This inspection took place on 15 and 18 September 2017. Both days of inspection were unannounced. We last inspected Paddock Stile Manor on 1 February 2017 and found the provider had breached a number of regulations we inspected against. Specifically the provider had breached Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically, the risk assessment process had failed to ensure all risks had been identified and assessed. There were discrepancies in relation to the frequency of overnight checks and positional changes which meant people may not have been receiving appropriate care and support. Nurse call bells in communal areas had been tied up out of people's reach so they would be unable to use them if they needed to call for help or support. Fire exits had been used to store items and personal emergency evacuation plans contained incorrect detail and were not in place for every person living at the home.We found the provider had failed to implement effective governance systems in relation to premises and equipment safety and care documentation. We also made a recommendation about the recording of mental capacity assessments and best interest decisions.
Following the inspection the provider had submitted an action plan, offering assurances that the required improvements would be made by 28 April 2017. During this inspection we found evidence of continued and new breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Paddock Stile Manor is a care home with nursing for up to 40 people. It is a purpose built care home spread over two floors.
At the time of the inspection there were 30 people living at the home, some of whom were living with a dementia. 13 people resided upstairs and had been assessed as needing nursing care and 17 people lived downstairs.
The service did not have a registered manager. The current manager had been in post since March 2017. In August 2017, they had submitted an application to the Commission to be registered. The previously registered manager had left their post on 13 February 2017.
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.
We found there were ongoing concerns in relation to the assessment and mitigation of risk. This included the accuracy and completeness of personal emergency evacuation plans. A failure to assess risks in relation to epilepsy, contradictions in relation to mobility and falls assessments and failure to assess environmental concerns.
Care documentation did not provide staff with sufficient information and detailed strategies to support people safely.
People’s medicines were not managed safely. Two people had not received their medicines as prescribed. There were gaps in the recording of medicines and appropriate guidance was not always in place.
Everyone we spoke with raised concerns about staffing levels. A dependency tool was used to assess people’s needs but we could not be sure this was accurate. The manager also raised concerns that the dependency tool was corrupted.
There was a reliance on agency staff, particularly nurses. This meant, given the failure to ensure accurate, up to date and complete records people were at risk of receiving care which was neither safe nor appropriate.
The concerns noted in relation to DoLS applications and authorisations meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
Staff had not received appropriate induction, supervision and appraisal which meant they had not received the appropriate support to enable them to fulfil their role and meet people’s needs.
We observed people were not treated with dignity and respect. We saw one staff member ignore someone who was showing signs of distress. Some staff referred to people by their room number rather than their name. Relatives raised concerns that people’s personal appearance was being neglected. We also observed poor moving and handling practice.
We have made a recommendation about the provision of meaningful activities for people living with a dementia.
Quality assurance and good governance had not been established, audits had not been completed in a timely manner and they were not effective in identifying concerns and areas for improvement.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.