Archived: The Paddocks - Braintree

We last inspected The Paddocks on 20 September and 3 October 2016. During the inspection we found the service was not meeting all of its legal requirements. We found that the care and treatment of people was not person centred and did not reflect their preferences. We also saw that people were not always treated with dignity and respect. The provider had failed to support people to make choices for themselves in line with the requirements of the Mental Capacity Act and where choices had been made on the behalf of people it was not always evident that this was done in their best interest or that the least restrictive option had been chosen. Risk assessments were not complete and staff had not completed training which ensured that they had the skills and competence to care for people and keep them safe from harm. We also found that the premises were not monitored and maintained to ensure people’s safety, effective infection control processes were not in place and people’s medicines were always managed safely. The overall rating for the service was 'Inadequate' and the service was placed in 'special measures'. Services in special measures are kept under review. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for 'The Paddocks' on our website at www.cqc.org.uk.

Following the last inspection the provider took the decision to close the service and people living there are currently in the process of being supported by the local authority to find suitable alternative accommodation. In the interim we undertook an unannounced inspection of the service on 3 May 2017 to check on the safety and well-being of people living in the service. This report only covers our findings in relation to this area.

At the time of the inspection there was a registered manager in post. 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 this inspection we found that some improvements had been made but these were not sufficient to ensure that people were always kept safe. The outside area of the service continued to be in need of some repairs and general maintenance in order to make it safe for people to access. At the time of the inspection the back garden was ‘off limits’ to people living in the service. We also found that some of the bedrooms continued not to have easy access to hot water.

Staff had been supported to attend safeguarding training which had provided them with an understanding of how to recognise different types of abuse and they were clear about what action they would take if a concern arose.

Risk assessments had been reviewed and detailed people’s current care needs. There were clear guidelines in place which provided staff with information about how to support people to manage potential risks in their daily lives.

There were enough staff available to meet people's needs and keep them safe. The service had a system in place to recruit staff and to ensure that they were safe to work with the people that lived there.

People’s monies were being managed by independent agencies and the service kept clear records detailing any expenditures.

Staff had completed medication training and people received their medication safely.

Our inspection was unannounced and took place on 20 September and 3 October 2016. The service had a registered manager in post. 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 overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Some risks to people had been assessed but assessments were not personalised or detailed and had not been regularly reviewed. There was no system in place for reviewing risk assessments which meant that they did not always reflect people’s current needs.

People received their medication on time. However, there were no systems in place to record the administration of homely remedies and topical creams were opened but not named or dated. One person had been receiving covert medication but no capacity assessment had been completed and there was no supportive information from the GP to support this decision. The provider did not carry out internal medication audits or assess staff competencies.

The premises were clean but the garden area was not well maintained or safe for people to use.

Staff were not supported to access training to maintain, develop and update their skills. Staff had not completed any mandatory or additional training for a number of years. One person required the use of a hoist however, staff had not completed annual refresher manual handling training to ensure that they were competent to meet the needs of this person.

Systems were in place to ensure that the appropriate recruitment checks had been carried out on staff before they were recruited into the service. However, new staff were not appropriately inducted into the service and staff did not receive regular supervision or annual appraisals.

Staffing levels were not always sufficient to meet the needs of the people living in the service. The provider did not have a systematic approach to determine the number of staff required to meet the needs of the people using the service and keep them safe at all times. One person living in the service required the assistance of two staff but at night time there was only one member of staff on duty. People’s choice of activities were also restricted because there were not always enough staff available to support people’s care needs and support people in the activity of their choosing.

Whilst care was provided in a way which was intended to keep people safe from harm, staff had not received recent training to recognise signs of potential abuse. This meant that they had a limited understanding of the Mental Capacity Act 2005 (MCA) and what actions they would need to take to ensure the home adhered to the MCA Code of Practice. No capacity assessments had been completed and no applications for Deprivation of Liberty Safeguards (DoLS) had been made to the Local Authority. Where decisions had been made on behalf of people the least restrictive option was not always chosen.

People’s nutritional needs had been assessed and people were supported to have a varied and healthy diet. However, staff were not accurately monitoring and recording the food and fluid intake or weight of people who had been identified as at risk of weight loss.

Staff knew people well and we saw that they were caring and kind when supporting people. However, we found that people were not always supported to be as independent as possible and the way that staff spoke to people and the written language in care plans was not consistently respectful.

People were not involved in planning activities or how they spent their leisure time. There were only a limited range of meaningful activities organised for people to engage in both inside and outside of the service and there was no evidence that people were given the opportunity to give feedback or make decisions about their care and support. There was a complaints system in place but it needed updating and the service had not produced any guidance or information on making complaints in a suitable format for the people who lived at the service.

The service was not well led. The registered provider had not ensured that there was good governance of the service. There was no evidence that quality assurance systems were in place to assist in monitoring, assessing and reviewing the service. There was no service improvement plan and the provider did not link to any local networks to ensure they were updated on new information and legislation related to adult social care.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service had limited communication skills and were not always able to share their views. We found that people who used the service understood the care and treatment choices available to them in a limited way. Where people did not have the capacity to consent we found that the provider acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Medicines were prescribed and given to people appropriately and kept safely. Records were kept securely and could be located promptly when needed.

We also found that there were enough skilled, experienced and qualified to staff to meet people's needs

We found that the service was meeting the personal, emotional and healthcare needs of people using the service. We found that the environment was maintained safely and odour free and that all health and safety checks were up to date.

One person told us that they liked to help the staff cook the meals for everyone. One person told us that 'I can make a cup of tea and staff help me so that I am safe.'

We found that there was an effective recruitment and selection process in place which included a full Criminal Records Bureau check before they commenced employment.

People were consulted about the service provided through informal systems of communication on a regular basis and any changes or improvements were made when necessary. No complaints about the service had been received by the provider in the past four years.

People told us that they were able to choose what activities they liked to do. One person told us that 'I like all the staff and I am happy here.'