This inspection took place on 25 July 2018. The Paddock is a residential care home for up to 19 adults with a learning disability. There were 14 people living at the service at the time of inspection. The accommodation is spread over one main building which contains bedrooms on the ground and first floor. There is a large garden front and back. The provider has also built a second kitchen in a building in the garden. The Paddock is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well-led to at least good. At this inspection we found that the service had improved and the service is now rated Good.

At the last inspection, on 18 May 2017 the service had failed to ensure that behaviours that challenged or equipment used were adequately risk assessed. This was a continued breach of Regulation 12 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection we found that the service was now meeting this requirement. Risks to people were assessed, including risks from the use of equipment and behaviour that challenged. There was guidance for staff to enable them to minimise risks. At the last inspection we recommended that a health and safety assessment be undertaken by a qualified and competent person of current window security on the first floor to ensure people were not being placed at risk. Risks from the environment had also been assessed and actions had been taken to protect people.

At the last inspection on 18 May 2017 the service had failed to ensure medicines were managed safely. This was a continued breach of Regulation 12 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection we found that medicines were now managed safely and people received their medicine as prescribed and on time.

At the last inspection on 18 May 2017 we found that overall monitoring of service quality remained ineffective. This was a continued breach of Regulation 17 of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. At this inspection the checks on the quality of the service were effective and actions identified had been undertaken.

The care at the service has been developed in line with the values that underpin good practice. These values included choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service had a registered manager in place. 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.

There were sufficient numbers of staff to meet people’s needs and support people effectively. Staff had the training, skills and knowledge they needed to support people with learning disabilities. The registered manager monitored staff performance and staff had supervision meetings, team supervisions and annual appraisals. New staff had been recruited safely and pre-employment checks were carried out.

There were systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and

The inspection was unannounced and took place on 18 May 2017. The service is residential service for up 19 people with learning disability and autistic spectrum disorder. There were 15 people living there at the time of our inspection. There are two vacancies as shared rooms are currently used as single accommodation so everyone has their own bedroom. There is no lift to the first floor; some bedroom accommodation is provided on the ground floor but there is limited accessibility to other parts of the ground floor for people using wheelchairs.

There was a registered manager in post. A registered manager is a person who is 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 registered manager had been in post for the last 14 years. The registered manager and the operations manager were both present at inspection.

This service was last inspected in May 2016 when we found that improvements the service had made in some areas had not been sustained in others. We issued requirement notices for action to be taken to improve arrangements for: the storage and administration of medicines, the risk assessment of behaviour and equipment used to support people, the provision of guidance to inform staff about risks associated with specific health needs, the servicing of all equipment and installations in the premises, the appraisal and training of staff, and a robust quality monitoring system that can highlight shortfalls to the registered manager. We asked the provider to tell us what actions they were going to take to address the shortfalls identified and they wrote to tell us what they had done to meet these shortfalls.

At this inspection we looked at whether these improvements had been implemented and sustained. The staff continued to provide care and support that was caring and responsive. Improvements had been implemented to ensure the service was also effective in the care and support it delivered. However, improvements to medicines had not been maintained. Risk management was inconsistent. Improvements in quality monitoring had not been fully embedded and remained ineffective in identifying shortfalls.

People were happy and settled living in the service. People's care needs were understood by staff. Care plans were designed around people’s needs and preferences. Relatives were satisfied with the standard of care and felt informed by staff about their relative’s needs. Relatives were invited to reviews and were asked to comment about the service through surveys. They commented that staff had the right attitudes and cared about the people they supported.

People were consulted about weekly food menus and enjoyed the meals they received. Staff monitored their health and they were supported to attend regular and specialist health appointments so they remained healthy. An activity programme was in place and people were asked about what they wanted to do; at times people appeared under stimulated. Staff now had the responsibility to support people with onsite activities and needed training and support to be proactive and feel confident of delivering activities suited to people’s needs.

The premises is a grade two listed building that requires an on-going programme of repair and upgrading, the communal lounge, some hallways and bedrooms have been redecorated since the last inspection and provide comfortable environments for people. Other areas such as the dining room and a smaller lounge would benefit from updating and providing a more homelike setting. All tests, checks and servicing of equipment and installations including, gas, electricity and the fire alarm had been kept updated. Staff attended fire drills so they understood how to evacuate the building safely.

