Archived: Shamrock House

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

A range of audits and checks were completed to maintain and where required, implement any required improvements. Further work was needed to embed these systems to monitor the quality and safety of the service, for example, single pane windows had not been identified in current audits. The registered manager took immediate action to address this during inspection. We have made a recommendation about the management of window safety.

People told us they felt safe. Staff had received training in safeguarding and felt confident in reporting any concerns. Risks to people's health, safety and wellbeing had been assessed and staff understood how to help keep people safe.

Staff responded promptly and were attentive to people’s needs. Staffing levels had been increased following our last inspection. Processes in place ensured staff recruitment was appropriate with a range of preemployment checks completed.

Risks to people had been assessed and recorded. Action had been taken to mitigate risks wherever possible.

Medicines were managed and administered safely, with regular checks completed. We were assured by the measures taken to help ensure the prevention and control of infection.

People and staff spoke positively about the management of the service and their openness to feedback. The registered manager was approachable, maintained regular communication and listened to the views of others.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 February 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, but remained in breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

We carried out an unannounced focused inspection of this service on 13 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their risk management and governance systems used to monitor the quality and safety of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Shamrock 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.

People’s experience of using this service: People were at increased risk of harm, because of how the service had been managed. Quality checks, systems and processes to manage the service did not have provider oversight to ensure they were completed or evaluated for their effectiveness. There was a lack of transparency to evidence which actions the provider had completed or planned, to determine how outstanding actions would be met.

Some people’s records had not been reviewed or updated to ensure staff had access to person centred information to provide people with safe care and support.

Systems and processes to certify equipment and to check the home environment was safe, failed to highlight the concerns we found during this inspection.

Staff had not received the training and support needed to carry out their roles and provide people with individualised safe care and support.

Accidents and incidents, including safeguarding concerns, were recorded. However, care plans had not always been updated to reduce the events happening again.

The registered manager had failed to notify the CQC of all events they were required to. Opportunities to learn lessons and improve the service were missed.

People were supported to enjoy activities and interests of their choosing.

People received good support to maintain a healthy balanced diet and, where appropriate, the provider worked closely with other health professionals to support people with their health and wellbeing.

The registered provider worked within the principles of the Mental Capacity Act 2005 and was in the process of updating records to ensure people’s capacity to consent was clearly recorded.

Staff ensured people received their medicines safely as prescribed.

People were supported by kind and caring staff, but the organisation and leadership of the service adversely effected the overall quality of the care people received.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: At the last inspection service was rated Requires Improvement (latest report published May 2018).

Why we inspected: This was a planned inspection based on previous rating.

Enforcement: We have identified breaches of regulation in relation to the safety of both the environment and the care provided, the quality of person-centred care, staff training and the governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At our previous inspection completed in May 2016, the service was rated as Good. This is the first time the service has been rated Requires Improvement.

Shamrock House is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The home is registered to provide accommodation for up to 17 people whose main need is in relation to their mental health. 16 people received a service at the home during our inspection.

The home had a registered manager. 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 not clear about their roles and responsibilities. They had not submitted all notifications or displayed the rating from the previous inspection in the home as they are required to do as part of the legal registration with the CQC.

Staff had received some training to safeguard people from abuse. Where concerns were raised these were investigated. However, training was not always up to date and staff did not have access to an up to date policy to ensure they followed best practice guidance.

People’s needs were assessed and risk assessments were in place. However, where reviews highlighted people were at a high-risk, support plans had not always been updated to ensure information was available to manage the risks and provide people with safe care and support.

Systems and processes in place to maintain and improve the safety of the environment were not effective to ensure the home remained clean and free from hazards and appropriate maintenance carried out.

People were at risk from not receiving their medicines as prescribed. There was no record to evidence staff remained competent or that they had received up to date training to administer people’s medicines. The policy and procedure was not up to date or reflective of the service.

Systems and processes in place failed to ensure staff received appropriate supervisions and support to carry out their role. The register manager had signed up to a new training provider but there was no training plan in place to ensure staff remained up to date or competent to carry out their role and meet people’s individual needs.

There was a staffing structure in place. However, staff were not always clear about their roles and responsibilities.

