The Shieling

The Shieling is a residential care home providing accommodation and personal care for up to 10 adults. The service is registered to support autistic people, people with learning disabilities, and people with sensory impairment. There were 8 people living at the home at the time of our inspection.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

People’s care was provided in a safe, clean, and well-maintained environment. Staff managed risks well to keep people safe. People’s medicines were managed safely and staff supported people to access healthcare services when they needed them.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to take part in activities, to access their community, and to maintain relationships with their families.

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.

Staff had the induction, ongoing training and support they needed to carry out their roles. Regular one-to-one supervision provided opportunities for staff to discuss their performance and any further training needs.

Right care

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff understood their responsibilities in protecting people from abuse and knew how to report any concerns they had. The provider’s recruitment procedures helped ensure only suitable staff were employed.

People received kind and compassionate care from staff who knew them well. Staff protected and respected people’s privacy and dignity. People were supported to be as independent as possible and to develop skills. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

The registered manager promoted a culture in which staff valued people’s individuality and protected their rights. The views of people who lived at the home, their relatives and advocates were sought and listened to. Staff knew people well and were responsive to their needs and wishes. People and those important to them were involved in planning their care.

The provider’s governance arrangements were effective in keeping people safe and ensuring the care they received met their individual needs. Staff were well-supported in their roles. Managers and staff had established good working relationships with other professionals to ensure people received well-co-ordinated care and support.

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 25 May 2018).

Why we inspected

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

Follow up

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

At the last inspection on 24 February 2016, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

Staff provided people’s care in a safe way. They understood the risks involved in people’s care and managed these safely. Staff recorded and responded to accidents and incidents and learnt from mistakes. The rota was planned to ensure there were sufficient staff to keep people safe and meet their needs. People’s medicines were managed safely and people received their medicines in line with the prescription guidelines.

People lived in an environment that was suitable for their needs. It was clean and hygienic and people’s rooms were personalised and homely. People were cared for by staff who were trained for their role and the providers’ recruitment procedures helped ensure the service employed only suitable staff. Staff understood their responsibilities in terms of keeping people safe and protecting them from abuse. In the event of an emergency people’s care would continue uninterrupted.

People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training in this area and knew how the principles of the Act applied in their work.

People’s nutritional needs were assessed and any dietary needs recorded in their care plans. Where people needed assistance with eating and drinking there was a care plan in place to outline the support they required. Staff understood people’s healthcare needs and supported them to maintain good health.

People were cared for by kind staff who treated people with respect. People were enabled to have privacy if they wished and encouraged to be as independent as they could. There was a complaints procedure in place should people or their relatives wish to make a complaint.

People received a service that was responsive to their needs. People’s care plans reflected their individual needs and preferences about their care. Staff told us that care plans provided sufficient information on how to care for people. People had access to a range of activities.

Quality assurance checks were carried out help ensure people continued to receive a safe and appropriate service. Staff felt involved in the running of the service and told us they felt supported in their role. The registered manager worked with external agencies to provide suitable care to people, following guidance where necessary. The registered manager was continually looking for ways in which to improve the care provision. There was an open person-centred culture within the service, however we did find the registered provider had not taken prompt action to enable people in their daily life’s through the use of new technology. We made a recommendation to the registered provider in relation to this.

This was an unannounced inspection which took place on 24 February 2016.

There was 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 and associated Regulations about how the service is run. The registered manager was present during our inspection.

People lived in an environment that was safe, supportive, kind and caring. Staff had a good relationship with people, understood their individual needs and respected people.

The registered manager ensured enough staff were on duty each day to enable people to participate in their individual activities, whether this was indoors or outside of the home.

Staff encouraged people to be independent and to do things for themselves, such as help around the home or get involved in the cooking. For example, people were involved in making lunch on the day of the inspection.

Staff understood the legal requirements in relation to any restrictions for people and ensured these were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

Staff supported people in an individualised way and activities were arranged which meant something to people.

People’s care would not be interrupted if there was an emergency in the home or the home had to close for a period of time. Staff had up to date fire training and regularly practised fire drills and evacuations.

People were kept safe because risks had been identified and assessed. People were not prevented from doing things they enjoyed because of potential risk. Instead staff developed ways to keep people free from harm to ensure they could continue their preferred activity. For example, by being accompanied by staff or using facilities on the St Ebbas site, or using a special seatbelt when they went out in the vehicle.

Staff were provided with training specific to the needs of people which allowed them to carry out their role in an effective way. Staff met together regularly and felt supported by the registered manager. Staff were able to meet their line manager on a one to one basis regularly to discuss their work. There was a good culture and ethos within the home and staff worked well together as a team.

Medicines were stored and administered in a safe way. Regular governance audits were undertaken within the home to help ensure people were receiving a good quality of care. Appropriate checks were carried out to help ensure only suitable staff worked in the home. Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event.

