The Paddocks

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all eight quality statements in this key question, learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection prevention and control (IPC) and medicines optimisation. Systems were now in place to ensure safety was effectively managed. The service had effective safeguarding systems, and staff had a good understanding of the actions to take to make sure people were protected from harm. Care planning information provided detail about how to meet people’s needs and to minimise distress for people and reduce the risk of safeguarding incidents. The service learned from incidents and shared learning to reduce the risk of similar incidents. Staff were recruited safely and received training to meet people’s needs. Staff demonstrated a good understanding about people’s needs and the support they should provide. Relatives felt people were supported safely and were aware of incidents and actions taken by the registered manager.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives said they felt their relative was safe in the home and confirmed the registered manager informed them of incidents.

The registered manager said they have oversight of accidents and incidents and complete investigations to identify lessons learned. The registered manager said they audited incidents, and they shared this information in weekly emails with the leadership team. Leaders said incidents and lessons learnt were also shared with other services in the organisation to raise awareness and prevent similar incidents. Staff confirmed how the team learnt from incidents and said they were made aware of new procedures in place to minimise risk.

Processes were followed to reduce the risk of accidents and incidents, including the management review of accidents and actions took place to reduce risk . For example, reviewing the risks to a person travelling in a vehicle and placing additional control measures to ensure this activity took place safely.

Relatives felt there was effective communication between the service and health professionals.

The registered manager said either themselves or the deputy manager were always on call and would support any emergency hospital admission where essential information would be shared about the person.

Partners fed back positively about the service. One partner said, “The manager at The Paddocks is always friendly and helpful. She works well to support our visits and work as a team. The home follow guidelines to support the client. They put the client’s needs first and are responsive to the client’s communication.”

Processes were in in place in case of the event of people needing to go to hospital. The service also now had a more in-depth admissions assessment. However, they had not had any new admissions into the home to embed this process. People’s behaviour support care planning information contained relevant detail about how to support people to reduce the risk of distress.

Relatives felt their relation was safe in the home and were aware of safeguarding incidents. However, one relative fed back they were aware of what had happened and how the registered manager had dealt with the safeguarding, but did not know the final outcome. The relative said there had not been any more incidents since. The registered manager confirmed they had spoken to the main contact about this.

The registered manager said all staff had received advanced safeguarding training and they check staff understanding during supervisions. The registered manager said they had management oversight of safeguarding incidents and can check this information effectively using their electronic records. Leaders said they spend time in the home observing practice, speaking with people and staff . The registered manager said they worked on shift supporting people and had regular opportunities to get feedback from people about their care and identify any safeguarding concerns. Staff confirmed their awareness of safeguarding procedures and to whom they would report safeguarding concerns.

We saw staff supporting people safely in the home in line with their risk assessments. For example, we saw staff following a person’s care plan to reduce the risk of distress which could have become a potential safeguarding incident. We also observed staff supporting a person with their meal in line with the person’s care plan.

Systems were now in place to protect people from the risk of potential abuse. For example, there was a current safeguarding policy and management oversight of safeguarding incidents. The registered manager notified the care quality commission (CQC )and others about safeguarding concerns. All staff were compliant with the organisation’s safeguarding training requirements. Staff had received training to support people at times of distress.

Relatives said they felt the home managed and reviewed the risks for people regularly and were involved in discussions about risks for people.

The registered manager said they involved people in their risk management by re-wording the information in a way that each person understands. The registered manager said relatives were also involved in decisions and care planning assessments. They told us “It doesn’t matter how well we think we know a person; their family member knows their relative better and can tell us a more person-centred way to manage risks.”

Staff were aware of risks to people and took steps to follow people’s risk assessments. We observed staff supporting a person with their meal in line with the person’s Speech and Language Therapist (SALT) eating and drinking guidelines.

Processes were now in place to ensure risks were identified. Control measures to keep people safe were clearly explained in people’s care plans. There was an effective system to ensure all staff were aware of changes to people’s care plans and risk assessments through the staff handover.

