Archived: Paramount Care (Gateshead Ltd)

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.

Paramount Care (Gateshead Limited) is a residential care home providing personal care to 20 people with a learning disability.

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

Staff maintained effective infection prevention and control (IPC) practices. The environment was clean. Staff understood the procedures to minimise the risks of infection. The provider had introduced checks to make sure visitors were safe to access the service. Staff used personal protective equipment (PPE) appropriately.

Staff told us safe staffing levels were maintained. Staff received the training, guidance and support they needed to care for people when they were distressed.

Incidents and accidents were investigated, and action taken to keep people safe.

The last rating for this service was good (published 12 October 2018).

Why we inspected

We undertook this targeted inspection to check on IPC practices and follow-up on recent anonymous concerns relating to staffing levels, managing behaviours that challenge and responding to incidents and accidents. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Paramount Care (Gateshead Ltd) is ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Paramount Care (Gateshead Ltd) can accommodate 20 people in one adapted building comprising of six different houses joined together and on the date of this inspection there were 17 people living at the home. Most of the people living at the home had fluctuating capacity due to an underlying medical condition or a learning disability.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice and the promotion of independence and inclusion. People with learning disabilities and autism using the service were supported to live as ordinary a life as any citizen.

There was a new manager in post who was in the process of registering with the CQC as the registered manager for the service 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.

The premises were safe and people felt safe living there. There were safeguarding policies and procedures in place to keep people safe. Staff had received regular training and supervision around safeguarding vulnerable adults. The manager at the home escalated all safeguarding concerns appropriately to the local authority.

Staff were recruited safely and had undertaken all necessary training to safely fulfil their role. Staff received regular supervision from the management team but the managers did not receive regular supervision or support from the provider of the service. There were regular health and safety checks of the premises by the manager. Risk assessments were in place to keep people safe in the least restrictive way possible. There was a fire risk assessment in place.

Infection control procedures were in place at the home and during the inspection we saw regular cleaning of the home. There was a business continuity plan in place to ensure the service could still provide care to people in the case of an emergency.

Medicines were safely managed and care was delivered in line with best practice and national frameworks. There were procedures in place to ensure the safe receipt, storage, administration and disposal of medicines.

Accidents and incidents were recorded, investigated, were appropriately acted upon and lessons learned were documented and shared with staff. Safeguarding concerns raised to the local authority were linked to the corresponding incident.

People’s treatment was delivered in line with best practice and current national frameworks. People’s needs were regularly reviewed and care plans were created in partnership with people. Consent was sought by staff before carrying out any aspect of personal care with people.

We saw regular involvement from GPs, local authority, clinical commissioning group (CCG) and other partnership agencies documented in people’s care files. Care files contained daily recordings of the support people received and we also saw referrals to other health care services within these.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. Staff demonstrated their understanding of the MCA and worked in accordance with this. The registered manager had made applications to the local authority supervisory body, on behalf of people living at the service, to restrict their freedom for their own safety in line with the MCA. We saw staff asking people for consent when supporting people with personal care. People had access to Independent Mental Capacity Advocates (IMCAs) and independent advocacy services if they wished to receive support to express their views. Information related to advocacy services was on display in the home.

Staff and people enjoyed a positive relationship and we observed kind and caring interactions. Staff knew people well and knew people's likes and dislikes. People were treated with dignity and respect and were supported to maintain a balanced diet.

There were three managers in post at the home who worked towards the same vision to improve the lives and independence of people living there. The new manager in post was applying to be the registered manager and the two other managers were the previous registered managers at the service. Both managers had de-registered within the CQC, one in August 2016 and the other in July 2018. All three managers were aware of their responsibility to ensure appropriate safe care was delivered. There was a quality and assurance framework in place used by the managers to maintain the safety and quality of the home. The provider did not have a scheduled governance framework in place to maintain oversight of quality and safety of the service.

Paramount Care (Gateshead Ltd) accommodates 20 people with learning disabilities in six different houses in the same complex. At the time of our inspection, there were 14 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Paramount Care (Gateshead Ltd) was last inspected by CQC in December 2016 and was rated Requires improvement overall. At the inspection in December 2016 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 17 (Good governance)

Regulation 18 (Staffing)

At this inspection we found improvements had been made in all the areas identified at the previous inspection.

The provider had taken seriously any risks to people and put in place actions to prevent incidents and accidents from occurring.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

Procedures were in place for safe the administration of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Staff were suitably trained and training had been arranged to update training when needed. Staff received regular supervisions and appraisals.

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

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Paramount Care (Gateshead Ltd). Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Support plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were supported to access the local community and to take part in events.

The provider had an effective complaints procedure in place.

Staff said they felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys. Family members told us the management were approachable and communication was good.

The provider had an effective quality assurance process in place and regular audits of the service were carried out.

Paramount Care (Gateshead Ltd) is registered to provide accommodation for persons who require nursing or personal care at The Ropery for up to 20 people. There were 15 people living at the home at the time of the inspection, most of whom were people with learning disabilities. The service is split into three six bedroomed houses, two four bedroom houses and six one bedroom flats. Some of the accommodation was used as additional communal areas or office space for staff.

The service did not have a registered manager as the previous manager had cancelled their registration in August 2016. The deputy manager was intending to register with the Care Quality Commission. 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.

Risks to people’s safety were now being correctly assessed and managed by the service so people were no longer at risk of harm. Routine health and safety checks in the service were more consistent and robust and actions arising from checks were completed by staff in a reasonable timescale.

