Archived: Shaw Red Hill Care Centre

Shaw Red Hill Care Centre 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.

Shaw Red Hill Care Centre accommodates up to 60 people across three separate units within one adapted building, and specialises in care for people with physical disabilities and people living dementia. At the time of our inspection visit, there were 53 people living at the home.

A registered manager was in post and present during our inspection. 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.

At our last comprehensive inspection of the service on 6 December 2016, we found breaches of Regulations 9 and 10 of the Health and Social Care 2008 Act (Regulated Activities) Regulations 2014. We gave the service an overall rating of Requires Improvement. These breaches related to the provider’s failure to treat people with dignity and respect, and to consistently meet people’s individual needs. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider had made significant improvements to the service, and that they were now meeting the Regulations. People’s privacy and dignity was promoted and respected by staff and management. People received person-centred care, shaped around their individual needs, choices and preferences.

People were supported by staff who had received training in, and understood, how to protect them from avoidable harm, discrimination and abuse. The staffing levels maintained at the home ensured people’s individual needs could be met safely and flexibly. Systems and procedures were in place to ensure people received their medicines safely and as prescribed, and to protect people from the risk of infection. Accidents and incidents involving people who use the service were analysed by the management team to stop things from happening again.

People’s needs and choices were assessed in order to develop effective care plans and achieve positive outcomes for people. Staff received effective induction, training and support to enable them to fulfil their duties and responsibilities. People were supported to have a balanced diet and any risks associated with their eating and drinking were assessed and managed. Staff and management worked collaboratively with external professionals, team and agencies to ensure people received coordinated care. Steps had been taken to adapt the premises to the individual needs of the people using the service. People’s consent to care was sought and their right to make their own decisions respected.

Staff treated people in a kind and caring manner, and took the time to get to know them well. Staff protected people’s personal information, ensuring this was stored securely. People were encouraged and supported to express their views about the service.

People’s care plans reflected their individual needs and were kept under regular review. Staff supported people’s participation in a range of social activities. People and their relatives were clear how to raise a complaint about the service, and felt comfortable doing so. People received appropriate support at the end of their life.

The management team promoted a positive, open culture within the home. Staff were clear about their responsibilities, and felt able to approach management for any additional support needed. The provider’s quality assurance enabled them to drive improvement in the service people received.

The home consists of four units. Three of these were being used to provide care to people at the time of our visit. Topaz unit provides care to people living with dementia. Sapphire unit provides nursing care to people and the Entimos unit provides care to people with brain injuries.

A registered manager was in post at the time of our inspection. 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.

During the previous inspection on 11 and 15 December 2015 we found the way people were cared for required improvement and that the provider was not meeting the law. This was because people were not always treated with dignity and respect and people’s privacy was not always maintained. The provider had sent us a plan to say how these matters would be addressed. At this inspection we found people were not consistently supported by staff to maintain their dignity and people’s rights to privacy were not always acted on.

We also found at this inspection people did not always receive the individual care they needed when they were anxious. Staff did not always find out why people were distressed, or take action so their needs would be met.

People had plans in place which detailed how they preferred their care to be given and their risks managed. However, we found staff had not always taken action to follow the plans so people would receive the care they needed. We also saw people’s plans did not consistently reflect their preferences or care needs as their circumstances changed. Some people enjoyed the interesting things staff had provided for them to do, but other people’s needs were not met and they were withdrawn.

The provider and registered manager checked people’s experiences of living at the home, but this did not consistently drive improvements in the care people received.

People’s safety and care needs were understood by staff, but people were not consistently supported by staff so their needs were met in the ways they preferred. There were enough staff to meet people’s safety needs, but some people told us they did not always receive care from staff who knew them well, in a timely way.

Staff had received training so they would have the skills and knowledge they needed to care for people, but we found staff did not always use their training to inform how they supported people.

Most people had built good relationships with staff who were permanently employed to care for them. People told us it was more difficult to do this with temporary staff. People were supported by staff to make their own day to day decisions about their care. There were systems in place so complaints raised would be investigated.

Staff were confident action would be taken if they raised any concerns for people's safety or well-being, and we saw examples where staff took action to promote people’s safety. Some people administered their own medicines, with other people receiving support from staff to do this.

Staff cared for people in ways which recognised people’s rights to make their own decisions. Staff supported people in ways which protected their freedom and recognised their independence. People were able to make choices about the meals and drinks they wanted and had enough to eat and drink to remain well. People received help from staff to see health professionals when this was needed.

