Paisley Court

Paisley Court is a residential care home providing personal and nursing care to up to 60 people. The service provides support to older people, a number of whom lived with dementia. At the time of our inspection there were 57 people using the service.

Paisley Court accommodates people across 4 separate ‘suites’ within a two storey building, each of which has adapted facilities.

People’s experience of using this service and what we found

Improvements were needed to ensure the service was properly maintained, clean and secure. Systems to monitor the quality of care within Paisley Court failed to always identify or demonstrate actions taken to make improvements which were needed around the cleanliness of the environment, care planning and monitoring of people’s risks.

Further improvements were also needed to ensure aspects of medicines were safely managed. Records didn't always accurately reflect prescriber instructions regarding prescribed creams and thickening products in drinks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we identified further development was needed around keeping MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) current to reflect changing needs and also in relation to delivering best practice person centred care to people who live with dementia.

Appropriate checks on temporary (agency) and permanent members of staff were in place to ensure they were suitable for the role before working with people. Staffing levels were safely planned, which was determined by people's needs. There were some shortfalls in ancillary workers which the provider was planning to review; and further action was needed to ensure care staff were effectively deployed across the service to ensure people’s needs could be promptly met at busy times of the day.

Although we found some improvements were needed, we did observe positive and caring interactions between staff and people living at Paisley Court. Staff demonstrated an understanding of people’s preferences and people had access to appropriate healthcare services.

Staff told us they enjoyed working at Paisley Court and felt supported by the management team. Professionals who regularly visited the service spoke positively about the staff team and the registered manager took action to address the areas of improvement we identified in this inspection.

People were protected from the risk of abuse. Systems were in place to monitor and appropriately report accidents and incidents to external agencies.

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

Rating at last inspection

The last rating for this service was good (published 11 January 2018).

Why we inspected

We received concerns in relation to staffing levels and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Paisley Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the cleanliness and security of the home and equipment which created a risk to people’s safety as well as shortfalls in effective oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

We have also made recommendations to the provider in relation to following best practice guidance when supporting people who live with dementia and staff deployment across the service.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had safe systems in place to facilitate and support visiting at the home in line with the national guidance.

Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant guidance. Throughout our inspection staff were wearing the required levels of PPE.

Staff and people living at the home were tested regularly for COVID-19 in line with the national guidance.

The provider had systems in place to ensure it was meeting the COVID-19 vaccination requirements for staff and people visiting the service.

The home was clean and hygienic. Frequent cleaning was carried out throughout the day ensuring good standards of hygiene and cleanliness were maintained.

Paisley Court 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.

Paisley Court is a purpose built fully adapted service registered to accommodate up to 60 people who require nursing or personal care. The service specialises in providing nursing care to older people with age related conditions including dementia. The service is divided into four units spread over two floors, with access to the upper floor via stairs and a lift. There is a car park to the front of the building and gardens to the rear.

At the last inspection on 11 November 201610 the service was rated Good. At this inspection we found the service remained Good.

At the last inspection we identified a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because appropriately trained staff were not always deployed in sufficient numbers to meet people’s needs. At this inspection we found improvements had been made and the breach was met.

There were enough trained and experienced staff on duty at all times to care for people.

The service was relaxed and homely and people could move freely around the service as they chose. People were supported to have maximum choice and control over their lives and encouraged to remain independent.

People’s individual needs had been assessed and used to develop care plans. These provided staff with guidance about the care and support people needed and how they wanted this to be provided.

People and their relatives were consulted about their care to ensure wishes and preferences were met. People chose how to spend their day and they took part in a wide range of activities they enjoyed. Visitors were welcomed at any time.

People received a varied and nutritional diet that met their preferences and dietary needs.

People were supported by a kind, caring and consistent staff team who knew them well. Staff had been recruited safely and had the skills and experience to meet people’s needs and provide effective care.

People received their medicine safely and were supported to access the support of health care professionals when needed. People were protected from the risk of abuse because staff understood how to identify and report it.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Relatives felt concerns would be taken seriously and acted on. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Paisley Court is registered to provided support for 60 people. At the time of this inspection 56 people were living there. The home was split into four units, Newsham, Woolton, Sefton and Jubilee. At the time of this inspection Newsham provided support to men only.

Situated in the Dovecot area of Liverpool the home is near to local amenities and bus routes. All of the bedrooms are single and provide en-suite toilet and basin facilities. Accommodation is over two floors with a passenger lift available for people to use.

The home has a registered manager. 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.

During the inspection we spoke individually with four of the people living at the home and with five of their relatives. We also spent time observing the care and support provided to people.

We spoke individually with eight members of staff who held different roles within the home and held a meeting attended by 18 members of staff. We examined a variety of records relating to people living at the home and the staff team including care plans, health and safety records and training and recruitment records.

At this inspection we found a breach of regulations. This was because there was not always sufficient numbers of competent staff working in the home who had received sufficient training and support to carry out their duties.

You can see what action we told the provider to take at the back of the full version of the report.

Staff sickness and a shortage of staff impacted on planned staffing levels on occasions. This meant that staff sometimes felt under pressure and unsupported. It also meant that newer staff or agency staff did not always have the information or support available to support people as well as possible.

Relatives told us that they thought Paisley Court was a safe place to live. Safeguarding policies and procedures were in place to provide guidance for staff and these had been followed when needed. People knew how to raise concerns or complaints and systems were in place for dealing with them.

People’s medication was safely managed with systems in place to ensure they received medication as prescribed and minimise the risk of errors occurring. Staff were aware of people’s health care needs and monitored their health, providing the support people needed. Permanent staff were also aware of the support people needed to manage the effects of their dementia and ensured this was provided.

Individual care plans were in place for everybody living at the home. These contained guidance for staff to follow to monitor the person’s care needs and ensure they were met.

People received the support they needed to eat their meals and were offered a choice of meals and drinks. Staff monitored people’s food and drink intake when required.

The building was clean and tidy with sufficient space for people to use mobility aids. Equipment and aids and adaptations were in place to support people with their mobility, health and personal care needs. Systems were in place and followed to ensure the building and environment were safely managed.

Permanent staff knew people well and spent time interacting with them as well as meeting their care needs. Permanent staff received training that helped them to carry out their role effectively and to understand and support people living with dementia.

The home had a registered manager who was knowledgeable and enthusiastic about the service provided and in planning further improvements.

Systems were in place for auditing the quality of the service and were effective at identifying and planning future improvements to the service people received.

Staff had mixed views about the support they received from senior staff and the organisation. Although steps had been taken to support staff and keep them informed, these had not been fully effective.

We used a number of different methods to help us understand the experiences of people who lived at the home. This was because the residents had complex needs and were not able to tell us about their experiences. People were encouraged to express their views and to be involved, where possible, in making decisions about their care and support. Relatives we spoke with told us they could express their views. They told us they felt listened to when discussing their relative's care needs. Staff confirmed to us they involved relatives, where possible to ensure people received the right care and support.

We spent time in all areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.