We carried out an unannounced comprehensive inspection of this service on 26 October 2017 and 01 November 2017. At that inspection the service was rated good overall and there were no breaches of relevant regulations. After that inspection we received concerns in relation to staffing levels, the safety of people and the governance within the service. As a result, we undertook a focused inspection of Paramount Care (Gateshead Ltd) on 16 and 17 August 2018 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Paramount Care (Gateshead Ltd) on our website at www.cqc.org.uk.

Paramount Care (Gateshead Ltd) is ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Paramount Care (Gateshead Ltd) can accommodate 20 people in one adapted building comprising of six different houses joined together and on the date of this inspection there were 17 people living at the home. Most of the people living at the home had fluctuating capacity due to an underlying medical condition or a learning disability.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice and the promotion of independence and inclusion. People with learning disabilities and autism using the service were supported to live as ordinary a life as any citizen.

There was a new manager in post who was in the process of registering with the CQC as the registered manager for the service 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.

The premises were safe and people felt safe living there. There were safeguarding policies and procedures in place to keep people safe. Staff had received regular training and supervision around safeguarding vulnerable adults. The manager at the home escalated all safeguarding concerns appropriately to the local authority.

Staff were recruited safely and had undertaken all necessary training to safely fulfil their role. Staff received regular supervision from the management team but the managers did not receive regular supervision or support from the provider of the service. There were regular health and safety checks of the premises by the manager. Risk assessments were in place to keep people safe in the least restrictive way possible. There was a fire risk assessment in place.

Infection control procedures were in place at the home and during the inspection we saw regular cleaning of the home. There was a business continuity plan in place to ensure the service could still provide care to people in the case of an emergency.

Medicines were safely managed and care was delivered in line with best practice and national frameworks. There were procedures in place to ensure the safe receipt, storage, administration and disposal of medicines.

Accidents and incidents were recorded, investigated, were appropriately acted upon and lessons learned were documented and shared with staff. Safeguarding concerns raised to the local authority were linked to the corresponding incident.

People’s treatment was delivered in line with best practice and current national frameworks. People’s needs were regularly reviewed and care plans were created in partnership with people. Consent was sought by staff before carrying out any aspect of personal care with people.

We saw regular involvement from GPs, loc

This inspection took place on 26 October and 1 November 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Paramount Care (Gateshead Ltd) accommodates 20 people with learning disabilities in six different houses in the same complex. At the time of our inspection, there were 14 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Paramount Care (Gateshead Ltd) was last inspected by CQC in December 2016 and was rated Requires improvement overall. At the inspection in December 2016 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 17 (Good governance)

Regulation 18 (Staffing)

At this inspection we found improvements had been made in all the areas identified at the previous inspection.

The provider had taken seriously any risks to people and put in place actions to prevent incidents and accidents from occurring.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

Procedures were in place for safe the administration of medicines.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Staff were suitably trained and training had been arranged to update training when needed. Staff received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Paramount Care (Gateshead Ltd). Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Support plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were supported to access the local community and to take part in events.

The provider had an effective complaints procedure in place.

Staff said they felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys. Family members told us the management were approachable and communication was good.

The provider had an effective quality assurance process in place and regular audits of the service were carried out.

This was an unannounced inspection which took place over three days, 15 and 16 of November and 1 December 2016. The service was last inspected in July 2016. Five breaches of regulation were found at that time. These related to safe care and treatment; staffing; consent; person centre care and governance. Warning notices were issues to the provider.

Paramount Care (Gateshead Ltd) is registered to provide accommodation for persons who require nursing or personal care at The Ropery for up to 20 people. There were 15 people living at the home at the time of the inspection, most of whom were people with learning disabilities. The service is split into three six bedroomed houses, two four bedroom houses and six one bedroom flats. Some of the accommodation was used as additional communal areas or office space for staff.

