Paisley Court

Updated 19 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors.

Service and service type

Paisley Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Paisley Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on 2 of the 3 days we visited.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 9 relatives about their experience of the care provided. We observed interactions between staff and people living at Paisley Court and spoke with a visiting professional.

We spoke with 23 members of staff including the registered manager, deputy manager, clinical lead, operational support manager, senior carers, carers, domestic staff, a member of the maintenance team and the head chef.

We reviewed a range of records. This included 11 people’s care records and multiple medication records. We looked at 8 staff files in relation to recruitment and staff supervision. We also looked at a sample of temporary (agency) worker records in relation to suitability for the role and induction. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 19 November 2022

About the service

Paisley Court is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, a number of whom lived with dementia. At the time of our inspection there were 57 people using the service.

Paisley Court accommodates people across 4 separate ‘suites’ within a two storey building, each of which has adapted facilities.

People’s experience of using this service and what we found

Improvements were needed to ensure the service was properly maintained, clean and secure. Systems to monitor the quality of care within Paisley Court failed to always identify or demonstrate actions taken to make improvements which were needed around the cleanliness of the environment, care planning and monitoring of people’s risks.

Further improvements were also needed to ensure aspects of medicines were safely managed. Records didn't always accurately reflect prescriber instructions regarding prescribed creams and thickening products in drinks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we identified further development was needed around keeping MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) current to reflect changing needs and also in relation to delivering best practice person centred care to people who live with dementia.

Appropriate checks on temporary (agency) and permanent members of staff were in place to ensure they were suitable for the role before working with people. Staffing levels were safely planned, which was determined by people's needs. There were some shortfalls in ancillary workers which the provider was planning to review; and further action was needed to ensure care staff were effectively deployed across the service to ensure people’s needs could be promptly met at busy times of the day.

Although we found some improvements were needed, we did observe positive and caring interactions between staff and people living at Paisley Court. Staff demonstrated an understanding of people’s preferences and people had access to appropriate healthcare services.

Staff told us they enjoyed working at Paisley Court and felt supported by the management team. Professionals who regularly visited the service spoke positively about the staff team and the registered manager took action to address the areas of improvement we identified in this inspection.

People were protected from the risk of abuse. Systems were in place to monitor and appropriately report accidents and incidents to external agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 January 2018).

Why we inspected

We received concerns in relation to staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Paisley Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the cleanliness and security of the home and equipment which created a risk to people’s safety as well as shortfalls in effective oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

We have also made recommendations to the provider in relation to following best practice guidance when supporting people who live with dementia and staff deployment across the service.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.