The inspection took place on 13 and 15 June 2017. Our inspection visit on 13 June was unannounced but we the provider knew we were returning to complete our inspection on 15 June.

The service provides residential and nursing care for up to 100 people, some of whom are living with dementia. The service is divided into three separate buildings providing residential, nursing and dementia care respectively. At the time of our inspection at total of 80 people were using the service including several for respite care.

A registered manager was in post and had been very recently registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

At our last inspection we rated the service Good. However some concerns were raised in the earlier part of this year about the unsafe management of medicines on the dementia unit and about other poor practice. The local authority investigated concerns and the provider worked hard to address all concerns. At this inspection we found that the new registered manager had put plans in place to bring about the required improvements. This was still a work in progress but the management team demonstrated good oversight of the work needed and had plans and strategies in place to continue to develop the service.

Medicines were managed safely and people received their medicines as prescribed. Robust new auditing and checking procedures ensured errors had been reduced and staff were confident in the management of medicines.

Staffing levels, and the deployment of staff, were a concern for some people and had an impact on the timeliness of care provided. Measures had been put in place to review staffing levels and these had already been increased. However, people on one unit reported occasionally having to wait too long for staff to meet their care and support needs.

Risks were assessed, documented in care plans and measures put in place to reduce these them. Health and safety audits and learning from ‘near miss’ incidents contributed to ensuring people were safe.

Infection control measures were in place and staff had a good understanding of how to limit the risk and spread of infection.

Staff were trained in safeguarding people from abuse and the manager referred incidents appropriately to the local authority safeguarding team for investigation.

Staff received a good induction and relevant training to help them carry out their roles. Staff were supported with regular meetings, supervision and appraisal.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals and relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Practice related to MCA and DoLS was good and the service operated in line with legal requirements. Staff sought consent appropriately for day to day care support.

Oversight of people’s nutritional needs was good. People who used the service praised the food and those at risk of not eating or drinking enough were appropriately monitored and referred to dieticians if needed.

People were supported to access the healthcare support they needed promptly. There was evidence of good partnership working with the GP, GP matron service and district nursing team. Feedback from healthcare pro

Two adult social care inspectors and an expert by experience carried out this inspection. An expert by experience is a person who has experience of the care sector, either from caring for other people or from receiving care themselves. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well led?

As part of this inspection we spoke with 12 people who used the service and one visitor. We also spoke with the manager, a Director who represented the provider, and 10 members of staff. We reviewed records relating to the management of the service which included four care plans, daily records, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risk assessments for care needs were completed and provided appropriate guidance for the identified risk to be reduced. They stated they were involved in reviewing their care plan and were supported to make decisions regarding their immediate care needs and wishes.

People received the care and support they required to improve their health and well-being. Care records were written in enough detail to provide clear guidance to staff members.

Applications had been appropriately made in regard to Deprivation of Liberty Safeguards for people whose liberty was restricted. Staff members and the manager showed they had appropriate knowledge regarding recent guidance.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. They told us they would be able to tell someone if they were worried, but that they had not needed to.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

Recruitment checks were carried out or obtained prior to new staff members starting work with the service.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with. They told us that they were satisfied with the care they received.

They told us and we observed that staff members told people what they were going to do before carrying out any tasks and gave people the opportunity to decline if they wished. Assessments of people’s mental capacity were completed and information was available to staff members if people did not have the capacity to make certain decisions.

Health needs were responded to and people had access to health care professionals if they needed this. Information and guidance given by health care professionals was included in people’s care records so that staff members knew how to promote their health.

Is the service caring?

People said that staff members were polite and kind; they respected people's privacy and dignity, and involved them in their care. Everyone we spoke with had confidence in the staff and felt that they had a good relationship with them. We heard comments such as, “We’re all treated very well”, “The staff are very nice and treat you very well” and, “They are very nice to us”. Staff members knew people's care needs and their personal preferences when we spoke with them.

We observed interactions between people and staff members and we found that the members of staff were patient and understanding of people's individual needs.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and planned for. Their individual choices and preferences regarding their support and care were respected.

Is the service well led?

There had been an annual survey to gather the views of people using the service last year. Responses from the last survey were positive. There were other systems in place to monitor and assess the quality of the service provided; the service had analysed this information for any trends or themes resulting from complaints, accidents or incidents.

Our observations of staff in the home and speaking to people living there showed that management of the service was a strong element in the day to day running. One person said about the manager and her assistant, “They’re always around the place. They may be the people running it but they work hard”. A staff member told us that, “There is a strong and caring management team here”.

