Archived: Shassab Residential Care Home

Shassab Residential Care Home (Shassab) is a family-run home which caters for people of different ages from the Asian community, and offers support to people with mental health needs and/or learning disabilities. The home can accommodate up to eight people. There are four bedrooms on the ground floor and four on the first floor. At the time of this inspection, there were six people living there. They each had their own bedroom.

There was a manager in post who has been registered with the Care Quality Commission since October 2010. The manager was also the registered provider. 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.

Most of the people living at Shassab and some of the staff did not speak English as a first language. We used an interpreter to help us communicate with them.

We found breaches, some continuing, of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in safe care and treatment, staffing, person centred care, safeguarding people from improper treatment, need for consent and governance systems. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The service did not consistently deploy sufficient staff to help ensure people were kept safe. This issue had been raised at the previous inspection.

Recruitment processes were not safe as the provider did not adequately undertake all pre-employment checks to help ensure staff employed were suitable to work with vulnerable people.

Risk assessments did not adequately detail actions required by staff to mitigate risk nor did they provide further actions to be taken to ensure that the risks were managed. In some people’s care files, we saw risks had been identified but there were no plans in place to manage these risks. This meant that people were not adequately protected from risk of harm.

Medication administration needed to be more robust. Staff did not sign medication records appropriately and the service did not keep a specimen signature list of staff administering medication. We saw medication audits had been undertaken but these had not been done since August 2016 and the audit tool was not effective.

Not everyone living at the care home had a personal emergency evacuation plan in place. Improvements were needed to manage the risk of infection.

There was a lack of leadership and management intervention to help ensure improvements were made. Governance systems in place failed to identify critical aspects of keeping people safe and ensuring that effective care and support was provided.

People told us staff were good at their jobs. We saw that mandatory training had been done previously; this training included health and safety and moving and handling. However the deputy manager told us staff training required refresher training. This meant that people may be at risk of harm because staff did not have the appropriate skills.

The service was not working within the principles of the Mental Capacity Act 2005; this issue had been raised at the last inspection. The registered manager had not made the necessary Deprivation of Liberty referrals to the local authority meaning that people were being unlawfully deprived of their liberty.

Staff told us they treated people with dignity and respect in how they spoke with and cared for them. We found some practices of the service did not demonstrate the hallmarks of a caring organisation.

There was a lack of activities and recreation provided at the home to stimulate the people living there. This was also the case at our last inspection.

Records showed that people had access to a variety of health care professionals such as GPs, opticians and hospitals. This should ensure that people received the right care when required.

People and relatives felt that staff were caring and kind toward their relations and understood their needs.

Care records showed that people or/and relatives had been consulted at the initial stages of the care provision.

People told us the service provided was good and that they were happy living at Shassab. We observed staff worked as a team. People told us the home was managed well and that they could rely on the registered manager to deal with any issues they may have.

Shassab Residential Care Home is a family-run home which caters for people of different ages from the Asian community, and offers support to people with mental health needs and/or learning disabilities. It can accommodate up to eight people; there were six people living there at the date of our inspection. They each had their own bedroom. There are four bedrooms on the ground floor and four on the first floor. The home has been open for over twenty years.

Shassab Residential Care Home has a registered manager who has been registered since 2010. He is also the registered provider. 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 minimum of two staff were supposed to be on duty at all times, according to the staff rota. When we arrived at 9.05am there was only one member of staff in the home and the second person arrived at 9.30am. This was a breach of the Regulation relating to having enough staff on duty.

Medicines were stored securely and the administration of medicines was recorded. In one person’s case the numbers of tablets remaining in two boxes showed that they had not received all the medicines that they were recorded as having received. This was a breach of the Regulation relating to the safe and proper handling of medicines.

Recommendations made by a fire officer after our last inspection had been carried out. Plans for emergency evacuation needed to be improved. This was a breach of the Regulation relating to reducing risks to people living in the home.

All the necessary checks had been done for the recruitment of staff, both regular staff and volunteers.

The registered manager had responded to suggestions made after an infection control inspection. However, there were no dedicated cleaners. Care staff were expected to complete cleaning tasks on a schedule. Hand cleaning gel and paper towels were missing. There was a breach of the Regulation relating to infection control.

Staff we spoke with had a basic understanding of safeguarding and knew how to report any incident of abuse or potential abuse. We have recommended better training in safeguarding.

The registered manager had told us that all staff were trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), but we did not see evidence of this training. We saw that some people had mental capacity assessments, and in one case a best interests decision had been made that a person should stay in Shassab Residential Care Home. However, no application had been made for authorisation under DoLS. This was a breach of the Regulation relating to depriving people of liberty without lawful authority.

