Padgate House provides intermediate care and nursing support for up to 31 people and a further four people requiring neuro rehabilitation. The service provides short term support for up to six weeks in a residential setting to help people regain daily living skills and independence.

The service is provided jointly by Warrington Borough Council and Bridgewater Community Healthcare. On the day of our inspection the service was providing accommodation and nursing care to 33 people.

At the last inspection the service was rated overall good. At this inspection we found the service remained good.

People continued to remain safe from the potential harm of abuse or ill-treatment as staff knew how to recognise and respond to such concerns. People were supported by enough staff to meet their needs. People received their medicines safely.

The provider followed safe recruitment procedures when employing new staff members.

Staff members had the training and skills to meet people’s individual needs.

People had care and support plans that reflected areas of their lives which they needed assistance with. When changes occurred in people’s needs these care and support plans were reviewed to reflect the changes.

People were supported to have choice and control over their lives. They were assisted by staff in the least restrictive way possible. Staff were aware of current guidance which directed their practice and people’s human rights were protected by the staff who supported them.

People received support that continued to be caring and compassionate. Their privacy and dignity was valued by those providing assistance. People were supported by staff at times when they felt anxious or nervous.

Staff members knew people’s support needs and assisted them in the manner they preferred. People and their relatives were encouraged to raise any concerns or complaints. The provider had systems in place to address any issues raised with them.

The management team were approachable and supportive. People were encouraged to be involved in decisions about Padgate House and their suggestions were valued by the provider.

Staff members felt valued as employees and their opinions and ideas were listened to by the provider. The provider had systems in place to monitor the quality of service and where necessary made changes to drive improvements.

Further information is in the detailed findings below.

This inspection was unannounced and took place on the 19 January 2015.

The service was previously inspected in May 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Padgate House provides intermediate care and nursing support for up to 31 people and a further four people requiring neuro rehabilitation. The service provides short term support for up to six weeks in a residential setting to help people regain daily living skills and independence. The service is provided jointly by Warrington Borough Council and Bridgewater Community Healthcare. On the day of our inspection the service was providing accommodation and nursing care to 35 people.

At the time of the inspection there was a registered manager at Padgate House. 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 our inspection, people receiving intermediate care at Padgate House were observed to be comfortable and relaxed in the presence of staff. We observed interactions between staff and people using the service to be kind, caring and personalised. We also observed people’s choices were respected and that staff communicated and engaged with people in a polite and courteous manner.

People using the service spoke highly of the standard of care provided. Comments included: “They always ask permission to do things with you and explain what is going to happen”, “They do everything I need. They are always there to help you and I think they are very good”; “They are lovely with you, they call you by your name and from top to bottom it’s been very good”; “The staff are very good. They are always explaining where you are going wrong with your walking and put you right. They are absolutely marvellous. They always knock before they come into my room, they respect my privacy” and “They are trying to get me back on my feet and walking again. I’m happy with the way they treat me, they are very friendly and very nice”.

Examination of records and discussion with staff confirmed staff had access to formal supervision and a range of induction, mandatory and other training that was relevant to individual roles and responsibilities. The training was delivered via e-learning or face to face sessions.

We saw that there were corporate policies and procedures in place relating to the Mental Capacity Act 2005 and Deprivation of Liberties (DoLS) and staff had access to training in this area. This helped to safeguard the rights of the people using the service.

A range of auditing systems had been established to monitor and develop the service. There were also arrangements in place for people at Padgate House to be consulted about their opinions via monthly meetings and to provide feedback via questionnaires on the service provided.

It became clear from discussions with staff that some staff felt there was potential to improve integration between staff employed by the registered provider (Warrington Borough Council) and Bridgewater Community NHS trust. For example, two staff spoken with described the service as “Disjointed”and “Fractured”. Likewise, there was scope for the development of more centralised records and management information systems.

We spoke with seven people who were using the service and one of their relatives. People told us that they had a care plan and that the staff had assessed their needs.

People told us they were happy with the service they received and that they would be happy to raise any concerns they had with the staff team.

People’s comments included “staff are very nice”, “lovely people” and “very helpful”. People told us that Padgate House was “very comfortable” and “nothing was too much trouble.”

Since we last visited the service has made improvements as to how the manage and maintain records relating to people’s care and support.

We saw recruitment procedures helped ensure that only people suitable for the role were employed and that staff received training and support for their role.

Systems were in place to regularly assess the quality of the service being delivered to people.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We spoke to seven people using the service during our visit. Most people told us that staff respected their privacy and dignity. Their comments included “I couldn’t be better looked after”; “I am spoken to well by nurses, they’re like friends” and they will change things if you want them to.”

A visiting relative told us “we would happily pay for this care” and “my mother is treated with full dignity and respect.”

People told us good things about the food they received. Comments included “food is very good”; “food is well cooked and would nourish anybody”; “food is excellent” and “food is appetising and you have a choice.” One person told us “I only have a small appetite so I only ask for small meals.”

A visiting relative told us that that their relative ate their meals in their room and “the food is nicely served and beautifully presented”. The family member told us that staff asked how much of the meal had been eaten and the relative felt that food consumption was being monitored.

The majority of people told us that they knew who to speak to if they were not happy. One person told us “I feel safe here and well cared for.” Another person told us that they were reluctant to complain as they were still a patient there.

People who use the service that we spoke to told us that staff were available to help them. Comments included “I couldn’t be better looked after”; “staff are very pleasant” and “staff are marvellous.”