Archived: Shannon Court Care Centre

There was a manager at the service who was in the process of registering 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.

The unannounced inspection took place on 06 December 2016. At the last inspection on 20 July 2016 the service was rated as inadequate and placed into special measures. This was due to finding multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, meeting nutritional and hydration needs, good governance and staffing. At this inspection we found significant improvements in all areas.

A new dependency tool was now in use to calculate the level of need for each individual. This was used to inform staffing levels to ensure there were sufficient staff on each shift. There were enough staff on the day of the inspection.

The recruitment process was robust to help ensure suitable staff were employed at the service. Safeguarding protocols had been improved and staff had undertaken refresher training in this area.

A new treatment room had been set up and this was clean, tidy and well ordered. Medication systems were robust and medicines were now being managed safely at the service. Individual and general risk assessments were in place. Equipment was fit for purpose and was regularly serviced and maintained to ensure it was in good working order.

The environment was clean and tidy and a recent infection control audit had been carried out. The service had scored 98% which was a significant improvement on the last audit.

There was a new induction programme which helped ensure new employees were given appropriate training and orientation to work at the home. A programme of training had been commenced and all staff were undertaking training in appropriate subjects.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.

People’s nutritional and hydration needs were assessed and recorded appropriately. The mealtime experience had been improved and new, more appropriate crockery had been purchased.

We saw that staff were kind and caring and there were good interactions between staff and people who used the service throughout the day. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people’s dignity and privacy.

People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes.

The new care files we looked at had more information about each individual enabling staff to deliver care in a person centred way, taking into account people’s preferences, likes and dislikes.

There was a programme of activities at the home and people were encouraged to participate if they were able to. Some one to one interaction was undertaken with people who were unable to participate in group activities.

There was an appropriate complaints policy and this was displayed throughout the home. Concerns were responded to in a timely and appropriate manner.

Staff told us morale had improved since the new manager had commenced and they said she was supportive towards them. Regular team meetings were held, and a programme of staff supervisions was underway.

We saw evidence of audits and the analysis of information and follow up actions were now being undertaken.

Shannon Court Care Centre provides general nursing, dementia nursing and dementia residential care. The home can accommodate up to 78 people in single rooms, most of which are en-suite. On the day of the inspection there were 75 people currently using the service.

There was a registered manager at 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.

However, at the time of the inspection the registered manager had been on sick leave for a period of approximately two months and had recently handed in her notice. The service was being managed in her absence by two deputy managers. The provider had identified someone who would register as manager in the near future.

During this inspection we found multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 with regard to person centred care, dignity and respect, consent, safe care and treatment, safeguarding, meeting nutritional and hydration needs, good governance and staffing.

You can see what action we told the provider to take at the back of the full version of the report.

On observing the premises we found them to be extremely dirty and untidy with a number of cross infection risks apparent. There was an outside roof patio overlooking the car park with a low wall which people who used the service could have fallen or climbed over, suffering significant harm or injury.

The service had a robust recruitment procedure in place to help ensure people being employed were suitable to work with vulnerable people. Staff rotas and observations on the day showed that staffing levels were insufficient to meet the needs of the people who used the service.

Individual and general risk assessments were in place. However some of the monthly evaluations of individual risk assessments were not up to date. Medicines were not managed safely at the service, as we saw evidence of unsafe administration, storage and disposal of medication throughout the day.

Notifications of serious injuries had not been submitted to the CQC as required over the last 12 months.

There was a safeguarding policy in place but staff knowledge and understanding was basic and safeguarding incidents had not always been reported as required.

In looking at staff files we saw that the service’s induction was basic and there was no evidence of staff supervisions or appraisals for the last 12 months. There had been little training given to staff over the last year.

Information in people’s care files was inconsistent in quality and content. Consent forms for the use of photographs were present within files but were not signed.

There was little choice with regard to meals and we saw that people were not being assisted with nutrition and hydration. Dietary requirements were documented inconsistently.

The environment was not dementia friendly and had little in the way of signage to help with orientation or distinctions between doors and the floor to help people distinguish between them.

The service was not working within the legal requirements of the Mental Capacity Act (2005) (MCA).

We saw that people who used the service were poorly presented. People’s privacy and dignity was not always respected by staff delivering care. There was no evidence that people who used the service, or their relatives where appropriate, were involved in care planning and reviews. We saw some evidence that the service had engaged with people to help ensure their end of life wishes were known.

There was some evidence that people’s choices were respected, for example, times they wished to get up or go to bed. However, care plans were inconsistent in including information about personal preferences, backgrounds, likes and dislikes. There was evidence that some activities took place regularly but we saw no meaningful one to one interactions occurring between staff and people who used the service.

There was an appropriate complaints policy, which was displayed around the home. There had been no complaints in the previous 12 months.

The service had poor leadership as, in the absence of the registered manager, those in charge were lacking in authority and experience. Team meetings had not been held for the last 12 months.

Quality audits were ineffective as there was little evidence of follow up to address concerns and issues identified.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.