Penrose Care Limited

Penrose Care Ltd is a domiciliary care service that provides personal care and support to older people in their own homes in and around North London. People receiving a service included those with physical disabilities, and health issues relating to the progression of age. At the time of this inspection the service was providing a service to 12 people out of which seven people received the regulated activity of personal care.

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

Penrose Care was a small service embedded in the community in North London. The service had a well-defined ethos to remain small and provide holistic and highly personalised care. The most characteristic of the service was that the support they offered met people's specific needs and enabled them to live their lives as comfortable as possible despite the need for care and support. The service's commitment to improving people's lives led to their families being overjoyed with the care. This was because the highly effective and responsive care led to improvements in people's wellbeing in ways families wanted but never expected.

The services strong ethical stand exceeded toward their staff. The service provided the staff team that was suitably paid, well trained, supported and motivated to do their best. The "No Problem" approach meant that the service was very adaptable and dealt with arising issues efficiently and easily. The service empowered staff to sort things out and go the extra mile to ensure people receive their needed care.

Stakeholders, including people using the service, their relatives, local community members, and external health and social care professionals, gave consistently positive feedback about this service. They described the service as very well run, passionate about supporting people, and highly responsive to people's needs. They described staff as intelligent, well trained and having an exceptional level of commitment to facilitating people's improvement. They gave us numerous examples of how staff commitment to providing a high standard of care and readiness to go the extra mile contributed to the wellbeing of their relatives improving.

Staff had an in-depth knowledge of people's needs which they achieved through extended induction every time they started supporting a new person. The same small group of care staff supported each person. This helped to develop a trusting and friendly relationship between people and staff. People's care plans were comprehensive and provided staff with detailed information on risks, needs and preferences related to people’s care.

Staff proactively sought continuous professional development to ensure they knew how to best support people. The staff promptly sought support and liaised with other health and social care professionals when needed. As a result, staff safely and effectively met people's needs.

The provider regularly consulted people about their views of the service. People and family members confirmed that they were fully involved in planning people's care and that staff promptly acted on any changes to the support needs. They told us that this readiness to respond to emerging needs gave people and relatives additional comfort and reassurance that the service could meet people's needs.

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 provider was passionate about ensuring that they suitably rewarded staff employed at the service for their continuous contribution to improving people's wellbeing. They provided staff with the necessary and additional benefits, not common in similar services, such as, medical insurance, safe transport home to and from work and full-time employment contracts. Staff confirmed this had contributed to their wellbeing and work satisfaction. They described the managers at Penrose as always exceptionally supporting and caring.

The provider's contribution to the quality of life of people using the service and the local community was outstanding. They initiated, funded, and carried out a range of initiatives within the local community to ensure the quality of life for people's families and other local community members improved. This was especially observable during the Covid-19 pandemic. For example, the service started an alfresco dining initiative called “Streatery” and delivered PPE resources to other health services at the start of the pandemic.

The registered manager monitored the quality of people's care and support provided by Penrose Care. They have stayed in regular contact with all people who used the service and their families and staff to ensure people were happy with the service received and that staff had everything they needed to provide a high standard of care.

The service had effective processes and procedures in place, which helped ensure the service met all the Health and Social Care Regulations.

Staff received appropriate training and induction to ensure they safeguarded people from harm and that the care they provided was effective. The recruitment procedures were safe, and the provider ensured that only suitable staff supported people. We were assured that the service followed current guidelines on infection control and Covid-19 risk reduction measures. The provider had a range of effective quality monitoring systems that helped to ensure the continuous provision of ethical and high-quality care. Any shortfalls in the care provision were quickly spotted and addressed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Outstanding (last report published on 08 April 2019)

Why we inspected

This was a planned inspection as part of our quality assurance process checking a range of Good and Outstanding services.

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

People’s experience of using this service:

The agency provided exceptionally good care to people who used it. All stakeholders we spoke with, including people using the service, their family members and external health and social care professionals gave consistently positive feedback about the agency. They thought the agency was very well run and was very responsive to people’s needs. They described staff as very skilful and having an exceptional level of commitment to supporting people and facilitating their improvement.

