About the service: Peter’s Place is a residential care home with nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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,

This inspection took place on 25 February 2016 and was unannounced.

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.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

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.

Before our inspection at Peter's Place, we had received some information via our website which raised concerns about how staff were recruited to the service and the accessibility of information given to visiting professionals.

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.

During our visit to Peter’s Place on 23 October 2012, we observed people receiving care and support on a 24 hours basis, in a friendly, homely atmosphere. 11 people lived at Peter’s Place and whilst they were not able to tell us about their experiences due to their learning disabilities and communication difficulties, we observed them expressing their feelings through facial expressions, body language, and communication methods appropriate for them. Everyone was smiling and looked well cared for.

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”.