The service did not have a registered manager as the previous manager had cancelled their registration in August 2016. The deputy manager was intending to register with the Care Quality Commission. 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.

Risks to people’s safety were now being correctly assessed and managed by the service so people were no longer at risk of harm. Routine health and safety checks in the service were more consistent and robust and actions arising from checks were completed by staff in a reasonable timescale.

Staffing was still under review with commissioners. People and staff told us they felt there was enough staff to provide support. People who used the service were supported to take part in therapeutic, recreational and leisure activities in the home and the community. We saw that occasional non-essential activity did not take place due to staff absence, but this was having a limited impact on the overall delivery of activities.

People’s medicines were well-managed by the service. Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines. The service had almost completed an action plan to improve medicines management and staff had attended recent update training.

Staff were trained in and demonstrated they had knowledge of the Mental Capacity Act 2005, though this was not always clearly reflected in the service’s records.

All people’s care plans had been updated in line with the provider’s new procedures. It was not yet clear how effective the review process was as records were not sufficiently detailed. It was not always clear whether people, or their representatives, were involved in their care reviews. Action was taken by the provider after our inspection to improve the review and recording process. Care plans were now consistent and contained the details to show how the service supported people in a manner of their choosing.

Staff told us they received day to day support from senior staff to ensure they carried out their roles effectively. However, formal induction and supervision processes were not always used to enable all staff to receive feedback on their performance and identify further training needs.

Arrangements were in place to request health and social care support to help keep people well. External professionals’ advice was sought when needed. Feedback from external professionals was that staff were now more engaged and consistent in responding to their advice.

Care was provided with kindness, compassion and in a dignified manner. People could make choices about how they wanted to be supported and were treated with respect. People told us they felt cared for by staff who listened to them.

The systems and processes in place to make sure the staff learnt from events such as acciden

This was an unannounced inspection which took place over three days, 12, 13 and 21 July 2016. The service was last inspected in November 2015. Four breaches of regulation were found at that time.

Paramount Care (Gateshead Ltd) are registered to provide accommodation for persons who require nursing or personal care at The Ropery for up to 20 people, mostly with a learning disability. There were 16 people living at the home on day one of the inspection, one person was absent. The service is split into three six bedroomed houses, two four bedroom houses and six one bedroom flats. Not all the rooms were registered so the houses had un-used rooms; some were used as additional communal areas or office accommodation.

There was a registered manager who had been in post since June 2015. They informed us they were in the process of de-registering. 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.

Risks to people’s safety were not always correctly assessed and managed by the service so people were at risk of harm. Routine health and safety checks in the service were not robust and actions were not taken by staff in a reasonable time. The provider did not take actions after our last inspection and people experienced avoidable harm as a result.

Staffing was not always deployed effectively across the houses to provide consistent support throughout the day and night. Senior staff had to support staffing teams when required rather than manage the service effectively.

People’s medicines were managed well. Staff were trained and monitored to make sure people received their medicines safely. Care plans were in place to support the use of ‘when required’ medicines.

Staff had attended training and demonstrated they had an awareness and knowledge of the Mental Capacity Act 2005, but this was not always reflected in the records or in how care plans were developed. Not all care records were written in a person centred way and it was unclear how progress towards goals was being made or evaluated for some people. Some people’s care plans had been specifically targeted and updated, but others had not been updated.

Staff told us they received day to day support from senior staff to ensure they carried out their role effectively. However formal induction and supervision processes were not used consistently to enable staff to receive feedback on their performance and identify further training needs. It was not always clear if staff had successfully completed induction as the service did not keep effective records.

Arrangements were in place to request health and social care support to help keep people well. External professionals’ advice was sought when needed, but some external professionals told us that staff did not always use advice consistently across the service and that staff needed support to complete behaviour support documentation.

