Giles Shirley Hall

At the last inspection the service was rated good. At this inspection we found that some improvements to the service were required and as a result the service was rated as requires improvement.

Giles Shirley Hall is registered to provide accommodation for up to 12 people who require accommodation and support with their personal care due to living with learning difficulties. The home is located in Bromborough, Wirral. At the time of our inspection eleven people lived at the home.

In June 2017, CQC published best practice guidance called ‘Registering the Right Support’. This good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism. During our visit, we found that the service was not consistently developed or designed in line with this best practice guidance.

For example, the size and layout of Giles Shirley Hall did not comply with this guidance. It was situated in a campus style setting with the provider’s day services accommodated in various other buildings outside the home. Day services also operated from within Giles Shirley Hall itself. Giles Shirley Hall, the provider’s day services and associated car park were clearly labelled with exterior signs which identified them as providing services for people with learning disabilities and or autism. This detracted from the values set out in the ‘Registering the Right Support’ guidance which advocates that people’s choice, independence and ability to live as life as ordinary in their own home should be promoted in service delivery. This signage therefore clearly defined people who lived at the home as a separate and distinct community group.

All of the people who lived at the home attended the provider’s day services. From people’s records it was clear that people had a choice in what they attended and enjoyed these activities. The provider’s approach for supporting people who did not wish to attend day services was however unclear. Other aspects of service delivery did not always promote the values specified in the Mental Capacity Act 2005 with regards to gaining people’s consent. Nevertheless we did see evidence of people’s day to day choices being respected and for the most part they were free to choose how they lived their life at the home.

People’s support plans contained clear and easy to understand information about their needs and risks and how to support them effectively. Support plans were person centred and contained information about people’s preferences, daily routines and what was important to them. For those people who were unable to express their needs and wishes verbally, staff had detailed guidance on the behaviours, gestures and body language the person would use to communicate their needs or wishes. From talking to staff it was clear they knew people well. They were able to tell us about people’s changing needs and how the support provided had been adapted to respond to these changes. People’s support plans however had not always been updated to reflect this.

The atmosphere at the home was positive and inclusive. The people we spoke with and their relatives were happy with the support provided. Everyone was confident that people were well looked after, safe and happy at the home.

New staff was recruited safely and there were enough staff on duty each day to meet people’s needs. Staff had received adequate training and support to do their job role and staff spoken with told us they felt supported.

Medication was managed safely and people had access to a range of health and social care professionals in support of their needs.

There were mechanisms in place to monitor the quality and safety of the service but these were not always effective. For example, the provider’s quality assurance system failed to identify that the service did not always reflect best practice guidelines or that aspects of service provision such as adapting the premises to meet people’s needs.

People who lived at the home were given opportunities to express their views and where possible any suggestions for improvement were acted upon. Feedback on the service was positive and from our observations it was clear that people liked the staff and the place in which they lived. Staff morale was good and all of the staff spoken with had a positive, can do attitude. During our visit, we had no concerns about the support people received and the manager and staff team appeared committed to providing a good service.

Giles Shirley Hall is registered to provide accommodation for persons who require nursing or personal care and also provides end of life care. The home is registered to provide accommodation and care for up to 12 people. At the time of our inspection, there were 11 people living in the home. The people who lived in Giles Shirley Hall had conditions on the autism spectrum and other conditions related to this.

Giles Shirley Hall is part of a large Victorian building. The provider is Wirral Autistic Society (WAS), now known as Autism Together. It occupied about half of the building at one side and the other half provided day care facilities for a range of people using the services of WAS.

The home was split into four flats and there were large communal areas and a sleep-in/office room. Also nearby this building were other WAS homes and a garden centre. The church building adjacent to Giles Shirley Hall had been converted and now offered drama and music sessions to people supported by WAS.

The home required 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. Giles Shirley Hall had a registered manager who had been in post for several years.

We looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the registered manager. We checked that we had received these in a timely manner. We also looked at safeguarding referrals, complaints and any other information from members of the public.

We observed the people in the home on the day of our inspection, but most were unable to communicate verbally with us.

We saw that people received sufficient quantities of food and drink and had a choice in the meals that they received.

Medication procedures were followed and the medication stored tallied with the records.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the six files looked at there was updated information that reflected the changes of people’s health.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place that included training them to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

We saw that people appeared to feel safe and confident in the staff. The staffing levels were seen to be appropriate to support people and meet their needs and the staff we spoke with considered there were adequate staff on duty.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded.

People generally had good appetites and there were no concerns regarding weight loss. Individual dietary needs were identified and catered for.

The home was divided into four flats and each person had their own bedroom within one of the flats with en suite shower room. The home was decorated and furnished to a good standard. Maintenance certificates were all current and up to date. Wirral Autistic Society provided a team of maintenance staff who were on call.

The staff rotas we looked at showed that staffing levels were always maintained and named members of staff provided the one to one support for individuals. All of the regular staff had achieved a national vocational qualification at level 2, 3 or 4.

People were given information about how to make a complaint and the manager responded appropriately to complaints and concerns and kept good records.

All the relatives we spoke with told us they were part of the care planning process. They told us that people who used the service could make their own choices in how they wished to be supported and were given options to participate in social activities or to have part time work.

We found that Giles Shirley Hall had safeguarding measures in place and that staff were trained to identify and act if there were any safeguarding issues. One relative we spoke with said' 'It's a huge weight off my mind to know he is safe.'

We found that staff received regular training and supervisions to make sure they could support people who used the service.

We found that Giles Shirley Hall had systems for monitoring quality assurance in place. Relatives told us they were aware of how to make a complaint but knew they could always talk to the manager if they had any concerns. Relatives told us they did not have any concerns about the care people received.