Penwortham Grange and Lodge

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• 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

People were protected from the risk of abuse due to effective safeguarding processes, and the provider made sure that actions were taken to reduce the likelihood of mistakes being repeated. Staff knew how to meet people's needs and reviewed risks regularly. People were protected from environmental risks and people commented they had the right equipment to help maintain their independence. Staff were recruited safely although people and relatives felt that the service would benefit from more staff. However, we identified 1 breach of the legal regulation in relation to the safe management of medicines. Improvements were required to the medicine's policy, guidance for staff and recording. Actions were put in place by the manager and provider to address.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew how to record incidents and we saw evidence of this. We observed a 'flash' meeting and managers reminded staff to complete these for a relevant incident. Managers told us they had oversight of incidents and used these to recognise any themes and make changes or improvements.

There was a clear process to record incidents. Managers used an electronic system to monitor these and made sure incidents were recorded correctly. We were aware of an incident related to medicines from a few months ago which had not been recorded. However we could see that with a new management structure, improvements had been made.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff said they completed safeguarding training and knew what to do if they had a safeguarding concern. Staff knew about the whistleblowing policy and how to view it. Staff said they didn’t always know the outcome of a safeguarding referral. A staff member told us, "It would depend on the seriousness of it and the confidentiality. We might share in the flash meeting that a concern is being investigated but we would not expose the details." The manager told us that safeguarding concerns were discussed in daily flash meetings.

There was a safeguarding policy and safeguarding information available on posters. The manager raised concerns with the local authority and worked alongside them to look at any issues. Concerns were collated in an accessible folder. Safeguarding training was in date.

People told us they were involved in decisions about their care. A person said, "The staff talk to you and get to know your likes and dislikes. I think they know what I need and how I want to be looked after, I have no qualms at all." A relative said, "The staff are aware of any risks [my relative] may face."

Staff told us they were involved in reviewing people's care and they communicated any changes to the senior. A staff member told us, "Yes we are asked for feedback and it is listened to and implemented. The senior would update the care plan. I think it is a really happy home and person-centred." Staff said they had the right training to be able to support complex needs for example, moving and handling techniques, using equipment and administering drink thickener.

Pre-admission assessments were completed by the manager or seniors. Care plans and risk assessments contained relevant and up to date information, and were reviewed regularly. We saw relevant processes to guide staff. We saw that people and relatives were involved in their pre-admission assessments and reviews.

People told us they had all the right equipment they needed to keep them safe, and to aid their mobility and independence. People and relatives said the home was comfortable and free of hazards.

Staff confirmed they were trained to use equipment. Staff said they had fire drills and knew people's needs in the event of a fire. Staff said maintenance issues were resolved quickly. The maintenance manager said, "If there are small issues we deal with it and big issues are reported higher up. We walk around the home and sort out any tasks required."

There was a system to manage maintenance issues. During the inspection we observed a couple of minor maintenance issues and these were resolved quickly. Health and safety checks such as gas, electrical testing and water safety had been completed as necessary. Hoist safety checks were in date. People had individual plans to guide staff in the event of a fire. Fire safety assessments had been completed and recommended actions by the fire safety team were in progress.

We received mixed responses from people about staffing levels. A person said, "We could always do with more, but we are fine. The staff work very hard. We know the staff they are regular, and they have got to know us. I don’t know about agency staff." Another person said, "I think they could do with more. Some left recently due to the hours and pay. There has been quite a big turnover of staff. I don't really know why but some come in with a different uniform." A third person felt they needed more at certain times of the day, for example in the morning to support people to get out of bed.

Some staff thought there were enough staff and said there had been a recent recruitment drive. A different staff member told us, "I think we could do with more staff, it can be difficult in the morning but it does depend on what is happening that day. It can be stressful to get everyone up, washed and dressed, it is important to have this done by mid morning." Staff said higher staffing numbers would help with making sure anyone that wanted a shower could do so. A staff member told us "I’d like to do more showers, some people might want this every day and it would be good to be able to do that. It would need more staff." Regarding induction and training a member of staff told us, "We pair new people up with someone more experienced for around 6 shifts or more if they need it." Another staff member told us, "We have face to face moving and handling training. We have to keep it all up to date on the system, it is every year and it checks nothing is out of date."

Staff induction and training was in place and up to date. We checked 5 staff recruitment files and found necessary safety checks had been made, including references and Disclosure and Barring Service (DBS) checks. The manager checked that agency staff received appropriate training via their agency. The manager covered some shifts with agency staff, they were usually consistent and knew people. There was a recent recruitment drive and the manager planned to recruit more permanent staff. The provider employed 3 activities coordinators to support people with social stimulation.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

A person who had been prescribed antibiotics did not receive these in a timely way. A visitor to the home told us they had occasionally seen a tablet on the floor in 1 person’s room. People told us they received their medicines when they needed them. A person said, "The staff are able to recognise the signs that I am in pain and come to ask me if I need any painkillers."

Staff we spoke to could not explain how to read minimum and maximum medicine fridge temperatures. Daily records showed that the monitoring of medicine's fridge temperatures was inadequate. A member of staff told us they had completed medication training and their competency to administer medicines was regularly assessed. We saw records of staff’s medicine competency assessments. Managers told us that medicine errors were recorded and escalated as necessary. However, we were aware of an incident that was not recorded. Improvements were made with recent management changes.

Medicines were not always managed safely. There was a medicine's policy however this was at provider level and lacked detail which was specific to Penwortham Grange and Lodge. The section of the policy on reconciling medicines referred only to paper medicine records, however the service used electronic medicine records. The policy did not include information about how to record the addition of thickening powder to people’s drinks. Thickener may be added to the drinks of people who have been assessed as at risk of choking, and if ingested incorrectly can cause harm. Staff did not always record information about drink thickener in people's care notes properly. We found a container of drink thickener in an unlocked cupboard within a communal area. Records for applying emollient and barrier creams to people’s skin needed to be improved. One person did not receive their antibiotic medicine in a timely way, putting them at greater risk of harm from an infection. Another person was given their medicines covertly, as agreed by their GP and advised by a pharmacist but there was no record of the person’s representative being consulted. A person had not received their prescribed medicine for several weeks due to an error which could potentially have caused harm. (This has been reviewed outside of the inspection process). The concerns demonstrated a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and we have requested an action plan to reflect how the provider will address this. Medicines were stored securely, stock records allowed all medicines to be accounted for and controlled drugs were handled safely. Weekly medicine audits were conducted and areas for action noted.