Shire House Care Home

Shire House Care Home is a residential care home. The home is registered to accommodate up to 22 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 19 people living in the home.

People’s experience of using this service and what we found

Since our last inspection the provider had used a care consultant to help identify areas where risk management and oversight could be improved. They had taken appropriate action to ensure people were kept safe and quality maintained. The registered manager understood the importance of taking a pro-active approach to risk.

There were sufficient staff to meet people’s needs. The home used a dependency tool to set staffing levels accordingly. People and relatives said there were always enough staff and they responded in good time when they needed assistance.

People told us they felt safe living at the home. Their relatives agreed. One person said, “I absolutely feel safe.”

People received their medicines on time and as prescribed. The home liaised with health professionals to ensure people’s medicines were regularly reviewed to help ensure they were still benefitting from taking them.

The home was visibly clean throughout and free from malodours. We were assured with infection prevention and control practices.

Accidents and incidents were reported and recorded appropriately. Accidents and incidents were analysed to identify the cause, any themes and what could be done to prevent a recurrence.

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

The home had a friendly and supportive culture. People, relatives and professionals felt the home was well-led. There was praise for the registered manager and management team. The registered manager told us they feel supported by the provider.

The registered manager and senior staff had developed and maintained good working relationships with a variety of external professionals in health and social care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 21 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shire House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Shire House Care Home is a residential care home. The home is registered to accommodate up to 22 older people in one adapted building. Nursing care is not provided by staff in the home. This type of care is provided by the community nursing service. At the time of this inspection there were 20 people living in the home.

People’s experience of using this service and what we found:

People were supported to eat and drink safely. People told us they enjoyed the food and improvements made to the oversight of risks related to eating and drinking enough had been implemented effectively.

Staff supported people with social distancing and frequent handwashing to protect against Covid-19. People with dementia were supported with these measures in ways they understood.

The home was clean and well maintained. Staff cleaned frequent touch points frequently. Cleaning chemicals used at the home were effective against Covid-19. Infection prevention and control audits took place and spot checks were carried out.

Staff had received training on how to keep people safe during the COVID-19 pandemic and had plentiful supplies of personal protective equipment. Staff were seen to be wearing their PPE appropriately throughout our visit. Staff breaks had been staggered to allow for social distancing to be maintained in the staff room and a larger room had been made available to them.

Staff and people were regularly tested in line with the government’s current testing programme. Visitors to the home were tested where this was appropriate, and the registered manager was preparing for the start of in home visiting in line with the change in government guidance.

The size and layout of the home meant there were well ventilated spaces for people who wished to spend their time with others. The staff room had been moved to afford staff a larger place to take their breaks. This helped to promote social distancing.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received about risk management related to the monitoring and response to people’s food and drink intake. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shire House Care Home on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Shire House Care Home provides residential care without nursing for up to 22 older persons. There were 17 people living at the service when we visited some of whom were living with dementia.

A registered manager was employed to manage 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.

We previously inspected the service in May 2016 and found breaches of regulation related to staffing, risk management and care being person centred. The provider wrote and told us about improvements they would make to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They told us they would make these improvements by the end of August 2016. At this inspection we found that these improvements had been made.

People were supported by staff that understood how to recognise signs of abuse and the actions they needed to take if they suspected abuse. The staff also put an emphasis on the need not to go to external authorities without talking to the management team first. The registered manager and nominated individual checked this understanding with the staff team and addressed the importance of whistleblowing during our inspection.

Healthcare professionals had been concerned about some aspects of risk management. The provider organisation had changed ownership in August 29017 and the new owner had discussed concerns with the district nurse team and plans were in place to ensure these issues were acted upon.

People received their medicines as prescribed. Records, however were not always accurate and stock levels of one medicine were unnecessarily high. The registered manager and nominated individual addressed these issues immediately and put measures in place to ensure they would not be repeated.

The risks people lived with had been assessed and were reviewed regularly. Staff understood the actions in place to minimise these risks. Staff had a good knowledge of the risks people lived with and their role in reducing these risks.

Where people needed to be deprived of their liberty to live in the home, applications for Deprivation of Liberty Safeguards (DoLS) had been made. One DoLs that had been authorised had expired. This was rectified during our inspection and a system put in place to ensure this would not be repeated.

Staff were supporting people in line with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s ability to make decisions about specific aspects of their life were regularly assessed and kept under review. When people could not make decisions for themselves this was done in line with the principles of the MCA.

People were supported by enough staff to meet their needs. Staff had been recruited safely which included checks that they were suitable to work with vulnerable people. Staff had the appropriate skills and training to support people safely and effectively. Staff felt supported and received regular supervision and an annual appraisal.

Staff understood people’s eating and drinking requirements, likes and dislikes. There were systems in place to ensure that risks associated with eating and drinking were managed effectively.

People had access to healthcare for ongoing and emergency treatment, This included GP’s, district nurses , dentists and opticians.

People were supported by staff who knew them well and understood their history , likes, dislikes and preferences. Staff were caring when they spent time with people and spoke about them with warmth and respect. People had their dignity and privacy respected and were supported in a way that reflected a person’s individuality.