People we spoke with during our inspection on 19 February 2014 were generally positive and complimentary about the care and support that they were receiving. Care was well coordinated, recorded and reviewed to ensure that people received good care.

Infection control and hygiene procedures needed to be improved in a number of areas in the home, including clinical areas, to ensure people’s safety. Improvements were also needed to the monitoring and auditing of infection control.

Improvements were needed regarding the administration, ordering and temperature control of medication.

Staff received ongoing training in mandatory subjects. There were supervision and appraisal arrangements in place.

Arrangements were in place to gauge people’s opinion of the service. Meetings were held with staff to discuss issues and developments in the home. However there were not effective quality assurance procedures in place to adequately monitor some processes and practices to ensure the safety of people living in the home.

We did not speak with people during this inspection because we were following up specific areas of concern highlighted to us during our previous inspection of 17 July 2012 and 19 July 2012.

During our inspection of 16 October 2012, records seen demonstrated to us that care and treatment was provided to people according to their specific needs. People's needs were assessed and reviewed regularly with clear guidelines in place for staff to provide individual care.

Staff and senior management had undertaken training provided by Norfolk Safeguarding Services to ensure that people were protected from the risk of abuse. Safeguarding policy's and procedures had been updated in line with Norfolk Safeguarding's own guidance, and staff were able to demonstrate to us a clear understanding of safeguarding procedures in line with these policy's.

During our inspections on 17 July 2012 and 19 July 2012 people told us they felt safe and comfortable at The Paddocks Care Home and that staff were always cheerful and friendly. People spoken with said they felt supported by staff and would speak up if they had any concerns.

People using the service said they thought they were always listened to by staff and that their dignity was maintained at all times. People we spoke with told us they liked they way they were treated by staff and that they attended to them quickly when required. One person told us, “It’s a nice place here, comfortable, friendly and they make people welcome”. Another person said that their privacy was maintained during personal care.

During our visit to The Paddocks we spoke with people who were accommodated on Nightingale and Kingfisher units. We also used a formal observation so as to enable us to directly observe and report on the quality of care experienced by people on Sandpiper unit. We did this by observing people's general level of wellbeing and engagement and to assess how those providing care and support interacted with people who use the service.

Throughout the course of our visit we saw many examples of people being consulted about their care and people we spoke with told us that their individual wishes were respected. People said they could attend meetings where they could give their opinions about the service. They said that their suggestions were usually acted upon.

People told us that staff were polite and treated them with respect. They felt their privacy was maintained and everyone we spoke with said that staff would not enter their bedrooms without knocking. One person told us, "Our bedrooms are our private domain."

Everyone we spoke with told us they liked living at The Paddocks. They said that staff understood their needs and the care was good. One person told us how staff had worked with them to help them to be able to walk. However, whilst observing care on Sandpiper unit we saw that staff were not following a person's care plan to ensure that they received their drink safely.

We were told that people felt safe at the home. One person told us they had never been worried or upset by anyone at The Paddocks and another person told us, "The staff are all pretty caring, there is no-one I dislike and no-one I avoid."

People commented on the cleanliness of the home and everyone we spoke with said they liked their bedrooms.

We heard some very positive comments about the staff team and one person told us they thought the staff were well trained to do their jobs.

This inspection took place on 2 and 3 September 2015 and was unannounced. The Paddocks Care Home is a nursing care home providing personal care and support for up to 100 older people, some of whom may live with dementia. There were 85 people living at the home at the time of our inspection.

The home had a registered manager who had been in post since October 2010. 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.

At a previous inspection in February 2014, we asked the provider to take action to make improvements to some parts of the environment and practices in regards to infection control requirements. We found that this work had been completed to provide areas such as treatment rooms and sluices were clean and compliant with the Department of Health Code of Practice on the prevention and control of infection.

People told us they felt safe and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There were enough staff available to meet people’s needs.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager had acted on the requirements of the safeguards to ensure that people were protected.

Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interest decisions to guide staff about how to support the person to be able to make the decision were available.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans contained enough information to support individual people with their needs and records that supported the care given were completed properly.

A complaints procedure was available and people were happy that complaints would be responded to. The manager was supportive and approachable, and people or their relatives could speak with him at any time.

The home monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible. Action plans to show improvement and analysis of these records were not always available in the home. Analysis of complaints had also not been carried out to identify themes and trends.