Relatives told us, “The home are forever doing things to maintain/improve the environment and the setting is fantastic. [Person] can get agitated by change, but they manage that with them.” And “the front door is always locked and has a keypad, the rear garden is enclosed, therefore, I have no concerns about the safety of the home.”

The registered manager said they completed regular audits and had action plans to check the environment’s safety, and these had oversight from the area manager. The registered manager said they made sure staff practise fire evacuations regularly and that equipment is regularly serviced. Staff confirmed their awareness of their own responsibilities in relation to checking the safety of the environment.

The environment was clean and tidy with no obvious slip or trip hazards inside. However, the kitchen appeared run down and we were told there was a plan to refurbish the kitchen. We noted the patio had multiple raised slabs which could cause trip hazards for people. The registered manager said this had happened during some recent flooding and there were plans to address this and had put a risk assessment in place to reduce the risk to people, staff and visitors.

There were processes to ensure a safe environment, for example regular day and night evacuation practice took place and checks on fire extinguishers and moving and handling equipment. Regular audits took place to check for hazards in the service and the provider took action to make improvements. Plans were in place for the service to make improvements to the home environment and there were risk assessments where risks in the environment were identified.

Relatives said there were enough staff to meet their relative’s needs.

The registered manager said they made sure there were enough staff to support people. They used a dependency tool based on people’s needs and activities which identified the number of staffing hours needed. Staff confirmed there was enough staff on each shift and there was a system to help staff understand their responsibilities on each shift. For example, a shift plan identified who was leading the shift and assigned staff to people they needed to support.

We saw there were enough staff to meet people’s needs during the assessment in line with the rota requirements. We observed people being supported by staff in a calm and unhurried manner and in line with their risk assessments.

Systems were in place to ensure people were safely recruited. There were recruitment processes to ensure people were supported by staff with the appropriate experience and character. There was an induction programme to ensure all new staff had received appropriate training and support. Staff received regular supervision and team meetings. Staff were now trained to meet people’s needs and were compliant with training in line with the provider’s training requirements.

People told us the home was clean. One person said, “The cleanliness of the home is good.”

The registered manager said they checked the home for risks of infection by completing monthly audits, daily walk around the service and checking staff washed their hands in line with infection prevention and control guidance. The registered manager said the home had an infection prevention and control champion to support their oversight of IPC. The IPC champion had been given extra training in IPC.

We found the home clean and free from offensive odours. We saw food was stored safely in the kitchen.

There were processes to minimise the risk of infection, and these were followed by staff. This included legionella checks, regular cleaning and ensuring food was stored and managed safely. Staff received appropriate training in line with the organisational training requirements. Risk assessments were in place to ensure the risks of infection were minimised in relation to the sheep, pigs and chickens living in the grounds of the service.

People’s medicines were seen to be given in a safe and caring way. Medicines were administered in a timely manner and recorded on people’s medicines administration record (MAR) charts. We saw that people’s preferences were considered, in the way that they liked to take their medicines.

Staff we spoke with told us the medicine system currently worked well, and they had support from management. Staff told us they received medicines training and had regular competency assessments, and we saw records that showed these had been completed. Staff we spoke with were knowledgeable about people’s needs and their medicines.

There were policies and processes to ensure people received their medicines safely. Medicines were stored securely in a cupboard in the medicines room. There was no dedicated fridge for storage of medication requiring refrigeration. However, there was a fridge in the kitchen used for the storage of medicines if required, however this fridge was not lockable. There was a process in place to ensure this fridge was monitored and any medicines requiring refrigeration were stored in line with the service’s medicines policy. The registered manager said the service would purchase a medicines fridge if someone required regular medicines requiring fridge storage. There were processes for managing drug alerts and actions if appropriate. In some cases, when required (PRN) medicines were not present for some people. For example, the topical MAR was missing for a resident’s cream. The registered manager confirmed they had addressed this at the time of the medicines assessment and the registered manager had not reordered this medication during the last medication order because the cream had not been required by the person.