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Inspection carried out on 12 December 2018

During a routine inspection

We carried out an announced inspection of the service on 12 December 2018. Sternhill Paddock is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service supports people who have a learning disability.

Sternhill Paddock accommodates up to six people in one building. During our inspection there were five people living at the home. This is the service’s second inspection under its current registration. The service was rated as ‘Requires Improvement’ after the last inspection. This rating has now improved to ‘Good’.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection on 24 July and 2 August 2017 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed. After this inspection we asked the provider to send us an action plan to inform us how they would make the necessary improvements to ensure they complied with the fundamental standards.

At this inspection we checked to see whether improvements in these four areas had been made and found they had.

People were now supported by staff in a way that protected them from avoidable harm and abuse. Risks to people’s safety were now appropriately assessed and acted on. There were enough staff in place to support people and to keep them safe. Robust recruitment procedures were now in place that ensured the risk of people being supported by unsuitable staff was reduced. People’s medicines were managed safely. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. Accidents and incidents were now regularly reviewed, assessed and investigated by the registered manager and the provider’s senior management team.

People received care and support in line with their assessed needs and in accordance with current legislation and best practice guidelines. Staff were well trained, received regular supervision of their role and were encouraged to develop their careers through the completion of nationally recognised qualifications. People were supported effectively with their meals and contributed to choosing the menus. People had access to support from external health and social care agencies. The home environment was well maintained and adapted to support people with a learning and/or physical disability. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People liked the staff and we saw clear examples of warm, positive, kind and caring interactions. Staff supported people with dignity, respect and compassion. People were supported by staff who understood their needs and supported them with making decisions about their care. People’s diverse needs were respected. People were provided with information about how they could access independent advocates. There were no restrictions on people’s friends or relative

Inspection carried out on 24 July 2017

During a routine inspection

We inspected Sternhill Paddock on 24 July and 2 August 2017. The inspection was unannounced. The home is situated in the small village of Eakring, Nottinghamshire and is operated by Creative Care (East Midlands) Limited. The service is registered to provide accommodation for a maximum of six people with a learning disability. There were four people living at the home on the days of our inspection visit. This was the first time we had inspected the service since they registered with us.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in place at the time of our inspection. 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.

During this inspection we found that people were not always protected from risks associated with their care and support. Staff did not always follow guidance in care plans and incidents were not thoroughly reviewed to prevent the risk of repeat events. Although people’s relatives told us they felt their relations were safe, appropriate action was not always taken to ensure that people were protected from the risk of abuse and improper treatment. People were not supported by staff who had been safely recruited. People’s medicines were not always stored or managed safely, although immediate action was taken to address this.

We were not assured that people would be protected from the use of prolonged physical interventions and records relating to physical inventions required improvement to ensure people were supported safely and effectively.

Staff received an induction when starting work at the service and felt supported in their role. On the whole, staff had access to training to meet people’s needs. Improvements were underway to ensure that staff received training in a timely manner. We found that there were not always enough staff available to meet people’s needs and ensure their safety. Swift action was taken to increase staffing levels following our feedback.

The principles and application of the Mental Capacity Act were understood by staff and where people lacked capacity to make decisions for themselves their rights were protected. People had enough to eat and drink and were provided with assistance as required, however improvements were required to ensure that people were supported to maintain a healthy diet. People’s day to day health care needs were met and people had access to support from specialist health professionals. There was a risk that people may not receive appropriate support with specific health conditions, although action was underway to improve this.

People were given choices about their care and support and staff acted upon this to ensure that support was based on their individual needs and wishes. People had access to advocacy services to help them express their views if needed. Staff understood how people communicated and people were supported to maintain their independence. Staff understood the importance of treating people with kindness, dignity and respect and we observed this in practice. Staff also respected people’s right to privacy.

Staff had a good understanding of how to support people. There were care plans in place detailing the care people needed, although these required some improvement to ensure they were clear and easy to use. People spent their time doing things that they enjoyed and this was based on their individual interests. They had the opportunity to get involved in activities in the home and the local community. People knew how to complain and complaints were documented, investiga