Archived: Cranleigh Paddock Care Home

People’s experience of using this service:

The provider had not always ensured risks to people and staff had been adequately managed. They had not acted in accordance with all of the recommendations made in the 2015 legionella risk assessment and had not followed national guidance.

People confirmed they were treated by staff with kindness and compassion. People’s comments included: “Everyone is lovely and they smile at me a lot”. “This is a very happy place, everyone gets on well together”. “The place has a good atmosphere here, all the time”.

People’s privacy and dignity needs were understood and respected, including during physical or intimate care. We observed that staff showed concern for people’s wellbeing and responded to their needs quickly.

People’s needs were assessed and staff had a clear understanding of people’s care plans.

People and when appropriate their families or other representatives were involved in discussions about their care planning. People were encouraged to provide feedback on the service provided both informally and through quality questionnaires.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to maintain good health. Any health concerns were addressed promptly and referrals sought from appropriate professionals when needed.

People told us they enjoyed their meals and received any support they needed. The service catered for people’s individual needs, including specialist pureed meals which mirrored the visual appearance and colours of food.

People felt confident that staff had the necessary knowledge and skills to meet their needs. A system was in place to track the training that each member of staff attended. There was a staff supervision structure that included observation and monitoring of care practices and annual appraisals.

There were safe systems for the management, administration and storage of medicines, so that people received their medicines as prescribed, in a way and at a pace that met their needs and preferences.

Robust recruitment procedures were in place to ensure that only staff who were suitable to work in a social care setting were employed. People confirmed that staff were available when they needed care and support.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

People were confident they could raise concerns or complaints and that these would be dealt with.

There was an open, inclusive and empowering culture within the service. A system of regular audits of the quality and safety of the service took place. The registered manager had a plan for the continuous development and improvement of the service.

Rating at last inspection: Good. Last report published 22 December 2016.

At this inspection the overall rating for the service has changed from Good to Requires Improvement. We found the evidence did not continue to support a rating of ‘Good’ in all areas and we have rated the service ‘Requires improvement’ in the ‘Safe’ and ‘Well led’ key questions.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection in October 2016.

Enforcement: We have identified a breach in relation to assessment of environmental risks at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Cranleigh Paddock is registered to provide care for up to 32 people. The home is registered with the Care Quality Commission to provide accommodation and personal care for older people. There were 26 people using the service at the time of our inspection including people living with dementia. The accommodation is provided at ground floor level and is divided into four units, each of which accommodates up to eight people.

The home 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.

People told us they felt safe and staff were aware of the procedure to take if abuse was suspected.

People's needs had been identified and the risks associated with people's care and support had been assessed and managed. Where risks had been identified these had been minimised to better protect people's health and welfare.

Staff were recruited safely and records included appropriate checks as well as proof of identity to ensure they were suitable for the role they were employed to undertake.

There were enough staff deployed to meet the care and support needs of the people living in the home. The registered manager monitored staffing levels on a monthly basis to ensure appropriate numbers of staff were deployed.

People received their medicines as prescribed. Systems were in place to regularly audit the medicines held at the service and appropriate records were being kept.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the MCA 2005 process had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

People and their relatives thought that the home was well-led. They all spoke positively about the registered manager and the staff group.

Complaints policies and procedures were in place and were available to people and visitors. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with accordingly.

During this inspection we spoke with a person who was using the service, who praised the care and support they received and said 'I don't know where I'd be if not here'. They told us they ate well and 'The food is good'. They said the 'Staff are marvellous'. We also spoke with the registered manager, the assistant unit manager and six members of staff. People's needs were assessed and care and support was planned and delivered in line with their individual care plan. Their health needs were monitored and referred to health professionals appropriately.

People were supported to be able to eat and drink sufficient amounts to meet their needs. There was a relaxed atmosphere in the home and we saw that staff communicated well with people and promoted an inclusive, supportive environment. Training and supervision was provided to staff to ensure they were supported to deliver care and support safely and to an appropriate standard. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

A person who uses the service confirmed that staff discussed their care and support with them and told us they were happy with the way care was given. They said that living at Cranleigh Paddock was like 'a home from home' and that they felt 'looked after and cared for'. They said they were able to 'have a laugh and a joke' with the staff, who were 'always cheerful'. A visiting relative told us that staff consulted them about the care their mother was given and that they had no concerns in relation to the care she was receiving at the home. Both the person using the service and the relative were confident that the management would respond appropriately to any concerns or issues they might have.