Penley Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a proactive and positive culture of safety, based on openness and honesty. Staff knew how to escalate any safety concerns, and all concerns raised had been investigated promptly. Lessons were learnt to continually identify and embed good practice. For example, action had been taken to understand why a person had become distressed and why an incident occurred and what could be changed to prevent further occurrences. Risks associated with potential closed cultures had been identified. People had access to professionals, family and friends outside of the service they could raise concerns about their safety with. A relative told us, “They take feedback even at weekends and late at night and are very responsive”.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services. Staff described how they ensured for example, a transition from child services to adult services was safe. This included several pre-assessment visits to understand the person’s needs and potential risks. People benefited from consistent support when experiencing an anxiety or distressed behaviour which ensured their safety. Care plans were in place to support people to have a good day, and strategies were in place to prevent distress.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns promptly and appropriately.

There was a clear commitment to using the least restrictive practice to ensure any restrictions were legally justified, proportionate, necessary and always treated as a last resort. For example, the records showed the community learning disability team had prescribed an intervention that could be seen as a potential restriction. The feedback from the leadership team confirmed its use was monitored to protect person’s right and that the intervention was no longer required due to the improvement in person’s behaviour. The kitchen door was locked to mitigate risk, we saw people were supported to gain access under staff supervision when requested.

Where people were waiting for the renewal of deprivation of liberty authorisations, the service was in contact with the local authority responsible for the assessment. The service reviewed care arrangements to ensure that people were subjected to the least restrictions possible.

We observed notices, also in accessible format around the service advising how to raise any safeguarding concerns and who to contact. Staff we spoke with knew how to report any concerns and had a full confidence any issues would be appropriately reported by the service’s management team.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care that met people’s needs, was safe, supportive and enabled people to do the things that mattered to them. People that lived with medical conditions such as epilepsy, were supported effectively to protect them from the risk of avoidable harm. Best practice guidance was followed, and the risks were identified and mitigated whilst ensuring people were able to maintain their independence and dignity.

People’s needs were clearly identified, assessed and mitigated. When people’s needs changed, they were reassessed. For example, staff identified changes in a person’s sleep pattern, and they worked with the person’s GP and psychiatrist to understand what had happened and how their support could be adapted in a way that promoted the person’s wellbeing and choices.

People were now supported and empowered to take risks in areas they wanted to and to enhance their lives. For example, people were being supported to access services and amenities with the right support, where previously this had been considered too risky.

Staff were skilled in providing care that met people’s needs, which was safe, supportive and enabled people to do the things that mattered to them. One member of staff told us, “Care plans are good here and give you a good idea of what people’s needs, preferences and communication needs are.”

People’s personal emergency evacuation plans (PEEPs) were in place. A PEEP is a plan describing the level of assistance, for example mobility wise needed to be safely evacuated from a building to a place of safety in the event of an emergency such as fire.

The provider detected and controlled potential risks in the care environment. They made sure facilities; equipment and the use of technology supported the delivery of safe care. People had been consulted about the environment to ensure adaptations and reasonable adjustments were made to meet their individual needs. For example, an additional space had been created in response to a person’s request for their own space they liked to call their office. Each person’s individual sensory needs had been assessed and considered, so the environment could be adapted. People had their sensory needs met to prevent overload and aid the feeling of relaxation at the home.

We observed it was important to people’s emotional wellbeing to have visual and communicative access to staff working in the office. The service had carefully considered their duty to keep records and medicines safe against people’s needs and resolved this with a secure half door. We saw this worked well in practice and we observed people waving and smiling to staff based in the office.

People benefited from a well-maintained environment with good lighting and accessible signage enabling people to move around the home and outdoor areas safely. People were able to personalise their personal space, choosing their own décor, 1 person had their favourite music bands posters in their room.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff told us there were sufficient staffing levels including additional time allocated for team leaders to complete administration tasks. One relative said, “Yes, enough staff, I always see the same staff”.

Staff were recruited safely and records evidenced relevant pre-employment checks had been undertaken prior to new staff commencing employment. Staff told us there was an inclusive recruitment in place meaning people were involved in the recruitment process. The registered manager described how they were aiming to ensure new staff’s hobbies matched people’s hobbies, this was to enable meaningful activities opportunities. New staff had a structured induction and shadowing (working alongside experienced colleagues) opportunities before working unsupervised.

