Paternoster House

We found the following examples of good practice.

There were sufficient stocks of personal protective equipment (PPE) which staff used appropriately. Staff had undertaken training in relation to infection control.

Cleaning schedules were increased to ensure high touch surfaces such as door handles and light switches were cleaned regularly. Additional cleaning had been introduced to maintain good hygiene standards.

Regular contact exchanges were arranged with people that used the service and their family and friends. Safe visiting spaces had been created.

Paternoster House is a care home providing personal and nursing care for 74 people at the time of the inspection. The care home can accommodate up to 108 people across four separate units over two floors.

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

The service’s quality assurance processes which were in place did not identify the concerns we found at the inspection. There were some areas of the environment that needed repair. Infection prevention and control policies and procedures were in place in line with the current government guidelines in respect of COVID-19 pandemic, however staff did not always wear the personal protective equipment (PPE) correctly. In addition, some aspects of environment did not allow for effective cleaning. The service was following government guidelines for visitors, and COVID-19 swab testing was being carried out for people and staff.

There had been frequent changes to management which had impacted on staff morale and effective oversight in some areas. The new manager had been in post for a few weeks prior to the inspection. They had made changes to the daily management and had taken a proactive approach to making improvements. Staff were positive about the new manager and the changes they were making.

Some incidents and accidents that should have been raised as safeguarding concerns had not been identified. The new manager was carrying out audits and analysing incidents and accidents and reporting safeguarding concerns. This gave us reassurance that the processes were being followed.

People and their relatives told us they felt safe using the service and knew how to raise any concerns. Staff had received safeguarding training. People and their relatives told us they were happy with the care provided and staff were kind and caring.

Care plans contained risk assessments. Where risks had been identified, people were referred to the relevant health professional for advice.

The service followed a safe recruitment process. There was enough staff on duty to meet people’s needs. Staff received medicine administration training which included observations in practice to ensure competency. Medicine management followed legislation and guidelines.

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 9 April 2019).

Why we inspected

We received concerns in relation to the management of the service, incidents and accidents and infection control. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.

We reviewed the information we held about the service. No areas of concerns 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.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. At the time of inspection and since the inspection, the provider has responded positively, and some improvements have been made. Please see the Safe and Well-led sections of this report.

You can see what action we have asked the provider to take at the end of this report.

The overall rating for the service has changed from Good 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 Paternoster House on our website at www.cqc.org.uk.

Follow up

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

Paternoster House is a care home with nursing. Many of the people living at Paternoster House are living with dementia. They also support younger people with complex nursing needs. At the time of our inspection 92 people were living in the home.

People’s experience of using this service:

People living in the home received personalised care that focussed on the quality of their lived experience. Staff were kind and compassionate in their approach and we saw people were supported to maintain their identity, independence and to carry on with their interests. Visitors were welcomed into the home, which had a pleasant environment, with plenty of variety in the areas people could spend their time. The staff focussed on ensuring people had opportunities for engagement and a wide range of activities were offered that reflected people’s individual tastes and needs.

People received care from suitable staff who were supported and developed by the provider. Staff felt valued by their managers and the registered manager recognised the contribution staff made to the home.

People were kept safe by the systems in place to mitigate risks. People were supported to take risks and make their own decisions. People were supported safely with their mobility and staff ensured people were informed about what was happening to make sure they felt secure. People were supported to take their medicines and confirmed staff offered them pain relief if they needed it. Healthcare professionals told us they had strong links with the home and this was reflected in people’s experience of being able to access healthcare services easily and in a timely way.

The registered manager had developed a positive, person-centred culture in the home. Complaints and incidents were investigated in a robust way and duty of candour obligations were met. Quality assurance systems operated effectively to address issues with the quality and safety of care when these were identified.

Support for people approaching the last stages of their life was not as detailed or personalised as other aspects of care. We have made a recommendation about supporting people to prepare for the last stages of their life.

Rating at last inspection:

The service was rated Good in all areas in July 2016.

Why we inspected:

This was a scheduled inspection in line with our public commitment to return to services within certain timescales.

Follow up:

We will continue to monitor the service to ensure it maintains its good rating.

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

There was a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run. The registered manager had a good knowledge about the needs and preferences of the people who lived at the home. They were committed to ensuring people received the best possible care.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

There were enough skilled, qualified staff to provide for people's needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills and were supported by way of supervisions and appraisals.

People's needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had a variety of nutritious food and drink available to them. There were freshly made, home cooked meals from a menu that had been devised using people's likes and dislikes. The chef made regular checks that people were happy with the meals and choices provided. Snacks and fruit were also available.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

In June 2013, the provider sent us a written plan to tell us the actions they had taken, and planned to take, to put this right.

We inspected the service on 30 September 2013 to check that the provider had taken appropriate steps to ensure that medicines were safely administered and that this was accurately recorded. We did not speak with people using the service at this inspection. We spent time in four different areas of the home over a two hour period and observed medicines being administered.

We saw that procedures for administering and recording medicines safely were followed. Records showed that the provider had taken action to ensure that staff understood the correct procedures. They also showed that the staff understood the serious outcomes that would follow if staff did not comply with these in practice.

People were provided with a choice of suitable and nutritious food and drink. There was a lack of clarity as to whether all of the people using the service were offered food between the evening meal at 5pm and breakfast the following morning. Overall, people were satisfied with the meals and drinks available.

People were not protected against the risks associated with medicines because the provider's procedures for administering and recording medicines safely were not always followed.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had effective recruitment process in place. People told us that the staff were able to provide the support and care that they needed. One person said, 'The staff are very good to me, very attentive and patient.'

The provider had a complaints system available. People we spoke with told us they could approach staff if there was anything that concerned them or they needed clarification on. Comments included, 'I have no complaints, I could tell them if I did', and 'I have no complaints or grumbles and have never had any concerns but would feel able to ask them about anything.'

We spoke with seven people and they all stated that they felt respected and confirmed that they could make choices. Three people pointed out that it took a long time to get help from NHS services. Although care plans addressed the issues people raised with us, they were not updated. They also confirmed people's concerns about the long time needed to resolve these concerns.

Safeguarding procedure and measures were in place and ensured that people were protected. All seven people who we spoke with confirmed that they felt safe. Two staff members also confirmed that they were aware of and confident in how to deal with any potential safeguarding issue.

The provider had a system in place monitor the quality of the service.