Archived: Paradise Lodge

Updated 19 January 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

Inspection team:

One inspector and one assistant inspector carried out this inspection.

Service and service type:

Paradise Lodge is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced.

What we did:

The registered manager was registered to manage three care homes. We had concerns about the safety and management of two of these services, Chignal House and Paradise Lodge. We therefore carried out the inspection of the two services over two days in the same week. As part of the inspection, we reviewed a range of information about the service. This included safeguarding alerts and statutory notifications, which related to the service. Statutory notifications include information about important events, which the provider is required to send us by law.

We require the provider to submit a Provider Information Return. 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. At the time of this focused inspection the registered manager was still completing their return.

We spoke with people who lived at the service and observed how they were cared for. Where people at the service had complex needs, and were not able verbally to talk with us, or chose not to, we used observation to gather evidence of people's experiences of the service. We spoke with three family members to ask their views on the service their relative received. We also spoke with two health and social care professional who had contact with the service.

We met with the provider who was also the owner, the registered manager, acting deputy manager and two care staff. We reviewed the care records of three people who used the service. We also looked at a range of documents relating to the management of the service, including three staff files.

Updated 19 January 2019

We looked at whether the people using the service were safe and whether the service was well-led

At our last inspection we raised a number of concerns regarding people’s safety. Whilst some improvements had been made, we found the systems in place to keep people safe were not sufficiently robust. The provider and registered manager had improved how they dealt with daily risk, however, there was a lack of investment in the property and in long-term planning for the future. As a result, risk to harm was not fully minimised.

The new registered manager had settled in well. They were registered manager for three services. Whilst the other two services they managed were fairly settled, Paradise Lodge required a manager with sufficient time to address specific areas of issues and concerns at the service.

Some of the processes and records at the service needed streamlining to ensure they were effective. New quality audits had been introduced, however they were not always sufficiently robust and where concerns were found they were not consistently resolved.

The registered manager had significantly enhanced the administration of medicine. Training and guidance about the support each person needed in this area had improved. The registered manager observed staff competency and carried out regular checks to ensure people received their medication as prescribed.

Communication had improved across the service and staff felt supported to speak out about any concerns they had. The provider and registered manager communicated well with families and people. The provider had introduced formal meetings with the registered manager and senior staff which were starting to support improvements at the service.

The provider was focused on recruiting enough staff to meet people’s needs. If there were not enough care staff at any time, gaps were filled by the provider or senior staff. Whilst this meant there were enough staff on duty, this practice meant senior staff were not able to carry out planned tasks, which increased pressure on the management of the service.

The quality of risk assessments, and guidance to staff about keeping people safe had improved since our last inspection. However, improvements were needed to ensure a focus on supporting people to stay safe did not result in them being overly restricted. In addition, the risk assessment process had not considered fully the risk of missing or broken window restrictors.

Staff knew what to do if they were concerned for people’s safety. The property was clean and homely, however a lack of investment in the property meant risks from the spread of infection were not minimised.

Staff worked well with external professionals to meet people’s needs and to address concerns at the service. There was scope for the registered manager to develop positive networks outside the service for support and to learn and share about best practice.

More information is in detailed findings below.

We identified a continued breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Requires Improvement (report published 16 May 2018)

About the service:

Paradise Lodge is a residential care home that provides personal care and accommodation to up to five people with learning disabilities. At the time of the inspection there were five people living at the service.

Why we inspected:

We carried out this focused inspection to see whether the provider had made the necessary improvements since our last inspection. We had also received concerns regarding the safety and management of the service.

Follow up:

Following this report being published we will continue discussing with the provider their future plans for the service and how they will ensure the rating improves to at least good. We will work with the local authority to monitor progress.