Penley View

Penley View is a residential care home providing personal care to 2 people at the time of the inspection. The service can support up to 6 people.

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

Right Support:

We judged that 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. However, the policies and systems in the service required improvement to continue supporting this practice.

The provider did not use safe recruitment procedures to employ staff. Therefore, there was a risk people could be supported by unsuitable staff putting them at increased risk of harm.

Staff supported people with their medicines in a way that promoted their independence. However, other aspects of medicine management such as record keeping, and checks needed improvement.

The service gave people care and support in a safe, well-furnished environment that met their sensory and physical needs. However, some aspects of premises safety such as cleaning records and practice needed some improvement.

Staff supported people to take part in activities. However, further improvements were needed to ensure people could pursue their interests in their local area with people who had shared interests and achieve their aspirations and goals.

People had a choice about their living environment and were able to personalise their rooms. The service and staff supported people to have the maximum possible choice, control and independence over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful life.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and well-being.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care:

Provider needed to review staff organisation and how staff’s training needs and skills were managed in order to meet some people’s specific needs.

The provider did not always ensure that actions were consistently taken to reduce assessed risks to people's personal safety. Not all staff had the right knowledge to encourage and enable people to take positive risks.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff spoke to people politely giving them time to respond and express their wishes.

People’s care, treatment and support plans reflected their range of needs and this promoted their well-being and enjoyment of life.

Right Culture:

We found the provider did not ensure we were notified of reportable events within a reasonable time frame.

The provider did not always follow their quality assurance policy effectively so they could assess, monitor and mitigate any risks relating to the health, safety and welfare of people using services, the service and others.

The provider did not consistently maintain accurate and complete records relating to person’s care and service management.

The provider did not always follow and kept a copy of all the actions taken as required in the duty of candour regulation when a notifiable safety incident occurred.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

People and those important to them were involved in planning their care. Staff valued and acted upon people’s views.

Staff turnover was stable, which supported people to receive more consistent care from staff who knew them well. People were supported by staff who understood their different range of needs or sensitivities.

The service enabled people and those important to them to work with staff to help improve the service. The home manager and staff were working together to ensure the risks of a closed culture were minimised so that people received support based on transparency, respect and positive culture in the service.

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 inadequate (published 18 May 2022) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. We also found the provider remained in breach of some of the regulations.

At our last inspection we recommended the provider seek advice from a reputable source about end of life care planning. At this inspection we found the provider was working to review this aspect of support.

This service has been in Special Measures since 17 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted due to the previous rating and to follow up on enforcement action.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to quality assurance and record keeping; risk management; notification of incidents; management of medicines; staff recruitment at this inspection. We have made recommendations about assessing, reviewing and recording mental capacity; ongoing staff training monitoring and to reflect the latest best practice guidelines; staff and senior staff deployment; management and record keeping of activities for people; management of records for duty of candour requirements. 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.

Penley View is a residential care home providing personal care and accommodation to up to six people. The service provides support to adults with a learning disability, autism, dementia, mental health conditions, physical disabilities and sensory impairments. At the time of our inspection there were six people using the service in one purpose-built unit, which is adjoined to a separately registered care home operated by the same care provider. One person left the service after the first day of our inspection and another person was admitted to hospital after our third onsite visit.

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

People did not always live safely or free from unwarranted restrictions because the service did not assess, monitor or manage people’s safety well. The service did not work well with other agencies to protect people from the risk of abuse.

The skills of staff did not match the needs of people using the service. Records were not in place to demonstrate the correct level of staffing was planned and delivered. Staff recruitment and induction training processes did not promote safety, including those for agency staff. Staff were not always familiar with people needs or risks.

Relatives told us they experienced staff who were generally helpful and caring although they felt staff language barriers impacted people's care and effective communication. During our inspection we found the service had identified one member of staff’s English language needed to improve, however, there was no development plan in place to support this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

Staff did not complete functional assessments for people who needed them to understand people’s behaviours. Care and support plans were not holistic, strengths-based and did not capture people’s needs and aspirations.

People’s relatives felt they were kept informed of changes to their family members needs and were involved in reviews of people’s plans. Records showed the service did not always consult people’s relatives about unexplained injuries.

Staff members did not always treat people with warmth, dignity and respect when interacting with people. People were not supported to express their views using their preferred method of communication.

Systems were not established to capture and respond to complaints and gather feedback to improve the service. Governance processes were not effective to hold staff to account, keep people safe, protect people’s rights or provide good quality care and support

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

The service did not plan effectively with people for when they experienced periods of distress. This meant alternatives were not always explored to ensure people’s freedoms were restricted as a last resort. Staff were not supported to learn from incidents and how they might be avoided or reduced.