You can see what action we told the provider to take at the end of this report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We inspected the provider to see if they were now meeting the legal requirements. This inspection took place on 11 and 15 December 2015. The inspection on the 11 December 2015 was unannounced. We visited the service again on the 15 December 2015, which was announced, to conclude our findings. We checked that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had followed their plan which they had told us would be completed by the 30 April 2015 and we found that the legal requirements had been met. The provider ensured people were assessed for their individual care needs and care and treatment was followed in-line with the plan of care.

Shaw Red Hill Care Centre is registered to provide accommodation and nursing care for up to 90 people. There were 72 people living at the home at the time of our inspection.

The home is purpose built and consists of four units. Topaz unit specialises in the care of people living with dementia. Sapphire unit provides nursing care to people and the Entomos unit provides care for people with brain injuries. The Worcester Intermediate Care Unit (WICU) provides nursing and personal care to people who may require rehabilitation. People who are on this unit may have been discharged from hospital but need extra support before they return home or to another service. The inspection team made checks in all four areas of the home.

At the time of our inspection 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 2008 and associated Regulations about how the service is run.

People who lived on Sapphire, Entomos and WICU told us that staff treated them kindly, with dignity and their privacy was respected. We spent time on the Topaz unit to understand how staff supported people to maintain their dignity. However, we found staff did not always promote or maintain people’s dignity and privacy. For example, ensuring people’s clothes protected their privacy, or that doors were always shut when people received personal care in their bedroom. We raised our concerns with the registered manager who agreed that this was not acceptable.

People lived in a safe environment as staff knew how to protect people from harm. We found that staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

People and relatives told us there were enough staff to help them when they needed them. Staff said there were enough staff to provide safe care and support to people. We found when staff raised concerns about low staffing levels during a night shift the provider had responded and put further staff in place.

People who lived on Sapphire, Entomos and WICU units told us that their medicines were managed in a safe way and received their ‘as required’ medication, such as pain relief, when they requested it. We found that medicines were handled and stored in a safe way.

People felt staff cared for them in the right way and that staff were competent in their roles. Care and support was provided to people with their consent and agreement. Staff understood and recognised the importance of this. Where it had been deemed that the person did not have the capacity to make decisions on their own behalf the provider had taken steps to ensure the Mental Capacity Act (MCA) had been followed.

We found people were supported to eat a balanced diet and were supported with enough fluids to keep them healthy.

People had access to healthcare professionals, such as their doctor or the district nurse when they requested it or when staff recognised that the person required external advice and support.

While most people felt involved in the planning of their care, there was a lack of communication between staff and people which meant that people were not always actively involved or updated in the planning or support of their care. People’s views and decisions they had made about their care were not always acted upon by staff in the way that was individual to the person.

People were supported to continue their hobbies and interests by those who worked in an activity co-ordinators role. However, care staff were focused on completing task orientated roles and missed opportunities to bring people’s interests and hobbies into people’s everyday lives. Opportunities to reminisce or explore different personalised interests with people were missed which meant people were not engaged through-out the day. Staff we spoke with explained they were always busy with tasks, staff did not recognise opportunities to involve people within the home.

People knew how to complain and felt comfortable to do this should they feel they needed to. Where the provider had received written complaints, these had been responded to. Learning had been taken from complaints received and actions were put into place to address these.

The provider had not fully promoted a positive culture within the home to empower people and relatives. While people were given the opportunity to discuss improvements to the service, some people felt they were not always empowered to make changes and improvements to the service provision.

Staff felt supported by the registered manager. They told us the registered manager was visible within the home. Staff said the registered manager was approachable and listened to them.

We found that the provider did not always have adequate checks in place to ensure the equipment, such as hoists and slings were safe for use. We raised this at the time of our inspection as people were put at risk. The registered manager informed us that action would be taken promptly to ensure checks were in place to ensure the equipment was safe for use.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was in relation to Regulation 10, Dignity and Respect.

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

Shaw Red Hill Care Centre provides accommodation for persons who require nursing or personal care for up to 90 people. The home has four units that specialises in different services. The intermediate care unit provides nursing and personal care to people who have come from hospital. The Topaz unit specialises in services for people with dementia. The Sapphire unit provides nursing care to people and the Entomos unit provides care for people with brain injuries.

