Archived: Paddock Lodge

Updated 7 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 and 29 August 2017 and was unannounced. The inspection team consisted of two adult social care inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The registered provider had not been asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Prior to this inspection we reviewed information we had received from the provider, such as statutory notifications. We also contacted Healthwatch to see if they had received any information about the provider or if they had conducted a recent ‘enter and view’ visit. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We contacted the local authority commissioning and monitoring team, infection control teams and reviewed all the safeguarding information regarding the service.

We used a number of different methods to help us understand the experiences of people who lived in the home. We observed the lunchtime experience in the communal dining areas and in one of the communal lounges. We spoke with five people who lived at Paddock Lodge and three relatives who were visiting during our inspection. We spoke with a further three relatives over the telephone following our inspection. We spoke with the area manager, the manager, two team leaders, and two care staff.

We reviewed five care files and daily records for people living there. We also reviewed the maintenance and audit records for the home and records relating to staff and their training and development.

Updated 7 October 2017

This inspection took place on 22 and 29 August 2017 and was unannounced. The service was previously inspected on 27 February and 10 March 2017 and was in breach of the regulations in safe care and treatment, good governance and staffing. The registered provider sent us an action plan and at this inspection we checked to see if improvements had been made.

Paddock Lodge is registered to provide accommodation and nursing care for up to 24 older people. There were 21 people living at the home on the first day of our inspection. There was a registered manager in post who had been registered since 2014 and was currently working part time at the service. They intended to deregister once the person who is in the role of manager registered with the Care Quality Commission. 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 our last inspection we found not all risks had been minimised to ensure people were safe. There had been improvements in this area but we still had some concerns in relation to moving and handling for those people requiring support to move.

Risk assessments had been undertaken for those people at risk of malnutrition and pressure ulcers. The home completed risk assessments to minimise falls, infection control hazards and choking. The manager had analysed falls and implemented measures to reduce the number of falls at the home which had been effective.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents.

At our last inspection we concluded there were not enough staff to ensure people were supported safely. At this inspection we found staffing numbers had increased to ensure there was always a member of staff to support people in the communal areas.

Medicines were administered safely and we observed medicines being administered appropriately during our inspection. However, the temperature of the storage area had exceeded recommended guidelines which meant they were not stored safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The manager understood their responsibility in relation to the Deprivation of Liberty Safeguards and had appropriately applied for authorisations. There had been some improvements around the assessment of mental capacity but further improvements were required.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people told us they enjoyed the food. People received support to access health care services to ensure they maintained their health and wellbeing.

People told us staff were kind and caring and we saw this ourselves during the inspection. Staff knew people well, and were patient and kind in their interactions. People's privacy and dignity was respected and their independence promoted.

Support was provided for people to maintain their cultural and religious preferences, including meal requirements and help to practice their faith.

People were provided with care which met their choices and preferences and they were encouraged to share their views on how they wanted the service to be run.

The home did not have a dedicated activities coordinator and staff undertook activities with people in and amongst their caring duties. There was a programme of activities available and we received a mixed response in relation to whether people were satisfied with the level of activities on offer. We have made a recommendation about the provision of meaningful occupation to improve mental wellbeing.

Care records had improved. Some records we reviewed contained information to enable staff to provide personalised care, whereas others needed further improvement.

People living at Paddock Lodge and care staff told us the managers were approachable and supportive; they felt listened to if they had any concerns. The service was meeting its statutory obligations in terms of displaying their CQC ratings and notifications to CQC had been made as required