This inspection took place on 14 May 2018 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 16 May 2018 and was announced.

Paddock Stile Manor 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. Paddock Stile Manor provides residential care and support for up to 40 people, some of whom are living with dementia. At the time of our inspection 14 people were living at the home.

The manager was registered at another service and had started their application to add Paddock Stile Manor to their registration. They were supported by an interim manager and deputy manager.

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.

We last inspected Paddock Stile Manor on 15 and 18 September 2017 and found the provider had breached five of the regulations we inspected against. The principles of the Mental Capacity Act 2005 (MCA) had not been followed and Deprivation of Liberty Safeguards (DoLS) were not appropriately monitored. Care and treatment was not being provided in a safe way, service users were not treated with dignity and respect, systems and processes had not been established or operated to effectively ensure compliance. The provider had failed to maintain securely accurate, complete and contemporaneous records in respect of each service user. Sufficient numbers of suitably competent, skilled and experienced staff had not been deployed. There was a failure to ensure staff received the appropriate induction, support, training, supervision and appraisal to enable them to carry out their duties.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Whilst the home had made some improvements we still found areas that required further advances.

The home had introduced effective systems to monitor people’s DoLS ensuring people were not being deprived of their liberty without the appropriate authorisation. We found that best interest decisions were still not decision specific. We recommended the provider consulted the Mental Capacity Act 2005 (MCA) Code of Practice.

Care plans had improved since the last inspection although the care records we viewed were not fully completed and the home did not always address identified risks.

We observed one unsafe moving and handling action. Most of our observations between staff and people were extremely positive but we did hear a lack of patience whilst staff were supporting a person in their room. Sufficient staff were deployed to ensure people’s needs were met in a timely manner.

Staff had completed mandatory training. Whilst most staff had received supervisions we found gaps in the frequency. The provider did not ensure people were supported safely during mealtimes as not all staff members supporting people to eat had the appropriate training and did not have the required DBS check.

At the last inspection we had made a recommendation about the provision of meaningful activities for people living with a dementia. The home had utilised the services of a company which specialised in virtual reality (VR) technology to explore reminiscence, they had commenced recruitment

This inspection took place on 15 and 18 September 2017. Both days of inspection were unannounced. We last inspected Paddock Stile Manor on 1 February 2017 and found the provider had breached a number of regulations we inspected against. Specifically the provider had breached Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically, the risk assessment process had failed to ensure all risks had been identified and assessed. There were discrepancies in relation to the frequency of overnight checks and positional changes which meant people may not have been receiving appropriate care and support. Nurse call bells in communal areas had been tied up out of people's reach so they would be unable to use them if they needed to call for help or support. Fire exits had been used to store items and personal emergency evacuation plans contained incorrect detail and were not in place for every person living at the home.

We found the provider had failed to implement effective governance systems in relation to premises and equipment safety and care documentation. We also made a recommendation about the recording of mental capacity assessments and best interest decisions.

Following the inspection the provider had submitted an action plan, offering assurances that the required improvements would be made by 28 April 2017. During this inspection we found evidence of continued and new breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Paddock Stile Manor is a care home with nursing for up to 40 people. It is a purpose built care home spread over two floors.

At the time of the inspection there were 30 people living at the home, some of whom were living with a dementia. 13 people resided upstairs and had been assessed as needing nursing care and 17 people lived downstairs.

The service did not have a registered manager. The current manager had been in post since March 2017. In August 2017, they had submitted an application to the Commission to be registered. The previously registered manager had left their post on 13 February 2017.

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.

We found there were ongoing concerns in relation to the assessment and mitigation of risk. This included the accuracy and completeness of personal emergency evacuation plans. A failure to assess risks in relation to epilepsy, contradictions in relation to mobility and falls assessments and failure to assess environmental concerns.

Care documentation did not provide staff with sufficient information and detailed strategies to support people safely.

People’s medicines were not managed safely. Two people had not received their medicines as prescribed. There were gaps in the recording of medicines and appropriate guidance was not always in place.

Everyone we spoke with raised concerns about staffing levels. A dependency tool was used to assess people’s needs but we could not be sure this was accurate. The manager also raised concerns that the dependency tool was corrupted.

There was a reliance on agency staff, particularly nurses. This meant, given the failure to ensure accurate, up to date and complete records people were at risk of receiving care which was neither safe nor appropriate.

The concerns noted in relation to DoLS applications and authorisations meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Staff had not received appropriate induction, supervision and appraisal which meant they had not

This inspection took place on 30 January 2017 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 1 February 2017 and was announced.

This was the first inspection of Paddock Stile Manor with the provider Indigo Care Services Limited.

Paddock Stile Manor is a care home with nursing for up to 40 people. It is a purpose built care home spread over two floors. The top floor of the home had been refurbished since being managed by Indigo Care Services Limited.

At the time of the inspection there were 28 people living at the home, some of whom were living with a dementia. 12 people resided upstairs and had been assessed as needing nursing care and 16 people lived downstairs.

A registered manager was registered with the Care Quality Commission at the time of the 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 the provider had breached the regulations relating to safe care and treatment and good governance. The risk assessment process had failed to ensure all risks had been identified and assessed. For example, for people living with epilepsy and for one person in relation to a choking risk. There were discrepancies in relation to the frequency of overnight checks and positional changes which meant people may not have been receiving appropriate care and support. Nurse call bells in communal areas had been tied up out of people’s reach so they would be unable to use them if they needed to call for help or support. Fire exits had been used to store items such as staff coat’s, bed rail bumpers, water bottles, foots stools and ladders.

The quality assurance processes for ensuring care plans and risk assessments were complete and accurate were not effective as they had not identified the concerns noted during the inspection.

We found the provider had failed to implement effective governance systems in relation to premises and equipment safety.

We have made a recommendation about the recording of mental capacity assessments and best interest decisions.

You can see what action we told the provider to take at the back of the full version of the report.

Recruitment processes included appropriate checks before staff commenced in post however there was no record of one staff member’s references on file and not all agency staff had documented checks in place prior to them working at the home.

Staff had attended regular training and they told us they felt supported by the registered manager and nursing staff. We found some gaps in the delivery of supervisions and appraisals but this was being addressed. Staff understood how to report accidents, incidents and safeguarding concerns.

People and visitors told us staff treated them with dignity and respect. We saw compassionate and caring interactions between staff and people. For example, offering reassurance when supporting people with mobility needs.

People were appropriately supported with their medicines, nutritional needs and had access to healthcare professionals when needed.

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.

There were two activities co-ordinators in post. Activities ranged from events in the community, such as coffee mornings and outings, to exercise, dance, musical instruments and arts and crafts. A men’s group was available and the activities co-ordinator explained how they tried to ensure some activities related to people’s interests, hobbies or past employment.

A complaints procedure was in place and there had been