The Paddocks Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance. The service was previously in breach of the legal regulation in relation to governance. Improvements were not found at this assessment, and the service remained in breach of this regulation.

This service scored 32 (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 have a clear shared vision, strategy and culture which was based on transparency and engagement.

Although the provider had a number of strategies in place aimed to embed a culture and vision for the service, staff were not fully on board. Some staff described a poor culture where tasks were handed down and where they did not feel confident to speak up. Some staff did not feel part of a shared culture, although all felt they worked well with colleagues and pulled together as a small team.

Measures such as daily ‘We Can’ meetings were designed to assess the daily feel of the service, identify any issues and ensure the service was performing in line with its values. It was not clear who attended these meetings, and we found meetings were very sparsely recorded and those we viewed did not fully achieve their aim.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who always embodied the culture and values of their workforce and organisation. Leaders did not have all the skills, knowledge, experience and credibility to lead effectively.

The regional management team was not aware of the poor culture within the service and did not have effective oversight of the key issues of staffing and communication which impacted negatively on the service.The relatively new in post manager told us they did not feel supported and terminated their employment during the assessment process. However, we did also note the provider had tried to be proactive in supporting this manager in their new role.Key management positions were vacant at the time of our assessment, although we understand some have now been filled. There was no evidence of reflection on the part of the provider as to why so many key posts were vacant and why so many managers had left the service in a short space of time. Since our last assessment in October 2020, there have been 4 registered managers and additional managers and temporary managers in post in between. The result of so many new managers was the people who used the service were confused as to who was in charge. Some staff told us the number of new initiatives each new manager introduced led to some confusion. One person said, ‘[There are] concerns with each management change as to how long they are going to stay.’ Another commented, ‘They all introduce different ideas.’

People did not feel they could speak up and that their voice would be heard.

Some staff, including senior staff, spoke of a punitive rather than an inclusive and empowering culture. Some staff said they would hesitate to raise issues for this reason. Although the provider had processes in place for staff to be able to share concerns, we were not assured these would always be adopted by staff. Staff also told us that supervision was not always a two-way process and was not as regular as they would have liked. Records confirmed this and meant this further limited the opportunities for staff to raise issues and seek support. One person had only one supervision session on record despite being in post for several months.

People who used the service had forums to raise concerns with occasional meetings and the newly instigated Resident of the Day initiative. However, many people did not have confidence in these systems or even know about them. One person who used the service commented, ‘We don’t seem to have had any meetings recently. You don’t really get asked what you think about things here.’ Another said, ‘I know what to do if I wanted to complain. I am not very confident that things will get sorted though.’

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had a diverse workforce, including staff sponsored from overseas. These staff told us they felt valued and had been given a good induction to the service. Records demonstrated overseas staff were well supported both on a formal and informal basis to get used to new ways of working and a new culture.

However, some permanent staff felt the culture at the service was not always fair and told us about issues which they did not believe had been dealt with well or to their satisfaction.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider’s processes for monitoring the quality and safety of the service were not fit for purpose. A suite of audits had not identified the issues we found on this inspection. Where the provider’s systems had identified issues, such as poor fire evacuation procedures, these had not always been addressed leaving people at risk. Although permanent staff received a good induction and training, the provider had not ensured knowledge was embedded and some staff were not clear about all aspects of their role.

There was poor oversight of staffing and multiple vacant posts in key roles. The potential risks associated with using high numbers of agency staff had not been anticipated and mitigated. The provider told us senior agency staff had access to the electronic recording system, received a thorough induction prior to being left in charge of a wing and had adequate handover time. We found none of these to be the case on the two out of hours visits we conducted. There was no protected handover time between shifts which had a negative effect on the quality of information handed over from shift to shift.

The provider had been sending CQC a monthly update to their development plan in response to conditions placed on the service’s registration in 2020. These updates had not identified the concerns we found.

The provider did not understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

We found some concerning practice with regard to partnership working. The local GP service raised multiple concerns about how the service had sometimes failed to put their advice and instruction into place or failed to be proactive when people’s health needs changed.We also received concerns relating to an incomplete handover being given to a service when someone had been moved to another provider and information about a person’s allergies to medication had not been communicated. This is currently being investigated.

Systems were not designed to enable the accurate and timely sharing of information. Staff were not always able to find key information when it was needed. This was partly the fault of poor systems and partly due to the use of agency staff who were not sufficiently familiar with the systems which were in place.

Other relationships with health professionals were working better and, following our inspection, we saw the provider had recommenced some regular meetings with key health partners to try to bring about improvements.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Although the provider did not always have effective systems in place to innovate and improve the service at the time of our inspection, some new initiatives were underway. The provider had begun to use an external agency to enhance the interior design of the service and had responded positively to the staffing issues we identified. They employed a new temporary manager and introduced measures to improve recruitment and retention, especially of senior care staff, to reduce the high agency use. New forms and systems were introduced aimed to address the concerns with handover and induction for agency staff and the management of fluids. Further work was needed to address all the concerns identified during this assessment process.