Penniston Barn

We found the following examples of good practice.

Visitors to the service had their temperature taken and wore personal protective equipment (PPE).

The service had an ample supply of PPE. All staff had received training in the correct use of PPE, and how to take it off and put it on safely.

People were supported to have contact with their families and friends either through planned visits or through video and telephone calls. The service had set up a sensory room in an outdoor building for people to meet their visitors in.

Regular COVID-19 testing for all people and staff living and working in the service was regularly carried out.

The building was clean and free from clutter. Cleaning of the service, including frequently touched surfaces, had increased to reduce the risk of transmission of infection.

Management supporting the service had developed procedures and guidance for people and staff in response to the COVID-19 pandemic. Risks to people and staff in relation to their health, safety and wellbeing had been assessed.

Penniston Barn is a residential care home providing personal care to six younger adults living with a learning disability or autism the time of the inspection. People had their own bedrooms, with en-suite shower rooms and shared communal areas such as the kitchen, the lounge and the garden.

The service had 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.

The service was in a rural location far away from local amenities with limited access to public transport. The service was clearly advertised as a care facility with identifying signs and industrial waste bins. However, this did not have a negative impact on people using the service. The service was decorated as a home environment inside based on people's choices and people had their own vehicles which they could use to access the community.

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

People and their relatives were positive about the care they received. One relative said, ‘‘[Staff] are great and work well as a team as well as working with [Person]. It is a great little service and [person] is so happy there.’’

People received exceptionally effective care which ensured that they achieved fantastic outcomes and were supported to improve their quality of life. Without exception people were encouraged to communicate their needs more effectively, access the community more and manage their own anxiety and distressed behaviours. the support which people received to maintain a balanced and healthy diet was exemplary. Relatives feedback about the impact the support at the service had for their family members was complimentary. The manager kept up to date with best practice guidance and used this to continually improve people’s support.

People were supported by a kind and compassionate staff team who had got to know them as individuals. People were kept at the centre of their care and supported to make choices in all aspects of their daily living. Staff promoted people’s independence and respected their privacy and their dignity. People’s support was tailored to their individual needs and preferences and staff supported people to take part in a wide array of activities based on their interests. Staff supported people to communicate in ways which they understood.

People felt safe living at the service and staff had a good understanding of safeguarding. Staff followed people’s risk assessments when supporting them to ensure that they stayed safe whilst taking positive risks. There were enough staff to support people safely and staff were recruited in line with best practice and guidance. People were supported safely with their medicines. The service was clean and staff followed good infection control practices.

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. The manager had a detailed complaints procedure in place and responded to any complaints made promptly. Staff were working to help people put plans in place for the end of their life and document their wishes.

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. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The manager and staff team were passionate about providing a positive atmosphere for people at the service. The manager completed audits to monitor the quality of the service and acted to make improvements where these were necessary. People, relatives and staff were encouraged to be involved and feedback about the service. The service linked and worked well with other organisations. Feedback about the support which the manager and staff team gave to people was exceptionally positive.

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 13 March 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the community encouraged.

People’s experience of using this service:

• The service was not always cleaned to the required standard.

• There was an infection control risk due to poor cleaning and poor maintenance of areas within the home.

• Audits were not always effective in documenting what issues were found and what work was required.

• Timely action was not always taken to respond to known areas of required improvement.

• People received safe care. Staff understood safeguarding procedures.

• Risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were trained to support people effectively.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people’s likes, dislikes and preferences.

• People were able to take part in a wide range of activities and outings.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The registered manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required

• The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published 11/05/2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Enforcement :

• Action we told provider to take (refer to end of full report)

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Penniston Barn provides accommodation and personal care for up to six people with a learning disability, autistic spectrum disorder, and other associated complex needs. It is part of a group of three services located on a rural site run by the same provider. At the time of our inspection there were six people living at the service.

The service had a registered manager. 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.

At the last inspection on the 11 and 12 May 2016 we asked the provider to take action and to make an improvement. This was because a breach of legal requirement was found in relation to Regulation 15 of the Health and Social Care Act Regulations 2014 Premises and Equipment. We found that the floor covering on the stairs leading to the office was worn. Floor coverings in the communal corridor and the entrance hallway leading to people’s bedrooms were not appropriately cleaned and maintained. There were also noticeable gaps in the flooring between rooms and evidence of water damage to door frames and skirting boards. This meant that cleaning was ineffective and presented a risk to the infection control of the service.

