Shangri-La Residential Home

We rated the home ‘Requires Improvement’ at its last inspection in December 2016. At that inspection we identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These included breaches of Regulation 9, person centred care; Regulation 11, need for consent; Regulation 12, safe care and treatment and regulation 17, good governance.

At this inspection we found the provider had rectified the breaches found at the last inspection; the home is now rated ‘Good’.

There was a registered manager at the home. 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 and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of all oral medicines. However, the system in place to ensure that topical creams were not used beyond there ‘safe to used by date’ was not robust. This was discussed with the registered manager who told us that they would review the current system and take immediate action to ensure that creams were labelled clearly. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Risks to people had been assessed and completed risk assessments contained detailed personalised information about the person and their circumstances. Risks assessments identified the risks along with the actions taken to reduce these risks. Staff were able to explain the risks relating to people and the action they would take to help reduce the risks from occurring.

There was enough staff to meet people’s needs and staff had the time to engage with people in a relaxed and unhurried manner. People received person centred care from staff who knew each person well and understood there needs and personal preferences.

Staff had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Staff developed caring and positive relationships with people and were sensitive to their individual choices, treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were provided with appropriate mental and physical stimulation through a range of varied activities.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. People and their families were encouraged to provide feedback on the service provided both informally and through quality assurance questionnaires.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

There were systems in place to monitor the quality and safety of the service provided and manage the maintenance of the buildings and equipment.

People and their families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role.

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 service was last inspected in November 2015 and was rated as requires improvement. Requirement actions were made regarding seven breaches relating to a lack of risk assessments, the deployment of skilled staff, medicine management, the lack of clear personalised records, the lack of staff training and mental capacity assessments. We received an action plan from the provider in December 2015, telling us how they were going to take action to ensure compliance with the breaches.

Staff understood the principle of keeping people safe and were aware of safeguarding protocols. Risk assessments had been completed but had not always been personalised or kept up to date to reflect people’s changing risks. Staffing levels met the needs of people, and staff enjoyed the training programme. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely but records needed to improve.

Staff had a basic knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without their agreement or being in their best interests. People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.

People’s records did not demonstrate people had their needs met in a planned and personalised way. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and were clear about their roles and the values of the home. Records were not always accurately maintained and this was not an effective part of the quality audit process.

We found breaches in 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three of these are repeated regarding risk assessments, records and personalised care. You can see what action we told the provider to take at the back of the full version of the report.

The manager had improved the detail in the care plans, so they accurately reflected the needs of each indivual. People told us their needs were met and they liked the staff. People told us.the staff are "wonderful and very patient".

Medication procedures were well managed in the home.

Staff went through an effective recruitment procedure to ensure people were not placed at risk.

The manager had an effective system to ensure the service it provided to people was monitored and reviewed.

Assessments and care plans had been completed. Care plans did not always detail the correct information or explain the identified risks relating to the care plan.

From records regarding the administration of medication it was not always possible to establish if people had received all their medication. Controlled drugs were not being stored appropriately.

Staffing records viewed demonstrated not all the necessary checks had been carried out on staff before they started work in the home. People told us they liked the staff.

Clear information was displayed in the home regarding the complaints procedure. We were able to establish complaints were taken seriously and acted upon.