The Paddocks Care Home

Updated 17 March 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection activity began on 1 October 2020 and ended on 12 October 2020.

Inspection team

The inspection team consisted of three inspectors, an assistant inspector and two Expert by Experiences. 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 Paddocks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The inspection visit was announced. We gave the provider less than 24 hours’ notice. This was to check if any staff or people at the service had tested positive or had symptoms of COVID-19 and to discuss arrangements for the inspection.

What we did before the inspection

We reviewed all the information we held about the provider and feedback we had received about the service from the local authority, health professionals and the public since the last inspection. We used all this information to plan our inspection.

During the inspection visit

We visited the service on 1 October 2020 where we observed the care being provided to people and spoke with four staff members including kitchen and care staff.

After the inspection visit

On 5 and 6 October 2020 we spoke with four people who lived at The Paddocks and seven relatives over the telephone for their feedback about the quality of care provided. We also spoke with a further seven staff over the telephone. On 9 October 2020 we held a meeting with the registered manager to discuss infection control and governance. On 12 October 2020 we provided feedback about the inspection to the registered manager and the provider’s operations manager.

We reviewed a range of records. This included four people’s care records and multiple mediation records. We looked at three staff files in relation to recruitment and training. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 17 March 2021

About the service

The Paddocks Care Home is a residential care home that was providing accommodation and personal care to 38 people at the time of inspection visit. The service is registered to support up to 100 people.

The home is split into three units of accommodation, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia.

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

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

Some risks to people’s safety had been appropriately assessed and managed well but others had not. This placed people at risk of harm.

Systems and processes were in place to monitor the quality of care people received. However, these were not always robust at identifying shortfalls and therefore action had not always been taken to mitigate risks to people’s safety.

CQC had not always been notified of important incidents as is required by law, to enable us to carry out our regulatory duties.

People received their medicines when they needed them. People’s oral medications were managed safely but improvements are needed to the storage of prescribed creams to ensure they were safe to use.

Most areas of the service and equipment people used was clean. However, improvements are required to ensure the standard of cleanliness in all areas is maintained. Some practices were observed that increased the risk of the spread of infection.

Systems were in place to investigate any incidents or accidents that occurred. People and relatives had been consulted and kept fully informed during the investigation process as is required. However, lessons had not always been learnt to reduce risks to people’s safety.

There were enough staff available to keep people safe. Sufficient checks on a prospective staff member’s character had been performed to ensure they were safe to work in the service.

Staff felt valued and fully supported in their role. There was an open culture where people, relatives and staff felt able to raise concerns without fear.

Staff felt the home was managed well as did relatives, however the people we spoke with gave us mixed views within this area.

Communication with people and relatives during the pandemic had been good. They told us they had been kept fully informed about what was happening within the home with reasons given for example, when visiting restrictions had been put in place.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 17 April 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and staffing levels. We also wanted to check whether improvements had been made in relation to the key questions of safe and well-led. Therefore, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Paddocks Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches at this inspection in relation to the identification and management of risk, safeguarding, governance systems and failure to notify CQC of important incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.