The Paddocks Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to meeting people’s nutrition and hydration needs.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had their needs assessed before being admitted to the service but information about people’s needs was not always fully recorded. For example, two people’s care plans had a section about them as person and their life history. Both sections were mostly empty. Permanent staff knew people well and may have been aware of these people’s histories, but the high numbers of agency staff may not have been aware of some key information had they relied on the care plan.

Information about people’s health and care needs was mostly well documented in care plans, however there were some inconsistencies within plans. Agency staff did not have access to the electronic recording system and so were not able to identify people’s needs or update records easily. The provider has told us they have addressed this and are ensuring senior agency staff will be given their own log-in in future.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used tools such as the Waterlow Scale (for pressure ulcer risk) and the IDDSI scale (International Dysphagia Diet Standardisation Initiative). IDDSI documents the degree to which people’s food and drink needs to be modified, by pureeing or thickening, to ensure it can be swallowed safely. Records, including the care plan and handover sheet, were inconsistent for one person whose IDDSI level had recently changed. This inconsistent information placed the person at risk.

All assessments and ongoing reviews of care were not always carried out with the input of the people concerned. A typical comment we received was, ‘I haven’t been asked about my care or seen a plan.’ Another person commented, ‘I haven’t seen a care plan or had any chats about my care. They just get on and do what’s needed.’ Although the provider told us they have a process to discuss people’s care with them, feedback to us did not support this.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when people moved between different services.

Although there were processes in place to assess and review people’s needs, these were not robust. We received negative feedback from another service, where key information about a person’s allergies to medicineshad not been shared with them when a person had moved there. The local GP surgery fed back that there had been occasions when important updates to people’s care needs had not been put into action in a timely manner. This left people at risk of not receiving the care they needed.

Processes to hand information over from shift to shift were not effective and staff were not always aware of the most current changes in a person’s needs. This was particularly important when staff were handing over to agency or newly employed staff. Permanent senior staff who led shifts carried a huge amount of knowledge and responsibility. They were often supported by a team of agency and newly appointed staff whose knowledge of the people who used the service was quite basic. We understand additional permanent senior staff have now been appointed to help address this issue. Staff also told us they never knew who was coming in on the next shift as they could not access the rota. This has also been reviewed by the provider.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We were not assured people’s care plans were always fully updated or followed by all staff. Senior agency staff on duty on two nights we visited were not fully aware of people’s health conditions such as diabetes or Parkinson’s disease or their risks and the measures in place to mitigate these. Care plans were not fully accessible to agency staff which meant there was a risk people would not have all their health needs met. For example, one person received one to one funding, and we observed agency staff providing this on two occasions. Staff were not able to tell us about the person they were supporting or any health conditions they had.

People’s eating and drinking during the heatwave were not well managed and there was a risk of people becoming dehydrated and this impacting significantly on their health. Fluid levels for some people were well below the target for a normal day and the risk of the increased temperatures had not been fully assessed to ensure hydration targets were appropriate. One person had drunk less than 1 litre of fluids in the last 24 hours. There were no seasonal alternatives to hot lunches. On a different day we observed handover and nearly all the people on one of the dementia units had not eaten well or at all at lunch. However, there was no further analysis of this, discussion with kitchen staff or evidence of additional foods encouraged. We received mixed feedback about the food and people told us they were often thirsty.

Feedback from the local GP surgery was positive about how the service monitored and improved people’s weights in recent months. This had been an area of concern in the recent past and there was clear improvement which impacted positively on people. Care for people with diabetes was good and staff demonstrated a good understanding of people’s needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Whilst some areas were good and staff demonstrated a good understanding of people’s needs, some staff and the service’s own systems did not support effective monitoring and oversight. Care records were not always accurate and oversight of eating, drinking and repositioning was poor. During our inspection process the provider changed the way fluids were monitored, and we noted an improvement both in the quality of information handed over and the level of fluids being consumed. A new resident of the day initiative had been adopted to have more structured oversight of people’s care.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We identified some assessments of people’s mental capacity were not carried out in line with the Mental Capacity Act 2005. The manager acknowledged some of these assessments required review and said this had been identified already. People told us they were mostly asked to consent to their care but some tighter procedures were required to ensure people had always given valid consent to receiving vaccinations for example. Although this process was carried out by nurses from the local surgery, the provider also had a responsibility to ensure people had consented, but this was not always in place.