Archived: The Shieling

Updated 21 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the registered provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors, a pharmacy inspector and an inspection manager carried out the inspection.

Service and service type

The Shielings is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post however they were on leave.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service, including information from the registered provider about important events that had taken place at the service, which they are required to send us. We sought feedback from the local authority. The registered provider was not asked to complete a registered provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with six people who lived at the home about their experiences of the care provided. We spoke with eight members of staff including the human resources manager, senior care staff on the inspection. We spoke with two relatives. We also spoke to the director who is also the owner of the service. We reviewed a range of records. This included six people’s care records, multiple medication records, accident and incident records three staff recruitment records and we looked at a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the owner and the nominated individual to validate evidence found. We met with the local authority and other stakeholders to discuss our findings. We looked at training data and quality assurance records and sought feedback from health and social care professionals.

Updated 21 September 2022

About the service

The Shieling is a care home providing accommodation and personal care for up to 29 adults. There were 29 people living at the service at the time of the inspection. Some of the people lived with dementia and required support with their physical needs.

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

People did not receive safe care and treatment. Our observations and findings showed that care practices did not follow safety guidance. People did not always receive their medicines safely to manage their conditions. Safeguarding protocols had not always been followed to report injuries and falls and to ensure oversight from external agencies. Risks to people were assessed however, they had not been timely reviewed. People at risk of repeated falls, dehydration and skin breakdown had not been adequately monitored and supported in line with their care plans. Risks associated with fire were not managed because staff were untrained, and the premises had not been serviced as required. The provider’s recruitment practices were unsafe. Infection prevention protocols were not robust to prevent and reduce the spread of infections.

People were not supported by staff who had the right skills and knowledge. Staff did not receive suitable induction and training to meet people’s needs. People were not supported to have maximum choice and control of their lives because their capacity to make decisions was not always assessed. People were not adequately supported to ensure they received enough to eat and drink. People told us staff sought their preferences. Staff supported people to have access to health professionals and specialist support. The registered provider did not have robust governance arrangements to promote a person-centred approach and the delivery of safe and high-quality care. There was a lack of audits, monitoring and shortfalls were not identified and resolved in a timely manner. Staff gave mixed responses regarding the culture and management style in the home and there was low morale. There was a lack of robust leadership and oversight on the running of the service and people’s experiences of care.

People were not always supported to ensure they received the care that they required and in line with best practice guidance. Care records were not reviewed when people’s needs changed to reflect people’s current needs, and some had no care plans for their needs. People were not adequately supported towards the end of their life and staff had not received training in end of life care. There were arrangements to maintain regular communication between relatives and staff.

People and their relatives were positive about the service and said staff were kind and caring. However, our findings showed that this was not consistent, and the unsafe use of medicines had a potential impact on people’s dignity, respect and human rights. People’s property was not always returned after they were deceased.

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 02 April 2020).

Why we inspected

We received concerns in relation to the management of people’s needs, the governance and the leadership in the home. A decision was made for us to inspect and examine those risks.

We have found evidence that the registered provider needs to make improvements. Please see the safe, effective and well-led sections of this report. We took immediate action to protect people.

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 COVID-19 and other infection outbreaks effectively.

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 register providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from preventable harm such as medicines management and falls and fire safety risks. We also found concerns regarding safeguarding, responding to changes in people’s needs, deploying suitably qualified staff and poor governance at this inspection. Please see the action we have told the registered provider to take at the end of this report. 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 the future of the home. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered provider’s registration, we will re-inspect within six months to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.