The inspection took place on 19 and 22 September 2017. This was an unannounced inspection visit to the service.

The service was previously inspected on 23 and 24 May 2016 and was not meeting the requirements of the regulations at that time. The service was in breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to medicines practice, staff recruitment, monitoring the service and record keeping.

During this inspection we found improvements had been made and the service was meeting the relevant requirements.

Penley Grange provides care and support for up to six people with learning disabilities. Six people were living at the service at the time of our inspection. The service was being managed by one of the provider’s registered managers from one of their other services at the time of our inspection. An application for them to become the registered manager at Penley Grange had been submitted.

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 received mainly positive feedback about the service. Comments we received were, “I am quite happy with Penley Grange and I feel my family member is safe there” and “Yes she is safe as she has a tendency to want to run away and she can’t because the security is really good.”

We found medicines were managed safely. Medicine charts we viewed were completed correctly and staff had received relevant training in medicine administration.

We found there were sufficient staff to meet people’s needs. Staff knew the people they were supporting and interacted well with them in a way that was relevant for each person. For example some people could not communicate and specific aids were used such as Makaton and picture cards.

Staff received safeguarding training to ensure they recognised the signs of abuse and were able to respond to safeguarding concerns to the relevant local authority.

Staff received on-going training to ensure they were knowledgeable to meet the needs of people. New staff received an induction followed by regular supervision.

Care plans had been written to ensure the individual needs of people were met. Preferences were documented for how people wished to be supported. People were supported to have maximum choice and control of their lives and staff supported them in the least restricted way possible; the service had policies and procedures to support this. People were treated with dignity and respect and we saw they were given choices.

Staff supported people to attend healthcare appointments. People were supported to take part in a range of activities. 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.

Monitoring systems were in place to identify where improvements could be made. Records were maintained to good standards and were easily located.

Evacuation plans were in place in the event of a fire and had been written for each person to support them safely. On the first day of our visit we were told where to assemble in the event of a fire.

This inspection took place on 23 and 24 May 2016. It was an unannounced visit to the service.

We previously inspected the service on 23 January 2015. The service was meeting the requirements of the regulations at that time.

Penley Grange provides care for up to six people with learning disabilities. Five people were living at the home at the time of our visit.

The service had 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.

We received positive feedback about the service. Comments included “It’s a lovely home,” “Staff are absolutely lovely and friendly,” “Staff are very kind,” “Residents always look well turned-out and very happy” and “The care is generally very good.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns.

We found people’s medicines were not handled safely. For example, there were gaps in medicine administration records and staff had given an incorrect dose of one person’s medicine.

We found there were sufficient staff to meet people’s needs. We saw they interacted well with people and took an interest in them. Staff recruitment procedures were not robust enough to make sure people were supported by staff with the right skills and attributes.

Staff received support through a structured induction and supervision There was an on-going training programme to provide and update staff on safe ways of working. We have made a recommendation to ensure the service follows good practice in the supervision and development of staff.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs. People were supported to take part in a range of social activities. Staff supported people to attend healthcare appointments to keep healthy and well.

The building was well maintained. Evacuation plans had been written for each person, to help support them safely in the event of an emergency. Staff told us where to assemble in the event of the fire alarm sounding. We have made a recommendation to ensure people are protected from environmental risks at the service.

There were clear visions and values for how the service should operate and staff promoted these. For example, people were treated with dignity and respect and we saw they were given choices.

Monitoring and auditing systems were not always robust enough to identify where the service needed to improve practice.

We found records had not been maintained to a good standard and were not always easy to locate; some needed to be sent to us after we visited the service.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines practice, staff recruitment, monitoring the service and record keeping. You can see what action we told the provider to take at the back of the full version of this report.

When we visited the service on 10 June 2014, we had concerns about how four outcomes were managed – cleanliness and infection control, supporting workers, assessing and monitoring the quality of service provision and notification of incidents.

We set compliance actions for the provider to improve practice. The provider sent us an action plan which outlined the changes they would make to become compliant.

