line with people’s assessed needs. Staff ensured that people’s privacy and dignity were maintained.

People received personalised care which took in to consideration their preferences and choices. People were supported to maintain community links and be involved in a range of social activities.

The provider had a complaints procedure in place and people were given opportunities to raise concerns.

Further information is in the detailed findings below.

Rating at last inspection:

Good (Report published 27/07/2016)

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

We inspected Pennine View on 22 June 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Pennine View is a bungalow that provided care for two people with learning disabilities. The registered manager also oversees staff who support four people that live in two housing associated owned bungalows. These bungalows provide accommodation for one person and accommodation for three people. They are staffed at all times.

The registered manager has been in post since 2014. 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.

At the time of the inspection we met both people who lived at the home and three of the people who were supported by staff in their own accommodation. The two people who lived at Pennine View had very limited verbal communication so we observed how staff interacted with them. We saw staff could pick up on the smallest change in their behaviour and could readily interpret what the people were indicating they wanted.

The people who used the supported living accommodation told us that they were very happy with the service and found it met their needs. They told us all about the improvements they had made when interacting with others and the communication skills they had learnt. We found that there was a lot of humour and jovial interactions between the people and staff. The people felt able to freely discuss any concern and ask questions about everyday matters.

We had a very warm and lively discussion about the life of maggots and how maggots were used in the fishing expeditions people enjoyed. We also discussed the holidays people went on and how they were taking action to improve their daily living skills.

We found that the registered manager and staff consistently ensured people were supported to lead an independent lifestyle. Staff readily identified triggers that would lead people to become distressed and were adept at using deescalating techniques.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

We saw that detailed assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to reduce the risks identified as well as support plans.

We saw that people were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight.

We saw there were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities and autism spectrum disorders.

Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The staff we spoke with unders

Two people were living at the home at the time of this inspection. We were able to hold limited conversation with one person and received some comments about their experiences of living at Pennine View. Because we had difficulty talking with people we used different methods of gathering their experiences during the inspection. We observed care practices, saw how staff and people living at the service interacted with each other and spoke with relatives of people living at the home.

The atmosphere in the home was relaxed, warm and homely. Staff were seen giving support to people and engaging people in conversation where they were able. We saw that people living in the home had a friendly relationship with staff members. The staff knew people very well and were aware of how to respond to them. We observed that people were listened to by staff and requests made about their welfare were, where possible, accommodated. People were able to make decisions and take reasonable risks in relation to life choices. We saw people reacting positively to staff interactions.

The body language, facial expressions and actions of people using the service conveyed people were at ease with staff.

Families told us staff were friendly, caring, compassionate and treated people with respect and dignity.

We saw that people’s welfare was maintained and their wellbeing promoted through meeting their physical, mental, social, emotional and day time activity needs as described in their care files. People’s personal care needs were supported and met. Staff used appropriate communication for people. We saw that staff demonstrated genuine affection, care and concern for people using the service.

Families said, “it’s good quality care. It’s a lot better since Steve (new provider) came. There’s a more stable staff group. I’ve always been involved with … care, but now the service ask for my views, whereas they didn’t before” and "for us the care is fantastic and … is happy and content.”

We spoke to one person who lived at Pennine View. They told us that they liked living at the home. They said that the staff were “Nice” and “Good.” They said that they felt safe and commented; “The staff help me, and I can talk to them.” We observed and overheard interactions between staff and people living at the home. Staff spoke to people in a respectful and patient manner.

We spoke to one person who used the service, who told us they felt safe, that their needs were being met, they got on well with the staff and felt respected by the way staff supported them. They told us,

“It’s ok living at Pennine View”.

“My Mum came to see me”. “I visit my Mum”

“I go to the local pub to do Karaoke and sing all sorts of songs”.

“Happy about everything, but if not I would tell staff or my Mum and Dad”

We spoke to three relatives. One relative told us, “On the whole I am happy with the care”. And, “They encourage my son to get involved in activities”. Another relative said, “My son is well looked after, his personal hygiene is cared for very well, he has a bath every morning, nice clothes and clean room”. And “My son seems happy and staff care about him, he is looked after properly and treated with dignity and respect”.

Two relatives advised us that they had been told to ring before they visited the home. One parent felt uncomfortable about this and we have asked the Registered Manager to address this formally to ensure relatives are clear about the arrangements and rationale for arranging visits.

This inspection included checking that improvements had been made to the three outcomes the provider was non compliant with following our inspection on 23 July 2012.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that people were supported to make day to day decisions, for example, what to have for breakfast, with assistance from staff.

Staff knew people living at Pennine View very well and were able to interpret their non verbal and verbal communication in order to assess mood, behaviours and wellbeing.

Since the last inspection the whistle blowing procedure displayed in the main lounge had been updated to explain how and where people, staff and advocates could go to whistle blow if they were concerned about the possibility of abuse happening at the service.

People were now protected against the risks associated with medicines because the provider had improved the arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people received.