The Paddock

Updated 5 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 25 July 2018 and was unannounced. The inspection team consisted of one inspector and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection report and notifications about important events that had taken place in the service which the provider is required to tell us by law. We used this information to help us plan our inspection.

We sought feedback from Healthwatch, relevant health and social care professionals and staff from the local authority on their experience of the service. Healthwatch are an independent organisation who work to make local services better by listening to people’s views and sharing them with people who can influence change.

During the inspection, we spoke with three people who lived at the service. Some people living at the service did not communicate verbally. During the day we spent time observing the interactions between people and staff in the communal area and out at an event. We spoke with relatives of people, to gain their views and experiences. We looked at three people's support plans in depth and looked at specific areas in two others. We looked at the recruitment records of four staff employed at the service.

We spoke with the registered manager, the deputy manager and four other members of staff. We viewed a range of policies, medicines management, complaints and compliments, meetings minutes, health and safety assessments, training records, accidents and incidents logs. We also looked at what actions the provider had taken to improve the quality of the service.

Updated 5 September 2018

This inspection took place on 25 July 2018. The Paddock is a residential care home for up to 19 adults with a learning disability. There were 14 people living at the service at the time of inspection. The accommodation is spread over one main building which contains bedrooms on the ground and first floor. There is a large garden front and back. The provider has also built a second kitchen in a building in the garden. The Paddock is a ‘care home’. People in care homes receive accommodation and 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.

At the last inspection the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good. At this inspection we found that the service had improved and the service is now rated Good.

At the last inspection, on 18 May 2017 the service had failed to ensure that behaviours that challenged or equipment used were adequately risk assessed. This was a continued breach of Regulation 12 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection we found that the service was now meeting this requirement. Risks to people were assessed, including risks from the use of equipment and behaviour that challenged. There was guidance for staff to enable them to minimise risks. At the last inspection we recommended that a health and safety assessment be undertaken by a qualified and competent person of current window security on the first floor to ensure people were not being placed at risk. Risks from the environment had also been assessed and actions had been taken to protect people.

At the last inspection on 18 May 2017 the service had failed to ensure medicines were managed safely. This was a continued breach of Regulation 12 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection we found that medicines were now managed safely and people received their medicine as prescribed and on time.

At the last inspection on 18 May 2017 we found that overall monitoring of service quality remained ineffective. This was a continued breach of Regulation 17 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection the checks on the quality of the service were effective and actions identified had been undertaken.

The care at the service has been developed in line with the values that underpin good practice. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had 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 were sufficient numbers of staff to meet people’s needs and support people effectively. Staff had the training, skills and knowledge they needed to support people with learning disabilities. The registered manager monitored staff performance and staff had supervision meetings, team supervisions and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

There were systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Where people did not have capacity to make decisions staff had followed guidance in line with the Mental Capacity Act 2005.

Peoples support was personalised to them and met their needs. People participated in the activities of their choosing. People’s support plans were updated when their needs changed. People and their relatives were involved in decisions about their support. People had access to food and drink when they wanted it and had a choice of what they ate and drunk. People continued to be supported to maintain their health and wellbeing and had regular access to healthcare services. When people accessed other services such as going in to hospital there was continuity of care.

People were treated with respect, kindness and compassion. People were supported to communicate their wishes and express their feelings. Staff had a good understanding of how people expressed themselves and recognised when people were upset or anxious and responded to this appropriately. Staff were aware of people’s decisions and respected their choices. People’s privacy was respected and levels of dignity were maintained.

People were supported to increase their independence and undertake activities of daily living. There was a complaints system in place if people or their relatives wished to complain. The registered manager continued to monitor the quality of service provided by seeking feedback from relatives and people who used the service.

The environment had been adapted to meet people’s individual needs and was personalised to reflect the people that lived there. The service was clean. Staff were aware of infection control and the appropriate actions had been taken to protect people.

Staff, relatives, people and health and social care professionals told us the service was well-led. The service was in a period of transition of ownership. The long standing registered manager continued to run the day to day service with support from the owner. The registered manager had a clear vision and values for the service, which staff understood and acted in accordance with. Staff and the registered manager understood their roles and responsibilities. When things went wrong lessons were learnt and improvements were made.