Pegasus Care Home

Pegasus Care home is a residential care home providing accommodation and personal care for up to 12 people with a learning disability, mental health needs and autistic people. At the time of the inspection 11 people were living at the care home.

The provider is also registered to provide a supported living service. At the time of the inspection 7 people were supported to live independently in their own homes. Some of these people lived with other people in ‘shared homes’ and received 24 hour staff support.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

Staff supported people with their medicines, however records needed improving to ensure the number of medicines at the care home was recorded accurately and checked to confirm people had their medicines when they needed them. Risks to people were not always properly assessed and recorded to explain why people may not be able to use certain parts of the home for their safety. People were supported by staff who knew them well and understood their needs. However, care plans and risk assessments were not always detailed and reflected people’s aspirations, goals and development of life skills. The registered manager was responsive to our feedback and took action to address the issues identified.

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

Pegasus Care home does not fully meet the current guidance on small, ordinary homes forming part of a local community. However Pegasus Care home was close to local amenities and people regularly accessed local facilities.

Right Care:

Staff protected and respected people’s privacy and dignity. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

Right Culture:

Improvements were needed to the current systems to make them more effective to monitor the quality of the service and drive improvement. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. People and those important to them, including advocates, were involved in planning their care. The registered manager was open and transparent throughout our inspection and demonstrated a commitment to delivering improvements and achieving best outcomes for people. They acted on queries and our feedback throughout the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update. The last rating for this service was good. (Published 17 April 2019.)

Why we inspected

The inspection was prompted in part due to concerns received about unexplained bruising. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led Key question of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pegasus Care home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of risk and how the provider monitors the service provided.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

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.'

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.