The Paddocks

Updated 19 January 2023

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 Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on a concern we had about systems to manage the service.

Inspection team

This inspection was carried out by one inspector.

Service and service type

The Paddocks is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us The Paddocks is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spent time with people and observing the interactions with staff. We spoke with the operations manager, registered manager and staff who were working. We reviewed a range of records related to the management of the service including policies and procedures, audits and risk assessments.

Updated 19 January 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

The Paddocks is a residential care home providing personal care without nursing for up to five people with a learning disability and/or autistic people. At the time five people were living at the home. One was in a self-contained flat in an annex to the house. Another person had a living space as well as a bedroom and bathroom. Some people at the service had limited verbal communication or communication difficulties.

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

Right Support

People were not always being supported by staff who had received enough training to keep them safe and meeting their needs. Care plans were not always personalised and lacked guidance for staff to provide consistent support. Systems were not in place to support those who lacked verbal communication to make choices. The national staff crisis was placing an impact on people living fulfilled and rich lives. Staff were not recognising or acting proactively to support people who became distressed, anxious and/or upset.

Current best practice, guidance and legislation was not always being applied when staff were providing support to people. This had not been identified by the management systems. The safety of the environment lacked effective oversight by the management to make sure it was keeping people safe. Although improvements had occurred around fire safety since the last inspection.

People were supported safely to manage their medicines and improvements had been made since the last inspection. Staff supported people to participate in a range of activities which was in line with their wishes. Links with other health and social professionals was positive although timely referrals had not always been made.

Right Care

People’s care and support plans were not always personalised especially for those newer to the home. Staff and the management had not explored a range of communication strategies for those who did not verbally communicate. No end of life plans in line with people’s needs and wishes were in place. Staff and the management we spoke with lacked understanding of the legislation around making choices for people who lacked capacity and/or had fluctuating capacity.

Not all risks were assessed for people which placed them at risk of potential harm or inconsistent care. The management had not effectively assessed people knew to the home to consider how compatible they were. Also, that all their personalised care needs were in place prior to them moving in.

The registered manager promoted equality and diversity in the support for people and led by example. Most of the time people’s privacy and dignity was respected.

Right culture

People were not always receiving care which empowered them. Quality assurance systems were not effectively picking up concerns found during the inspection. The registered manager wanted to drive improvement although systems were not always in place to allow this to happen. There was a lack of staffing structure at the home to promote high quality, positive support for people.

Staff were generally compassionate and not task focussed. People had advocates and those important to them were involved in their care and support. Informal systems were in place to hear feedback and for people to raise concerns. These were not always being documented to learn from. People who were able to express their views were listened to.

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

This service was registered with us on 9 May 2019 and this is the first comprehensive inspection leading to an overall rating and rating in each domain. The last focussed inspection looking at safe and well led was published on 17 April 2021 and there was no overall rating. At this inspection the service is now rated requires improvement.

At the last inspection two breaches of regulations were found. 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 in the areas of concern. However, new concerns were identified, and the provider is still in breach of the regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and follow up concerns from the previous 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.

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe from potential abuse including restrictive practices, mitigating risks to people, making decisions for people who lack capacity and/or have fluctuating capacity, lack of staff training and management of the home at this inspection.

We have warned the provider to make improvements around governance systems and will be following this up in three months to make sure improvements have happened. For all other breaches please see the end of the report for the actions we have asked the provider to take.

We have also made recommendations around recruitment of staff and end of life care.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.