The Paddocks Care Home

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.

The Paddocks is a residential care home registered to provide personal care for up to 100 older people, some of whom may be living with dementia. There were 63 people using the service when we inspected. The Paddocks is split into three units, two of which are residential and one which was for people living with dementia. One of the residential units was in the process of being refurbished and had minimal occupancy. The dementia unit was a totally separate building and operated somewhat independently with its own staff.

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

Poor communication and recording systems placed people at risk. Audits did not identify patterns and trends relating to risk. This meant staff did not take prompt action to mitigate risk and ensure they met people’s individual care needs.

The environment posed some health and safety hazards, some of which had been identified by the service but not acted upon. Systems designed to give oversight of various aspects of the service were not robust. This was of particular concern in the main kitchen. This was not clean even though regular cleaning schedules had been signed as being completed and cleaning practices regularly audited. Domestic cleaning staff understood infection control procedures but poor hygiene practices in the kitchen placed people at risk.

The poor recording, ineffective auditing and lack of co-ordinated systems to identify and meet people’s care needs meant that we had significant concerns about the leadership and governance of the service.

Following our inspection we required the provider to take action on the most serious issues we found, relating to the safety and quality of the service. The provider did this and continued to keep us updated about their progress. Due to this prompt and comprehensive response, and the open and honest dialogue the provider had with us, we did not take any urgent enforcement action.

Staff were recruited safely and staffing levels were appropriate on the days of our inspection. However, some people shared negative feedback about sometimes having to wait an excessively long time for personal care. Medicines were well managed, and staff understood their responsibility to safeguard people from abuse and effective systems were in place.

Staff were trained and supported to carry out their roles. Staff managed people’s healthcare needs well but poor information systems meant some people did not always get the care they needed. People’s dietary needs were not always well managed. Feedback about the food was not positive and the service did not always identify and respond quickly to people’s increasing or decreasing weight.

People consented to their care and support, although some records relating to consent required reviewing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were caring, patient and kind. They went the extra mile and feedback about the staff was very positive. They created a warm and homely atmosphere within the service. However, constant call bells, set off by motion sensors on the unit where people were living with dementia, impacted negatively on this and caused people living there some distress.

Poor recording systems made it impossible for staff to demonstrate they provided person centred care. Repositioning, food and fluid charts were not always completed and we were not assured people were getting all the care they required.

The service provided appropriate activities for people on the residential wings and supported them to follow their hobbies and interests. People living with dementia were not so well catered for and most were under occupied much of the time.

There was an effective complaints policy and procedure in place. People received good end of life care and their wishes regarding the end of their life were recorded.

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

Rating at last inspection

The last rating for this service was Good (published 22 September 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety, the cleanliness of the environment, person centred care and leadership at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an updated action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 rating, we will take action 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.

The service provides residential and nursing care for up to 100 people, some of whom are living with dementia. The service is divided into three separate buildings providing residential, nursing and dementia care respectively. At the time of our inspection at total of 80 people were using the service including several for respite care.

A registered manager was in post and had been very recently registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 rated the service Good. However some concerns were raised in the earlier part of this year about the unsafe management of medicines on the dementia unit and about other poor practice. The local authority investigated concerns and the provider worked hard to address all concerns. At this inspection we found that the new registered manager had put plans in place to bring about the required improvements. This was still a work in progress but the management team demonstrated good oversight of the work needed and had plans and strategies in place to continue to develop the service.

Medicines were managed safely and people received their medicines as prescribed. Robust new auditing and checking procedures ensured errors had been reduced and staff were confident in the management of medicines.

Staffing levels, and the deployment of staff, were a concern for some people and had an impact on the timeliness of care provided. Measures had been put in place to review staffing levels and these had already been increased. However, people on one unit reported occasionally having to wait too long for staff to meet their care and support needs.

Risks were assessed, documented in care plans and measures put in place to reduce these them. Health and safety audits and learning from ‘near miss’ incidents contributed to ensuring people were safe.

Infection control measures were in place and staff had a good understanding of how to limit the risk and spread of infection.

Staff were trained in safeguarding people from abuse and the manager referred incidents appropriately to the local authority safeguarding team for investigation.

Staff received a good induction and relevant training to help them carry out their roles. Staff were supported with regular meetings, supervision and appraisal.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals and relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Practice related to MCA and DoLS was good and the service operated in line with legal requirements. Staff sought consent appropriately for day to day care support.