There was enough sta

The inspection was unannounced and took place on 5 May 2016. The service is residential service for up 19 people with learning disability and autistic spectrum disorder. There were 16 people living there at inspection with one vacancy, this was because two shared rooms are currently used as single accommodation so everyone has their own bedroom. There is no shaft or stair lift to the first floor; some bedroom accommodation is provided on the ground floor but there is limited accessibility to other parts of the ground floor for people using wheelchairs. People tend to stay in the service so the age range is from 18 and over with a number of people over 65 years of age.

This service was last inspected on 16 April 2015 when we found the service required improvement to the recruitment of staff, notifications to the Care Quality Commission in respect of Deprivation of Liberty authorisations, quality monitoring, ensuring staff induction records were in place and that the electrical installation had been serviced.

We asked the provider to tell us what actions they were going to take to address the shortfalls identified and they wrote to tell us what they had done to meet these shortfalls. At this inspection we looked at whether these improvements had been implemented and sustained; we found that action had been taken by the registered manager and measures implemented to address the shortfalls in all but one area. Due to changes in the management structure in the organisation there had been a delay in expanding, developing and taking forward an effective quality monitoring system for the assessment and monitoring of the service; progress in this area had stalled and this remains a continued breach of regulation.

There was a registered manager in post. A registered manager is a person who is 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 the time of inspection the registered Manager was away on holiday and the deputy manager was providing cover during this period.

The ordering, receipt and disposal of medicines was well managed; we identified shortfalls however, in their storage and administration that need improving. The absence of an effective quality monitoring system meant that the registered manager was unaware servicing of moving and handling equipment was overdue, or could evidence that an inspection of the gas installation had been undertaken.

Risk assessment around use of equipment and people’s behaviour had not been assessed and implemented. Some important staff training that helped them to keep people safer was also overdue, staff monitored peoples health and well being but individualised guidance for staff around some health conditions was lacking. There was a culture of appraisal and supervision of staff but changes to the management structure within the company had delayed the annual aprrasial of staff. Recruitment procedures ensured that all relevant checks were made of new staff and that they were suitable for their role.

The service offers people a comfortable clean environment, the atmosphere is relaxed with people easy in each other and staffs’ company. Staff provide kind patient and attentive care and demonstrated a good understanding of people’s characters and individual needs. The Registered manager provides staff with strong leadership and staff found her approachable and they felt listened to. Relatives respect and value the registered manager and staff input. People experience a good quality of care.Relatives were complimentary of the service and the delivery of care they observed and experienced for their relative, similarly care professionals who provided feedback expressed no concerns overall about the service. People themselves told us they liked wh

We undertook an unannounced inspection of this service on 16 April 2015. This service is registered to provide accommodation and care for up to 19 people with a learning disability. However in order to provide single room accommodation for people only 17 people are usually accommodated. At the time of inspection 17 people were living in the service. The service was last inspected in January 2014 and no concerns were identified from that inspection.

The service is located in a residential area of Lydd on the Romney Marsh. It is within walking distance of local amenities, shops and public transport. The service has a registered manager in post. 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.

People told us they liked living in the service and were happy there, they liked the staff and the opportunities they had for going out and doing the things they wanted. Comments included,: “I like living here, I like people here”. “Staff treat us well”. “I get enough food and drink when I want it.” “I like the people who help me”. Health professionals and relatives commented positively about the standard of care people received. Relatives told us that they were kept informed and their views were always sought.

The service is provided in a large period property that required some upgrading. Works that needed to be done had been identified and prioritised for completion but a schedule of timescales had not been implemented; other more urgent works had taken precedence to ensure people were kept safe and warm. The majority of weekly, monthly, and annual safety checks were completed, but the registered manager was unable to confirm that the periodic check of the main electrical installation had been undertaken and was still in date.

There was an established recruitment procedure that required applicants to complete application forms and attend for interview. Interview records were made to support decisions to employ new staff. The service ensured all relevant conduct in employment references; a criminal record check and evidence of personal identity were received prior to new staff commencing work. However, staff records were incomplete and failed to address gaps in employment histories, the medical fitness of applicants and reasons for leaving previous employment in care.

Staff told us they had received a good induction to help them understand and support the needs of people. They said their competency to do so was assessed by senior staff and the registered manager but records of induction and competency assessments of new staff were not completed to show how this was delivered to them and how their competencies and understanding were assessed. Staff told us that a programme of essential training was in place to provide them with the necessary skills to fulfil their role, and records supported this. Staff said the registered manager was proactive in sourcing training for them to do.

