The Paddocks

About the service

The Paddocks is a residential care home providing personal care for up to 5 people who have a learning disability and/or autism. At the time of the inspection 5 people were living at the home.

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

Right Culture

This is a targeted inspection that followed up the warning notice served at the previous inspection around how well led the service was. Based on our inspection there had been improvements around some areas highlighted in the warning notice. However, systems to audit the service were still being developed. Some areas of the registered manager oversight lacked structure and was not embedded into practice.

The provider was completing more detailed visits focussing on the quality and safety of care. Audits did not always contain sufficient detail or cover relevant areas. Policies and procedures accessible to the staff were still not in line with legislation and current guidance. There was a delay to new policies being produced by a third party. Following the inspection the provider shared with us draft versions they were working on.

Systems to manage safeguarding were now in place and external parties were being notified appropriately. There was now a clear staff structure in the home to support the registered manager to run it. Additionally, an extra layer of senior management had been put in place by the provider to support the registered manager with improvements. Systems were now in place to ensure staff were receiving appropriate training to support the needs and wishes of people.

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 August 2022).

At the last inspection we served a warning notice around good governance. At this inspection we found improvements had been made and the provider had met most of the warning notice. The provider remained in breach of regulations around governance as further improvements were required and needed embedding into practice.

Why we inspected

We undertook this targeted inspection to check whether the warning notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement and Recommendations

The provider remains in breach of regulations found at the last inspection. These relate to keeping people safe from potential abuse, mitigating risks to people, making decisions for people who lack capacity or have fluctuating capacity, lack of staff training and management of the home.

Although there have been improvements in the three months since we served a warning notice the provider remains in breach of governance systems at this inspection.

The recommendations from the last inspection around recruitment and end of life care remain. We have also made a recommendation at this inspection about the provider’s knowledge of regulations in order to oversee the home.

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

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.

About the service

The Paddocks is a residential care home providing personal care without nursing for up to five people with a learning disability and/or autistic people. At the time five people were living at the home. One was in a self-contained flat in an annex to the house. Another person had a living space as well as a bedroom and bathroom. Some people at the service had limited verbal communication or communication difficulties.

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

Right Support

People were not always being supported by staff who had received enough training to keep them safe and meeting their needs. Care plans were not always personalised and lacked guidance for staff to provide consistent support. Systems were not in place to support those who lacked verbal communication to make choices. The national staff crisis was placing an impact on people living fulfilled and rich lives. Staff were not recognising or acting proactively to support people who became distressed, anxious and/or upset.

Current best practice, guidance and legislation was not always being applied when staff were providing support to people. This had not been identified by the management systems. The safety of the environment lacked effective oversight by the management to make sure it was keeping people safe. Although improvements had occurred around fire safety since the last inspection.

People were supported safely to manage their medicines and improvements had been made since the last inspection. Staff supported people to participate in a range of activities which was in line with their wishes. Links with other health and social professionals was positive although timely referrals had not always been made.

Right Care

People’s care and support plans were not always personalised especially for those newer to the home. Staff and the management had not explored a range of communication strategies for those who did not verbally communicate. No end of life plans in line with people’s needs and wishes were in place. Staff and the management we spoke with lacked understanding of the legislation around making choices for people who lacked capacity and/or had fluctuating capacity.

Not all risks were assessed for people which placed them at risk of potential harm or inconsistent care. The management had not effectively assessed people knew to the home to consider how compatible they were. Also, that all their personalised care needs were in place prior to them moving in.

The registered manager promoted equality and diversity in the support for people and led by example. Most of the time people’s privacy and dignity was respected.

Right culture

People were not always receiving care which empowered them. Quality assurance systems were not effectively picking up concerns found during the inspection. The registered manager wanted to drive improvement although systems were not always in place to allow this to happen. There was a lack of staffing structure at the home to promote high quality, positive support for people.

Staff were generally compassionate and not task focussed. People had advocates and those important to them were involved in their care and support. Informal systems were in place to hear feedback and for people to raise concerns. These were not always being documented to learn from. People who were able to express their views were listened to.

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

This service was registered with us on 9 May 2019 and this is the first comprehensive inspection leading to an overall rating and rating in each domain. The last focussed inspection looking at safe and well led was published on 17 April 2021 and there was no overall rating. At this inspection the service is now rated requires improvement.

At the last inspection two breaches of regulations were found. 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 in the areas of concern. However, new concerns were identified, and the provider is still in breach of the regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and follow up concerns from the previous 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.

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe from potential abuse including restrictive practices, mitigating risks to people, making decisions for people who lack capacity and/or have fluctuating capacity, lack of staff training and management of the home at this inspection.

We have warned the provider to make improvements around governance systems and will be following this up in three months to make sure improvements have happened. For all other breaches please see the end of the report for the actions we have asked the provider to take.

We have also made recommendations around recruitment of staff and end of life care.

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.

The Paddocks is a residential care home providing accommodation and personal care for up to five people with learning disabilities and / or autism in one adapted building. There were three people using the service at the time of the inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a focused inspection and did not cover all areas of the Right support, right care, right culture during this inspection. People had limited access to external activities and reduced social contact due to the current government guidelines around the pandemic. However, staff were supporting people to be as independent as possible and to maintain contact with people who were important to them.

The provider had not ensured fire risks in the building had been properly assessed and updated to reflect building work in the home.

Medicines prescribed to be taken ‘as required’ were not managed well. A lack of clear guidance for staff increased the risk that people would not receive their medicines as they were needed.

Incidents were not always clearly recorded and reviewed to check whether changes were needed to the way people were supported.

The service had not had a registered manager since August 2020. It is a condition of the provider’s registration that there must be a registered manager in place. The manager indicated they intended to submit an application for registration.

Infection prevention and control systems had been updated to reflect the COVID-19 pandemic. Whilst all areas of the home appeared clean, we signposted the provider to seek guidance about cleaning some areas of the home during the building work, such as bare plasterboard and areas of worn paintwork.

Relatives felt people were happy living at The Paddocks and received good support from staff. People appeared comfortable in the company of staff and staff demonstrated a good understanding of people’s needs.

The home had a new management team in place, who had identified improvements they felt were needed. Staff said they felt well supported by the management team.

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

Rating at last inspection

This service was registered with us on 09/05/2019 and this is the first inspection.

Because this is a focused inspection and the service has not been previously rated, we were not able to produce an overall rating for the service as we have not inspected all of the key questions.

Why we inspected

We undertook this targeted inspection due to a COVID-19 outbreak. A decision was made for us to inspect to assess infection prevention and control measures in place. We inspected and found there was a concern with fire safety and risk management so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.