Archived: Paramount Care (Gateshead Ltd)

Updated 6 July 2022

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 team

The inspection was carried out by three inspectors.

Service and service type

Paramount Care (Gateshead Ltd) 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

We gave the provider short notice of the first date of inspection. This was because it is a small service and we needed to be sure the provider or registered manager would be in the office to support the inspection and prepare people for our visit.

We visited the home on 22 July 2021, 3 August 2021 and 9 August. We returned to the home on 21 September 2021 as part of this inspection due to further risks identified by visiting professionals.

What we did before the inspection

We reviewed the information we held about the service including information submitted to CQC by the provider about specific incidents. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We sought feedback from the local authority contracts monitoring and safeguarding adults' teams and reviewed the information they provided. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service about their experiences of the care provided. We spoke with 25 members of staff including support staff, team leaders, a deputy manager, a service manager, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included seven people's care records and nine people’s medication records.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked this was a suitable communication method and people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with one person which enabled them to tell us their experience.

After the inspection

We contacted two relatives to seek their views on the service and the care provided. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, policies and procedures, were reviewed.

Updated 6 July 2022

About the service

Paramount Care (Gateshead Ltd) is a residential care home providing personal care for up to 20 people with a learning disability and/or autism. At the time of inspection 18 people were living at the home.

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

People were not receiving person-centred care that promoted their independence. People’s care records did not accurately reflect the support they needed. Care was not delivered safely, as risks people faced were not fully identified, assessed or reviewed which placed people at serious risk of harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care used at the service did not promote people’s independence or choice. For example, one person was unable to access the local community because they had displayed a behaviour which challenged the staff the day before, and another person could not access the community because staff did not know them well enough to support them. Care plans were written negatively. For example, care plans reflected only what people could not do and not what they could do independently. People’s choices were not documented, and people’s care and support plans were task orientated.

There was a negative staff culture at the service and there was no leadership by the registered manager. People did not live empowered or inclusive lives. People were not involved in their care, and advocate support was not always sourced in a timely way.

Infection prevention and control processes were not followed by staff. People were at risk of infection and COVID-19 as staff were not wearing PPE or wearing it appropriately. The provider failed to address these issues during the inspection process.

Medicines were not managed safely. Policies and processes in place did not provide sufficient guidance or information to allow staff to safely support people with their medicines.

Staffing levels were adequate but the deployment of staff did not always ensure people were supported safely, due to the additional tasks staff had to complete as part of their working day. People did not always receive care from staff who knew them well or were aware of their needs. Staff told us agency staff working with people did not have enough information available to provide safe care as records were missing or not fully completed.

The quality and assurances systems in place were not effective, audits were not fully detailed, and records were not always present. The provider failed to ensure the quality and safety of the service was monitored effectively. Records at the service, including people’s care records, were not always present, accurate or reviewed.

The home environment was lacking personalisation and mirrored a clinical setting. The fire risk assessment had not been reviewed since 2017 and the provider could not provide evidence to demonstrate issues identified as requiring action in 2017 had been completed.

Staff did not feel supported by the registered manager or management team. Staff had not received or completed all necessary training required to provide safe care to people. Some staff had worked with people for a long period of time and knew people well. People we spoke with said staff supported them kindly.

Due to the failings identified at the service, the local authority and Clinical Commission Group (CCG) have worked with CQC to provide additional support to the provider to ensure people receive safe care. A private consultancy company is now working with the provider’s management team to offer support and guidance to improve the service, recruit new staff and work with the provider to ensure they understand the regulations fully and their responsibilities.

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 10 October 2018).

Why we inspected

We received concerns about the safety of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We inspected and found there were concerns with the care people received and record keeping, so we widened the scope of the inspection to review all of the key questions of safe, effective, caring, responsive and well-led.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

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 in relation to safe care, staff training and knowledge, medicines management, person-centred care, promoting independence, infection prevention and control, governance and the leadership of the service.

On 11 August 2021, following our first site visits we imposed urgent conditions on the provider's registration to ensure they complied with government guidance for PPE, monitored and mitigated risk, and to ensure the provider has systems in place to have oversight of risk and infection prevention and control. We found these conditions were not being adhered to on 21 September when we returned to conclude our inspection. The provider had continued to place people at serious risk of potential harm.

Following the inspection we have taken enforcement action against the provider and have cancelled the location from the provider's registration and the home has now closed.

Follow up

We are currently having regular meetings with the provider, the consultancy company and the local authority to ensure people are receiving a better level of care. The consultancy company has been appointed by the provider to take over the day to day management of the service, ensure the safety of people and improve the service. We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We are currently working alongside the provider and the local authority to monitor progress and to make sure safe care is provided to people. 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.

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.