This inspection took place on 11 and 13 January 2017 and was unannounced. Shirley View is registered to provide accommodation, nursing and personal care for up to 22 people. At the time of our inspection there were 15 people using the service. There was a registered manager in post. 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.
At our last comprehensive inspection on 26 January 2016 we found three breaches of regulations in relation to staffing, good governance and notifications of incidents. We carried out a follow-up inspection on 5 and 8 July 2016 and found these problems had been resolved. However, we also found the provider was in breach of the regulation in relation to safe care and treatment because fire doors were not closing properly and medicines were not always stored securely.
At this inspection, we found the provider had resolved the issue with the fire doors. However, there were still problems with medicines management. Cupboards and refrigerators used to store medicines were not kept locked, although these were kept in a lockable room. There were not always sufficient instructions for staff about when to give people certain medicines or what to do if people declined to take their medicines.
We also found that some risks were not managed adequately, including some risks presented by the home environment and some risks that were specific to individuals, such as the use of bed rails. However, there were detailed risk management plans to help staff protect people from other risks, such as those of falling or developing pressure ulcers.
The provider had checks and audits to help them monitor and improve the quality of the service, but these were not sufficiently robust as they had not identified the issues described above.
We found two breaches of regulations. We have served a requirement notice for the breach of regulations in relation to good governance. We are taking further action against the provider for a repeated failure to meet the regulation in relation to safe care and treatment. Full information about our regulatory response is added to reports after any representations and appeals have been concluded.
People had care plans covering areas where they needed care and support. However, these were not always sufficiently personalised and did not contain information on people’s likes, dislikes and preferences about how they wanted their care delivered, or about how to meet people’s emotional and psychological needs. Although the staff we observed appeared to know people well and we saw staff supporting people appropriately, there was still a risk that new or temporary staff would not have the information they needed to respond to people’s needs.
The provider had appropriate policies and procedures in place for reporting alleged or suspected abuse. Staff were familiar with how to recognise and report abuse and people and their relatives felt they were safe at the home. There were enough staff to keep people safe and the provider carried out appropriate checks when recruiting staff to help ensure they were suitable to care for people.
Staff received the training and support they needed to do their jobs well, including specialist support in caring for people living with dementia. Staff had opportunities to learn about specific health conditions people had and to discuss good practice as a team.
Staff were aware of their duties in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation intended to ensure that where people are unable to consent to the care and treatment they need, this is only provided in their best interests and in such a way as to ensure their rights are not compromised. Where people were able to consent, staff obtained their consent before providing care.
People received enough nutritious food and fluids to meet their needs. Staff were aware of people’s specific dietary requirements. People received the support they needed to access healthcare services, including specialist healthcare providers as required. Staff monitored people’s health closely to ensure they received healthcare support when they needed it. The home worked with local healthcare providers to help reduce the frequency and length of hospital admissions.
Staff spoke to people kindly and respectfully. They took time to get to know people including what was important to them. Staff helped ensure people were comfortable living in the home and provided emotional support and reassurance when people needed it.
Staff provided people with the information they needed to make choices about their care, although we recommend that the provider seek advice on how to make some information more accessible as it was written in a style that some people might find difficult to read. Staff respected people’s privacy and dignity.
The provider was working to improve the provision of activities at the service. A range of culturally appropriate activities was offered to people and staff worked to protect people from the risks of social isolation and boredom.
The service had an appropriate complaints procedure and this was displayed where people could see it. The registered manager encouraged people and relatives to raise concerns and give feedback and they acted on these promptly.
There were systems in place to help ensure smooth transitions when people moved between services, particularly between the home and hospital. Staff kept up regular communication with the other service and with people’s relatives to ensure information was shared as required for the benefit of the person.
The service had an open and supportive culture where people, staff and relatives felt enabled to voice their opinions and raise concerns. The provider carried out surveys and meetings to gather the views of people and their relatives and used these to help improve the service. Staff kept records and communications to a high standard, meaning information was passed efficiently within the staff team. The registered manager and staff had a good relationship with the other providers and attended regular meetings with them to discuss joint working and to share relevant information.