About the service: Penniston Barn is registered to provide accommodation and personal care for up to six people with learning disabilities and autism. At the time of inspection, six people were using the service. The service was located in a rural location, away from populated areas.

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.

This focused follow up inspection was unannounced and took place on the 23 November 2016.

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.

This inspection took place on 11 and 12 May 2016 and was unannounced. At the last inspection in October 2014, we found the provider was not meeting all the legal requirements in the areas that we looked at. We asked the provider to take action to make improvements to the assessment of risk to people, the maintenance of the environment and the impact this had upon people and the way by which staff were recruited to the service. We also asked that they look at the staff training processes, the content and review of people’s care records and the quality assurance processes used to drive future improvement.

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 varie

When we visited Penniston Barn on 12 June 2013, we used a number of different methods to help us understand the experiences of people using the service. This was because some people had complex needs which meant they were not always able to tell us their experiences.

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.

We carried out this visit on 26 October 2012 to follow up on a previous visit we had made on 29 May 2012 when we had identified areas of no compliance that we considered had an impact on the people using the service.

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

We made a visit to this service on 29 May 2012 as a result of whistle blowing concerns that had been raised with us. During the visit we spoke with people who were able to communicate with us and we used a number of different methods to help us understand the experiences of those who had complex needs which meant they were not able to tell us their experiences. We observed the care provided and the interaction between the people using the service and the staff team, spoke to social workers who had carried out reviews, and tracked the care provided. We observed that people who use the service were relaxed in the staff company. One person told us that the staff sometimes ignored her and we saw an example of this while staff were eating. We saw that people using the service had access to the kitchen and could request food when they wanted it although they were not involved in preparing or planning meals.

We spoke with one of the five people using the service about their experience with medication. We asked about self medication and were told “staff have the keys and look after the medicines not me”. We did not see how the decision that staff should hold all medications on behalf of people using the service had been made.

This inspection took place on 22 and 23 October 2014 and was unannounced.

We had received information of concerns and based on this information we had decided that an inspection was required to establish whether the concerns were legitimate and whether people were at risk. We raised a safeguarding alert to Central Bedfordshire Safeguarding Team. We spoke with the local authority about this service.

Penniston Barn is a care home that provides accommodation and personal care for up to six adults with learning difficulties. On the day of the inspection, there were five people living in the home.

There was a registered manager at the time of our inspection. 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.

The recruitment procedures were not effective. People were put at risk because Disclosure and Barring Scheme (DBS) checks had not been carried out before staff were able to provide personal care. There were insufficient numbers of suitably qualified, skilled and experienced members of staff on duty to meet the needs of people.

People’s dignity was not respected. Although people were treated with respect, there were practices that did not promote and respected their dignity. Information about the safeguarding procedures and how to report any allegations of abuse outside the service was available.

The changing needs of people had not been reflected in their care plans and therefore up to date information was not available to staff when supporting people in meeting their needs. Where people were experiencing behaviour that challenged others, the help, support and advice of other health care professionals had not been sought.

People were put at risk of harm or injuries because the premises had not been safely maintained.

The management did not promote a culture of learning or reflective sessions following incidents to prevent recurrence.

We had issued a warning notice and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Regulations 2014. ‘You can see what action we told the provider to take at the back of the full version of the report.’