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The Shires Requires improvement


Inspection carried out on 16 July 2019

During a routine inspection

About the service

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.

Inspection carried out on 31 August 2016

During a routine inspection

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.

Inspection carried out on 7 January 2014

During a routine inspection

People told us that they liked being at The Shires and that they felt well supported by the registered manager and the staff team. One person said, "Nice residents and nice staff. It's a very nice home - I like it here".

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.

Inspection carried out on 21 September 2012

During a routine inspection

During our inspection we spoke with three of the eleven people living at The Shires and with four staff, including the acting manager. People were positive about the care and support they received. They said they received all the help they needed and liked being there. One person described the staff as, "golden" and said that it was, "a very good place, it's A1".

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.