We looked at whether the people using the service were safe and whether the service was well-led

At our last inspection we raised a number of concerns regarding people’s safety. Whilst some improvements had been made, we found the systems in place to keep people safe were not sufficiently robust. The provider and registered manager had improved how they dealt with daily risk, however, there was a lack of investment in the property and in long-term planning for the future. As a result, risk to harm was not fully minimised.

The new registered manager had settled in well. They were registered manager for three services. Whilst the other two services they managed were fairly settled, Paradise Lodge required a manager with sufficient time to address specific areas of issues and concerns at the service.

Some of the processes and records at the service needed streamlining to ensure they were effective. New quality audits had been introduced, however they were not always sufficiently robust and where concerns were found they were not consistently resolved.

The registered manager had significantly enhanced the administration of medicine. Training and guidance about the support each person needed in this area had improved. The registered manager observed staff competency and carried out regular checks to ensure people received their medication as prescribed.

Communication had improved across the service and staff felt supported to speak out about any concerns they had. The provider and registered manager communicated well with families and people. The provider had introduced formal meetings with the registered manager and senior staff which were starting to support improvements at the service.

The provider was focused on recruiting enough staff to meet people’s needs. If there were not enough care staff at any time, gaps were filled by the provider or senior staff. Whilst this meant there were enough staff on duty, this practice meant senior staff were not able to carry out planned tasks, which increased pressure on the management of the service.

The quality of risk assessments, and guidance to staff about keeping people safe had improved since our last inspection. However, improvements were needed to ensure a focus on supporting people to stay safe did not result in them being overly restricted. In addition, the risk assessment process had not considered fully the risk of missing or broken window restrictors.

Staff knew what to do if they were concerned for people’s safety. The property was clean and homely, however a lack of investment in the property meant risks from the spread of infection were not minimised.

Staff worked well with external professionals to meet people’s needs and to address concerns at the service. There was scope for the registered manager to develop positive networks outside the service for support and to learn and share about best practice.

More information is in detailed findings below.

We identified a continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires Improvement (report published 16 May 2018)

About the service:

Paradise Lodge is a residential care home that provides personal care and accommodation to up to five people with learning disabilities. At the time of the inspection there were five people living at the service.

Why we inspected:

We carried out this focused inspection to see whether the provider had made the necessary improvements since our last inspection. We had also received concerns regarding the safety and management of the service.

Follow up:

Following this report being published we will continue discussing with the provider their future plans for the service and how they will ensure the rating improves to at least good. We will work with the local authority to m

We inspected all three of Paradise Lodge Care Home Limited services, known as Paradise Lodge, Chignal House and Willow Tree Lodge, over a period of three days, 07, 08 and 12 March 2018 as these services are all in close proximity.

The inspection of Paradise Lodge took place on 07 March 2018 and was unannounced.

Paradise Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Paradise Lodge accommodates five people in one adapted building.

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.” Registering the Right Support CQC policy

There was a manager in post. Following an interview with CQC they have been approved as the registered manager as of 16 March 2018. 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.

This inspection found that, there was a breach of regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to information not being analysed to identify an overall picture of how well the organisation was meeting people’s needs and performing. Although the provider spent a lot time working across all three services, we found a lack consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning management of risk and regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty. The provider told us that they were in the process of selling this service and this had resulted in some procedures and processes had fallen behind those at their other services.

The manager and staff did not fully understand the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm and / or abuse.

A contingency plan was in place with contact details for staff to respond to in emergencies and staff knew who to contact should an emergency occur. The service had infection prevention and control systems in place, which ensured people’s health was protected. Staff were trained and understood their roles and responsibilities for maintaining cleanliness and hygiene.

Safeguarding matters and people's finances were well managed. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Where people had moved from a previous service, relatives were complimentary about how staff had supported their family members to make this transition.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.

Staff understood what people could do for themselves, where they needed help and encouragement and how they communicated. Staff talked passionately about the people they supported and knew

Paradise Lodge provides accommodation and personal care for 5 people who have a learning disability and require 24 hour support and care.

This was an unannounced inspection which took place on the 30 January 2015 and meant the service and staff did not know we were visiting.

A registered manager was in post. 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS) and to report on what we find. The service was up to date with recent changes to the law regarding DOLs.

People who used the service told us that the service was a safe place to live. There were procedures in place which advised staff about how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to and how to report any concerns.

There were procedures and processes in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with recent changes to the law regarding DOLs.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People spoke highly about the quality of the food and the choices available.

A complaints procedure was in place. Everyone we asked said they would be comfortable to raise any concerns with the staff.

People and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

We observed that staff were attentive to people`s needs and treated them with respect and dignity calling them by their name. We saw that staff sought people`s agreement before providing any support and assistance. One person who used the service told us: “staff always asks me what I want to do."

We saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences.

We saw the provider had systems in place to protect people using the service from abuse. Staff told us that they had participated in regular training, which had enabled them to gain the skills and knowledge required to protect people who used the service.

We saw that there was a complaints policy and procedure in place which was in a format that met the needs of the people who used the service. Staff were able to explain the complaints procedure and felt confident to support people using the service to complain

People told us they were happy living at Paradise Lodge and felt safe and well supported. One person said, “I like living here. I would tell staff if I wasn’t happy with something. I feel safe here.”

We found people participated in a range of activities in the home and in the community and were involved in all aspects of their lives. One person said, “It’s alright here. We go out places – football and Mencap and swimming on Sundays and bowling.”

We saw that people who used the service and staff were relaxed and comfortable in each others company. Staff were respectful, encouraging and kind and knew the needs of people who used the service.

All the necessary policies and procedures, records, quality assurance and monitoring systems were in place for the protection of people who lived at Paradise Lodge. However, improvements were needed in staff training in the safeguarding of vulnerable adults from abuse.

Staff were supported by the management and carried out their support roles efficiently and professionally.

People told us that they were involved in their care. They said that they were treated well and that staff were respectful to them. People said that they were happy with the care provided at Paradise Lodge. They were very positive when interacting with members of staff. People told us that they liked living in the home and that they felt safe.

People told us that they liked the staff. They said that the staff always treated them well and spoke to them respectfully. We observed staff interaction with people using the service during our visit in November 2011 and it was good.

People told us they were very happy with the service. People told us that they took part in meetings where they were able to say how they felt and what they wanted to do. People said that they enjoyed living in Paradise Lodge.