Training in a wide range of areas had been delivered to all staff in the autumn of 2015. Staff were supported with supervision and appraisals; although there had been no supervisions for six months they were about to resume.

Food was appropriate to the culture of most of the people living in the home. People told us they liked it. However there was one person who preferred another style of food. Failure to meet that person’s preferences was a breach of the relevant Regulation.

The building was suitable for its purpose as a home. Records were kept of people’s access to health professionals.

People told us they were well supported and were happy in the home. Their personal care needs were met. People were encouraged to be as independent as they could be. Staff respected their privacy. Some people were free to come and go when they wanted. People got up when they chose to.

Care plans were detailed and provided enough information for professionals to understand the care that was being delivered. Care plans were reviewed regularly although on some files successive reviews were identical. People were assessed before they moved into the home, and also given a trial period to see whether they wanted to live there.

The activities schedule was identical for everyone even though people’s needs differed widely. Some activities were available for each person but in an unstructured way. Weekly access to an activity centre had ceased. There was a breach of the Regulation relating to meeting people’s needs.

Shassab Residential Care Home had not met all the requirements to report significant events because they had failed to report a death. This was a breach of the relevant Regulation.

There was a self audit checklist in use but it did not cover all areas. There was a separate audit of medicine administration but the findings of this inspection indicated it needed to be used more effectively. There were some improvements needed to the premises which had not been identified by the provider. The lack of an effective audit system was a breach of the relevant Regulation.

The service used volunteers as well as employed staff. This was within the culture of the Asian community to provide help and support. Documents were being translated into Urdu to enable staff to understand them better.

Staff meetings were infrequent but were planned to take place more regularly. Surveys were used to obtain family members’ views of the care provided at Shassab Residential Care Home.

We found breaches of six Regulations. You can see what action we told the provider to take at the end of the full version of the report.

There were six people living in Shassab Residential Care Home at the date of our visit. All of them were of Asian origin, as were all the staff. The provider, who is also the registered manager, was not present but the deputy manager showed us round and provided us with the information we needed. We talked with two members of staff. We looked at care plans and other documents.

We used the evidence we gathered to answer the five questions which we now always ask of services:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found. The evidence supporting these findings can be found under our judgements for each standard.

Is the service safe?

The building was a safe environment which met the needs of people living there. There was at all times a minimum of two staff to look after the six people living there. Care plans were thorough and meant that people's health needs were met. People were taken regularly to outside health services to ensure their health was maintained.

Staff had been trained in safeguarding but the training required to be updated. There had not been any identified incidents of harm or abuse to people living there since our last inspection.

We were concerned to note that it was recorded that someone received medication when they had not yet received it. We have asked the provider to take action to prevent the same error happening again.

Is the service effective?

All the staff working at Shassab Residential Care Home were of the same ethnic origin as the people living there, which meant the staff were sensitive and sympathetic to their needs. We looked at a sample of people's care plans and saw evidence which showed that, where possible, people or their close relatives had been involved in developing their care plans.

Is the service caring?

We observed that staff took good care of people's physical needs. For example staff patiently assisted one person to eat their lunch, and then changed their shirt afterwards when a little food had been spilled. People who smoked were allowed to smoke once an hour, but not encouraged to do so.

We noted that one person was allowed to sleep as long as they wanted, and often got up at 4pm. We considered that it might be in that person's best interests to be encouraged to lead more normal hours, and we spoke with staff about this.

Is the service responsive?

The management had responded positively to a number of criticisms in our last report. We saw that changes had been implemented. We also saw that for the most part the service had adopted recommendations made by the contract officer of Manchester City Council. We saw evidence that the service responded to the needs of individuals.

Is the service well-led?

We knew that the provider who was also the registered manager had been in post for many years, and shared the management responsibility with the deputy manager. We saw that the service had devised a self-audit checklist but this had not yet been used. We saw that training in all areas was due to be completed by October 2014, but had not yet been booked. During our inspection we found that timed entries were being made in care records in advance of the events occurring. We therefore considered that there was room for improvement in how the service was led.

One person said: "The people are very nice here and so is the food."

We found there was a system in place for recording people's consent to their care and treatment. We found that in the main people were well looked after and had their basic needs met, but that there was scope for providing more and a greater variety of activities, better suited to individuals.

We found that the food was nutritious and appropriate to the people living in the home.

We also found that staff were well supported in their roles, although additional training was required for some staff who had missed courses.

We found that the sheet of information intended to accompany people to hospital was incomplete and that this had a moderate impact on the safety and welfare of individuals.

We also found that the care plans included obsolete and contradictory information and that the system of reviewing care plans required improvement. We found this had a minor impact on the safety and welfare of individuals.