Care was provided with kindness and compassion. People could make choices about how they wanted to be supported and staff listened to what they had to say. People told us they felt cared for by staff who listened to them. People were treated with respect. Staff understood how to provide care in a dignified manner and respected people’s right to privacy and choice. However not all peoples care documentation, which could support staff’s understanding of how best to support them, was completed.

It was not always clear that people, or their representatives, were involved in their care planning and review. Care plans were inconsistent and did not contain enough detail to show how the service supported people in a manner of their choosing.

People who used the service and visitors were supported to take part in therapeutic, recreatio

Paramount Care (Gateshead Ltd) is registered to provide care and support for up to 20 people with a learning disability. The location is made up of six individual houses, one of which has been made into apartments. At the time of our inspection only four houses were in use and there were 15 people living at the service.

Our inspection team was made up of an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Below is a summary of what we found. The summary is based on observations during the inspection, speaking to people who used the service and the staff supporting people.

The people we spoke with told us they felt happy and safe living at Paramount Care (Gateshead Ltd). We saw staff treated people with respect and were mindful of their rights and dignity.

The deputy manager, who assisted us on the inspection, told us she was confident she and all staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). She talked us through the process the service had recently gone through to gain a DoLS for a person living at the service. We noted a number of DoLS were in place and these were completed correctly and appropriate risk assessments and care plans were available to support staff in caring for these people.

We found the arrangements for handling medicines were safe. Staff told us they received regular training on medication to ensure they were confident in the processes.

We found some people were involved in the assessment of their needs and care planning but this was not always consistent and varied depending upon the homes. We saw some good examples of how people had written documentation to go in their care files and how they went through the documents monthly with the staff. This however was not applied to all of the houses.

We saw everyone was involved in discussions about their food intake and were supported to ensure this was nutritious. We noted each house had chosen to organise meal times in a different way. We saw one house had decided to do a group menu each week, whereas in another house each person had individual meals but they all went together to complete a weekly shop. Staff told us if required they would seek specialist advice in relation to nutrition and dietary requirements.

We saw all staff had positive and effective relationships with people using the service. We saw people had a rapport with the staff members and knew them all by name.

The majority of people at the service received one to one support; however staff told us they still encouraged people to be independent. Some people told us they liked to spend time in their room and that staff respected this.

Staff told us the service used a MORE (Motivation, Occupation, Recreation, Education) Planner, whereby people planned their activities for the week. We noted the use of this was inconsistent between the houses. One person told us how she completed her MORE planner each Sunday and planned all her activities with the staff members. Staff told us how they tried to use the activities to support people’s care needs. However, we identified in another house the MORE planner was not completed weekly and instead there was one planner which was a template of ideas. We noted the information documented was more around house chores and when we spoke to people using the service at this house they told us activities they would like to do but didn’t get to. We have spoken to the provider regarding this and he is going to ensure staff work with people to ensure they can plan and attend activities they want to do.

The deputy manager told us residents meetings were per house. When we spoke with people using the service we identified two houses had residents meetings and were very happy with how involved they felt and the support they received during them. The people using the service at the houses however were not aware of any meetings and told us things they would raise if there was to be a meeting of this sort.

Everyone we spoke with said they would be confident to make a complaint, should this be required. Staff members told us they would support people if they wanted to complain.

As the majority of people using the service receive one to one care, we noted the rotas for the service were consistent and people received care from a regular group of carers.

The management at Paramount Care (Gateshead Ltd) was split between the houses. The deputy manager told us she managed two houses and the registered manager was responsible for the other two. We noted although the leadership and working relationship in each was effective and supportive, there was no consistency in service delivery and no overall monitoring of the service.

We noted a person centred approach appeared to be happening in each individual house, however due to lack of consistency in management there no clear values or equality throughout the overall service.

People were asked for permission before receiving care. We found people were encouraged and supported to make choices and decisions. One person commented, “You can make your own decisions. I choose where I want to go”, and, “Whatever you fancy, staff will normally help you to do it.”

