We inspected all three Paradise Lodge Care Home Limited services, known as Chignal House, Paradise Lodge and Willow Tree Lodge, over a period of three days, 07, 08 and 12 March 2018 as these services are all in close proximity. The inspection of Chignal House took place on 08 March 2018 and was unannounced.
When we completed our previous inspection on 26 January 2017, we found there was a lack of good governance systems in place to monitor the quality of the care provided at the service. This was a breach of regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found care plans were not always person centred or regularly reviewed to ensure they reflected people’s current needs. Medications were not always stored safely and their recruitment process needed reviewing to ensure people were safe. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well led to at least good. The provider did not send this action plan within the set timescales. The inspector contacted the provider to request a copy of this via email; however, at this inspection the provider told us they had not received these emails.
At this inspection, we found that, there continued to be a breach of regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to information not being analysed to identify an overall picture of how well the organisation was meeting people’s needs and performing. Although the provider spent a lot time working across all three services, we found a lack consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning management of risk and regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty.
We recommend the provider review their building risks assessment to ensure risks to people are assessed in line with recognised guidance on managing health and safety in care homes.
The manager and staff had not understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm and / or abuse.
Improvements had been made to the storage of medicines, however the medicines audit had not identified inconsistencies in the amount of a person’s medicines held, resulting in medicine being unavailable when they needed it to help manage a period of distress and anxiety.
Following this inspection, the provider sent us a plan to address the issues we raised during our inspections of all three of Paradise Lodge Care Homes Limited services. This showed they had taken seriously the issues we raised and had taken steps to address these, including but not limited to carrying out an investigation into missing medicines, health and safety concerns and identifying a different training provider to deliver a robust MCA and DOLS training programme for all staff.
Chignal House 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. Chignal House accommodates three people in one adapted building.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy
There was a manager in post. Following an interview with CQC they have been approved as the registered manager as of 16 March 2018. 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.
A contingency plan was in place with contact details for staff to respond to emergencies and staff knew who to contact should an emergency occur. The service had infection prevention and control systems in place, which ensured people’s health was protected. Staff were trained and understood their roles and responsibilities for maintaining cleanliness and hygiene.
Safeguarding matters and people's finances were well managed. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Where people had moved from a previous service, relatives were complimentary about how staff had supported their family members to make this transition.
There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.
Staff understood what people could do for themselves, where they needed help and encouragement and how they communicated. Staff talked passionately about the people they supported and knew their care needs well. People’s care plans were regularly reviewed to ensure they reflected people’s current needs and covered all areas of the person’s health, welfare and safety. These provided detailed guidance for staff to know how to support and provide care and treatment. Different communication methods had been used to support people to understand information about their care and decide how they spent their day. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.
People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.
The provider’s mission statement contained a clear vision and strategy to deliver high-quality care and promote a positive culture achieving good outcomes for people. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect. Equality and diversity, was understood and promoted across all three services owned by the provider. The provider had taken steps to meet people’s cultural needs.
People’s relatives and staff spoke positively about the provider and the manager. Staff felt supported and said there was good communication between the management and themselves Staff felt supported. They described both the provider and manager as approachable, very hands on, supportive and demonstrated good leadership, leading by example.
At the time of our inspection, no one using the service was nearing the end of their life, and therefore we were unable to assess how this aspect of the service was managed. However, we noted that peoples’ care plans did not contain information about people’s preferences regarding future care at the end of their life, where they wished to die or their spiritual and cultural needs.
We recommend that the service seek guidance from a reputable source, about supporting people with learning disabilities to express their views and involve them in decisions about their end of life care arrangements.
This is the second time the service has been rated Requires Improvement. We found 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.