Everybody had a care plan. Assessments had been completed to determine people’s capacity to understand and consent to their care and support. However, the provider was not always adhering to the Mental Capacity Act which meant people may not always receive care and support that was the least restrictive or in their best interest. There was limited evidence of people being involved in the planning or consenting of their care. Information was not always available to ensure people were supported to improve their lives by monitoring outcomes for independent living skills.

During our inspection we found staff had limited knowledge of the Mental Capacity Act and the Mental Health Act which may impact on how people received safe care and support and have access to appropriate pathways of care to meet their needs. There was no evidence of a record of a health care plan to monitor if the recommended annual health check were completed or actions to support the person to achieve successful outcomes.

Care plans contained details of people's preferences and any specific dietary needs they had. For example, whether they were diabetic, had any allergies or religious needs. However, records did not always include information to support people to maintain a healthy weight.

Care plans included information to ensure staff were informed and respectful of people's cultural and spiritual needs. However, reviews failed to evaluate the care and support provided to ensure records were available for staff to follow to provide people with person centred care and support according to their individual needs.

Where people could be, they were supported to live fulfilled meaningful lives. The provider supported people to obtain skills to take up opportunities of work and attend college. However, where people remained in their rooms, staff were unsure how to encourage and support them to participate in routine social interactions to avoid social isolation.

The registered manager completed checks and audits to maintain and improve the service. However, the systems and processes were not robust and failed to highlight and action the concerns we found during this inspection. There was a lack of oversight at provider level to ensure systems and process used were evaluated for their effectiveness; to maintain and improve the service.

The provider failed to ensure it had robust arrangements to ensure the security, availability, sharing and integrity of confidential data, and records in line with data security standards. Where the registered manager told us, information had been lost there was no evidence of how they had investigated the data loss or where any actions had been implemented to safeguard information because of the data security breaches.

Policies and procedures that were available as guidance for staff were not up to date and not specifically written for the service provided. This meant care and support may not be delivered following up to date and best practice guidance.

The provider ensured staff were selected and recruited safely.

Where people had difficulties with communication this was recorded however, information was not always available in a format they could understand and there was little guidance to support people using other methods.

Staff understood the importance of respecting people's dignity and upholding their right to privacy.

There was information available on how to express concerns and complaints. People were encouraged and supported to raise their concerns and processes were in place to ensure these were responded to.

We found the provider was in breach of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The home is registered to provide accommodation for up to 17 people whose main need is in relation to their mental health. On the day of the inspection the home was fully occupied. The home is situated in Goole, in the East Riding of Yorkshire; it is a short walk to town centre amenities and the bus and rail stations. There are two communal areas and bedrooms are located on all three floors of the premises. There is no passenger lift or stair lift so people who live at the home have to be physically able to manage the stairs.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following the home's recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us that they felt safe whilst they were living at Shamrock House. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people had no concerns about how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff and that their care plans were reviewed and updated as needed. People's nutritional needs had been assessed and people told us they were very happy with the food provided.

There had been no formal complaints made to the home since the previous inspection but there was a process in place to manage complaints should they be received. There were also systems in place to seek feedback from people who lived at the home, relatives and staff.

Care staff and people who lived at the home told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote safety and optimum care to people who lived at the home. Staff told us that, on occasions, the outcome of surveys and audits were used as a learning opportunity.

People told us they felt safe in the home and the care was good. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.

Our observations of the service showed us that the staff were very kind and caring and all the people who spoke with us were very happy with their care. One person said 'The staff are very good, they listen to what we say', another person said 'The staff look after us well, nothing is too much trouble.'

People said they were happy with their rooms and the communal areas. However, we had a number of concerns about the environment and fire safety practices within the service.

We saw that staff had appropriate training and development, but staff supervisions and appraisals were not all up to date.

We found that improvements were needed to the quality assurance system to ensure people's health, safety and care was monitored effectively and that appropriate action could be taken where necessary to make changes in the service.

We found that improvements had been made to medication practices and record keeping within the service. The provider and staff had acted on the information in the report from October 2012 and made positive changes to working practice, staff training and the medication system.

People we spoke with said 'Staff are friendly, supportive and caring' and 'We are consulted about our care and we can make our own decisions about life in the home.'

People said 'The food is good and that the choice of food, for each meal, is flexible.'

People told us they felt safe in the home and the care was good. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.

We have raised concerns in this report about poor staff practices with regard to medication and we have asked the provider to take action to ensure people receive their medication safely and as prescribed.