In May 2014 we found the provider had not met three of the essential standards. We undertook an unannounced out of hours inspection on Saturday 13 September 2014, following concerns received into CQC. We spent our inspection time on the dementia unit, Topaz. People were unable to speak with us about their care and treatment due to their dementia illness. We spent our time observing the care and experiences that people received. Due to the level of concern found on this inspection we visited again on the 19 September 2014. This was to establish what systems the provider had in place to monitor the quality of the service. Four inspectors carried out the inspection over two days.

At the time of our inspection there was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? As part of this inspection we spoke with people who used the service, staff, the registered manager and the provider.

Our findings from our inspection confirmed that the provider was in breach of three regulations. These were, regulation 9, care and welfare of service users, regulation 12, cleanliness and infection control and regulation 10, assessing and monitoring the quality of the service provision.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that people were not kept safe as staff did not know how to protect people from harm. People had their freedom restricted and were not cared for in a supportive way. There were sufficient numbers of staff to meet people's needs. However the staff on duty did not know people's individual needs. Therefore staff had not provided the care that people needed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The provider had notified the appropriate authorities, however, the provider had not notified CQC.

Is the service effective?

We found that staff did not know people's nutritional risks which meant people were at risk of dehydration. We saw that when people asked staff for a drink they were ignored.

Is the service caring?

We observed the interaction between people and the care staff. We observed situations where care staff spoke kindly to people. However we found occasions where some staff ignored people and did not promote people's dignity.

Is the service responsive?

We found that the service had not responded to people's health needs. For example, where people had lost significant weight no action had been taken. We saw that people were left alone in their room for long periods of time and there were no meaningful activities that were personalised to their choice.

Is the service well-led?

The Registered Manager told us they promoted a positive culture, in which people and staff could talk to them about any concerns they may have. Staff told us they found management approachable however they did not feel listened to, as concerns had been raised but no action had been taken.

There was no analysis of incidents such as falls and accidents, and no management overview of the environment, infection control, medication management or people's welfare. Information that we asked for regarding these systems was not provided to us.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with nine people using the service, three relatives, ten care staff supporting them, one physiotherapist and looking at six people's care records. The care centre is divided in to four separate units, Entimos, Topaz, Sapphire and Worcestershire Intermediate Care Unit (WICU). If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "I feel safe here". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

People were asked for their consent to care and support and where people did not have the capacity to give consent, the provider had acted in line with legal requirements.

People had not always been cared for and supported in line with their individual care plan and risk assessment. This meant that people's welfare and safety was not always protected.

People were not cared for in a clean and hygienic environment. This meant that people were not protected from the risk of infection.

Systems were not in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People were not included in the planning of their care. One person told us, "I had been prescribed some treatment and I didn't know about it. No one had discussed it with me". We found that care plans and risk assessments were not followed by staff. This meant people were not receiving effective care that met their needs.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

The manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "The staff really care about us". Some people raised concerns about the way in which some staff approached them. For example, people told us there was a lack of respect shown to them by night staff and that night staff kept them waiting for support.

People's preferences, interests and diverse needs had been recorded but care and support was not always provided in accordance with people's wishes.

Is the service responsive?

People we spoke with told us that the manager was always responsive to requests that they made. Relatives, staff and health care professionals all told us, where issues had been raised or comments made about improving the service that these had been acted on.

We found that the provider employed people specifically for the purpose of organising and carrying out activities.

Is the service well led?

People and staff told us that the registered manager was striving to improve the quality of the service provided.

The service had quality assurance and risk management systems in place. The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems.

The people we spoke with told us that they were happy with the home and the staff. One person told us: 'It's grand, couldn't be better,' and another said: 'It's a smashing place.' A third person told us: 'The staff are good, very friendly.'

We watched staff as they cared for people. They provided care and support that met people's needs.

Staff knew about the needs of the people they were caring for. We looked at care records for eight people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that people were able to have a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs.

We found that people's medicines were not managed appropriately. There were discrepancies between the amounts of medicines recorded as given and the amounts remaining in stock.

The provider had a system in place to monitor the quality of its service regularly.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

We found that staff kept accurate and up to date records of the care that people had received.

We found that people received their medication at the right time and that staff had appropriate guidance in when to administer medication prescribed 'as required'.

We found that the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

Some of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We found that there were sufficient numbers of trained and qualified staff to meet the needs of the people at the service on the day of our inspection. We also saw that an increasing number of staff had received specialised dementia training in order to meet the needs of this group of people.

We found that the provider had made some improvements to its quality assurance system but this system was not working effectively in relation to record keeping.

The provider had taken steps to improve the physical security of people's records since our last inspection.