Staff were exceedingly committed to providing best support to people. Therefore, people’s wellbeing and activity levels had been noticeably improved. Staff were consistently commended for their kindness, patience and professionalism. Staff provided empathetic care and adapted this to meet the rapidly changing needs of people.

Staff knew people well. Without exertion staff supported people in enhancing their lives so people felt valued, empowered and fully included in their care. Staff continuously involved people in making decisions about their care and supported them to have their voice heard. With staff thoughtful support, people could participate in the community events, socialise, follow their hobbies, travel and lead independent lives as much as possible. Feedback from various stakeholders clearly attributed people’s improved wellbeing to staff support, encouragement and commitment. They thought, because of staff support, that people were achieving better than expected outcomes and they could live the best life possible with their health conditions.

Motivation to meet people’s needs well was at the heart of the agency’s exceptional performance. The agency worked closely with other professionals to develop bespoke care packages for each person using the service. This helped to ensure the care and support provided to people suited their often very complex and highly demanding needs. People’s care plans had comprehensive information related to care needs and how care should be provided. People, relatives and external professionals thought the agency was very flexible in their approach and could provide high quality additional support even at short notice.

Staff received regular mandatory and additional training to ensure they had sufficient skills and experience to support people in a safe and effective way. Regular supervision, appraisal and managerial spot checks ensured that staff were appropriately supported and that they provided care in the way that matched people’s needs.

The agency provided safe care. People told us they felt very safe with staff who supported them. There were effective safeguarding systems in place that helped to protect people from harm. Appropriate recruitment practice protected people from unsuitable staff.

An ongoing risk assessment and management process helped to minimise the occurrence of and effects of risks relating to people’s health, activities and environment. This included places people visited. People received their medicines as prescribed. There were robust procedures in place to ensure medicines were managed safely.

There were sufficient staff deployed to support people. People said staff were always on time and they never missed a planned visit. People and relatives were confident care would be provided as planned.

People were supported to have enough food and drinks and have a balanced diet that matched their needs and preferences.

The agency was working within the principles of the Mental Capacity Act 2005 (MCA). Staff supported people in making decisions about their everyday care and they ensured people were asked for their consent before this care was provided.

Staff respected people’s dignity and privacy when providing personal care.

The service was an integral part of the community and was involved in various community events and actions aiming at improving understanding the needs of people using the service and improving their life in the community.

People were encouraged to give feedback about the service provided. This could be done via the complaints procedure, regular care reviews of direct contact with the staff and the management team. Feedback received had been taken into consideration and appropriate action had been taken to address issues occurring.

The agency had a clear managerial structure and individual work roles were clearly defined and allocated. All employees were provided with guidelines on what their responsibilities and accountabilities were.

Staff felt supported by their managers. They could contact the management team at any time about any work issues and they were confident they would be assisted. Staff were invited to regular team meetings where they could share ideas and experience. Staff thought their contribution was valued.

The agency was committed to continuous learning and improving care. Proactive action had been taken by the management team when things went wrong and where the service provided needed to improve.

The agency worked in close partnership with the local community and external care and social care professionals. Feedback received from the professionals suggested that they were impressed with care provided by the agency and they would not hesitate to recommend it to others.

Rating at last inspection: Good (last report published on 23 August 2016)

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor the agency and we will revisit it in the future to check if they continue to provide good quality of care to people who use it.

Penrose Care Ltd is a small domiciliary care agency that provides personal care and support to older people in their own home in and around North London. People receiving a service included those with physical disabilities, learning disabilities, acquired brain injuries and health issues relating to the progression of age. At the time of this inspection the agency was providing a service to seven people. The agency provided a variety of visits ranging from a minimum of ninety minute calls to waking nights and sleep in’s depending on people’s individual needs. In addition to the provision of personal care as a regulated activity, the agency also provides additional services which include companionship, domestic support, support with shopping and escort services.

During our visit the registered manager was present. 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 and relatives that we spoke with were highly complementary of the service that they received. They spoke very highly of the registered manager and the care staff team that supported them. Care staff were aware of people’s individual needs and how they were to meet those needs. People and relatives also commented on how responsive the service was with regards to providing additional care even at short notice.

The agency had a number of policies and procedures which were available to help ensure people were protected from abuse and the risk of abuse. These included risk assessments that considered people’s individual potential risks, a robust recruitment process, staff training and guidance and direction on how to identify abuse and the actions to take if abuse was to be suspected.

