Shalimar

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of our inspection there was 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.

The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people using the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. Records confirmed that robust recruitment procedures were followed. Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People using the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were involved in discussions and decisions regarding the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People using the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

The service ensured people were treated with kindness, respect and compassion. People also received emotional support when needed. People told us they were involved in planning the care and support they received and were able to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

People who used the service and staff spoke highly of the management team and told us they felt supported. CQC’s registration requirements were met and complied with and effective quality assurance procedures were in place.

Further information is in the detailed findings below.

Shalimar provides accommodation, care and support for up to five people living with a learning disability and/or mental health needs. At the time of our inspection there were five people living in the home.

The registered manager had been in post since 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People who lived in the home were safe and were cared for by staff who had appropriate training for their role. All staff completed a comprehensive induction to their role and felt supported by their colleagues and the manager. Safe recruitment practices were in place and all staff had satisfactory criminal records check carried out. There were adequate levels of staff to meet people’s individual needs.

Staff had an in depth knowledge of people’s individual needs and people’s care was reviewed regularly. Where risks had been identified with regards to a person’s health these were safely managed and minimised.

Medicines were managed, stored and administered safely by staff who had received the appropriate training.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager and staff were knowledgeable about when a request for a DoLS should be submitted but mental capacity assessments were not in place before best interests decisions were made for people.

Appropriate advice and support had been sought from professionals such as the GP, speech and language therapist and psychiatrists to inform people’s care plans. People’s nutritional needs were being met and they were provided with appropriate support with their nutrition.

People were encouraged to be as independent as possible and make choices about their care. The care plans were person centred and were written with people who lived in the home. Links with the community were maintained and people would attend regular activities away from the home. Staff supported people to maintain relationships with their family.

Staff felt supported by their manager and said that they felt that the service was well led. There was regular input from the provider and senior management to support the manager and review the quality of the service. Regular audits were carried out both internally and by senior management.

Relatives we spoke with were satisfied with the care that was provided by the service and felt able to raise a complaint if they needed to. A complaints procedure was in place and people were supported to make a complaint if they wanted.

Below is a summary of what we found.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us that they liked the staff who worked with them. We observed that people showed no reluctance in seeking out staff to assist them.

Improvements had been made to the way that medicines were managed so that these were safely recorded and administered.

Systems were in place to ensure that the safety of the service was monitored. There were procedures in place for dealing with emergencies. This reduced the risk to people and helped the service to continually improve.

The home had procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). No applications had been made regarding deprivation of liberty for anyone living at the home. However, the manager gave us an example of how they had involved the local authority DoLS team for advice. This meant people would be safeguarded as required. We saw that the contact details for this team were displayed in the office. We discussed a recent legal decision regarding DoLS with the manager so that further advice could be taken if required.

Is the service effective?

People's health and care were discussed with them. Specialist advice regarding mental health, behaviour, dietary needs, communication and swallowing difficulties had been sought where this was appropriate. The advice was incorporated into people's plans of care so that staff knew how to support people effectively.

It was clear from our observations and speaking with staff that they had a good understanding of people's care and support needs. Staff had received training to help them meet the needs of people living in the home. We asked people if they felt staff did their jobs properly and supported them well. They told us that they did.

Is the service caring?

We saw that people were supported by attentive staff. There was a lot of laughing and good humour. People told us they felt well treated by staff. Staff took time to engage people in their preferred activities within the home, such as making drinks and doing jigsaw puzzles. Following some increase in anxiety, one person was supported quietly and discreetly with staff reading a book to them in their room. We observed that staff respected people's privacy, knocking on bedroom doors and waiting for a response before they went in.

People's preferences and interests were recorded in their individual plans. Records showed that care was delivered to help meet these as people required.

Is the service responsive?

People were able to engage in activities inside and outside their home, with staff support as needed. People were also able to discuss how the home was being run at 'service user meetings'. Staff were able to give us examples of where people's needs had changed and how they were arranging for further advice in relation to their care.

Is the service well led?

The service had a quality assurance system so that shortfalls were identified and addressed promptly. This meant that the quality of the service could be improved where necessary.

Staff spoken with were clear about their roles and responsibilities. They told us how they were supported by staff meetings, training, supervision and appraisal to understand and carry out their roles. They said that things had improved with the new manager and that there was increased clarity about their roles within the home.

We found that people were given support to make choices about their meals and to eat and drink enough to keep them well. People told us about what they liked to eat and drink. We saw that their preferences for different types of drinks were respected and they were offered these regularly.

Medicines were stored safely. However, these were not always properly recorded and administered so that people were protected from associated risks.

We observed that people were supported by enough staff. People told us that there were always two staff on duty and sometimes up to four "...depending on what's going on."

People were confident their 'keyworkers' or other staff would help to "...put things right..." if they had any concerns. There was an 'easy read' guide to making a complaint, although we noted that this was not clearly displayed.