Oversight of people’s nutritional needs was good. People who used the service praised the food and those at risk of not eating or drinking enough were appropriately monitored and referred to dieticians if needed.

People were supported to access the healthcare support they needed promptly. There was evidence of good partnership working with the GP, GP matron service and district nursing team. Feedback from healthcare professionals was positive.

Staff were very caring and treated people respectfully, ensuring their dignity was maintained.

People who used the service, and their relatives, were involved in planning and reviewing their care and had opportunities to feedback about the service.

People received care that met their individual needs and took account of their likes, dislikes and preferences. Staff respected people’s individuality.

People were supported to follow a range of hobbies and interests and to be involved in their local community.

A complaints procedure was in place and complaints were very well managed with information shared with staff and lessons learned. Verbal and written complaints were thoroughly investigated and responded to in writing.

The new registered manager had introduced new systems and procedures to drive improvements. Their approach had been well received by the people who used the service, relatives and staff. Audits were in place to monitor the safety and quality of the service and were effective in identifying concerns and effecting change. The manager had innovative ideas and maintained good oversight of issues which affected the service. Where issues still required some further work we had confidence in the provider to continue to address these.

As part of this inspection we spoke with 12 people who used the service and one visitor. We also spoke with the manager, a Director who represented the provider, and 10 members of staff. We reviewed records relating to the management of the service which included four care plans, daily records, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risk assessments for care needs were completed and provided appropriate guidance for the identified risk to be reduced. They stated they were involved in reviewing their care plan and were supported to make decisions regarding their immediate care needs and wishes.

People received the care and support they required to improve their health and well-being. Care records were written in enough detail to provide clear guidance to staff members.

Applications had been appropriately made in regard to Deprivation of Liberty Safeguards for people whose liberty was restricted. Staff members and the manager showed they had appropriate knowledge regarding recent guidance.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. They told us they would be able to tell someone if they were worried, but that they had not needed to.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

Recruitment checks were carried out or obtained prior to new staff members starting work with the service.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with. They told us that they were satisfied with the care they received.

They told us and we observed that staff members told people what they were going to do before carrying out any tasks and gave people the opportunity to decline if they wished. Assessments of people's mental capacity were completed and information was available to staff members if people did not have the capacity to make certain decisions.

Health needs were responded to and people had access to health care professionals if they needed this. Information and guidance given by health care professionals was included in people's care records so that staff members knew how to promote their health.

Is the service caring?

People said that staff members were polite and kind; they respected people's privacy and dignity, and involved them in their care. Everyone we spoke with had confidence in the staff and felt that they had a good relationship with them. We heard comments such as, 'We're all treated very well', 'The staff are very nice and treat you very well' and, 'They are very nice to us'. Staff members knew people's care needs and their personal preferences when we spoke with them.

We observed interactions between people and staff members and we found that the members of staff were patient and understanding of people's individual needs.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and planned for. Their individual choices and preferences regarding their support and care were respected.

Is the service well led?

There had been an annual survey to gather the views of people using the service last year. Responses from the last survey were positive. There were other systems in place to monitor and assess the quality of the service provided; the service had analysed this information for any trends or themes resulting from complaints, accidents or incidents.

Our observations of staff in the home and speaking to people living there showed that management of the service was a strong element in the day to day running. One person said about the manager and her assistant, 'They're always around the place. They may be the people running it but they work hard'. A staff member told us that, 'There is a strong and caring management team here'.

Infection control and hygiene procedures needed to be improved in a number of areas in the home, including clinical areas, to ensure people's safety. Improvements were also needed to the monitoring and auditing of infection control.

Improvements were needed regarding the administration, ordering and temperature control of medication.

Staff received ongoing training in mandatory subjects. There were supervision and appraisal arrangements in place.

Arrangements were in place to gauge people's opinion of the service. Meetings were held with staff to discuss issues and developments in the home. However there were not effective quality assurance procedures in place to adequately monitor some processes and practices to ensure the safety of people living in the home.

During our inspection of 16 October 2012, records seen demonstrated to us that care and treatment was provided to people according to their specific needs. People's needs were assessed and reviewed regularly with clear guidelines in place for staff to provide individual care.

Staff and senior management had undertaken training provided by Norfolk Safeguarding Services to ensure that people were protected from the risk of abuse. Safeguarding policy's and procedures had been updated in line with Norfolk Safeguarding's own guidance, and staff were able to demonstrate to us a clear understanding of safeguarding procedures in line with these policy's.