Archived: Paddock Lodge

Paddock Lodge is registered to provide accommodation and nursing care for up to 24 older people. There were 21 people living at the home on the first day of our inspection. There was a registered manager in post who had been registered since 2014 and was currently working part time at the service. They intended to deregister once the person who is in the role of manager registered 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.

At our last inspection we found not all risks had been minimised to ensure people were safe. There had been improvements in this area but we still had some concerns in relation to moving and handling for those people requiring support to move.

Risk assessments had been undertaken for those people at risk of malnutrition and pressure ulcers. The home completed risk assessments to minimise falls, infection control hazards and choking. The manager had analysed falls and implemented measures to reduce the number of falls at the home which had been effective.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents.

At our last inspection we concluded there were not enough staff to ensure people were supported safely. At this inspection we found staffing numbers had increased to ensure there was always a member of staff to support people in the communal areas.

Medicines were administered safely and we observed medicines being administered appropriately during our inspection. However, the temperature of the storage area had exceeded recommended guidelines which meant they were not stored safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The manager understood their responsibility in relation to the Deprivation of Liberty Safeguards and had appropriately applied for authorisations. There had been some improvements around the assessment of mental capacity but further improvements were required.

People received appropriate support in order to have their nutrition and hydration needs met. Mealtimes were a pleasant experience and people told us they enjoyed the food. People received support to access health care services to ensure they maintained their health and wellbeing.

People told us staff were kind and caring and we saw this ourselves during the inspection. Staff knew people well, and were patient and kind in their interactions. People's privacy and dignity was respected and their independence promoted.

Support was provided for people to maintain their cultural and religious preferences, including meal requirements and help to practice their faith.

People were provided with care which met their choices and preferences and they were encouraged to share their views on how they wanted the service to be run.

The home did not have a dedicated activities coordinator and staff undertook activities with people in and amongst their caring duties. There was a programme of activities available and we received a mixed response in relation to whether people were satisfied with the level of activities on offer. We have made a recommendation about the provision of meaningful occupation to improve mental wellbeing.

Care records had improved. Some records we reviewed contained information to enable staff to provide personalised care, whereas others needed further improvement.

People living at Paddock Lodge and care staff told us the managers were approachable and supportive; they felt listened to if they had any concerns. The service was meeting its statutory obligations in terms of displaying their CQC ratings and notifications to CQC had been made as required

Paddock Lodge is registered to provide accommodation and nursing care for up to 24 older people. There were 21 people living at the home on the first day of our inspection. There was a registered manager in post who had been registered since 2014. However their role had recently changed and although they were on site during the inspection, a new manager was in place and in the process of registering with the 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.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. The home completed risk assessments to minimise falls, moving and handling, infection control and choking. However, we found not all risks had been minimised to the lowest level and we observed some moving and handling of people which was not in line with best practice.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any safeguarding incidents.

The manager utilised a dependency tool to determine staffing levels but the calculation of people’s dependency was lower that the tool stipulated. We observed there were times staff were not available in the communal areas during our inspection which drew us to the conclusion there were not enough staff at the service at all times during the day.

Medicines were stored and administered safely and we observed medicines being administered appropriately during our inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice Not all staff had received training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS), and staff did not have a good understanding of how to assess mental capacity, and the best interest process. This was not having a major impact on the people living there who mostly had mild cognitive impairment and could consent to their daily care requirements. The manager did understand the DoLS and had appropriately referred for authorisations.

People and relatives told us staff were kind and caring and we saw this ourselves during our inspection. Staff knew people well, and what they preferred to do each day and were patient and kind in their interactions. People's privacy and dignity was respected and their independence promoted.

People were provided with care which met their choices and preferences such as what time they got up, went to bed, what they ate and they were encouraged to share their views on how they wanted the service to be run.

The home did not have a dedicated activities coordinator and staff undertook activities with people in and amongst their caring duties. The manager was encouraging engagement with community facilities to improve access.

Care records did not always reflect an accurate portrait of the person’s care and support needs and had not been updated as people’s needs had changed. Some of the records we reviewed contained information to enable staff to provide personalised care.

Some audits completed at the home lacked rigour and did not always look at the quality aspect of service delivery which meant shortfalls in service delivery had not been identified. For example, the shortfalls in the determination of staffing, out of date care plans, infection control practices, and management of risk.

People living at Paddock Lodge and care staff told us how approachable and supportive the managers were. The service was meeting their statutory obligations in terms of displaying their ratings and notifications to the Commission.

We identified three breaches of regulation ; regulation 12 (safe care and treatment), regulation 17 (good governance), regulation 18 (staffing)

You can see what action we told the provider to take at the back of the full version of the report.

'We've had some good times".

"Some of the staff can be a bit clever with me"

"All I do is watch television, they said they would take us out but they don't"

"I'm safe here and very happy"

Prior to this inspection we had received some concerns about staffing levels, care practices and provision of food. We looked into all of these areas during our visit and did not find any evidence to fully support the concerns raised.

Whilst we found some areas where improvements could be made, we found that care was planned and delivered in a way which met people's needs. We saw that the meals served were nutritious and that people were offered plenty to eat and drink. Staff told us that there were occasions when they felt stretched, but were able to meet people's needs in a timely manner. People we spoke with said staff responded to them quickly and we observed this to be the case. We found that staff recruitment procedures were safe and that procedures were in place to monitor the quality of service provided.

"The home is very nice; I'm very happy here"

"Staff look after me well and answer my questions"

"The cook makes nice meals and makes me something different if I want it"

"Staff are very good and very kind"

Although we observed some activities taking place during our visit, we did see that people were left for long periods watching television programmes which they told us they were not interested in. People said the following:

"There's nothing to do really, we just sit around all day"

"I enjoy the dance activities"

" I would like a newspaper to read but there are none here. I would like to read the Yorkshire Post"

Staff we spoke with said that they recieved good training, were well supported and enjoyed their jobs.