After the comprehensive inspection, the registered person wrote to us to say what they would do to meet the legal requirement relating to Regulation 15 of the Health and Social Care Act Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Penniston Barn on our website at www.cqc.org.uk

We found that the provider had replaced the floor covering on the stairs leading to the office. The floor coverings in the communal corridor and the entrance hall leading to people’s bedrooms had been replaced with floor tiles. The defects on the door frames and skirting boards had also been remedied.

While an improvement had been made we have not revised the rating for the key question. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for ‘safe’ at the next comprehensive inspection.

Penniston Barn provides accommodation and personal care for up to six adults with a learning disability, autistic spectrum disorder, and other associated complex needs. It is part of a group of three services located on a rural site run by the same provider. At the time of our inspection there were six people living at the service.

The service had a registered manager. 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. At the time of our inspection the registered manager was unavailable to participate in the inspection process because they were on annual leave. A deputy manager was however overseeing the service in their absence.

Since our last inspection in October 2014, the registered manager and provider had acted upon inspection feedback with a view to evaluate and improve their practice and ensure compliance with the regulations. However, during this inspection we noted that the environment had not been suitably maintained and appropriate standards of cleanliness were not upheld in the communal hallway of the service. The flooring was stained and discoloured and gaps within the flooring meant that effective cleaning could not be completed. Water damage was also noted to the flooring, door frames and skirting boards.

Relatives felt that people were safe in the service. Staff were knowledgeable and understood their responsibilities with regards to safeguarding people. They had received effective safeguarding training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

There were sufficient numbers of staff on duty to meet people's needs and promote their safety at all times within and outside the service. Safe recruitment processes were in place and had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work. Staff were well trained and completed an effective induction programme when they commenced work at the service. Staff were supported in their roles and received regular supervision and appraisals.

People's needs had been assessed and detailed care plans took account of their individual needs, preferences and choices. There were comprehensive, personalised risk assessments in place that gave guidance to staff on how individual risks to people could be minimised. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current needs.

People's health care needs were being met and they received support from health and medical professionals when required. Medicines were stored appropriately, managed safely and audits completed. People were supported to make choices in relation to their food and drink and a varied menu was offered.

Positive relationships had developed between people and staff. Staff were patient, friendly and respectful. People's privacy and dignity was promoted throughout their care. Staff knew people's needs and preferences and provided encouragement when supporting them. People were encouraged to participate in meaningful activities and a wide variety was available. Relatives received relevant information regarding the services available and regular communication was maintained.

The registered manager was approachable and staff felt supported in their roles. Relatives and staff knew who to raise concerns with and there was an open culture. Relatives were asked for their feedback on the service and comments were encouraged. The registered manager completed detailed quality monitoring audits and it was clear how these were used to drive improvements in the service. Staff felt involved and were encouraged to contribute to the development of the service.

During this inspection we found the service to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and The Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with two of the four people who used the service and six members of staff. There was a relaxed atmosphere in this home, which provided a homely place for people to live. We saw staff interacting well with people and encouraging them to meet their aspirations and be as independent as possible.

We observed that people's consent was sought before care and support was delivered, and people were encouraged and supported to make their own decisions. Where people lacked the capacity to make decisions for themselves, appropriate processes had been followed to ensure best interest decisions were made on their behalf.

Staff were appropriately trained and were supported by the provider to maintain and expand their knowledge to enable them to work with people with complex needs.

The registered manager had effective systems in place to ensure people were kept safe and cared for in a safe environment.

There was information displayed relating to the complaints procedure, so that people who used the service and visitors to the home knew how to raise any concerns with the provider.

At this visit we saw evidence that the people were involved in their care and had the opportunity to influence how the home was run. For example to include everyone in menu planning picture cards of a variety of different meals and food stuffs were available for people to make choices from. We also saw that people were able to participate in a variety of different activities because there was sufficient staff to support them to do so. Staff confirmed that having sufficient staff on duty resulted in fewer altercations between the people living at Penniston Barn. The daily records that we looked at confirmed this.

We looked at the medication records in the home and saw that the people using the service were given their medications correctly and the documentation to confirm administration had been completed appropriately.

The registered manager and the management had systems in place to regularly audit the service provided in order to identify any concerns early and rectify them in a timely fashion