People were supported to keep healthy and had access to external health services. Professional involvement was sought by staff when appropriate. People’s care records contained sufficient information to enable a member of staff to understand the care a person required.

A complaints procedure was available for any concerns and relatives and people were encouraged to feedback their views and ideas into the running of the home.

As part of this inspection we spoke with four people who use the service, the registered manager, two care staff and six relatives of people who used the service. We also reviewed records relating to the management of the home which included, three care plans, daily care records, training and maintenance records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People's relatives told us they felt their relative was safe. They also told us they visited often and have never seen anything to give them concern about their relative's safety.

People's relatives also said they thought the building and their relative's bedrooms were suitable and clean.

We observed people were relaxed and confident around staff and they told us they liked the food. People told us that they always received sufficient food and drink.

We saw the service had adult protection policies and procedures known as safeguarding in place. This meant that staff had access to up to date guidance and information to assist them should they need to raise a safeguarding concern. We spoke to staff who were aware of safeguarding procedures and we confirmed that all had recent training in this area.

We saw that doors and areas that were required to be kept locked to protect people were secure, for example electrical cupboards and the Control of Substances Hazardous to Health (COSHH) Cupboard were locked and medication was secured.

We saw risk assessments. The risk assessments identified what action should be taken by staff so that risks to people's safety could be minimised.

The provider continued to notify CQC of any relevant issues relating to the safety and welfare of people who used the service and took the appropriate action if necessary. This safeguarded to people who used the service and ensured multi agency involvement and communication.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. To ensure people's rights applications have needed to be submitted regarding some people not being allowed out alone. Relevant staff had been trained to understand when an application should be made, and how to submit one and the proper policies and procedures were in place, to ensure applications were submitted for consideration where needed.

Is the service effective?

People's relatives also told us the food was good and their relatives were 'well fed'.

One person relative said the staff were well trained and had access to good training resources.

People's health care needs were assessed with them and written in a care plan.

People's relatives told us they had no complaints and they felt they were listened to when they raised any concerns or minor issues.

People said they had seen their care plans.

Is the service caring?

People also told us the staff were nice and they liked the home and their rooms.

People's relatives also told us the staff were caring, their relative was well cared for and the home kept them informed about their relatives well being and their care.

We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner.

Wes saw people were supported with meals where needed and staff did not rush people giving them as much time as they needed and wanted.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible.

People's relatives told us they felt they were listened to and the home would be responsive when they raised any concerns or minor issues

Is the service well led?

Although people's relatives told us they felt the home was well lead by the manager we found some shortfalls with record keeping.

We found that some people's care records were not accurate.

One person told us that although it can sometimes be difficult communication with a large organisation like the Trust, the staff made all the difference.

People who use the service, their representatives were asked for their views about their care and treatment.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare and an effective system to regularly assess and monitor the quality of service that people receive.

We met two care professionals who were visiting during our inspection. A care manager and a mental capacity act Deprivation of liberty assessor. They both told us that some records were out of date and needed updating. One care professional told us it made their job of assessing people accurately more difficult that information was not accurate due to being out of date or not recently reviewed.

A relative of a person who uses the service said that the food used to be very bad but after complaining it improved and was much better in quality and variety. They also said they visit often and are attending a party at the home in a few days where their relative will have a birthday cake.

Another person's relative told us that their relative used to have problems with eating and staff had worked with them to help them resolve their problems and they eat healthily now and look very well.

An advocate for a person who used the service told us they had advocated at meetings and medical appointments. They also told us that the menus looked healthy, that staff knew the person's likes and dislikes well and the person they advocate for enjoyed the food there. They also said we could report that the staff worked well with other professionals and that they had also been offered a great deal of support from staff at the home following a family illness.

We found where people did not have the capacity to consent, the provider acted within legal requirements.

We saw that staff received appropriate professional development and support.

We found that some records that were required to be kept and produced promptly when needed were not available at the home.

A person who uses the service showed us their room and how they had individualised it, and showed us pictures of their family.

There was a well attended relatives' meeting occurring at the time of our inspection so we were able to meet with six relatives. There was also an advocate present at the meeting.

People's relatives told us that the building was suitable. They said there were enough staff who communicated well with them and informed them about their relative's care. They felt their relative was looked after well and was safe there.

People's relatives also told us about their involvement in the running of the home through various relatives' meetings and quality boards. They said they had not needed to raise any formal complaints, but if they needed to raise anything, they felt they would be listened to and action would be taken to address the situation.

One person's relative told us that this home should be a benchmark for other homes to aspire to.

We found the home to be well maintained hygienic and clean.

We found that there where were enough qualified, skilled and experienced staff to meet people's needs and that staff were supported to deliver care and treatment safely and to an appropriate standard.