The team worked together well to provide safe care that met people’s individual needs. Staff providing care are required to receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. One staff member told us ‘breakaway’ training (skills to safely disengage from physical confrontations) was the right level before a recent incident due to a person’s distress, but now they felt further training would be beneficial to maintain safety. They told us the provider had already taken action to arrange additional training, which was confirmed by the leadership team. The management team advised the initial assessment did not identify the person required a higher level of physical intervention and that they would keep this under review through regular assessment and in response to any incidents.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff told us there were sufficient staffing levels including additional time allocated for team leaders to complete administration tasks. One relative said, “Yes, enough staff, I always see the same staff”.

Staff were recruited safely and records evidenced relevant pre-employment checks had been undertaken prior to new staff commencing employment. Staff told us there was an inclusive recruitment in place meaning people were involved in the recruitment process. The registered manager described how they were aiming to ensure new staff’s hobbies matched people’s hobbies, this was to enable meaningful activities opportunities. New staff had a structured induction and shadowing (working alongside experienced colleagues) opportunities before working unsupervised.

The team worked together well to provide safe care that met people’s individual needs. Staff providing care are required to receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. One staff member told us ‘breakaway’ training (skills to safely disengage from physical confrontations) was the right level before a recent incident due to a person’s distress, but now they felt further training would be beneficial to maintain safety. They told us the provider had already taken action to arrange additional training, which was confirmed by the leadership team. The management team advised the initial assessment did not identify the person required a higher level of physical intervention and that they would keep this under review through regular assessment and in response to any incidents.

Staff had undertaken the basic online awareness training, and the team had received additional support and supervision from the community learning disability team through referrals in response to people’s distressed behaviour. Where people were discharged from this service no further support was available. We therefore informed the leadership team about the requirement to arrange the training and competency assessments at a greater breadth and depth for new starters and ensuring an ongoing training for existing staff. This is to make sure staff’s skills to provide direct care to autistic people and people with a learning disability are up to date.

The provider assessed and managed the risk of infection. The service was clean, and we saw staff adhering to infection control good practice guidance. For example, staff used colour coded equipment and used washing bags when required. Personal Protective Equipment (PPE) was available. Any doors that should be kept locked were secured, with potential hazards such as cleaning products kept inaccessible to people. Bathrooms were well stocked with paper towels and soap. The team worked hard to ensure people benefited from clean and homely environment with high standards of cleanliness maintained. Since our last visit a number of improvements to the outside areas had also been made. There was a well-maintained back garden, and a new, secure and lockable bin storage area located along the driveway.

We found the team demonstrated exemplary understanding of Stopping over medication of people with a learning disability and autistic people (STOMP). The team promoted a proactive culture focused on investigating potential triggers and utilising non-clinical methods of managing people’s distress to reduce the need for additional medicines. Staff provided us with examples where they had delivered care that focused on people’s needs, likes and interests. This meant they successfully supported people in a way that reduced the need for the additional medicines which would be likely to make a person drowsy and therefore less likely to enjoy their daily activities. This meant the team’s actions positively impacted the person’s life avoiding over medication.

People received their prescribed medicines safely as prescribed. We observed staff administered people’s medicines in a way that considered people’s individual needs, preferences and good practice guidance. Staff received suitable training, and their competencies were being assessed on regular basis.

Where people had been prescribed PRN (when required) medicines there were detailed protocols in people’s care records, including the instructions for staff what to look for where people had been prescribed a variable dose. This included any non-verbal cues where people were not able to express their pain or distress. No people needed to receive their medicines covertly (hidden in food or drink), staff monitored people’s abilities to take the medicines and would liaise with the doctor if any for example, needed to be changed to a liquid form.

There were effective systems to ensure people had their required medicines with them when going away or visiting relatives. People’s medicines including controlled drugs and medicines requiring cold temperatures were stored and disposed of safely. Regular audits of all aspects of medicines administration took place on regular basis which ensured ongoing compliance with policies and processes.