Shaftesbury House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Shaftesbury House accommodates up to 28 older people in one adapted building. There were 26 people living in the service when we undertook this comprehensive unannounced inspection on 27 November 2017.
There was not 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 was a new manager working in the service and their registered manager application was being processed at the time of our inspection.
This service was rated as Good at our last inspection of 9 November 2015. During this inspection of 27 November 2017 we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Responsive and Well-led were rated as Requires Improvement. We found a breach of Regulation 12; Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Caring was rated as Good.
Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs. There were some inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met. The new manager and the regional manager had identified improvements needed in the care plans and had an action plan in place to address this. However, this was not yet fully implemented.
There were systems in place to provide people with their medicines, which were prescribed to be administered orally safely. However, improvements were needed in how staff recorded when people had been provided the medicines that were prescribed for administration externally, such as creams. This includes the application of barrier creams, used to reduce the risks of pressure ulcers. The records for when people repositioned did not identify that guidance in the care plans had been followed.
The ways that the service assessed risks to people and actions taken to reduce the risks required improvement to provide people with safe care at all times.
People’s nutritional needs were assessed. However, the systems in place for monitoring what people had to eat and drink were not robust.
There were systems in place designed to keep people safe, this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. However, there had been an incident which had not been reported appropriately until we had advised the service to do so.
The environment was clean and hygienic and there were infection control systems in place. However, there was a toilet in the lounge area, which was open plan with the dining room. The door to the toilet opened into the lounge. This was a potential risks to infection control and was not respectful of people’s privacy. There was a programme of refurbishment and redecoration in the service planned.
There were some staff vacancies which were being covered by existing staff and agency staff. The service was actively recruiting to these vacant posts. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.
Staff spoke about people in a caring and compassionate way. People had positive relationships with the staff who supported them. People’s views were listened to, valued and used to plan and deliver their care.
People were supported to see, when needed, health and social care professionals. The service worked with other professionals involved in people’s care to improve people’s lives.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were provided with the opportunity to participate in activities that interested them.
People’s views were listened to and acted upon relating to their end of life care. There were systems in place to support people to have a pain free and dignified death. However, a fault in a pressure relief mattress for one person was not supportive of this practice.
There was a system in place to manage complaints and these were used to improve the service.
Where incidents had occurred the service had systems in place to learn from these and use the learning to drive improvement in the service.
There were quality assurance systems in place which assisted the provider and the manager to identify shortfalls and address them. Where shortfalls were identified there were plans in place to address them to improve the service people received. However, these were not yet fully implemented to ensure that people were provided with good quality care at all times.