We returned to the service on 26 January 2015 to check whether improvements had been made. This was after the date the provider told us all actions to improve the service would be completed.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found Penley Grange provided a safe service. The home now had effective systems in place to reduce the risk and spread of infection. The premises were kept clean throughout. Shared bathrooms and an en-suite bathroom had been refurbished. Appropriate disposal bins were in place for clinical waste, to make sure it was handled safely. There were different coloured laundry skips to separate contaminated linen and clothing to help reduce the risk of infection.

We saw improvements had been made in the kitchen. For example, staff were no longer placing their bags and coats on the disused stove and they wore disposable aprons and gloves when handling food. Food storage areas were in good order with the date of opening added to packets of food. This helped ensure food was only consumed when it was safe to eat.

Is the service effective?

We found Penley Grange provided an effective service. The manager had put systems in place to make sure staff received supervision. This provided a forum to discuss how staff were working and to identify any training or development needs. Staff meetings had also been held to share ideas and promote best practice.

Staff training needs had been looked at. The manager said some staff had completed recent courses on safeguarding, the Mental Capacity Act (2005) and deprivation of liberty safeguards. Further staff would be completing these courses as places became available. The manager was also arranging for training on autism spectrum disorder and maintaining records, to increase skills and knowledge.

Is the service well-led?

We found Penley Grange provided a well-led service. The provider had visited the home each month to assess the quality of care and had carried out audits. For example, on medication practice, infection control and catering. These showed that people were receiving good standards of care.

A new manager had been appointed. We saw they had made improvements to how the home was run. For example, a daily tasks form had been set up to record which staff had been allocated to assist each person with their personal care. It also recorded which staff were responsible for ensuring tasks such as laundry and cleaning were completed. This helped to ensure all necessary actions were undertaken on each shift.

We found improvements had been made to notifying the Care Quality Commission about serious incidents. The manager had informed us of a safeguarding concern and had completed the necessary documents. The manager was aware of other serious incidents that needed to be reported to us. This meant people could be confident that important events that affected their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found Penley Grange needed to take action to provide a safe service.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was one current DoLS in place, which had been authorised by the local authority. This ensured there were proper safeguards in place where restrictions were placed on people. We noted the most recent record of authorisation was extended by the local authority until 6 February 2014. The provider may find it useful to note there was no record at the home of authorisation beyond this date. This would be needed to verify the restriction remained lawful.

We found there were sufficient staff to meet people’s needs. The manager position was vacant and recruitment was underway at the time of our inspection. Relatives we spoke with described staff as “Very, very nice,” and “Lovely, friendly, helpful.”

When we visited the service on 6 February 2014, we had concerns about standards of record keeping. We set a compliance action for the provider to improve practice. The provider sent us an action plan which outlined the changes they would make to become compliant. We used this visit as an opportunity to check that sufficient improvements had been made.

We found improvements had been made to records. People’s personal records were accurate and fit for purpose. Dates were now included on people’s personal records. This enabled the most up to date version of a document to be identified. The records we asked to see during the visit were located promptly. The only records not provided were reports of monitoring visits by or on behalf of the provider.

We had concerns about infection control practice at the home. The building had not been kept clean in several areas. For example, one person’s en suite shower room had a stained shower curtain, stained shower chair and stained shower cubicle. The toilet bowl was very stained below the water level. These areas provided places where bacteria and other harmful microbes could breed, which placed people at risk of infection. There were also issues about cleanliness in a communal bathroom and other areas of the home, which needed to be addressed.

Is the service effective?

We found Penley Grange needed to take action to provide an effective service.

There were systems in place for the induction and training of staff. This ensured they had the right skills and knowledge to meet people’s needs. Staff had not received the support they required to carry out their roles effectively. Supervision sessions and appraisals had not taken place routinely at the home. This may have led to inconsistencies in people’s care.

Is the service caring?

We found Penley Grange provided a caring service.

People’s needs were assessed and care was planned and delivered in line with their individual care plan. We saw care plans were in place for each person. We read two people’s care plans. Both contained comprehensive assessments of the person’s needs and any support they required. This helped ensure people received the support they needed.

