Archived: Paradise House

Paradise House is a residential care home providing personal care to 37 people who lived with dementia at the time of the inspection. The service can support up to 39 people in one adapted building.

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

Since the last inspection there had been significant improvements. At the time of the inspection people were no longer at risk of avoidable harm and the service was managed in an effective way.

The provider had recruited a new registered manager and a new regional manager. The senior management team had addressed the failings outlined at the last inspection (January 2019) and sustained improvements made.

People received safe care and treatment. Accidents and incidents were analysed, and lessons learnt recorded. Staff supported people with positive risk taking.

There had been some improvement in the way people’s medicines were managed for example; ordering and receiving of medicines. However, we found some areas of medicines management still needed improvement. We did not find any evidence of actual harm caused and the provider acted on our concerns immediately. We were reassured by the action taken and therefore we have made a recommendation about the management of medicines.

People’s relatives said staff had sufficient training and were competent to undertake their role and responsibilities. Staff told us they received a good standard of training and felt supported. People received good nutrition and were encouraged to remain independent at meal times.

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. We made a recommendation about the recording of mental capacity assessments.

Staff supported people in a kind, respectful and dignified way. Staff had built trusting relationships with people and understood their needs and preferences. The provider had procedures in place to promote equality and diversity. There was an inclusive culture and staff understood the importance of working in a non-discriminative way.

People received person-centred care and care plans contained information about their needs and preferences. Staff were responsive to people’s changing needs. Staff responded in a person-centred way when people were distressed.

We found staff sometimes did not acknowledge when people were disengaged. The registered manager assured us they would work with staff to improve understanding of people’s non-verbal behaviours and how to stimulate people living with dementia to improve their quality of life.

People were supported in a person-centred way when at the end of their life. The registered manager had started to improve the way people’s end of life wishes were discussed, including their preferred place of care to die.

There had been significant improvement in the way the service was led. Staff, relatives and visiting professionals told us the registered manager had created a positive culture. There were improved systems in place to assess, monitor and evaluate the service.

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 12 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Paradise 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.

People’s experience of using this service:

The service had deteriorated since the last inspection.

The provider failed to ensure individual risk’s for people who lived at the service had been assessed and this placed them at significant risk of avoidable harm.

Records of medicines administered and medicines stock levels did not always correlate and we therefore could not be certain that people were having their medicines as prescribed.

Staff were not always safely recruited; the provider did not always make sure checks were done in relation to their previous employment.

The service did not always follow safeguarding procedures when a person had fallen.

People were protected by the prevention and control of infection.

On the day of the inspection our observations found that the service was adequately staffed however, people's relatives told us that staffing levels were not always sufficient.

There was a system in place for measuring outcomes for people who lived at the service however, it was not effective and did not highlight the shortfalls found at the inspection. We found that the management team did not effectively quality assure the service. We received mixed feedback about the manager from people who lived at the service and their representatives. The service was not consistently well led. Staff told us that they felt supported by the manager and senior management team.

More information is in the Detailed Findings below.

Rating at last inspection: Good (report published 09 January 2018).

Why we inspected: This inspection was in responsive to concerns we received from people’s representatives, external professionals and whistle blowing information received by the Commission and the local authority.

Enforcement: Please see the 'action we told the provider to take' section towards the end of this report.

Follow up: The overall rating for this service is inadequate and the service is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Paradise House is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The home provides accommodation and personal care for up to 39 people, including the elderly and people living with dementia. At the time of this inspection there were 32 people living at the home.

The service was managed by a registered manager who had been registered since April 2017. 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.

We found that there were appropriate policies and procedures in place for the safe management of people’s medicines and that people received their medicines as prescribed by health care professionals.

Equipment used in the home was checked and regularly serviced but we found an unsafe practice around the use of bed rails for one person that the registered manager and provider resolved during the inspection. This has led to a recommendation in the ‘safe’ section of this report.

The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe. We found evidence that where people lacked the capacity to make decisions about their care, their relatives had been consulted to help ensure any decisions made were in the individual’s best interests.

Proper records were kept around essential items of care, action had been taken to support people with sufficient numbers of well-trained staff and checks were being made to ensure that the service operated effectively.

People using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Recruitment checks took place before staff started work but some issues around checks of previous employers were noted that the provider acted upon and resolved during the inspection.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

People told us they enjoyed the meals they received. They were provided with a nutritionally balanced diet that catered for their dietary needs and preferences.

The registered manager and provider conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the registered manager and provider.

Checks were in place to ensure that fire safety arrangements were robust and related equipment was in working order. Fire alarm tests and drills and had taken place since the service opened. This meant staff and people were aware of the correct action to take should the building need to be evacuated.