Archived: The Shires

Updated 5 August 2021

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 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.

This was a focused inspection to check on specific concerns we had about the management of people’s safety and how the home was run.

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

The inspection team consisted of one inspector and a specialist advisor in nursing.

Service and service type

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

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We also requested feedback from Healthwatch to obtain their views of the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spent time seeing how people were cared for and spoke with five people living at the home. We spoke with six members of staff including the registered manager, a nurse and four care staff.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff recruitment files and staff training. We also checked nursing registration documents. A variety of records relating to the management of the service, including quality audits, surveys completed by people living at the home and medicines management were reviewed. We checked documents relating to how staff communicate regarding people’s care and safety needs, accidents and incident records and key policies and procedures.

After the inspection

We continued to seek clarification from the registered manager and nominated individual to validate evidence found. For example, in relation to checks undertaken by the registered manager and plans for the maintenance of the premises. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 5 August 2021

About the service

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.