Staffing was still under review with commissioners. People and staff told us they felt there was enough staff to provide support. People who used the service were supported to take part in therapeutic, recreational and leisure activities in the home and the community. We saw that occasional non-essential activity did not take place due to staff absence, but this was having a limited impact on the overall delivery of activities.

People’s medicines were well-managed by the service. Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines. The service had almost completed an action plan to improve medicines management and staff had attended recent update training.

Staff were trained in and demonstrated they had knowledge of the Mental Capacity Act 2005, though this was not always clearly reflected in the service’s records.

All people’s care plans had been updated in line with the provider’s new procedures. It was not yet clear how effective the review process was as records were not sufficiently detailed. It was not always clear whether people, or their representatives, were involved in their care reviews. Action was taken by the provider after our inspection to improve the review and recording process. Care plans were now consistent and contained the details to show how the service supported people in a manner of their choosing.

Staff told us they received day to day support from senior staff to ensure they carried out their roles effectively. However, formal induction and supervision processes were not always used to enable all staff to receive feedback on their performance and identify further training needs.

Arrangements were in place to request health and social care support to help keep people well. External professionals’ advice was sought when needed. Feedback from external professionals was that staff were now more engaged and consistent in responding to their advice.

Care was provided with kindness, compassion and in a dignified manner. People could make choices about how they wanted to be supported and were treated with respect. People told us they felt cared for by staff who listened to them.

The systems and processes in place to make sure the staff learnt from events such as accidents and incidents were now being used to good effect. Regular audits and checks of quality had improved.

People, relatives, professionals and staff spoken with all felt the manager and deputy were approachable. However, staff told us there was still a lack of communication from senior staff and a lack of progress in clarifying the leadership and future direction of the service.

There had been significant improvements following our last inspection to improve the care planning, safety and staffing of the service. However we still found areas that required further improvement in relation to consistent supervision of all staff and responding to staff concerns about the leadership of the service.

Paramount Care (Gateshead Ltd) are registered to provide accommodation for persons who require nursing or personal care at The Ropery for up to 20 people, mostly with a learning disability. There were 16 people living at the home on day one of the inspection, one person was absent. The service is split into three six bedroomed houses, two four bedroom houses and six one bedroom flats. Not all the rooms were registered so the houses had un-used rooms; some were used as additional communal areas or office accommodation.

There was a registered manager who had been in post since June 2015. They informed us they were in the process of de-registering. 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.

Risks to people’s safety were not always correctly assessed and managed by the service so people were at risk of harm. Routine health and safety checks in the service were not robust and actions were not taken by staff in a reasonable time. The provider did not take actions after our last inspection and people experienced avoidable harm as a result.

Staffing was not always deployed effectively across the houses to provide consistent support throughout the day and night. Senior staff had to support staffing teams when required rather than manage the service effectively.

People’s medicines were managed well. Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines.

Staff had attended training and demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005, but this was not always reflected in the records or in how care plans were developed. Not all care records were written in a person centred way and it was unclear how progress towards goals was being made or evaluated for some people. Some people’s care plans had been specifically targeted and updated, but others had not been updated.

Staff told us they received day to day support from senior staff to ensure they carried out their role effectively. However formal induction and supervision processes were not used consistently to enable staff to receive feedback on their performance and identify further training needs. It was not always clear if staff had successfully completed induction as the service did not keep effective records.

Arrangements were in place to request health and social care support to help keep people well. External professionals’ advice was sought when needed, but some external professionals told us that staff did not always use advice consistently across the service and that staff needed support to complete behaviour support documentation.

Care was provided with kindness and compassion. People could make choices about how they wanted to be supported and staff listened to what they had to say. People told us they felt cared for by staff who listened to them. People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and choice. However not all peoples care documentation, which could support staff’s understanding of how best to support them, was completed.

It was not always clear that people, or their representatives, were involved in their care planning and review. Care plans were inconsistent and did not contain enough detail to show how the service supported people in a manner of their choosing.

People who used the service and visitors were supported to take part in therapeutic, recreational and leisure activities in the home and the community.

There had been limited progress in the action plan submitted to us after our last inspection. The service had not taken clear action after the last inspection leaving a number of areas unimproved. The systems in place to make sure the staff learnt from events such as accidents and incidents were inconsistently used by staff.

The provider had not always notified us of incidents that occurred, as required by current regulations. How people were consulted on the service provided was varied across the service.

Those people, relatives, professionals and staff spoken with all felt the registered manager was approachable. However some external professionals and staff told us they felt team leaders and overarching leadership of the service was inconsistent.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People had their needs assessed and the assessments were used to develop personalised care plans. One person said, "My life is better now since I move here. Staff are totally different, bubbly and smiley all the time and interact with you all the time. They are always there for you and are very approachable." Another person said, "I am very pleased to be here", and, "I like it here because members of staff are so good at supporting me."

The provider had policies and procedures in place to protect people from the risk of abuse. Staff had completed safeguarding training and had a good understanding of safeguarding. People said staff had spoken to them about keeping safe and what to do if they had any concerns.

Care staff said they were well supported by their manager and had regular supervision. One staff member commented that their manager was, 'Brilliant, really good and understanding.'

The provider had audit systems in place to check on the quality of the service. People raised no concerns about the care they received. One person commented, 'I am well looked after, I am very pleased with the team here. I have no complaints.'