Archived: Shalden Grange

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.

Shalden Grange provides accommodation, care and support for up to 35 people. At the time of this inspection there were 25 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 was completed in December 2016. The service was rated inadequate overall and placed into special measures. This was a focussed inspection to ensure that improvements were being made. 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?' has changed from Inadequate to Requires Improvement. The overall rating for the service remains as inadequate as the key questions of 'Is the service safe?', 'Is the service effective?', and 'Is the service responsive?', are rated as inadequate. We will review these areas at our next inspection.

Following the last inspection, the registered provider had provided CQC with regular reports of the actions being taken to ensure they complied with the requirements of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider and registered manager had also employed consultants to help with a review of the service and to assist with implementing the required improvements.

The registered manager and consultants had created an action plan to address the breaches in regulations. At the beginning of this inspection they made it clear that this programme was still ongoing and whilst progress had been made, they were aware that not all of the regulations were fully met.

People living in the home told us that they felt cared for and safe. Staff were enthusiastic about the improvements that had been made and had a better knowledge and understanding of people's needs and how to support people.

We found that improvements had already been made or were in the process of being planned but had not been fully completed. Nine regulations had been breached at the last inspection. At this inspection, we found that two of the regulations, regarding the safe recruitment of staff and notifications of events to CQC, that were breached at the last inspection had been fully met. Progress was being made with five other regulations relating to person centred care, privacy and dignity, safe care and treatment, good governance and staffing but the service was not yet fully met. The breaches of regulations regarding consent and complaints were not checked. CQC is now considering the appropriate regulatory response to the shortfalls we found. We will publish a further report on any action we take.

We found improvements in the condition of the building and the provision of facilities and equipment. Bedrooms were being redecorated and fire precautions work had been attended to. A wet room had been created which meant that many people were able to shower where previously they had not been able to.

Arrangements to manage people's medicines were improving and better records were being kept. People were better protected from abuse because staff had been given information about abuse and the procedures for reporting it.

The staffing structure had been reviewed and new staff recruited to provide additional support to staff and the registered manager. Staff were receiving regular supervision and a plan to ensure they were suitably trained was being developed.

The registered manager was taking a proactive role in the service with the support of the consultants. People looked better cared for and were more engaged with the people around them.

Shalden Grange provides accommodation, care and support for up to 35 people. At the time of this inspection there were 32 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.

This inspection was brought forward from the planned date because we received information of concern and safeguarding alerts from the local authority. At our last inspection in September 2016, we found shortfalls in a number of areas and the service was rated Requires Improvement. We found breaches relating to the way people received care and treatment, that people's consent was not always properly obtained and people were not always treated with dignity and respect, the management and administration of medicines, the management of risks to people, premises and equipment that was not safe to use, the recruitment, training and supervision of staff, the service did not act in accordance with the Mental Capacity Act 2005, quality monitoring systems were not effective and record keeping required improvement.

At this inspection we found that very little improvement had been made.

The first day of this inspection was unannounced. The registered manager was not in the home upon our arrival and was unable to come to the home when staff contacted them. The second day of the inspection was arranged with notice but the registered manager was still unable to attend the inspection or provide the records we requested. The registered provider was present but did not have knowledge of the management arrangements for the home or the work of the registered manager. We found that there was no system in place for the management of the service when the registered manager was absent.

People were not kept safe because systems relating to fire safety were not effective. Staff did not know how to keep people safe in the event of an emergency such as a fire.

The premises and equipment were not always properly maintained. We identified some issues that posed risks to people such as exposed hot water pipes which could burn people. Systems for the identification and management of risks were not effective.

People may not have always received their medicines as prescribed and systems to manage medicines were not safe. Not all staff that handled medicine had their competency checked to do this before being allowed to administer medicine to people.

Staff had not been safely recruited which meant that the registered provider could not be certain that people were of good character and had the necessary qualifications, competence, skills and experience necessary for the work to be performed by them. Staff also did not receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

People were not always protected from abuse. Staff had not been trained to recognise and understand signs that a person may be being abused or neglected and the action they should take if they suspected this.

People's rights were not always protected because staff did not understand or adhere to the Mental Capacity Act 2005. Some people were being deprived of their liberty and had Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place. Some people's conditions in relation to their authorisations were not being met and other people may have been deprived of their liberty unlawfully.

Care plans lacked detailed information and there was little guidance for staff about people's support needs and how to meet them. This meant that staff may not know enough about people as individuals to be able to provide personalised care. Some people's health care needs were not met to ensure that they kept well. A small number of people were not always treated with respect and their dignity was not maintained.