Right care

People did not always receive kind and compassionate care. Staff did not take action to protect and respect people’s privacy and dignity. The service failed to ensure there were enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture

The service failed to evaluate the quality of support provided to people or ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

The provider took immediate action to seek external support to address leadership and governance concerns and implemented an urgent action plan to mitigate risks to people's safety and quality of life. For example, the provider purchased and started to launch new policies within two weeks of our site visit.

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 requires improvement (published 5 May 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider considers current guidance on the safe recording of medicines and the accessible information standard and act to update their practice in these areas. At this inspection we found the provider had not acted on recommendations and improvements had not been made.

Why we inspected

The inspection was prompted in part due to safeguarding concerns received about nutrition, delayed medical intervention and staff interactions towards a person. We also received concerns about poor management oversight, staffing levels and staff training. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of accidents and incidents and seeking timely medical interventions. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care, safeguarding from abuse, person centred care, dignity and respect, staffing levels and suitability, nutrition and hydration, suitability of the environment, management of complaints, staff training, governance and leadership, reporting of incidents and duty of candour at this inspection.

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

We took enforcement action to cancel the manager's registration. Other action we proposed was withdrawn in response to improvements found at a further inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Penley View is a residential care home providing personal care to six people with learning disabilities in one adapted building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered for the support of up to six people. Four people were using the service at the time of our visit.

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

This is the first inspection for this newly registered service. The registered manager was managing three services at the time of our inspection. The lack of management oversight impacted on the running of the service. Following the inspection, we spoke with the provider, who assured us they were looking into various options to improve the management oversight of the service. Recruitment was on going and the provider assured us they would make sure senior staff would be in place within each service to oversee the management of the service until permanent staff were in place.

People’s relatives told us they did not think there were enough staff, however during our visit we observed there were. Staff from another registered service operated by the provider were covering gaps in the rota.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Overall the service was safe, however we found some aspects needed some extra consideration. Records, related to medicines were not always accurate, we have made a recommendation about the safe recording of medicines. Food was not always stored in a safe way. The front door had a key lock even though it was a fire exit, we asked to see a fire risk assessment with regards to this specific concern, but none was forthcoming. Following the inspection this was changed to a keypad. We noted there were no systems in place to summon help from other staff members if needed.

We found improvements could be made to the records related to incidents and accidents. It was not always clear what actions had been taken before and after an incident. We could not see from the records how the service prevented a reoccurrence. Concerns had been raised to the clinical commissioning group (CCG) in relation to the staffing levels, and the lack of detail in care related records and records related to people’s challenging behaviour.

Following the inspection, we requested records of staff training related to fire safety, these were not forthcoming. There was no evidence therefore, staff had completed the necessary training as required by the fire risk assessor. Records related to staff training were not up to date or accurate. Although the training matrix was not up to date at the time of our inspection, the registered manager told us they would update it. Following the inspection, the registered manager sent us the matrix but agreed it was still not up to date.

For other areas of care and the environment, risk assessments were in place and the maintenance of equipment meant they were safe to use.

People were supported to eat and drink sufficiently to maintain or improve their health. Staff worked alongside other health and social care professionals to ensure the care provided was appropriate. 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.

Staff were supported by the registered manager and provider. People were treated with respect and kindness. Staff took advice from people’s families and professionals to ensure the care provided was in people’s best interest and in line with their choices and preferences. The service had systems in place to assist people with two-way communication. This was important in order that people could maintain some control over their lives and make choices about how their care was provided.

Safe recruitment systems were in place to minimise the risk of unsafe staff working with people. Staff were knowledgeable about the appropriate action to take if they were concerned about a person’s welfare. Staff were confident to whistle blow if they were worried about aspects of the service that may not be in people’s best interest.

Work had been undertaken to make the service compliant with the Accessible Information Standards (AIS) however the staff needed to utilise the systems they had in place more thoroughly for the benefit of people using the service. This was agreed by the registered manager. We have made a recommendation about the AIS.

People were supported to maintain relationships with people who mattered to them. People appeared well cared for by staff who knew them. The relationships between staff and people were developing. The service was still relatively new, and the provider assured us they wished for the service to be stable before any more people moved in.

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

Rating at last inspection

This service was registered with us on 21 December 2018 and this is the first inspection.

Why we inspected

We inspected this service in line with our inspection schedule.

Enforcement

We have identified breaches in relation to safe care and good governance. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.