Penwortham Grange and Lodge

Penwortham Grange and Lodge is in a residential area of Penwortham. The home offers residential support for up to 86 people who do not require nursing care. The home is split into the Grange and The Lodge, The Grange for 44 older people, and The Lodge for 42 people living with dementia. Each area is further divided into an upstairs unit and a downstairs unit. All bedrooms are single occupancy with an en-suite shower and toilet. At the time of the inspection the home was providing care and support to 48 people.

We found the following examples of good practice.

The provider had established robust systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting including, displaying notices at the entrance to the home advising people not to enter if experiencing symptoms of COVID-19 and providing personal protective equipment (PPE) to visitors.

Arrangements had been put in place for testing and screening visitors for symptoms and their contact details were recorded to support the NHS Test and Trace service. The provider had established two visiting pods for facilitating safe visiting. They had followed national guidance on visiting including an individual approach to visiting arrangements. Technology such as video calling was used to facilitate contact between people and their relatives as well as medical professionals. Staff maintained regular contact with relatives.

The home had adequate sitting areas for people to use. Seating had been arranged to support people to social distance. The provider had ensured the building had adequate ventilation to promote air circulation.

The provider followed best practice when people were admitted to the home. People had a negative COVID-19 test before moving into the home and self-isolated in their rooms for 14 days after moving in.

During our visit we observed the staff using PPE safely, he registered manager regularly monitored this. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had supported people and staff to receive the COVID-19 vaccines. Staffing deployment supported cohorting (staff working in separate designated units) to prevent the spread of infections.

The home was clean and hygienic. Cleaning schedules were in place and frequently touched areas were cleaned regularly throughout the day to reduce the risk of infection. Staff had received training in infection prevention and control and the registered manager monitored staff’s well-being during the pandemic including access to counselling and mental health services.

The registered manager had completed risk assessments for people and staff who were likely to be at high risk of infection from COVID-19.

The provider had detailed and up-to-date infection prevention and control policies and procedures. They sought and acted on advice to further improve infection prevention and control procedures. They were aware of appropriate agencies to contact in the event of an outbreak of COVID-19.

The inspection visit took place on 25 and 26 September 2018. It was unannounced on 25 September and announced on 26 September.

At the time of the inspection 79 people lived at the home.

At our last inspection we rated the service good in all domains. On this inspection, we found the service good in safe, caring, responsive and well led. The effective domain was requires improvement. We found the evidence continued to support the rating of overall good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in place. 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. There had been a change of registered manager since the last inspection. The current manager had been in post for around one year. When we undertook this inspection the registered manager was on annual leave.

Medicines were entered stored and disposed of safely, but were not always given at the prescribed intervals. On occasions the intervals between doses of medicines were insufficient. Not leaving an adequate gap between doses of this medicine could place people at risk of unnecessary side effects. This was rectified immediately after the inspection.

People able to consent said staff checked they agreed for them to provide care and support. Where people did not have capacity to make specific decisions best interests decisions were not always clearly recorded and Deprivation of Liberty Safeguards (DoLS) applications were not always completed or renewed promptly. However, these were completed by the second day of our inspection.

We looked around the building and saw accommodation and equipment to assist people with mobility and personal care was in place, had been serviced and maintained as required. The décor in the Grange met and was appropriate for people’s needs. The Lodge had been recently been redecorated and looked clean and maintained. However social and leisure equipment aimed at encouraging interest and interaction from people with dementia was not in place.

We made a recommendation about providing access to dementia friendly equipment.

Staff had been recruited safely and received training sufficient to develop the skills and knowledge. Most people spoken with told us there were usually enough staff on duty and they didn’t have to wait for long if they called staff. However, we saw the downstairs dementia unit was busy at mealtimes and could be unsettled. We also received a number of comments that staff were very busy including, “The staff are very busy at times – too busy. My issues would be because of not enough people around.”

We made a recommendation that staffing be kept under review.

People told us they felt safe and looked after by staff. One person told us, “I feel safe because I can ring the bell and someone will come to see me.” Another person said, “Of course I feel very safe.” There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments had been developed to minimise the potential risk of harm to people. These had been kept under review and were personalised to meet people’s needs.

We observed interactions between staff and people who lived at the home. These were positive friendly and supportive. We saw staff were attentive to people’s needs and wellbeing and responded promptly to requests for assistance. Staff provided care in a personalised way, taking people’s preferences into account. One person told us, “This is definitely a very good home. I wouldn’t want to leave here it is lovely.” One relative said, “I can’t say enough or praise this home high enough. It has a wonderful feel. My relative is content and that speaks volumes.”

Staff were aware of the importance of upholding people’s rights and diverse needs and treated people with respect and care. People told us they were supported in the way they wanted. They said staff provided care in a way that respected their dignity, privacy and independence. One person told us, “The staff are very respectful. They make sure they keep my dignity intact.”

We saw people had access to healthcare professionals. People told us staff cared for them in the way they wanted and met their care needs promptly. They referred them to healthcare professionals in a timely way. Surveys and written compliments showed staff provided caring and compassionate end of life care. A relative wrote, ‘We are grateful for the dedicated care [family member] received during her time in the home. Everyone cared for her with great kindness and understood her dementia.’

People told us they could get involved in social and leisure activities although these were more limited for people with dementia. Staff were welcoming to peoples’ families and friends. People said this assisted their well-being.

People told us they enjoyed the food provided and had choice and variety. We observed the lunchtime meal. People received sufficient food and drink and the assistance they needed to meet their diverse needs. The kitchen was clean, organised and stocked with a variety of provisions and staff were trained in food safety. A relative told us, “I’ve had several meals here. It is like being in a five-star hotel.”

There were safe infection control procedures and practices and staff had received infection control training. Staff wore protective clothing such as gloves and aprons when providing personal care to people so they did not risk causing cross infection. One person said, “I am impressed by how clean the environment has been and the quality of care.”

People who lived at Penwortham Grange and Lodge, their relatives and staff were positive about the management support in the home. Relatives said the management were very responsive and helpful. “The staff have a lovely pleasant manner and are so helpful, since [registered manager] came.” A member of staff said, “It’s all down to [registered manager], she’s brilliant. She has a presence about her and inspires us.”

The management team sought people's views in a variety of ways. They assessed and monitored the quality of the service through audits, resident, relative and staff meetings and surveys. People told us the management team were approachable and willing to listen. They knew who to complain to if they were not satisfied with their care and felt appropriate action would be taken. People also had information about support from an external advocate should this be required.

Further information is in the detailed findings below.

Relatives were very pleased with the care at the home. Comments included, 'My father and I are both happy with the quality of care.' And 'I couldn't fault them.'

Residents also told us their support needs were being met. We were told, 'They are very kind and come when I need them to help me.' And 'They will phone the doctor if I am ill.'

Staff training, written guidance and good practice helped to safeguard people against the risk of abuse. Staff were clear about their respective roles in identifying and reporting concerns or allegations.

The range of staff, with different roles, skills and responsibilities helped ensure people's needs were being met. Staff worked well together and were clearly well organised.

Residents and relatives gave positive feedback about staff at the home. One relative told us; 'From care staff up to management, they are all very good.'

There were procedures in place to assess and monitor quality at the home. Regular checks and audits promoted the safety of staff and people living in the home.

Relatives confirmed they felt able to speak with senior staff if they had any concerns and were confident that any issue would be dealt with. One relative told us, 'When I have had to mention anything, they have bent over backwards to sort it out.'