Archived: The Paceys

The Paceys is part of The Wilf Ward Family Trust, a not for profit organisation. It is a home providing a short breaks residential service with a holiday style atmosphere providing personal care and can accommodate up to seven young adults with learning and/or physical disabilities and younger people. At the time of the inspection, the provider told us 45 people were receiving support from the service. During our inspection 2 people were staying at the home.

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

Right Support: 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. However, we found capacity assessments and best interests had not always been recorded or updated. This was identified on the provider’s continuous improvement plan to address when people next visited the home.

Medicines were managed safely although some records were not well completed. Documentation relating to medicines given on top of food was not in place for 1 person and some controlled medicine records had not been signed by 2 staff members. Risk assessments included detailed information about people's needs.

Right Care: Staffing levels were sufficient to meet people's needs. However, the provider acknowledged difficulties in recruiting staff and had therefore reduced the hours the service opened to ensure the quality of care remained good. Systems were in place to safeguard people from the risk of abuse and people told us they felt safe with the staff who supported them. Incidents and accidents were reported, investigated and measures taken to mitigate future occurrences.

Right Culture: The provider had robust quality assurance and governance systems in place to assess, monitor, and improve the quality and safety of the service. People and their relatives knew how to complain and felt comfortable raising concerns with the provider. People and their relatives told us they were happy with the support they received. Staff felt supported by the management team.

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 7 June 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the Key Questions Safe and Well Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have made a recommendation about the Mental Capacity Act.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

We were assured that this service met good infection prevention and control guidelines.

Risks of visiting professionals spreading infection were reduced. Visitors had their temperature taken and were asked about their health before entering the service. As the service is a respite stay visitors picking up or dropping off people did not enter the building.

Staff supported people to keep in touch with family and friends through video and phone calls to prevent isolation and promote people's mental wellbeing. Internal activities were also carried out to make up for the lack of community activities.

Cleaning schedules had been expanded to address more at risk areas of the building. The home was cleaned regularly using products appropriate to minimise COVID-19. Handwashing was encouraged.

Staff were trained on how to keep people safe from the risk of infection and use PPE correctly. Through observation and discussions with staff, it was clear training was well embedded.

The provider had appropriate arrangements to test staff for COVID-19 and was following government guidance on testing.

Further information is in the detailed findings below.

At the last inspection in January 2015 the service was rated Good.

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

At this unannounced inspection on the 7 June 2017 we found the service remained Good. The service met all relevant fundamental standards.

The service has 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.

Staff were knowledgeable about how to recognise signs of potential abuse and aware of the reporting procedures. Assessments we saw identified risks to people and management plans to reduce the risks were in place. We received extremely positive feedback from relatives of people who used the service. People we spoke with told us they felt safe and enjoyed staying at The Paceys.

Robust recruitments procedures ensured the right staff were employed to meet people’s needs safely.

At the time of the inspection there was sufficient staff on duty to meet people’s needs. Relatives told us that during the respite stays there was adequate staff to meet people's needs and facilitate regular activities.

Systems were in place to make sure people received their medications safely during their stay. This included medication training and regular checks and audits of the system.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People were treated with respect. People and their relatives told us staff were kind and very caring. Staff we spoke with were able to explain how they respected people’s choices, preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs while supporting them.

There was a system in place to tell people how to raise concerns and how these would be managed. Relatives told us they were listened to and felt comfortable raising any concerns with the management team.

Relatives told us they were very happy with how the service was run. There were systems in place to monitor and improve the quality of the service provided. Action plans were implemented for any improvements required and these were followed by staff.

The quality monitoring had identified that some environmental improvements were required, we saw that many had commenced including redecoration of communal areas and this was planned to continue into all areas. However, the kitchen required remedial work but there was no dates agreed for implementation of these improvements.

Staff were clear about their roles and responsibilities and had access to policies and procedures to inform and guide them.

Further information is in the detailed findings below.

We looked at three care plans, risk assessments and daily notes. We found that they were up to date and included detailed information which enabled staff to provide appropriate support. We saw that guests who used the service treated the break as a holiday and had opportunities to engage in a wide range of different activities of their choice throughout their stay.

We found that medication was stored, administered and recorded in accordance with clear procedures and staff understood what the medication was for and what some of the side effects might be.

We looked at three staff records and found that staff had been recruited in line with the policy of the provider and all checks had been completed. A recent recruitment process had involved people who use the service and their relatives.

We saw that the provider had processes in place for gathering feedback on the service, auditing systems and responding to complaints. We observed that the provider had acted on feedback in order to improve the quality of the service.

We spoke with three people who used the service, who told us they were happy with the care and support they received. They confirmed that the staff treated them with dignity and respect. One person told us; "I can stay up as late as I want and get up when I feel like it" and “We choose what we do, I like going clubbing best.” Another person said; "I love coming here." We observed people who used the service were being treated with respect and dignity.

We looked at four care plans and found that they were up to date, provided good information about how people's care and support needs were assessed. People said they were happy and felt safe staying at the home. We looked at three staff files and saw evidence that demonstrated appropriate training was provided to staff. We also saw evidence that the provider had systems in place for tracking and responding to complaints received.