About the service: Paddock Hill is a care home that provides personal care and accommodation for up to 40 people. At the time of this inspection there were 39 people using the service.

People’s experience of using this service:

• The service met the characteristics of good in the key questions of effective, caring and responsive. However, some aspects of the service required improvement to ensure people remained safe. We found staff were not always deployed effectively throughout the home. For short periods of time staff were not available to support people in communal areas. Improvements were also required to the assessment and recording of risks to people, to ensure all appropriate steps were taken to reduce identified risks;

• People received personalised support from staff who knew them well. Staff had built positive relationships with people living at Paddock Hill. Staff supported people to retain their independence and to remain involved in planning and reviewing their care. This helped to ensure care was provided in accordance with people’s preferences;

• Staff worked closely with a range of community health professionals to promote good outcomes for people;

• Staff were kind and caring. They treated people with dignity and respect. People we spoke with told us staff treated them well and they liked living at Paddock Hill;

• People living at Paddock Hill, their relatives and staff could approach the management team if they had any concerns;

• Staff received regular training and had developed the right skills to enable them to provide effective care to people;

• More information is in the full report.

Rating at last inspection:

Good (report published on 7 June 2016)

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

We found one breach of the Care Quality Commission (Registration) Regulations 2009. Details can be found in the key question of well-led. You can see what action we told the provider to take at the end of this report.

Follow up:

We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

Paddock Hill is registered to provide accommodation and personal care for up to 40 older people. Accommodation is based over three floors. Two floors are dedicated to supporting people living with dementia. All of the bedrooms are for single occupation. Communal lounges and dining rooms are provided on each floor. A passenger lift is available to provide access to each floor. The home has a secure garden and car park.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. 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. There was a manager at the service who was registered with CQC.

At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in regard to safe care and treatment, fit and proper persons employed and good governance and this action has been completed.

This inspection took place on 10 May 2016 and was unannounced. This meant the people who lived at Paddock Hill and the staff who worked there did not know we were coming. On the day of our inspection there were 40 people living at Paddock Hill.

People told us they felt well cared for and safe. Comments included, “We are all safe here” and “I’m not troubled at all. I am safe and well looked after.”

A healthcare professional spoken with told us they were visiting the home for the first time and had positive first impressions of the home.

We found systems had improved and were in place to make sure people received their medicines safely and medicines administration records were completed in line with safe procedures.

We found improvements to staff recruitment records which showed procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. They told us they worked well as a team and were well supported by the registered manager. All of the staff spoken with said they would recommend the home and be happy for a relative to live at Paddock Hill.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so their health was promoted and choices could be respected.

People living at the home said they could speak with staff if they had any worries or concerns and they would be listened to.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via questionnaires, the results of these had been audited to identify any areas for improvement.

Paddock Hill is registered to provide accommodation and personal care for up to 40 older people. Accommodation is based over three floors. Two floors are dedicated to supporting people living with Dementia. All of the bedrooms are single. Communal lounges and dining rooms are provided on each floor. A passenger lift is available to provide access to each floor. The home has a garden and car park.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Paddock Hill 12 August 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 24 March 2015 and was unannounced. On the day of our inspection there were 37 people living at Paddock Hill.

People told us they felt well cared for and safe. Comments included, “It’s smashing; my room, the food, the staff. It’s all good,” “I feel very safe here. If I have any worries I can talk to them [staff],” “It’s much better here. I like all the staff but some know me better, they are all respectful” and “I don’t think it could be any better. I have nothing to complain about.”

Whilst people living at Paddock Hill told us they felt safe, we found that systems required by regulations to ensure the safe handling, administration and recording of medicines were not always followed, to keep people safe. In addition, we found the provider had not always undertaken all the checks required to make sure people who worked at Paddock Hill were suitable to be employed. This posed a risk to peoples safety.

People told us they felt well cared for by staff that knew them well. However, we found that the provider did not have systems in place to ensure people’s care and welfare was protected.

We found care plans had not been consistently reviewed and some held information that did not reflect staffs understanding of the person. Staff held conflicting views of some people’s support needs. Staff were not consistently adhering to guidance set out in some care plans to ensure people’s welfare was promoted. Some confidential records were found insecurely stored in several areas of the home.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. They received supervision and appraisal for development and support. Staff spoken with understood their role and what was expected of them. Staff told us they worked well together and enjoyed their jobs.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of healthcare professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account their individual dietary needs and preferences so that health was promoted and choices could be respected.

People living at the home, and their relatives said that they could speak with staff if they had any worries or concerns and they would be listened to.

We saw people participated in a range of daily activities which were meaningful and promoted independence.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. However, these audits had not identified the gaps and inconsistencies found during this inspection, so they could be acted upon and improved. This showed the audits undertaken were not fully effective. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of the previous registered manager, Martha Buchanan appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People living at Paddock Hill told us that they were happy and that they were satisfied with the care they received. They told us, "It is all right, good" and "The staff are smashing and very kind.”

Relatives spoken with said that they were happy with the care their loved one received. They told us, “The staff know [my relative] well” and "We have no worries at all. I think this is a really good home."

During the inspection we were able to observe people's experiences of living in the home. We found that support was offered appropriately to people.

We found that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

The provider had a satisfactory recruitment and selection procedure in place to ensure that staff were appropriately employed.

The provider had an effective complaints system available.

We spoke to eight people that lived at Paddock Hill. They told us that they liked living at the home, and the staff knew them well and supported them in the way they needed. Comments included; “I know all the staff and can talk to them about anything.” “The staff are kind. They really are marvellous.” If I have any worries staff will help me.” “I am safe here; I get the support I need.” “It’s not as good as home, but the next best. I am content and happy here.” “You can’t fault the staff. They are friendly, helpful and always polite.”