People’s concerns were taken seriously and acted upon, but not always recorded to show that proper processes had been followed. Some stand-alone audits were undertaken that included health and safety, medicines and finances, but some of these were not robust or sufficiently in depth to provide assurance that the area assessed was operating effectively. An overarching assessment of service quality was in place but failed to identify the shortfalls highlighted by this inspection.

Our inspection showed staff to be caring and protective of the welfare and wellbeing of the people they supported, and staff showed commitment to ensuring people enjoyed a good quality of life. People were supported to make everyday decisions for themselves, but staff understood when they might need other people to help make some decisions on their behalf. Staff provided support in accordance with the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People felt safe and cared for by staff. They were supported to live their lives in the way they chose. Where able to, they were supported to maintain their independence or to develop skills, and to undertake tasks within their capabilities. There were enough staff to support people’s needs. There were low levels of accidents and staff understood how to keep people safe and how to use the reporting mechanisms for safeguarding, whistleblowing and accidents and incidents.

Staff told us they had regular supervision and found the registered manager approachable and supportive. Staff demonstrated an in depth knowledge of people’s individual needs and support. Personal care was managed discreetly, and people were provided with the equipment they needed to help with their care and support needs. People were consulted about what they wanted to eat and staff ensured that everyone had enough to eat and drink, and assisted those with special dietary needs. People were supported to access health appointments and their healthcare needs were monitored.

People who used the service and their relatives were asked for their views about the service and felt listened to.

We have identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We recommend that the service uses the complaints log to record all concerns and complaints to show that these are dealt with appropriately.

At the time of our inspection there were sixteen people living at the service. We spoke with four people who were living there, three members of staff, the manager and the area manager/provider representative.

Most people who used the service were not able to talk to us directly about their experiences due to their complex needs, but we observed how they spent their time and their interactions with the staff. One person told us that they “like to paint” and another person said they enjoyed “going to the pub on Sundays”.

We found that people were appropriately supported to make their own day-to-day decisions and were involved in how their care and support was provided. We found that care plans were individualised and contained details about people's choices and preferences.

We found that the home had arrangements in place to protect people from the risk of abuse and there were financial procedures in place to ensure people’s money was kept safely.

The service had processes and procedures in place to regularly check and monitor the quality of the service that people received.

At the time of the inspection sixteen people were living at the service. We spoke with five people who were living there, four members of staff and two external staff training assessors who were visiting the service. Some were not able to talk to us directly about their experiences due to their complex needs, but we observed how they spent their time and interactions with staff.

People were treated with respect and dignity. Records showed that they were supported to make decisions about their day to day lives and things that were important to them. People could choose when to get up and go to bed, what to do and what to eat each day and staff respected their choices.

People liked the staff and told us that staff were kind towards them. Staff understood people’s needs and their preferred individual methods of communication. People were supported to be as independent as they could and to learn new skills.

The service had financial procedures in place to ensure people's money was protected.

There were enough staff on duty to support people safely and in the ways they preferred.

The organisation had processes and procedures in place to regularly check on the quality of the service people received and to keep them safe.

This inspection was undertaken to look at one outcome area. This was to support the previous inspection that was undertaken on 2nd May 2012 which looked at four outcome areas.

We did not speak to people who used the service as a number of people were going out to local college and resource centres for their day.

The service was safe and secure for the people who lived there. The outside space provided opportunities for social activities and a quiet area for walks and personal space.

The service was clean and tidy and there were no unpleasant odours. People who used the service had been supported to personalise their rooms, one person agreed that the non-slip floor covering in their bedroom put in by the provider had assisted in keeping their room clean and promoted their health and wellbeing. One person told us that the environment "could do with improvement in places"; however recently there had been a lot of redecoration to the inside of the service.

The service showed much commitment and compassion to the people they cared for, this was evidence by the time and flexible approach they had to meet people's individual needs. During the inspection we saw people in the home were comfortable in their environment and staff supported people to access all areas of the service freely to promote independence skills and social activity.

We did not speak with people at the care home, but we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed 5 people in the main lounge and also observed other people in other parts of the home, and noted that they had positive interactions with each other and with support staff.

We found that people engaged positively with staff at the home. We noted that people at the home were comfortable, dressed appropriately and able to move freely about the home.