Archived: Shalden Grange

Updated 1 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13, 14 and 26 September 2017. The first day of the inspection was unannounced and carried out by an inspector and a specialist advisor. The second day was completed by two inspectors and the third by one inspector.

Before the inspection we reviewed the information we held about the service; this included any events or incidents they are required to notify us about. We also contacted the local authority safeguarding and commissioning teams to obtain their views.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

We spoke with and met eight people who were living in the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with seven staff, as well as the registered manager and one of the registered providers. We looked at 14 people's care and medicine records. We also looked at records relating to the management of the service including audits, maintenance records, and seven staff recruitment files.

Updated 1 December 2017

This was an unannounced inspection which took place on 13, 15 and 26 September 2017.

Shalden Grange provides accommodation, care and support for up to 35 people. At the time of this inspection there were 19 people living in the home.

The home has 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.

A comprehensive inspection took place in December 2016. The service was not meeting the regulations and was rated Inadequate. CQC took enforcement action which included putting the service in Special Measures and imposing specific conditions on their registration. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

A focussed inspection to ensure that improvements were being made was carried out in April 2017. This inspection looked at the questions of, 'Is the service safe?' and 'Is the service well led?'. We found improvements for both of these key questions and the rating for 'Is the service well led?' was changed from Inadequate to Requires Improvement.

Following the inspection in December 2016, the registered provider had employed consultants to help with a review of the service and to assist with implementing the required improvements. They completed their work with Shalden Grange at the end of July 2017.

At this inspection there were a number of areas where sufficient progress and improvements had not been made. We found seven breaches of the regulations. Breaches relating to person centred care, safe care and treatment, good governance and staffing had been identified at the previous three inspections, as well as at this inspection. There was a breach of the regulation relating to consent at the two previous comprehensive inspections and this inspection. Two other regulations relating to the safe recruitment of staff and notification of events and incidents to CQC had been breached at the two previous comprehensive inspections. At the focussed inspection in April 2017, systems had been put in place to ensure the regulations were complied with. However, these improvements had not been maintained and these regulations were again in breach at this inspection.

Where sufficient progress and improvements had not been made, this meant people were at risk of not receiving safe and effective care. For example, there were continued shortfalls in the management and administration of medicines, premises safety, risk management and health and safety. Staff induction, training and supervision had not been completed and people did not always have their rights protected because the service did not operate in accordance with the Mental Capacity Act. Care planning was still lacking in detail and contained inconsistencies and there was little activity and occupation for people living in the home.

The registered manager did not have the same level of oversight of the service as had been demonstrated during the inspection in April 2017. The culture of the service was, again, reactive rather than proactive in ensuring that a good standard of care and accommodation was provided for the people living in the home. Following our inspections in September and December 2016 and April 2017, some improvements were made and this was seen at our focussed inspection in April 2017. The improvements that had previously been made had not been sustained and the implementation of improvements had not been maintained. This meant that people were not kept safe and provided with good care from staff who had been properly trained to work to current standards and good practice guidance.

At this inspection we found that improvements had been made with regard to promoting dignity and respect and to receiving and acting on complaints. Staff were more confident and there were improved interactions between staff and people living in the home.

People in the home told us that they felt cared for and were comfortable. Staff confirmed that there were enough of them on duty on each shift to meet people’s needs. They were also positive about the training that they had completed in recent months.

CQC is now considering the appropriate regulatory response to the shortfalls we found. We will publish a further report on any action we take.