We carried out an inspection of Paddock Lodge Residential Care Home on 9 and 10 September 2015. The first day of the inspection was unannounced.

Paddock Lodge Residential Care Home provides accommodation and personal care for up to 16 older people, including people living with dementia. At the time of the inspection there were eight people living at the service, all of whom were female.

The service is set in a detached building in its own grounds, two miles from Burnley town centre in East Lancashire. Bedrooms and facilities are located over two floors and a stair lift is available. There is a lounge and dining room on the ground floor as well as a conservatory. Bedrooms do not have are ensuite facilities however there is access to suitably equipped toilet and bathroom facilities on both floors.

At the time of our inspection there was a registered manager in post at Paddock Lodge Residential Care Home. 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.

At our last inspection in June 2014, we asked the provider to make improvements to care plans and risk assessments, monitoring the quality of the service and sending the commission appropriate notifications of incidents. We received an action plan in July 2014 advising that the required improvements would be made by 30 September 2014. We reviewed these actions as part of this inspection and found that further improvements were required. We noted that the provider had sent the commission appropriate notifications and we saw evidence that care plans and risk assessments had improved. However, we found that further action was required in respect of the monitoring of the quality of the service.

We found a breach of our regulations related to the need for consent. Where people lacked the mental capacity to make decisions about their care, the guidance in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards was not being implemented. We found that capacity assessments were not being completed and there was no evidence that best interests decisions were being made.

We have made recommendations about staff competence to administer medicines, ensuring the service environment is safe, best interests decisions, staff training on the Mental Capacity Act and Deprivation of Liberty Safeguards and the auditing of the service. We have also recommended that the provider implement a redecoration plan to upgrade the home.

During our inspection people told us they felt safe. They said, “The staff help me in the bath. They are very careful”. Relatives told us, “My relative is always kept safe and we’re kept up to date with any changes in her health” and “I always think my relative is safe. I never worry about anything happening to her”.

We noted that staff had been recruited safely and received an appropriate induction and training. They had some understanding of how to safeguard vulnerable adults from abuse however not all staff were aware that they could raise a safeguarding alert directly with the local authority if they witnessed or suspected abuse.

People who used the service and their relatives told us that staffing levels were appropriate and sufficient to meet people’s needs. People living at the service told us, “Staff are always around if you need them” and “They’re very good to me. They come straight away if I want them. I don’t have to wait”.

There were appropriate policies and procedures in place for managing medicines and people told us they received their medicines when they needed them. However not all staff had been recently assessed to ensure they administered medicines safely.

People living at the service told us staff were able to meet their needs. They told us, “I like it here, the staff look after me” and “The best thing about here is I don’t have to worry about anything”. Relatives told us, “The staff have the skills and experience to look after my wife” and “We have no concerns about the care, we’re happy with it. The staff seem very capable”.

We found that staff were well supported. They received regular supervision and could access a wide variety of training. They told us communication between staff was good at the service and they always felt up to date with people’s needs.

We saw that people at the service were supported with their nutritional needs and the people we spoke with told us that the food was good and they always had plenty to eat and drink. The cook told us that people could always have an alternative if they did not like what was on the menu and people living at the service confirmed this was the case. We saw evidence that people were supported appropriately with special dietary needs.

People were supported with their healthcare needs and were referred appropriately to health care services. A visiting district nurse told us staff sought advice and support as soon as it was needed and following recent training significant improvements had been made in the quality of care provided. She told us she did not have any concerns about the service.

People living at the service and their relatives told us the staff and registered manager were caring. One person living at the home told us, “I like it here, they have looked after me”. Relatives told us, “We wouldn’t change anything. We’re more than happy with the care here”; “My mum’s always treated with dignity and respect by staff” and “I think my wife is well looked after here”.

People living at Paddock Lodge Residential Care Home told us they had the freedom to make a variety of choices including what time they got up and went to bed and where they ate their meals and we saw evidence of this during our visits.

People were treated with dignity and respect. We observed staff knocking on people’s doors before entering and asking where they wanted to sit at meal times. We saw staff seeking consent before providing care, for example by asking people if they were ready to receive their medicines.

We observed that people’s needs were responded to quickly and saw evidence that their needs were reviewed regularly. However there was no evidence that relatives were consulted when people lacked mental capacity and were unable to contribute to reviews of their care needs.

We saw evidence that the registered manager sought feedback about the service from the people living there, their visitors, staff members and professionals who visited the home. We noted that although some of the changes suggested had been made, many improvements such as the redecoration of the service and the creation of a shower room had not been completed.

People living at Paddock Lodge Residential Care Home told us they were happy with the way the service was managed. One resident told us, “I can’t say anything wrong about here but if there was, I would tell them”. Most of the visitors we spoke thought the home was well led. One relative told us, “The manager does a very good job”. However one relative told us they had raised concerns with the registered manager but improvements had not been made as a result.

During our inspection we observed that the registered manager was involved in providing care and support to people and noted that this was done in a caring and respectful way. It was clear that she knew the needs of the people living at the service well and that they and their visitors felt able to approach her.