Paddock Lodge Care Home

Paddock Lodge is a residential care home providing personal care for up to 24 people, some of whom were living with dementia. At the time of our inspection there were 20 people using the service.

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

Most aspects of people's medicines were well managed although some shortfalls were identified and addressed promptly by the provider. Risks associated with people’s care were usually managed safely and systems were in place for learning lessons when things go wrong. Regular checks of the premises and equipment were carried out although we saw actions to address some potential risks had not been addressed promptly. Robust recruitment checks were carried out by the management team. 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 did not always support this practice. The provider adapted staffing levels to people’s changing needs. The service followed safe infection, prevention and control procedures. The service had systems in place to safeguard people from abuse.

Care was usually planned and delivered in a person-centred way. The service had an activity programme although this was limited. People told us this was an area to improve. The management team said they would review their approach to activities. Relatives told us they felt listened to and could raise concerns and complaints.

The provider had introduced a more robust system to identify and manage risks to the quality of the service. People told us the management team and staff were engaging, kind and caring. Several people commented positively about the manager who had recently commenced in post. Our observations reflected people’s feedback and we saw staff were attentive and responsive to people’s needs. Staff felt well supported and were proud to work at Paddock Lodge Care Home. The service worked effectively with other professionals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 March 2022) and there were 2 breaches of regulation relating to management of risks to people and governance arrangements. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection carried out on 26 November 2019 to calculate the overall rating. This is based on the findings at this inspection.

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.

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

Recommendations

We have made 2 recommendations about the management of some medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Paddock Lodge is a care home providing personal care for up to 24 people, some of whom were living with dementia. When we visited 21 people were living in the home.

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

Environmental risks had not been identified which meant people were at risk. We found the fire panel was flashing to indicate a fault in one zone. However, insufficient action had been taken to ensure the system would sound correctly in the event of a fire. This was resolved following the inspection. The provider informed us that on the morning of the inspection, they had already arranged for maintenance to be carried out on the fire alarm system.

Improvements were needed to ensure infection control was suitably managed. Relatives expressed concerns about restrictive practice around visiting rights. We found the provider was not following government guidance at the time of our inspection. We have made a recommendation about the management of people's visiting rights.

Staff rotas showed shifts were usually fully covered, although we saw several examples of staff working consecutive shifts, which meant there was a risk that staff could be tired and not alert. The provider told us they had experienced significant staffing pressures during this period. The provider had a dependency tool which they kept under review.

People said they felt safe, although safeguarding records did not include concerns we had shared with the provider before our inspection.

People received their medicines as prescribed and the administration process was seen to be caring. However, allergies people suffered from were not always recorded on people’s medication front sheet. We could not be sure a time specific medicine had been given in accordance with the prescriber’s instructions.

Timely action had not been taken after we identified concerns found at our last inspection. Quality assurance survey outcomes had not been accurately represented in the findings report produced by the provider. ‘Resident’ meeting minutes were repetitive in the way they were recorded and staff meetings lacked user voice.

Systems used to demonstrate oversight of the home were not effective. These did not show that robust checks had been carried out or highlight concerns and remedial action required.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 18 January 2020) when there was a single breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

The inspection was prompted in part due to concerns received about visiting rights, the culture and management within the home and concerns regarding people’s safety. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led key questions of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risks to people living in the home and the management team not having the necessary oversight.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Paddock Lodge is a care home providing personal care for up to 24 people, some of whom were living with dementia. When we visited 16 people were living in the home and a further person was in hospital.

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

The home was not well maintained in its communal features as well as people’s individual rooms. A leak in the roof had been a persistent issue throughout the year, despite attempts to rectify this. Infection control was not well managed as a bed had been made over a urine stained mattress, and soaps and other toiletries were stored on top of toilet cisterns. Areas of the home required a deep clean.

There were sufficient numbers of safely recruited staff to meet people’s needs. Overall, medication was found to be safely managed. Risk to people’s safety had been assessed and some measures had been put in place to reduce those risks. However, unwitnessed falls at night time had not been identified as a theme and we found some people did not have bedside lighting.

Staff received regular formal support through training and supervision. Feedback showed staff were capable of recognising and responding to changes in people’s health. 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. People’s dietary needs were being met and people enjoyed the food they received. Protected mealtimes were in use.

Staff were seen to be caring. People were satisfied with the staff who supported them. People’s equality, diversity and human rights were respected, although there had been a lack of support in meeting people’s religious needs. Steps were taken by the management team to address this during our inspection.

Care plans were in place, although they were not always being followed. For example, people’s oral healthcare needs were not consistently being met. Some activities were taking place, although these were limited. Complaints were investigated and responded to. Concerns about the laundry service was an ongoing theme from early 2019.

A wide range of audits were being completed by the registered manager. Although these found some concerns prior to our inspection, other areas had not been identified as needing action. The management team were responsive to our feedback and put steps in place to begin to remedy some of these issues. Feedback was requested from people, relatives and staff in meetings and through satisfaction surveys. We found some evidence of partnership working.

We have made recommendations about the use of protected mealtimes, researching guidance on social stimulation and engagement with the local registered manager’s network.

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 requires improvement (published 11 October 2018). Since this rating was awarded the registered provider of the service has altered its legal entity. This was the first inspection of this service.

Why we inspected

This was a planned inspection based on our inspection schedule.

Enforcement

We have identified breaches in relation to standards of cleanliness to ensure good infection control and maintenance of premises and equipment.

Please see the action we have told the provider to take at the end of this report.

Follow up

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