People had their needs assessed and the assessments were used to develop personalised care plans. One person said, "My life is better now since I move here. Staff are totally different, bubbly and smiley all the time and interact with you all the time. They are always there for you and are very approachable." Another person said, "I am very pleased to be here", and, "I like it here because members of staff are so good at supporting me."

The provider had policies and procedures in place to protect people from the risk of abuse. Staff had completed safeguarding training and had a good understanding of safeguarding. People said staff had spoken to them about keeping safe and what to do if they had any concerns.

Care staff said they were well supported by their manager and had regular supervision. One staff member commented that their manager was, “Brilliant, really good and understanding.”

The provider had audit systems in place to check on the quality of the service. People raised no concerns about the care they received. One person commented, “I am well looked after, I am very pleased with the team here. I have no complaints.”

This was an unannounced inspection which took place over four days on 25 and 26 November and 3 and 11 December 2015. The service was last inspected in April 2014 and the service was meeting the regulations in place at the time.

Paramount Care (Gateshead Ltd) are registered to provide accommodation for persons who require nursing or personal care at The Ropery for up to 20 people, mostly with a learning disability. There were 18 people living at the home on day one of the inspection. The service is split into three six bedroomed houses, two four bedroom houses and six one bedroom flats. Not all the rooms were registered so the houses had 12 un-used rooms; some were used as additional communal areas.

There was a registered manager who had been in post since June 2015. 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 that the service was not always safe; people’s complex needs were not always managed safely. Risk assessment and care planning records did not always support effective management of people’s complex needs or of potential risks in their environment. People’s rights and choices were supported by the service, but records did not always reflect this. People using the service, their relatives, staff and professionals felt their concerns would be addressed by the staff and registered manager. However, staff failed to adequately review and learn from incidents, such as safeguarding and police incidents meaning care practice may not have improved.

We saw the registered manager recruited and trained staff to meet the complex needs of the people they cared for. Staff were encouraged to work safely and share good practice. The registered manager took disciplinary action against staff whose performance was ineffective.

Medicines were not always managed safely. We saw that ‘as and when required’ medication use was not always based on clear guidance. Storage and recording of medications was inconsistent. As people’s needs changed their medication and treatment was reviewed by external professionals.

Care plans were inconsistent and did not always reflect the care people were receiving. Feedback we received from people and staff indicated that people received effective care, but this was not being effectively evaluated by staff as the records kept could not support this process. Staff were knowledgeable about people, and knew them well. Relatives and professional feedback was that they felt the staff were effective.

It was not always clear how peoples consent and involvement was sought by the staff in delivering care and treatment based upon best practice. We saw people were supported to eat and drink enough. People were encouraged to make choices about their food and drink. Staff encouraged the development of kitchen skills so people could take control of their meals and become more independent.

People told us they were supported to access health care services and social support to work towards their goals of becoming more independent or of managing their behaviours. Support was available and staff were mostly intervening effectively when people needed them. This was largely due to effective handover between staff as care records did not always support this.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw that where people were deprived of their liberty this was in their best interests, and assessments of capacity had been carried out. However peoples, or their representatives, consent had not always been sought or recorded in their care plans where this was appropriate.

People, relatives and external professionals felt that the staff were interested in people’s development. Through the use of one to one time people and staff felt they had a stronger relationship based on trust and mutual respect. Staff encouraged people to express their views about how they wished to be supported.

People told us they were supported in way that respected their dignity. People’s privacy was promoted by staff and we saw that people’s relationships outside the service were supported and encouraged.

The care plans we saw were not always person centred and contained often contradictory or limited information on how best to support the person. It was unclear how people, their relatives or external professionals had been involved the creation or review of these plans.

The registered manager encouraged staff and people to speak up and make suggestions. However the quality of audits and review of the service were inconsistent. Checks of the service quality were not comprehensive and areas for improvement had not been identified by the registered manager. This meant continual improvement could not be assured.