Archived: Shulas

Shulas is a care home that provides accommodation and personal care to people with a learning disability and/or autistic people. The service can support up to six people. At the time of our inspection there were six people living at the service. The service was divided into two flats, with three people living in each.

People’s experience of using this service and what we found

The provider had failed to ensure the quality of care was monitored at Shulas. There was no effective system of governance in place and quality assurance systems were not embedded within the service. Some audits had been completed by the registered manager however, these were not always effective at identifying areas for improvement.

Incidents were reviewed and signed off by the registered manager, but no analysis was completed with a view to identify patterns and trends. There was limited evidence that lessons learnt were considered and shared with the team to prevent any reoccurrence.

Risk assessments were in place and these contained sufficient detail about how staff should support people, in line with their needs. However, there were inconsistencies between paper care records and the electronic care planning system. In addition, behavioural support plans varied in detail and contained insufficient guidance about how to support people effectively in different situations.

There were several environmental concerns at Shulas, which had been identified by the provider and were in the process of being addressed. However, we saw evidence that these issues had been ongoing for a significant period of time. The registered manager explained how these had been raised with the provider on several occasions but had not been addressed in a timely manner. This meant people had been living in unacceptable living conditions, with potential risks to their health and safety.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions of safe and well-led, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Shulas is a domestic property, with the building fitting into the local residential area and there was nothing outside to show it was a care home. People were provided with care that did not consistently promote their dignity, privacy and human rights. The provider had not fully considered how to maximise people’s choice, control and independence. Work was required to identify and support people to achieve their goals and aspirations.

We have recommended the service reviews the ‘Right support, right care, right culture’ guidance and considers the ways in which it can further promote person-centred care, which promotes choice, inclusion, control and independence.

Staff had received safeguarding training, were able to identify different types of potential abuse and knew how to report any concerns both internally and externally. Staffing levels were sufficient, and medicines were managed appropriately.

People, relatives and professionals provided us with positive feedback about the registered manager. Staff told us they felt well supported.

We were somewhat assured the service was managing infection prevention and control risks, in relation to COVID-19 appropriately and in line with guidance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 05 September 2017).

Why we inspected

We received concerns in relation to the provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shulas on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to the environment and premises and good governance at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in 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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

People were supported by staff who knew how to keep them safe from harm. Staff had received training in safeguarding and were aware of how to report any concerns. There were safe practices around recruitment and this further ensured that only suitable staff were employed to care for people in Shulas.

Individual risks to people had been identified and there was clear guidance about how these risks could be managed and mitigated. Risks within the environment were also managed in a safe way and regular servicing of the utilities as well as regular health and safety checks meant that any hazards could be identified in a timely manner.

People were supported to take their medicines in a safe way.

People are 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. However, people’s mental capacity was not always assessed and best interests decisions were not documented.

Staff received training relevant to their role in order to effectively support people with their health and mental wellbeing. People were supported to make healthy meals and were supported to access relevant healthcare professionals where needed.

Staff were caring and knew people’s support needs well. People were supported to be as independent as possible and were able to access a range of activities and groups in the community.

People were involved in planning their care and were treated as individuals. People’s care files were reviewed regularly and reflected people’s current care and support needs.

The registered manager was supportive and approachable. There was frequent communication between the management team, people living in Shulas and the staff. This allowed for everyone living and working in the home to get involved and share ideas about the running of the service. There were effective systems in place to monitor and assess the quality of service being delivered.

Further information is in the detailed findings below.

Another person told us that they knew what was in their care records and that they had regular reviews of their care with the staff.

We spoke with two people about the meals in Shulas. One person told us that they were vegetarian and said, 'The staff always make sure there's vegetarian food for me'.

Another person told us, 'I chose the dinner tonight; we're having steak and kidney pie. We had tuna pasta bake last night. We have a cooked breakfast every Saturday and a roast dinner every Sunday'.

One person we spoke with told us that they looked after their own medication and had the key to the locked cupboard in their room. This person said, 'I keep my pills in my room and the staff have made me a sheet to help me remember when to take my pills and remind me when I've already taken them'.

A member of staff we spoke with told us that they were very well supported by the manager and the organisation as a whole. This person told us that they received one-to-one supervisions every two months and also received an annual appraisal with their manager.

People told us they knew how to make a complaint if they needed to and made comments such as: 'I can talk to the staff who look after me', 'I can talk to any of the staff whenever I want, they're all good' and, 'Yes, I am safe here and I can tell the staff if I'm not happy'