Archived: Shadon House Dementia Resource Centre

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodated 16 people at the time of the inspection.

At our last inspection we rated the service outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Outstanding.

People were extremely well-cared for, relaxed and comfortable. Staff knew the people they were supporting very well and we observed that care was provided with great patience and kindness. The service went to great lengths to ensure people’s privacy and dignity were always respected. Everyone we spoke with complimented and praised the staff team and gave examples of the outstanding care that was delivered.

Staff were very well-supported by the management team. Staff were highly skilled and knowledgeable about each person they cared for and they were extremely committed to making a positive difference to each person. They were enthusiastic and believed passionately in the ethos of the service.

There was clear evidence of collaborative working and excellent communication with other professionals in order to help people progress and become more independent. The service was very flexible and adapted to people's changing needs and desires, enabling positive outcomes for all people. Records were well-personalised, up-to-date and accurately reflected people's care and support needs. Care was completely centred and tailored to each individual. Risk assessments were in place and they identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

There were enough staff available to provide individual care and support to each person. 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 appropriately supported in maintaining their health and they received their medicines in a safe way. They were provided with many opportunities to follow their interests and hobbies. They were all supported to be part of the local community. A wide range of therapeutic techniques were used to enhance people's well-being and provide stimulation. The building had been designed to meet the needs of people living with dementia, in line with current research, and provided plenty of sensory and tactile stimulation. Areas were decorated with 'themes' to help people orientate around the home.

Staff received opportunities for training including specialist training to meet peoples' care needs and in a safe way. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed.

The service consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way. The service had forged successful partnerships with an array of other stakeholders, was actively involved in research and innovation and aimed to provide an excellent care experience for people. The service frequently referred to best practise guidelines to formulate the type and style of care provided for people. The service's staff were often nominated for, and commended in, national care sector awards.

Further information is in the detailed findings below.

We last inspected this service in June 2014. At that inspection we found the service was meeting all the legal requirements in place at the time.

Shadon House Promoting Independence Centre is a care resource providing accommodation and personal support for older people, some of whom have a mental health or dementia-related condition. Specialist dementia care is provided for people who require respite care, or assessment. It has 23 beds and had 15 people were living there at the time of this inspection.

The service 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 provided strong, clear leadership and ensured an enabling and person-centred culture was firmly embedded in the service. The registered manager modelled good practice in working alongside staff and was visible and available at all times. The staff team and visiting professionals spoke very highly of the management of the service, and held the registered manager in high regard. Systems were in place to monitor the quality of the service. There was a clear commitment to continuous improvement of the service and evidence of innovation and creativity in all areas.

People spoke highly of the genuinely caring attitude of the staff team. They told us they were very well looked after and commented on the family-type homeliness of the service. People’s relatives told us they were very impressed with quality of the care provided, and spoke of the positive impact that a stay at Shadon House had on their loved ones. They told us the care was very person-centred and that people were treated as individuals by the staff. All the professionals we asked confirmed this approach, and commented on the excellence of the care provision.

There was a good rapport between staff and people in the home, and the atmosphere was relaxed, friendly and affectionate. Staff had time to sit and talk with people, expressing genuine interest in each person as an individual. People and staff smiled at each other, and we heard lots of laughter. People enjoyed appropriate physical contact. Interactions were highly person-centred, were unrushed and went at the person’s pace. Professionals commented on the patience and gentleness of the staff team.

People enjoyed a very stimulating environment and were able to engage in meaningful activity and express their creativity on a daily basis. The service worked closely with the local charity Equal Arts, which delivers stimulating creative projects to older people with communication difficulties. Musicians, story tellers, poets, writers, drama and guided reminiscence sessions featured prominently in the activities programme. The therapeutic benefits of caring for animals were recognised and the service had pioneered the involvement of people in keeping hens.

The building had been customised to meet the needs of people living with dementia, in line with current research, and provided plenty of sensory and tactile stimulation. Areas were decorated with ‘themes’ to help people orientate around the home. Bedroom doors were personalised to assist people to locate their own rooms. Strong colours and large signs helped people focus on important aids such as handrails and to find toilets and bathrooms.

There were sufficient staff to give people prompt and personalised care at all times. The staff team was experienced, knowledgeable and well trained. They showed a real commitment to their roles and told us of the enjoyment and pride they took from their daily work. Staff received good support from the registered manager and senior team and received regular supervision and appraisal of their work. New staff were only employed after rigorous checks had been carried out regarding their suitability to work with vulnerable people.

People told us they felt safe and well protected whilst living in the service and had no concerns. Relatives said they had never seen anything which concerned them about the safety or treatment of people at any time. Risks to people were assessed and appropriate measures taken to minimise risk, without unnecessarily restricting people’s independence. People received their medicines safely. All staff had been trained in the importance of recognising and responding to abuse and kept a close watch on people’s well-being. The service provided a safe environment for people and regular health and safety checks were carried out.

Staff were committed to upholding people's human rights and treated everyone with great respect and dignity. Every effort was made to help people communicate their needs and wishes, including the use of communication technology, so that care could be tailored to the individual person. Where a person was unable to express their needs and preferences or give informed consent to their care, their rights under the Mental Capacity Act were respected and decisions were made in their best interests.

People were encouraged and supported to be as independent as possible, and staff worked to help people regain lost skills and abilities. Relatives told us this approach was very effective and said their relatives were more able, confident and engaged when they left the service. A befriending service was offered to support people after discharge, and staff liaised with other agencies to ensure people were supported when back in the community.

People’s physical and mental health needs were assessed and met, using the full range of community health provision and specialist services. Professionals told us the service worked collaboratively with them, were responsive to advice, and had great insight and understanding about people’s needs. People were encouraged to maintain a healthy diet.

People and their families were given the information and support they needed to be fully involved in deciding their care needs and agreeing how those needs were to be met. They regularly asked their views about their care in reviews and surveys. Feedback about the service from people and their families was highly positive. People told us they knew how to make a complaint but never needed to do so. Any complaints received were responded to professionally and promptly, and apologies tendered where necessary. There was a culture of mutual respect between people, their families, staff and professionals.

Training records held by the registered manager, were now accurate and up to date and showed when certain training had been completed, needed to be refreshed and when future training had been arranged.

One senior support worker told us, 'It has taken blood, sweat and tears to get there, but supervisions, appraisal and development sessions are happening regularly and the training's back on track. Joanne (registered manager) has got everything sorted now, everything is going well.'

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. The building was clean, well maintained and secure and other appropriate measures were in place to ensure the security of the premises. One relative told us, "She's safe and well cared for here.' Another relative said, 'I'm very protective about my mother, but she's well looked after there. The staff are lovely and she is in very safe hands ' I have no worries whatsoever."

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. A district nurse told us, 'The residents are very settled. I find the staff competent and it's a good, well-run service.' However, we found that staff did not always receive appropriate training and suitable appraisal and supervision arrangements were not fully in place.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff training, appraisal and supervision arrangements.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One relative told us, 'The staff are very good with her; very caring." Another relative said, 'Her care and treatment is great and the staff are very friendly. They are smashing with her; so caring.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service for assessment, or respite, were reviewed every two weeks to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We saw people were cared for effectively and care was planned and delivered in line with the needs of the individual.

People were provided with a suitable choice of food and drink.

Risk was managed appropriately. People were safe and protected from abuse.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

The representatives or advocate of people who used the service were positive about the care and support provided. Comments included 'I love it here' and 'They (the staff) couldn't do any more for me'.