Archived: The Shires

The Shires is a care home providing personal and nursing care to 10 people with mental health care needs at the time of the inspection. The service can support up to 13 people.

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

Improvements needed to be driven through in the maintenance of the home, to continue to reduce the risk of infections and to enhance people’s lives further. The nominated individual gave us assurances improvements to key areas of the home would be undertaken without delay.

Governance systems required further development, so the registered manager could be assured people’s medicines were stored safely and remained effective. People’s care records did not always confirm if they had been offered care. The registered manager immediately took steps to address this.

People told us they valued living at the home, and the culture fostered by staff encouraged them to ask for support when they wanted it. People gave us examples showing how this had increased their confidence, independence, well-being and promoted their safety.

People worked with staff to identify their safety needs and to agree plans to promote their safety. Staff knew how to identify the signs of abuse and were confident senior staff would take action to support people.

There were enough staff to care for people.

Some people administered their own medicines. Where people wanted assistance to manage their medicines staff supported them. Senior staff promptly investigated medicine errors, so any learning could be taken from this. This had led to a reduction in the number of medicines errors.

Improvements had been made in the way staff were supported to develop the skills they needed to care for people. People’s needs were assessed, and staff took action to care for people. This included ensuring people had enough to eat and drink so they would remain well. In addition, people were supported to seek care from other health and social care professionals where this was needed.

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.

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 Requires Improvement, (published 31 August 2019).

Why we inspected

We received concerns in relation to the management of medicines and the premises. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection. However, we have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Shires on our website at www.cqc.org.uk.

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 Shires is a residential care home providing personal and nursing care for up to 11 people with mental health needs within one large adapted building. At the time of our inspection, there were 10 people living at the home.

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

Staff training provision did not fully reflect the needs of the people living at the home. This included a lack of basic mental health training for care staff. The arrangements for the clinical supervision of the registered manager and other nurses were not sufficiently robust. The provider’s quality assurance systems and processes were underdeveloped and inconsistent, limiting their ability to monitor and improve the quality and safety of people’s care.

Staff understood how to recognise and report any abuse involving the people who lived at the home. The risks associated with people’s individual care and support needs had been identified, recorded and plans put in place to manage these. Staffing levels ensured people’s individual needs could be met safely. The provider adhered to safe recruitment practices and checked the suitability of prospective staff. The provider took steps to protect people from the risk of infections.

People’s individual care needs were assessed and reviewed in order to deliver care and support that achieved positive outcomes for them. People were involved in choices about what they ate and drank, and they had support to maintain a healthy diet. Staff worked effectively with a range of community health and social care professionals to ensure people’s care and health needs were met. 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.

Staff treated people with kindness and compassion. People were encouraged to have their say about the service and to participate in decision-making that affected them. People were treated with dignity and respect at all times. Staff recognised the importance of promoting equality and diversity in their work and avoiding any form of discrimination.

The service was responsive to changes in people’s needs, working effectively with community health and social care professionals to address these. People were involved in developing their care plans, which were read and followed by staff. People had support to participate in a range of social and recreational activities, and to take advantage of job opportunities. People knew how to raise any concerns or complaints about their care. People’s wishes and choices regarding their end of life care were acted on.

The registered manager promoted an open and inclusive culture within the service, engaging well with and encouraging the involvement of people, staff and community professionals. Staff were clear what was expected of them and had the management support they needed to succeed in their job roles.

Rating at last inspection

The last rating for this service was Good (report published 8 October 2016).

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.

We undertook an unannounced inspection on 28 August 2016.

The Shires provides accommodation and nursing care for a maximum of 13 people who have mental health support needs. People who live at The Shires may need a long term home or be planning to move towards a more independent way of life. At the time of our inspection there were 11 people living at the home.

The manager for the service was in the process of registering with us. Since the inspection they are now the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

All the people we spoke with said they were happy at the home. They all said the staff and management team were caring and treated them with dignity and respect. People explained how staff supported them follow their interests which improved their well-being.

People told us they were supported by staff and the manager to make their own decisions about their own lives. The management team had a clear ethos that people using the service were at the heart of everything they did. People told us they were important to the staff and the manager. They said they were regularly asked their views about if they were happy with the support they received.

People we spoke with said they had support from regular staff who knew them well. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, these focussed on enabling people to be as independent as possible safely. People were helped to receive their medicines by staff when they needed support. Staff were trained and knew about the risks associated with people’s medicines.

Staff had up to date knowledge and training to support people living at the home. Staff always ensured people agreed to the support they received. People were encouraged to make their own choices about the food they ate. They explained that they were supported to make their own decisions and be as independent as they could. People told us staff would access health professionals as soon as they were needed and there were plans in place to support them.

People and their relatives knew how to raise complaints and the management team had arrangements in place to ensure people were listened to and appropriate action taken. Staff were involved in regular meetings and supervision meetings share their views and concerns about the quality of the service. People and staff said the management team were accessible and supportive to them. Staff were adaptable to changes in peoples’ needs and knew people well to recognise when additional support was needed.

The manager monitored the quality of the service and encouraged staff to be involved in the regular audits. The manager ensured there was a culture of openness for people using the service and staff. The management team had systems in place to identify improvements and action them in a timely way.

There were good relationships between the people living at The Shires and staff. The staff we spoke with told us they loved working there. One said, "It is a very special place". We saw that the staff checked with people what they wanted and encouraged them to make decisions about their lives. People's care and support was planned and agreed with their involvement.

There were arrangements in place to protect people from the risk of abuse. People we spoke with told us they felt safe and would tell the staff if they felt concerned about anything. They said they wouldn't worry about this because the staff would listen to them. One person commented, "I get on with everyone. It feels safe here".

Staff recruitment was done thoroughly and was based on robust policies and procedures. We saw that the expected checks were done to make sure people were suitable to be employed at the home. People who lived at the home were involved in the selection of new staff including being on interview panels.

Since our last inspection it had been decided that The Shires would continue to provide a service and would not close as had previously been planned. The registered manager confirmed that because of this all the bedrooms were now single rooms.

The support plans put people's own assessment of their abilities and goals at their centre. The people we met had all had some success in moving towards what they wanted to achieve. People we spoke with gave us examples of how their lives had improved while living at The Shires. There was a choice of food and people were able to take part in preparing meals. People told us that the food was good and they had enough to eat.

The management of medicines was safely organised. People who were able to look after their own medicines were supported to do this safely. This was done in a planned way with the help and support people needed at each stage.

The staff team was experienced and received training to give them the knowledge and skills they needed to do their jobs well. People living at the home told us they felt well supported by the staff.

The management of The Shires provided a well organised structure for the provision of the service. Care and support was being provided in a structured and thoughtful way. People were viewed as individuals and encouraged to develop their independence.