Penrith Drive

Penrith Drive is a residential care home providing personal care and accommodation for up to 6 people with learning disabilities. At the time of our inspection there were 5 people using the service.

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.

Right Support

People’s medicines were not always stored, managed and administered safely. Risks associated with people’s physical health was not always monitored. Environmental risks including risks of spreading infectious diseases were not always identified or managed. The registered manager took some immediate action, but further action was required.

People lived in a clean and well-furnished environment. People’s bedrooms were decorated, personalised and met their sensory needs. People were supported by staff who were familiar with their needs. Staff supported people to take part in activities and pursue their interests in their local area. Staff enabled people to access specialist health and social care support in the community.

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.

Right Care

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service worked well with other agencies to do so. People had enough to eat and drink and individual dietary needs were met. People received kind and compassionate care. Staff understood and responded to people’s individual needs, and respected their privacy and dignity. Where appropriate, staff encouraged and enabled people to take positive risks. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language) and pictures could interact comfortably with staff who understood them.

Right Culture

The provider’s oversight monitoring systems and processes were not used effectively to identity and mitigate risks to people.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. People were supported by staff who understood best practice in relation supporting people with a learning disability and autistic people. This meant people received compassionate and empowering care that was tailored to their needs. People’s quality of life was enhanced by the service’s culture of inclusivity. People and relatives were confident complaints were taken seriously. People and where appropriate their relatives views were sought through individual discussions and surveys.

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 27 November 2017). At this inspection we found breaches of regulation in relation to medicines management, risks to people including the environment and infection prevention and control and governance.

Why we inspected

This was a planned inspection and in part prompted by a review of the information we held about this service.

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.

We have found evidence that the provider needs to make improvements. 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 good to requires improvement based on the findings of this inspection. Some action was taken by the registered manager when concerns were raised, but further action was needed to mitigate risks to people’s safety.

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

Enforcement

We have identified breaches in relation to medicines management, people’s physical health and mobility, the environment, infection prevention and control and 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 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.

We found the following examples of good practice

Professionals were required to provide evidence of their testing and vaccination status. We were assured the service was following current Government guidance on visiting arrangements.

There were plentiful supplies of personal protective equipment (PPE) throughout the home which included gloves, masks and aprons.

There were PPE stations located around the home and close to bedrooms where people were required to isolate.

Isolation, cohorting and zoning were being used to manage any potential spread of infection.

Staff participated in a daily and weekly testing regime prior to commencing work. All staff had a designated area to change their clothes before and on completion of their shift.

We saw various cleaning records which included regular high touch point cleaning to ensure the potential for cross infection had been reduced.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff in keep people safe.

Staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing. Spot checks had been completed to ensure staff adhered to the training provided.

Penrith Drive provides accommodation and personal care to up to six people with learning disabilities.

At the time of our inspection the provider confirmed they were providing personal care to 6 people

At the last inspection in September 2015, the service was rated Good. At this inspection we found that the service remained Good.

There was 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.

People continued to receive safe care. Staff were recruited appropriately and there were enough staff at the home to meet the needs of the people living at the service. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff were well supported by the management team with supervision, training and on-going professional development that they required to work effectively in their roles. People were able to choose what they wanted to eat, and received the support they required within this area. People had access to healthcare professionals as required.

People were well cared for and were treated with dignity and respect. We saw that care plans had been written in a personalised manner and enabled staff to provide consistent care and support in line with people's personal preferences. People’s relatives knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

The service was well run and had an open culture. Staff told us that they had confidence in the management team and their ability to provide quality managerial oversight and leadership to the home.

Due to the nature of their disabilities, people living in the home were not able to tell us about their experiences. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff. A relative of one person told us that they had no concerns about the safety of their relation.

Care plans and risk assessments were in place which identified any specific risks for people who used the service and the actions staff should take to minimise the risk. Staff were knowledgeable about the needs and risks for each person who used the service, and the actions they should take to reduce the risk.

Medication was well managed. However we found there were no records to confirm that the pharmacist and GP had been consulted about one person's prescribed medication being given on a spoon with jam. The manager confirmed that they would follow this up to ensure the prescribed medication did not interact with jam.

Staff received training in safeguarding vulnerable adults and this was discussed at staff meetings. This helped to make sure that staff were aware of their responsibilities for safeguarding people who used the service.

The recruitment of new staff involved obtaining references and carrying out checks to help make sure that people were not put at risk.

Is the service effective?

People's health and care needs were assessed and plans of care developed according to their needs. Information about how people communicated their needs and wishes was clearly identified in care plans which helped ensure that new staff were able to provide appropriate care.

When we spoke with staff, we concluded that they had a good knowledge of each person's care needs and preferences because they were able to tell us about the support people needed, and how they delivered their care. Staff were able to tell us about specific risks such as the risk of pressure ulcers and showed us the equipment and checks in place which helped reduce the risk. This meant that people's care needs were effectively met.

Is the service caring?

We saw that staff were calm and organised and gave people time to express their needs through non- verbal signs and gesture. We saw that people who used the service were relaxed in the presence of staff and responded positively to them.

A relative told us that staff were caring and that they knew their relation liked staff through their gestures. They said they would give staff 'eleven out of ten' and told us they 'were thrilled that their relation was at Penrith Drive'.

Is the service responsive?

We saw that staff were kind and responsive to people's needs. The daily routine had been arranged according to people's individual needs and interests. For example, two people were out at a day centre, one person went for a walk with a member of staff before going to a hospital appointment and another was preparing to go out for a beauty treatment. Staff told us that another person had chosen to get up late that morning and staff would assist them with a bath when ready to get up. This meant that staff responded to people's needs and preferences.

We found that staff understood the importance of obtaining consent from people who used the service. Staff told us that if someone indicated through gesture that they did not want assistance with care and support, they would respect that and return at a later time.

Is the service well-led?

We found that the service was well managed. The registered manager also manages another small home and divides their time between the two services. We found that although the manager was not present when we arrived, staff knew where the manager would be and were able to contact them. Contact details for senior managers were also available to staff. Staff told us that management support was also available out of office hours. This meant that management support was available as and when needed.

Effective systems were in place to assess and monitor the quality of care. Regular checks on all aspects of the service were carried out by an area manager and where necessary improvements made.

We saw that staff had a good understanding of the needs of the people they supported. Staff understood how people communicated their needs and responded to their requests. People were encouraged to make choices in their daily lives.

People were relaxed and happy with the staff supporting them. Care staff were patient and respectful with the people who lived in the home.

We looked at a sample of care plans. These were very detailed and provided staff with the information they required to meet people's needs. Plans included details of people's personal care and support needs and how they communicated. There was also information about people's health needs, their likes, and dislikes and relevant risk assessments.

Care staff were well trained and supported. Several had worked at Penrith Drive for a number of years and told us how much they enjoyed their work.

We looked at a sample of care plans. These were very detailed and provided staff with the information they required to meet people's needs. Plans included details of people's personal care and support, health needs, risk assessments and people's likes and dislikes.

One relative told us that their relative was "so well looked after" and that it was "the best home they'd ever been in" and that "their key worker was marvellous"

Staff told us they enjoyed their work and one said that the home was the "best environment they had worked in" and that "everyone was caring and understanding".