OSJCT Paternoster House - Gloucestershire

Updated 1 December 2018

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.

The inspection team:

Three inspectors and an Expert by Experience completed the inspection on 16 October 2018. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Paternoster House is a nursing home. It provides care and treatment to predominantly older people who live with physical needs and who required nursing care. Some people also live with dementia.

The service had not had a registered manager for three months. 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.

Notice of inspection:

This inspection was unannounced.

What we did:

Prior to the inspection we reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about, such as abuse and deaths. We used information the provider sent us in the 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. We also sought feedback from the local authority and health care professionals. We used all this information to plan our inspection.

During the inspection, we spoke with six people who used the service and three relatives to ask about their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with ten members of staff which included the interim manager, a representative of the provider, nurses, team leaders, care staff, activities co-ordinator, chef and deputy manager. We reviewed a range of records. This included six people’s care records and multiple medication records. We also looked at three staff recruitment files and the home’s training record. We inspected the homes maintenance records and service certificates. Other records reviewed included a selection of audits and the service improvement plan. We reviewed the provider’s equality, diversity and human rights policy, complaints policy and safeguarding adults procedures.

Updated 1 December 2018

What life is like for people using this service:

People told us they felt safe. They were protected from potential abuse and discrimination. Risks to people were identified, assessed and action taken to reduce these or remove them altogether. People lived in a clean and safe environment. Medicines were managed safely and staff provided the support people needed to take their medicines as prescribed. Enough suitably recruited and skilled staff were deployed in order to meet people’s needs.

People’s health needs were assessed and people had access to a variety of healthcare professionals to support them. People were provided with the right amount and type of food to meet their health needs. People had a choice in what they ate and drank. People’s religious preferences were being met. At the time of our visit there were no diverse cultural needs requiring support, but staff explained that this would not be a problem if there were; these would be respected and met.

The principles of the Mental Capacity Act 2005 were followed. People were supported to make independent decisions and their care was delivered in the least restrictive way possible. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible”.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Staff were kind and caring towards people. They maintained people’s dignity and privacy. People’s choices, preferences and wishes were known to the staff who had taken time to find these out. Relatives and representatives of people were made welcome. They were, where appropriate, able to contribute to the planning and review of people’s care. Care plans gave staff guidance on how to meet people’s needs. Further detail about people’s care needs was also communicated to staff by means of staff handover meetings and additional information kept in the care office. Information about people’s care and treatment was kept secure and confidential.

A team of volunteers, led by an enthusiastic activity co-ordinator enhanced the quality of people’s lives. They supported people with meaningful activities and gave them opportunities to mix socially. Established links with local community groups, businesses and schools supported better outcomes for people.

Staff were experienced in supporting people, at the end of their life, to have a comfortable and dignified death. Professional relationships were in place to help support this, for example, with local GPs, pharmacies and community palliative care specialists.

The home did not have a registered manager in position. 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.

An interim manager had started working at the service in July 2018 when the former registered manager had retired. The interim manager was an experienced manager who was providing strong leadership to the staff. The provider’s quality monitoring processes had identified that some improvements were needed to the service. The interim manager had worked with the provider to achieve further action which was also planned as part of the home’s on-going plan of improvement. Staff were committed to providing people with good quality care and improving their generally quality of life. Both people and relatives considered the home to be well-led.

Rating at last inspection:

The last inspection was in March 2016 when the service was rated as ‘Good’ overall. The service remains ‘Good’ overall.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

About the service:

Paternoster House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can provide accommodation and care to 40 people. At the time of the inspection 39 people lived there.

Further information is in the detailed findings below.