We spoke with two relatives. Both were pleased with the standards of care at the home. One said their relative was “Looked after well.” Another told us “They’ve supported him very well.” They added “Any concerns we’ve had have been dealt with” and “He is happy to go back there after we’ve been out.”

Is the service responsive?

We found Penley Grange provided a responsive service.

We observed staff welcomed people back from day services and offered them drinks. Each person had been supported to dress appropriately for warm weather. We saw people were free to spend time in places of their choice, such as their room, the sensory room and the extensive gardens. We heard staff talking to people and taking an interest in them and what they had done during the day. Repetitive questions were answered patiently and politely.

There were arrangements in place to deal with foreseeable emergencies, such as a fire at the home. Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw risk assessments had been written for a range of activities and situations. For example, accessing the community, choking and managing behaviour. These assessments had been kept up to date to ensure information was current and reflected people’s circumstances. This helped reduce or control the potential for people to experience harm.

Is the service well-led?

We found Penley Grange needed to take action to provide a well-led service.

We saw learning from incidents / investigations took place and appropriate changes were implemented. A report had been made earlier in the year of missing money, belonging to someone who used the service. The provider looked into this and found the money had been logged inappropriately, but was not actually missing from the home. Since that time, a new system had been set up to safely store and record people’s money. This helped ensure there was better management of people’s money. However, providers and managers are required to notify us of certain incidents which have occurred during, or as a result of, the provision of care and support to people, such as the report of missing money. The provider had not notified us of this incident and they were unaware of the need to do so. This meant people could not be confident that important events that affected their welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.

The provider told us there was someone within the organisation who visited the home to monitor quality of care. We asked for copies of reports of these visits to be sent to us. We did not receive any evidence to show the visits took place. We could not, therefore, be confident the provider had an effective system to monitor the quality of people’s care.

We saw records which showed four audits had been undertaken at the home this year. These focussed on care plans, catering, infection control and medication. We noted deep cleaning and regular shampooing of carpets was identified on the infection control audit, carried out in March this year. There was no further audit to check this had been done. Our inspection findings showed they had not been actioned.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We found that the home understood consent and gave people as many choices as was possible and appropriate. They recognised when people could not fully understand things and make safe decisions.

People were offered a rewarding lifestyle and were happy living in the home.

We saw that people were well cared for and treated with respect and dignity.

The home was clean but was not ‘homely’ and was in need of some refurbishment. We saw that the home took health and safety seriously and kept people as safe as possible.

We found that there were enough properly trained staff to meet people’s individual needs.

We saw that the home had ways of looking at the care they offered so that they could make sure they maintained and improved it. They listened to the views of the people who lived in the home.

We found that some important records were not dated and not available to staff , who needed access to them.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not able to tell us their experiences.

We observed a calm and pleasant home with purposeful activity. We saw bright spacious rooms which were personalised and appropriate to the age group. During our visit, we heard positive interactions between staff and people who live there, and saw staff provide a high level of emotional support to a young person using the service. This demonstrated a high regard for the individual's preferences.

We read care plans, and heard that people went on visits to their families at the weekend. The families remained involved in the daily welfare of people who use the service; this denoted that people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Staff we spoke with were trained in the Safeguarding of Vulnerable Adults. They said they had seen no abuse in the home, and were able to demonstrate the correct procedure to escalate any concerns. Staff had requested some additional training which was being addressed by the manager.

There was a complaints procedure in place. We heard how complaints were dealt with, and noted none had been received in the last year.

We received positive accounts of the service from a relative and from a social worker.

The relative told us that it was a lovely home with plenty of space which had a nice atmosphere. The person said that the staff were all very nice.

A social worker told us that he was very impressed with the service provided by the home. He said that staff consistently provided high levels of emotional support to a person using the service and also maintained a good relationship with the person’s family and other services in the community. The social worker said that the service had a good staff team who not only provided excellent support to people but also endeavoured to find positive solutions to problems.