Penley Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question as inadequate. At this assessment the rating has changed to outstanding. This meant people's outcomes were consistently better than expected compared to similar services. People's feedback described it as exceptional and distinctive.

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. People’s needs had been assessed prior to them moving into the service, this was not only to ensure their needs could be met but also to ensure the new person would be a good fit for existing residents and their established routines won’t be affected.

Assessments included communication and there were tools in place always tailored to each individual and available to them. This enabled people to express their views, wishes and make decisions.We observed staff supported people to make day to day choices with the aid of visual references. For example, 1 person’s preference was that staff speak with them using animated tones, facial expressions and lots of smiles. We observed the staff team adopted this approach consistently and saw the person engaged positively with the interaction.

People and those involved in their care took part in assessments and reviews. Their views and opinions were respected, listened to and implemented as part of the day-to-day support.For example, people were supported by their key worker to review what was and wasn’t working well and care was then adapted if needed. One person enjoyed using a swimming pool with their relative, which staff then went on to support the person with this activity.

There was a focus on activities care plans aiming to empower people to try new things. Where people had multiple and complex needs, their activities care plan were developed in collaboration with an external healthcare specialist. People benefited from the multiple vehicles as there was a car and a minivan owned by the service. That gave people a choice to either travel on their own or as a group. The staff supported people in line with their needs and choices which ensured they were empowered to choose how to spend their time away from the service.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The positive outcomes achieved for 1 person by the team at Penley Grange led to a professional asking to use the person’s story and their journey as a case study for future training. For example, the staff had supported the person to be actively involved in various activities they were previously not able to. This meant the person was able to contribute to the community feeling at the service which resulted in an increased sense of belonging

The leadership team used various observation methods and tools to measure the impact of the support provided on people’s progress and wellbeing. When a person’s needs changed due to a significant life event and they were at risk of becoming more isolated and withdrawn, the staff worked tirelessly to re-establish their life full of purpose and community. Instead of changing everything, they preserved what mattered to the person the most: their routines, preferences and independence, anchored around the things important to them. People were supported to attend external appointments with reasonable adjustments being considered, planned for and communicated. Staff gave us examples of how they worked with a local business who made adjustments to accommodate the person’s needs in order for them to visit the place. This meant people had a positive experience, good outcomes and anything that could prevent them from accessing prompt care and treatment was considered.For example, a person had been able to access a blood test for the first time without experiencing distress because this intervention was so well planned and coordinated.

The provider worked well across teams and services to support people. Staff and leaders actively collaborated with health and social care professionals to deliver care in accordance with national best practice.

The Director of Operations is a National Board Member for My Home Life – England where they share best practice and collaborate with regulators, policy makers, and educational institutions. The Director is a sole representative of the Learning Disability sector, and the shared learning is filtered down to the team to be implemented in practice. The leaders registered the service with Neighbourhood Watch to be aware of local scams, staff safety concerns, and crime trends. Safety posters and leaflets are shared with the service and staff are vigilant, so any concerns are escalated to the relevant teams when required. The Registered Manager and the Director attend managers’ meetings, forums and network with other services recognised for providing best practice. It provides excellent opportunities for networking and for sharing good practice. The team excels at community engagement, for example they identified the main road signages were dirty and not visible. The team volunteered hours to clean these ensuring a safer environment for people living at the service, staff and other road users.

We saw multiple examples where the service worked with community health and social care teams to assess and meet people’s needs in relation to communication, positive behaviour support and dietary needs. Staff followed the standardised framework to make sure a person with swallowing difficulties received the correct thickness of liquids and the texture of foods.

Staff used a range of tools to help assess people’s needs and make changes, if necessary. For example, surrounding nutrition, risk of choking or developing skin pressure damage. These records were regularly completed helping to inform the further action and any changes to support required.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people to meet their nutrition and hydration needs. Records showed people had lost weight at a safe pace in accordance with assessed recommendations. We saw a variety of healthy meals and snacks were accessible alongside people’s preferences for less healthy foods. For example, staff supported people to make their favourite fruit smoothies or guacamole as a snack between meals.

There were goal pathways for each person to help them achieve meaningful outcomes. These pathways were developed in line with people’s interests, with the involvement of their family where possible and a key worker. Staff supported people to enable them to reach their goals and live healthier and more fulfilling lives.

The provider excelled in routinely monitoring people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both best practice and the expectations of people themselves. People’s relatives were happy with the service provided and told us staff consistently monitored people’s needs well. One relative told us how they were kept informed about any test results and interventions planned for their relative who was unable to make some decisions for themself. They said, “Manager phoned to tell me that it had been decided to leave it a year before medications were considered and try to manage with food choices and exercise. I’m notified if [person] has seen the psychiatrist.”

Staff introduced new ideas to people to enhance their quality of life, such as new activities and skills. The staff knew people extremely well, understood their abilities and preferences and focused on areas of interest that supported people’s emotional and psychological wellbeing.

One person’s progress meant they had been discharged from the community learning disability team and their support levels had been safely reduced. This meant they were no longer subjected to the restriction of ‘continuous supervision and control’ at nighttime, which was a significantly positive outcome for them.

We observed another two people who staff knew well and had worked with to improve outcomes, meaning they no longer appeared withdrawn or disconnected in comparison to our previous inspection visit. A third person’s demeanour was much happier and engaged, whereas they had been visibly distressed before. Our observations and feedback received from people’s relatives demonstrated that people’s outcomes were improved and people were receiving high quality support from staff who understood them well. One relative said, “[Person] withdrew during COVID-19 but now they interact, can tolerate more and are confident and curious.” Another relative said, “Before [person] was snoozing too much, now loves going out for walks, drives, seeing animals. The team has been successful in taking [person] out and about.”

People were supported to have control over day-to-day choices. Staff were patient when supporting people, giving them time to make their own choices. One staff member said, “We always give people choice, even small things like what clothes they want to wear or what activity they want to do. One [person] enjoys helping make their own food, and we support them step by step, but they make their own decisions.” People and their relatives were involved in decisions about their planned care. We observed staff supporting 1 person to use pictures of food next to the kitchen door to make a choice about their breakfast. We saw this approach was used multiple times throughout our visit.

The provider protected people’s rights, for example, they successfully challenged an external professional which resulted in the decision not to put a person on a medicine that could make them drowsy. The provider identified this as poor practice and escalated the concern appropriately so lessons could be learned, and this reduced the chance of recurrence. Advocacy services were actively involved including charitable organisations championing people’s rights. Advocates were involved in decision-making processes and acted as a voice for people ensuring their views and best interests were being represented.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff had received training regarding the MCA and policies were in line with the principles of the MCA.

People made their own choices and decisions about what they did, what they ate and how they filled their time. Staff supported people to understand information and to express their views using adapted communication methods to ensure people were in control of their own lives as much as possible. The provider ensured people’s mental capacity for specific decisions had been assessed and any best interest decisions had been made in accordance with the Mental Capacity Act 2005.