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Inspection carried out on 17 February 2019

During a routine inspection

About the service: The Paddock is a small residential care home that was providing personal and nursing care to three people at the time of the inspection.

People’s experience of using this service:

People enjoyed living at The Paddock, they felt safe and well cared for. Two people were being supported to move onto more independent living. Staff were supporting them with these plans.

Care and support was well planned and promoted people’s independence, choice and diversity. Staff understood what was important for each person and how best to deliver safe and effective care. Staff had good training to ensure their competencies and help them understand the complexities of working with people with acquired brain injuries.

Detailed risk assessments were in place to support people to take positive risks and remain safe.

Staff understood how to safeguard people from abuse. The staff team empowered people to make choices about what they wanted to do.

People were supported to maintain good health through ensuring regular check-ups, healthy eating and exercise. There was access to a multidisciplinary team to ensure people’s holistic needs were considered and met. This included physiotherapist and psychologist support.

Staffing levels were sufficient to meet people’s needs and staff had the right skills and support to deliver high quality care and support.

There was effective leadership and good team working. People’s views were sought and actions taken to improve where possible. The ethos and values of the service were embedded into everyday practice. People were treated with kindness and respect. Their privacy and dignity was upheld and their diverse needs were fully considered.

Good governance ensured records and the environment were well maintained. There was learning from any accident and incidents.

Rating at last inspection: GOOD (August 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 21 July 2016

During a routine inspection

The Paddock is registered to provide accommodation for 4 people who require support and personal care, due to an acquired brain injury. The service operates in partnership with The Woodmill, an acute rehabilitation service, which forms part of the nationwide rehabilitation support services provided by The Brain Injury Rehabilitation Trust (BIRT). People using the service are supported with their rehabilitation by the therapy and clinical teams at The Woodmill.

This unannounced inspection was carried out on 21 and 22 July 2016. At the last inspection on 21 January 2014 we found the provider met the regulations we looked at.

At the time of the inspection there were three people using the service. The service aims to support people to live as independently as possible.

A registered manager was in place and they were present on the days of the inspection. The registered manager was also registered as the manager of two other small community based residential services. They divided their working hours between the services. 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.’

People were very happy with the care and support they received. They said they were safe at The Paddock. People described the good relationships they had developed with staff and other people living at the service. One person said, “It is lovely here…I am really delighted with it…” There was a relaxed and homely atmosphere at the service. Staff were motivated and passionate about providing good care and people were relaxed around staff.

People said they found the staff caring. Staff demonstrated a caring and compassionate approach towards people and they ensured people’s privacy and dignity was respected at all times. Staff were knowledgeable about people and spoke about them with understanding and affection. People had opportunities to participate in a range of different social and therapeutic activities and were supported to access the local community.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of issues relating to safeguarding, and could describe the action to take should they have any concerns or should concerns be reported to them. Plans were in place to minimise identified risks. People were assisted to live as safely as possible whilst supporting their rehabilitation and independence. People's medicines were managed and stored appropriately.

There were sufficient staff on duty at all times with the right skills to ensure people received the care and support they required. Recruitment practices were safe and relevant checks had been completed to protect people from unsuitable staff.

People were supported to maintain good health. Their physical and mental health needs were closely monitored. People had access to healthcare services as well as input from the therapy team (clinical psychology; occupational therapy; physiotherapy and speech and language therapy) to support their continue rehabilitation. People were provided with a varied diet. They said they enjoyed the food and there were always sufficient amounts of food and drink available to them.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

There was a collaborative culture within the service. People using the service and staff were able to contribute ideas and suggestions. The provider obtained regular feedback about the quality of the care and support provided from people using the service and staff.

The leadership and management of the service en

Inspection carried out on 21 January 2014

During a routine inspection

At the time of our inspection there were three people living in the home. During our inspection we met and spoke to two people who lived there, five staff members and the manager. We observed the morning routine and breakfast at the home.

The home was inviting and was attractively decorated, smelt fresh and was very clean and tidy. The staff were very welcoming and helpful.

People living at The Paddock told us they enjoyed living there. One person told us � I like it here, I like the people who live here.� � The food here is great there is nothing I don�t like, we can help with cooking if we want to� Both people we spoke to told us they had choices with their daily lives and they enjoyed life at the home.

All the staff we spoke to told us they were happy there. They felt that the standard of care was good in the home and they felt well supported by the senior staff and management. They also felt they were making a positive difference in the people�s lives they were caring for.

We looked at care records and other general management records in the home and found they were appropriate and up to date. This meant people were protected by effective documentation.

We found that staff received training and support which enabled them to meet the needs of the people who lived in the home.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided

Inspection carried out on 1 March 2013

During a routine inspection

We carried out this unannounced inspection during one day, speaking with three people who lived at the home, three staff and the registered manager. We spent time in the communal areas observing how care and support was delivered. We also looked at some key records, these included care plans, staff recruitment files, risk assessments and minutes of meetings. This helped us to make a judgement about how well the home was being run.

We found that people�s care was being well planned. People were involved in making decisions about their care and treatment. People we spoke with said that they were happy with their care and support. Comments included ��staff are very good, I get a bit ratty sometimes but this is a fab place.�� ��Staff treat me pretty well here.��

We saw that the service ensured that there were sufficient staff with the right skills to meet the needs of people living at the home.

The service had a complaints system in place and any concerns or comments were dealt with quickly and appropriately. People said they felt able to make their concerns known. We spent time with one person and the manager talking about their concerns about their stay in the home and what actions had been taken by the provider to address this.