The systems in place for assessing and monitoring the quality and safety of the service were still not effective. Systems for the day to day running of the home in compliance with legislation were also not effective. For example, the registered provider had not notified us of all of the significant events that had happened at the home. This was a repeated breach of the regulations. We were also not notified about allegations of abuse at the home, the investigation or learning and outcomes.

Record keeping had not improved. There were still shortfalls in the accuracy of records kept.

There were continued shortfalls in the governance of the home and the home was not well-led. The management of the home had continued to be reactive rather than proactive in relation to assessing the quality of the service and taking action to mitigate risk.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Shalden Grange provides accommodation, care and support for up to 35 people. At the time of this inspection there were 33 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.

This inspection was brought forward from the planned date because we received information of concern and safeguarding alerts from the local safeguarding authority. At our last inspection in February 2015 we found the service was running well and rated it as good.

People told us they felt safe living in the home and that staff were mostly kind and caring. We found issues with poor maintenance of the building and equipment which meant that the fire alarm system was not adequate and many people had not been able to have a bath or shower for a number of months. There were also problems with the provision of hot water to some rooms and portable electric items had not all been risk assessed or tested to ensure they were safe to be used. Much of the furniture was old and damaged and many rooms had damage to ceilings and walls.

People were not always protected from the risk of harm and abuse. Staff had carried out assessments that had identified that people were at risk of things such as dehydration and pressure sores but had not always taken action to reduce and manage the risk. Not all staff had been trained to recognise and understand signs that a person may be being abused and the action they should take if they suspected this.

People were not protected against the risks associated with the unsafe management and use of medicines. Care plans and medicine records lacked detailed information and guidance for staff and errors were not identified through the audit process that was in place. This also meant that there was a risk that people were not having help to ensure that all of their needs were properly met.

People's rights were not always protected because the service was not acting in accordance with the Mental Capacity Act 2005. The service was caring but needed some improvement because some staff interactions and written information did not always respect people and uphold their dignity.

Staff were not always recruited safely and were not receiving regular and effective supervision and support. Most of the people we spoke with told us they had confidence in the staff and felt that they had the knowledge and skills to meet their needs. However, some people said they did not always feel that staff understood their needs. Not all staff had received training in the essential areas of care required for their role.

People told us that meals were good and the menu showed there were alternative options if someone did not want what was on the menu. We saw an evening meal and two lunches being served. Meals looked and smelt appetising and people were offered choice where one was available such as different sandwich fillings for the evening meal.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals. People had also been regularly supported with chiropody care.

There were some positive interactions between staff and the people they were supporting. Observations showed some staff had a good rapport with people. Most people told us staff were caring. However written records were not always completed in a way that upheld people’s dignity.

People’s needs were assessed before they came to live at the home. People’s assessment information was used to develop care plans about how someone wanted or needed to be supported. However, we found that people’s care needs were not always fully assessed and planned for. Some care plans were person centred and told staff how to support those people, but other care plans included insufficient information to enable staff to fully meet people’s needs.

Information about making a complaint was displayed in a communal area of the home and was also included in the information that was given to people when they moved into the home. Records had not been maintained of the date the complaints were received, how they were acknowledged and investigated and the outcome of the complaint.

Quality monitoring systems were not effective. The audits and management processes had not identified any of the issues found during this inspection. The registered manager responded to the concerns raised at this inspection but had not taken action to proactively assess and monitor these shortfalls prior to our inspection.

Some records contained errors and omissions and some were illegible. This meant that staff may not always have important information available to them.

The occurrence of some incidents and events must be reported to CQC. The registered manager had not made the required reports. This meant that the CQC were had not been made aware of important information about the service and the actions the service had taken with regard to the incidents and events.

People experienced care, treatment and support that met their needs and protected their rights. They were cared for by, suitably qualified, skilled and experienced staff that were safely recruited.

People were consulted about how they should be looked after where they were able to be involved.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were drawn up from assessments and were person centred and regularly reviewed. A relative we spoke told us they 'were very happy with the care' provided to their family member. An individual we spoke with said 'on the whole it's pretty good'.

The design of the premises provided a safe environment in which to care for people. A visiting health care professional we spoke with said 'the home is very nice and patients seem happy'.

Appropriate staffing levels were maintained to look after people. A relative we spoke to told us the staff were 'very nice and helpful'.

Shalden Grange had a complaints procedure which was publicised to individuals and/or their relatives.