Archived: The Shieling

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.

We found the following examples of good practice.

The home was visibly clean and hygienic, the service employed three cleaners who maintained regular cleaning schedules.

Staff were trained in infection prevention and control and followed guidance around wearing PPE.

The registered manager completed audits and spot checks to make sure staff were following guidance.

Staff and people living at the home were tested regularly for COVID-19 in line with guidance.

The registered manager made sure that friends and relatives could visit people safely in the home.

We found the following examples of good practice

• The service was booking visits with family and friends in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Information on what was expected from visitors to comply with infection control procedures was communicated at the time of booking.

• All visitors to the home had their temperature taken by an electronic device in the reception area. The temperature was recorded in the visitors sign in book. If someone had a temperature that caused concern they would be denied entry to the home.

• The registered manager was participating in the whole home testing process and had scheduled testing for people and staff.

• Sanitiser and PPE were available throughout the home. There were posters in the home to promote best practice guidance on how to put on and take off gloves, aprons and masks.

The Shieling is a residential care home providing personal care for up to 29 people aged 65 and over. At the time of the inspection the service was supporting 28 people.

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

People and their relatives felt safe at the home. One person said, “I feel safe here, the care is good, they [the staff] look after you.” We saw and people told us there were enough staff at the home to help people when needed. The home had systems in place to safeguard people from abuse and staff understood their responsibilities regarding safeguarding. Overall, the environment was safe, well-maintained and clean. We identified some relatively minor repairs that needed doing, which were completed by the end of the inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to have enough to eat and drink and were offered regular drinks and snacks throughout the day. Feedback about the quality and choice of food was positive. One relative commented, “The food is lovely, food and drink throughout the day, whatever [Relative] wants. [Relative] has put weight on.” Staff effectively assisted people to access other healthcare services when needed.

Some aspects of the environment were not in line with the home’s otherwise high standards respecting and promoting people’s privacy and dignity. Examples of this included staff having to access a cleaning storage area via a person’s room and some furniture at the home was worn and undignified. We have made a recommendation for the provider to address these issues. People and their relatives gave us positive feedback about the staff at the home. One person commented, “They [the staff] are very caring…they go out of their way.” Staff knew the people they were supporting well and were quick to recognise when people needed care and support.

People’s care plans were person-centred, informative and both gave staff the information they needed to get to know people and support them safely. People and their relatives were happy with the range of activities on offer at the home and staff had created various areas of interest around the home helping to share information and stimulate conversation. Staff also supported people to keep up with their religious preferences.

People and their relatives said the home was well-led. Comments included, “The manager is great, she’s on the ball.” There was a positive culture amongst staff at the home and staff worked to the principle ‘we work in our residents’ home, they do not live in our work place’.

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 17 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Shieling is a purpose-built residential home located in a semi-rural environment in Merseyside. The home provides personal care and accommodation for a maximum of 29 people. There is a registered manager in post at 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. There were 29 people living in the home on the day of our inspection.

People told us staff were very kind, polite and maintained their privacy and dignity. We observed extremely positive interaction between the staff and people they supported. Staff spoke enthusiastically about the people who lived in the home. They provided compassionate care and support towards people and their relatives.

People's individual needs and preferences were respected by staff. People told us they were listened to and their views taken into account when deciding how to spend their day. A ‘residents' committee’ was consulted and asked for their opinions on many issues and plans for the home, including the recruitment of staff.

Facilities were available for relatives to stay overnight at the home, if their family member was in very poor health and they wanted to remain close by.

The registered manager had recognised relatives’ anxieties about their family member living in a care home. They had set up a support group to enable relatives to meet to share their experiences.

The home had well-kept gardens and places for people to spend time with family members in private.

There was a very positive atmosphere within the home and people were very much at the heart of the service. People and their relatives were enabled to be involved in their care and staff ensured people had a meaningful and enjoyable life. A full programme of activities and events were available for people living at the home to participate in.

People living in the home and relatives told us they were able to share their views and were able to provide feedback about the service.

A process for managing complaints was in place. People we spoke with knew how to raise a concern or make a complaint. The home had received an exceptional number of compliments and extremely positive feedback.

People received their medicines safely, when they needed them. Risk assessments had been undertaken to support people safely and in accordance with their individual needs. There were enough staff on duty to provide care and support to people living in the home.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Staff were trained to ensure that they had the appropriate skills and knowledge to meet people's needs. They were well supported by the registered manager. They were appreciated and rewarded for their good work. The provider had robust recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. People living in the home were involved in the recruitment process.

People told us the staff had a good understanding of their care needs and their individual needs and preferences were respected by staff. Care plans provided information to inform staff about people's support needs, routines and preferences. Staff worked in partnership with health and social care professionals to make sure people received the care and support they needed.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

People told us they liked the food and were able to choose what they wanted to eat. Changes were regularly made to the menus to accommodate people’s suggestions for new choices and their preferences.

There was a strong emphasis on continually striving to improve. The registered manager was proactive in sharing their ideas, information and training they had put in place at the home with other home managers. Their attendance and input at the Care Home Innovation Project (CHIP) meetings every two weeks had seen changes made for people in the home. The necessity for hospital admissions was reduced and people were treated in the home or received advice from health care professionals via video link.

The home had good links with the local community; volunteers from local groups spent time in the home to learn about the needs of older people and provide activities.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service. Safety checks of the environment and equipment were completed regularly. The registered manager and deputy manager were committed to continuously finding ways to improve the home, for the benefit of the people who lived there.

The manager was aware of their responsibility to notify the Care Quality Commission (CQC) of any notifiable incidents in the home. The ratings from the last inspection were prominently displayed, as required.

The care being delivered at the home was person centred because people living there were involved in their care decisions, where appropriate, whilst respecting the person and their dignity. Reasonable processes were in place to ensure people were protected from harm and risk.

We spoke with people who lived at the home. We asked them to share with us their views and experience of care support they received. One person told us 'It is a lovely place here and the girls are kind. I have made new friends since I moved in.' Another person told us 'The staff and residents are always singing and dancing, it is a nice atmosphere.'

We spoke with four people who lived at the home and they told us that staff looked after them well and showed them dignity and respect at all times.

We spoke with staff who told us they felt well supported by the management and peers. They (the staff) said they worked well as a team and enjoyed their job. They told us they were encouraged to undertake further training.