Shooters Hill Residential Home

There were two registered managers in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found that improvements were required in that systems to monitor the quality and safety had not identified that fire risks assessments to minimise risk of fire had not been carried out or reviewed by an expert or a competent person.

Safeguarding adults procedures were in place to protect people from the risk of abuse. Staff confidently described the different types of abuse and knew to who contact to report their concerns. There was a whistle-blowing procedure available to staff and they said they would use it if they needed to. Risks to people were assessed and identified. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed safely and people received their medicines as prescribed by health care professionals. There was a system to manage accidents and incidents appropriately, and learning from this was disseminated to staff. People were protected from the risk of infection. Staff confidently described what they did to prevent the risk of infection. There were enough staff deployed to meet people’s needs and the provider followed safe recruitment practices.

Staff completed an induction when they started work, as well a programme of regular training and supervision to enable them to effectively carry out their roles. People's needs were assessed before they moved into the home to ensure their needs could be met. 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. Staff asked for people’s consent before offering support. People were supported to have enough to eat and drink. They had access to a range of healthcare professionals when required to maintain good health. Staff supported people when they moved between services through effective communication, to ensure their care and support needs were well co-ordinated. The home had been adapted to meet people’s needs, this included bath and stair rails.

Staff were kind and caring. They respected people’s privacy and dignity. People were involved in making choices and decisions about their daily care and support needs. People were encouraged and supported to be independent wherever possible. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People were involved in planning their care needs. People's diverse needs including religious beliefs were recorded in their care plans. The registered managers told us that people were supported to meet these individual needs when required. People were aware of the home’s complaints procedure and knew how to make a complaint if necessary. People’s end of life wishes were recorded in their care plans.

On the whole there was an effective system in place to monitor the quality and safety of the home. Regular resident and staff meetings were held, and feedback was sought from people about the home through annual surveys. Staff were complimentary about the registered manager. The provider worked in partnership with the local authority and other agencies to ensure people’s needs were planned and met. The registered managers were knowledgeable about their responsibilities under the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. We saw that the provider was aware of the need to display the current rating of service in the home and we saw the rating was on display as required.

There was a clear philosophy of helping people to maintain their independence and achieve their goals and aspirations in life. Staff said they enjoyed working at the service and they received good support from the registered managers. The registered managers worked in partnership with other agencies to help ensure people received good quality care and support. This included the local authority and mental health team.

This inspection took place on 13 and 14 June 2016 and was unannounced. Shooters Hill Residential Home was registered with the Care Quality Commission on 7 January 2011. We last inspected this service in May 2014 where we found the provider was meeting all of the regulations in force at that time.

Shooters Hill Residential Home is a large house in the London Borough of Greenwich split over two levels with five bedrooms with communal bathrooms, kitchen, dining and living room areas. There is an outdoor area with grassed lawns.

There were two registered managers in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Not all of the people using the service could express if they felt safe and how staff treated them so we observed the support offered and spoke with relatives and staff. During the inspection we saw that people appeared happy and content and not at risk of harm. Where relevant, people had an independently appointed professional such as an advocate who could express their views and help them to ensure their voice was heard

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. Appropriate recruitment checks took place before staff started work. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People were supported to have a healthy balanced diet. People’s medicines were managed safely and they received their medicines as prescribed by health care professionals.

Staff had received training specific to the needs of people using the service, for example, mental health awareness and safeguarding adults. They received regular supervision and an annual appraisal of their work performance. The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People’s relatives and health care professionals had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. Staff encouraged people to be as individual as possible and to do things they wanted to do. People’s relatives were aware of the complaints procedure and were confident their complaints would be fully investigated and action taken if necessary.

The managers recognised the importance of regularly monitoring the quality of the service provided to people. Staff said they enjoyed working at the home and they received good support from the managers.

Below is a summary of what we found. The summary is based on our observations during the inspections, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see evidence supporting our summary please read our full report.

Is the service safe?

We observed that people using the service were treated with dignity and respect. People we spoke with said ''The staff are good; they help me when I want support and understand what I need.''

Risk assessments were completed for each person using the service to identify such risks as self-neglect or violence towards others and these were reviewed every six months. There were safeguarding vulnerable adult's policies and procedures in place. Staff received training to understand how to protect people using the service from the risk of abuse. There were systems in place to ensure the environment was well maintained and that people knew how to respond to emergency situations such as fire. Accidents and incidents were recorded and appropriate actions taken to minimise the risk of reoccurrence.

Relevant checks had been completed by the registered manager before employing staff to ensure people were cared for by staff that were appropriately trained and qualified to do their job. There was a system in place to ensure complaints were responded to appropriately.

Is the service effective?

People's health and care needs were assessed with them prior to developing a care plan about the level and type of support each person required to be safe and have an independent lifestyle. We saw that care had been planned in consultation with people to ensure their needs were understood and appropriately supported.

People we spoke with told us that they had their own copies of their care plans which were reviewed with them. A relative we spoke with was complimentary about the care and support provided. They said, ''When I visit there is a good atmosphere and the staff always keep me informed about what is happening.'

Is the service caring?

We observed that staff demonstrated a good understanding of each person's needs and took time and care to respond to people's questions. People we spoke with told us they felt supported by staff. They told us they received help when required and staff listened to what they had to say. People using the service completed an annual satisfaction survey. Where concerns had been raised these had been responded to appropriately. Staff and people we spoke with both told us that they felt they were part of a family and people were able to use the service as they would their own home. People told us how they had been able to take holidays with staff if they wished.

Is the service responsive?

People and relatives we spoke with told us they knew how to complain however they had not had reason to do so. There was evidence to show that the service worked well with other agencies such as dentists and doctors to ensure people received care in a timely and coherent manner. We observed that people's wishes about aspects of their care and daily activities were respected and responded to appropriately.

Is the service well led?

The service had systems in place to monitor people's satisfaction with the service. There were monthly timetables provided by the registered manager to ensure staff were aware of all general management tasks due to be undertaken. These included such things as due dates of general maintenance tasks, planned training and appraisals. Staff explained these were used to ensure that there were no oversights and that there was a consistent quality service provided to both the people using the service and the staff employed.

We found that staff supported people by making decisions in their best interest where they lacked capacity themselves. People who used the service had care plans and risk assessments in place relevant to their needs and staff we spoke with knew about the support that was needed. Staff had an understanding of safeguarding vulnerable adults and knew the actions to take to ensure people remained safe. Staffing levels and training were sufficient to support people at the home and records were maintained and stored securely.