The agency ensured that care staff were equipped with the skills and knowledge needed to deliver high quality care. A number of methods were used to deliver the training which included face to face training as well as on the job experience alongside a more senior and experienced care staff.

The registered manager also told us about an innovative and dynamic training project which they had developed based on feedback they had received from people using their service. The programmed looked at training and developing the fine skills of its care staff in order to meet the more holistic needs of the people who used the service.

Care staff told us they enjoyed working for the agency and felt well-supported by the registered manager. Care staff received regular supervision as well as group reflective supervision conducted by one of the directors of the agency.

Penrose Care Ltd believes that to ensure people who use the service received continuity of care and a high quality of service, care staff should be trained well and should receive an appropriate wage which takes into consideration the type of work they do and the amount of time it takes them to travel between people’s homes. With this in mind the agency paid its care staff according to the living wage and also for the time they spent travelling.

We saw suitable and safe arrangements in place in relation to the administration and recording of medicines.

People received personalised care that was responsive to their needs. Care plans were person centred, detailed and specific to each person and their support needs. Care plans were reviewed on a regular basis. People and relatives confirmed that they were consulted and their care preferences were reflected within the care plan.

People were supported to make their own choices and decisions where possible. The registered manager and the care staff team were highly knowledgeable to the requirements of the Mental Capacity Act 2005 (MCA) and how this applied when supporting people. Care staff were able to demonstrate a good understanding on how to obtain consent from people and were able to provide examples. They understood the need to respect a person’s choice and decision where they had the capacity to do so.

People and relatives confirmed that they received regular carers who had developed positive and caring relationships with the people they supported. People and relatives felt that they were treated with respect and dignity. We were told that although staff were present to support people they also encouraged and promoted people to build their independent living skills.

People receiving a service and relatives that we spoke with shared a very good relationship with the registered manager. They felt able to raise concerns or issues and also give suggestions for improvement and were assured that these would be addressed by the registered manager. The agency had a number of quality assurance systems in place which included spot checks, feedback questionnaires and weekly audits of the daily recording notes.

As part of this inspection we spoke with two relatives of people who used the service, the registered manager and two care staff. We also reviewed records relating to the management of the home which included, four care plans, daily care records and two staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

There were appropriate staffing levels to support people using the service. Staff were knowledgeable in safeguarding vulnerable adults procedures and were able to recognise signs of potential abuse. The service had a system to respond to allegations of abuse and had details of the local safeguarding team.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted.

Is the service effective?

The staff had the skills and experience required to meet the needs of people who used the service. The team had access to training courses to update their knowledge and become familiar with any changes in policies or procedures.

The service undertook assessments with the person who used the service or a relative to identify their support needs.

Is the service caring?

People who used the service or a relative was involved in decisions about their care and support. Staff supported people and advised them but allowed the person who used the service to make the final decision. Staff told us, "we always ask [people who used the service] what they want."

A relative of a person who used the service told us 'they take a lot off of my shoulders, they are marvellous.'

Is the service responsive to people's needs?

The service liaised with other health professionals to meet the needs of people who used the service. The service had recently been in contact with a general practitioner about changes to the administration of medicines for one person using the service.

Is the service well-led?

The service was working to the strengths of individual staff members and using the skills and knowledge of staff to provide the required service to meet people's needs.

Staff told us they felt very involved and supported in their roles. They said that the manager of the service was accessible and approachable. They had regular supervision sessions and were able to meet with the manager as needed if they had any questions or concerns.

There were processes to monitor the quality of the service and to improve the quality of service delivery.

People were satisfied with the care and support provided by staff. They commented that they were 'very happy [about the service]' and staff were "very caring'.

The provider had policies and procedures including safeguarding, health and safety, and equality and diversity. Staff told us that they had attended induction and training programmes which they found it useful in caring for people.

Appropriate checks were undertaken before staff began work. This ensured that people were cared for by staff who were appropriately vetted.

People's care plans were based on their assessment of needs. This ensured that people received care that reflected and met their needs. The provider had a system in place for involving people who used the service or their carers to ensure that their views were taken into account in the way care was provided.