At the time of our inspection there were six people using the service. One adult social care inspector carried out the visit.We spoke with four people who used the service, one of the company's directors and one care staff. We reviewed four people's care plans. Other documents that we reviewed included the provider's policies and procedures, training records and the results from various audits.
We used the evidence we collected during our inspection to answer five questions.
Is the service safe?
We saw people being cared for and supported in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people living in the house. There was an on-call procedure for staff to telephone someone senior during the out of hour's period if they had any concerns. Processes for the prevention and control of infection were in place. Visitors to the house were asked to sign in and out. This helped to reduce risks in relation to health, safety and security.
People's care plans contained appropriate risk assessments in relation to the care and support they received. This meant that steps were taken to reduce any risks that could present to the person. The assessments included risks in relation to using public transport and people managing their own money.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act (MCA), 2005. The safeguards apply to people in care homes and hospitals, and aim to make sure people are looked after in a way that does not restrict or deprive their freedom inappropriately. No one who used the service, at the time of our inspection, had a DoLS authorisation in place. People had given their agreement and consent to the information documented in their care plans and care and support was planned and delivered in a way that was intended to ensure people's safety and welfare
There were arrangements in place to deal with foreseeable emergencies. We noted that people participated in a 'fire practice' on a regular basis. Emergency plans were written in an 'easy read' format that helped to ensure people understood the content of them.
Is the service effective?
People's health, social and care needs had been assessed with them individually. People were involved in reviewing their care plans and risk assessments. People's communication needs had been documented in their care plan. Staff could explain the different communication techniques that helped people to understand what was being said or proposed.
From the training records we reviewed, we found staff had received training to enable them to meet the needs of the people who used the service. This included specialist training to help meet the needs of people with diabetes and epilepsy. We found that staff's knowledge and skills had been put into practice and that they could effectively manage a person with these health conditions.
People's goals and aspirations were documented in their care plans. The people we spoke with told us that they had been actively involved in the writing of their care plans. We saw that people were supported to develop and maintain life skills to help increase their independence. People's outcomes were positive; the care and support they received enabled them to achieve their goals.
It was evident that staff knew the needs of the people they cared for very well. We observed positive interactions between the staff and people using the service.
The provider worked closely with other health and social care professionals. This included people's general practitioners, social workers, physiotherapist and chiropodist. This helped to ensure that all of people's needs were met by a multidisciplinary team.
Is the service caring?
We spoke with four people during our inspection. Each person told us that they were happy living in The Shires. One person said, 'I am very happy living here. Everything is good. The staff are lovely.' Another person said, 'I enjoy living here. The staff are nice. There is plenty to do. We go to the pub and places. I enjoy gardening and this year we have been growing tomatoes, strawberries and runner beans.' A third person said, 'I'm alright. Everything is good. The staff are good.'
The staff had received training in person-centred care and this was evident during our review of people's care plans as well as our observation of staff interacting with people in an individualised way. Staff understood the needs of people well. The level of support given to people reflected what had been assessed in their care plans. We saw that people were satisfied with their level of care and support. People told us that they appreciated being supported to remain as independent as possible.
Staff communicated with people using different communication techniques that were meaningful to the person. Staff spoke with people in a kind and calming manner. Any assistance given by the staff was not rushed or hurried. When staff were supporting people to undertake a task by themselves, we saw that they displayed both encouragement and patience. People's dignity and privacy was maintained at all times, throughout our inspection.
Is the service responsive?
The environment and scheduled activities were planned to help meet people's needs. This included a lounge area where people could choose to spend their time, as well as the kitchen and dining area where we saw people sitting and chatting with each other. We noted that there was a secure garden that had provisions for people to grow vegetables and fruits.
It was evident that the care and support people received met their individual needs. People's care plans included all activities of the person's daily living. There were support plans in place for staff to follow to help ensure they responded to people's needs in an effective way. We observed staff interacting with people in a positive way and this included encouraging people to develop certain skills to help them become more independent.
The service received minimal complaints. However, there was an effective complaints policy and procedure and all of the people we spoke with told us that they knew how to raise a complaint. The complaint procedure was also written in 'easy read' to help ensure people understood its content. Complaints were fully investigated and acted upon. This meant that the provider took account of complaints and comments to improve the service.
Is the service well-led?
The staff we spoke with told us that they felt well supported. One care staff said, 'I feel very well supported and have no concerns. I am very happy working in the home.'
We saw that there was an effective management structure in place to support the care staff. The service had regular visits from the directors of the company. These included visits during the weekend to help determine if the care staff required any support or assistance.
The supervisions that we reviewed included discussion points and actions and agreements with staff. The care staff we spoke with told us that they felt supervisions and appraisals were both productive and beneficial. They said that the management team worked 'alongside' the care staff in helping to determine what their learning needs were. Staff told us that they were supported to undertake a programme of training and education that enabled them to meet their identified needs.
Quality assurance processes were present within the service. These included the auditing of care plans, medicines management, maintenance issues and infection control procedures.