People’s care and support plans had been written and reviewed regularly with people or appropriate representatives. Staff understood the actions they needed to take to support people with their care. People’s decisions about how they wanted to spend their time was respected and reflected past lifestyles and interests.

People felt listened to and told us they knew how to complain. They felt if they did raise any concerns they would be listened to and actions taken.

Audits and surveys were robust enough to identify any areas for improvement and included both the environment and people’s care and welfare. A quality assurance process was in place that ensured people had the opportunity to share their views about the service they received. When any actions were identified they were acted on to ensure people’s safety and wellbeing.

People and staff held the management and home in high regard. They all reflected an ethos of staff working to create a family feel. Staff were committed to supporting each other to achieve good quality care for people.

Shire House Care Home provides residential care without nursing for up to 22 older persons. There were 21 people living at the service when we visited.

A registered manager was employed to manage 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 registered manager was available on the first day of the inspection, but was due to do night duty on the second day so was not available on this or the third day. The registered provider supported the inspection on the second and third day.

Prior to the inspection we received information of concern about staffing levels. We found there were not enough staff to look after people safely. People were at risk of not having their needs met, falling and of having their dignity compromised. Staff were moving people unsafely as there was not always another staff member who could work with them to support moving or caring for people. This was even when care records clearly stated two staff had to do this. The provider and registered manager had not acted when staff had raised a concern about this. We requested the provider took immediate action to ensure there were enough staff to meet people’s needs safely. The provider responded to this request by ensuring four care staff were available between 8am and 8pm. They also agreed to review how they calculated what number of staff were required according to people’s needs. We also had concerns about the emotional and physical safety of staff so we spoke with the environmental officer to advise them of our concerns in respect of staff health and safety. The environmental health officer visited on the second day of the inspection and communicated with the provider.

People gave us mixed accounts of whether they felt staff were caring. People explained staff were really busy and they did not want to be a nuisance. People said both positive and negative things about the staff. Staff told us eight people living with dementia were deliberately targeted so they were ready for bed by the time they night staff came on duty at 8pm. This was because these people were unable to communicate they did not want to go to bed. The provider agreed to review this practice.

People had detailed care plans in place which were reviewed with them and their representative. Staff said they read and understood the care plans but were unable to always follow them as they were too busy. Staff told us they had to make decisions about limiting people’s choices and preferences due to the lack of staff. Staff wanted this to change and felt people living at the service deserved better.

The provider had systems in place to judge the quality of the service but as they believed there were enough staff, the issues identified on inspection were not reviewed as part of that auditing process. Staff felt the culture of the service was task focused. They felt they were not always listened to when suggesting changes.

People were at risk due to staff delivering care whilst also making people’s tea time meal. Staff were wearing the same uniforms and inadequate cover to prevent cross contamination. Staff told us they washed their hands before returning to food preparation. The person completing the medicine round was also called away to help with care. People’s medicines were administered safely but interrupting the round can increase the possibility of mistakes taking place. We have asked the provider to review the latest guidance in respect of this and also review how they rotate and manage the stock of medicines.

People had individual risk assessments in place to support staff to look after people. There had been a high number of falls in 2015 and 2016 to date. The falls had not been reviewed to ensure this risk was then mitigated. Other areas such as the time of the fall, staffing and call bell response times had not been reviewed to identify why people were having falls at this level.

Staff had some knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s ability to consent to their own care was being assessed but the assessments were not always specific or detailed how staff were acting in people’s best interest. We observed some people did not have their right to consent to any care respected. We have been advised the registered manager and provider planned to review the issue of consent with staff to improve practice.

People had their need for food and drink met in most cases. Where there were concerns people’s needs were reviewed. However, we found one significant concern where the understanding of assessments of how people’s needs for their food to be prepared to prevent choking was misunderstood by the registered manager. Also, people in the lounge did not have drinks available to access when they wanted to.

Activities were provided to keep people cognitively and physically stimulated. People’s religious needs were met and they could go out into the community. There was an activity co-ordinator employed most days. They were sometimes called away to support care needs which could reduce the amount of activities available to people.

Staff underwent a level of training to ensure they could carry out their role effectively. Staff understood how to identify abuse, report this and ensure action was taken to keep people safe. Staff were recruited safely.

People’s complaints were reviewed and they received feedback to ensure they were happy with the outcome. The provider had systems in place to ensure the equipment and premises were safe.

We found breaches of the regulations. You can read what action we have told the provider to take at the back of the full report.

People told us that they felt positive about the quality of care they received and with their relationships with the staff. We saw people moving freely around the home and interacting with the staff in a relaxed way. A person told us, 'We are well catered for here. The food is good. We get a glass of wine with lunch -- We're a very happy bunch.'

People told us that they were asked for their consent when making choices and decisions about their daily lives; and that their choices and decisions were respected by the staff. A person told us, "They do ask before they do anything.'

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way. The registered manager told us, "The owner is a qualified pharmacist."

We found that there were sufficient numbers of staff, with the right competencies. A person told us, "The staff are kind and helpful -- There are enough staff here -- I feel safe here.'

The home was taking account of people's comments or complaints. People told us that they could be sure that their comments were listened to, and responded to appropriately.