Shulas

Updated 19 November 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.

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 was undertaken by one inspector.

Service and service type

Shulas 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.

Inspection activity started on 26 August 2021 and ended on 22 September 2021 when we gave feedback to the provider. We visited the service on 26 August 2021.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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 this information to plan our inspection.

During the inspection

We spoke with four people who used the service. We observed people’s interactions with staff and the support they were offered. We spoke with the registered manager and deputy manager. We reviewed one person’s care records and checked medication for one person. We also reviewed a variety of records relating to the management of the service.

After the inspection

Following our visit to the service, we spoke with one relative, one advocate and two professionals about their experience of the care provided. We also spoke with five staff members. We accessed the provider’s electronic care planning system. We reviewed incident and accident data, recruitment records, training data and quality assurance records and continued to seek clarification from the provider to validate evidence found.

Updated 19 November 2021

About the service

Shulas is a care home that provides accommodation and personal care to people with a learning disability and/or autistic people. The service can support up to six people. At the time of our inspection there were six people living at the service. The service was divided into two flats, with three people living in each.

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

The provider had failed to ensure the quality of care was monitored at Shulas. There was no effective system of governance in place and quality assurance systems were not embedded within the service. Some audits had been completed by the registered manager however, these were not always effective at identifying areas for improvement.

Incidents were reviewed and signed off by the registered manager, but no analysis was completed with a view to identify patterns and trends. There was limited evidence that lessons learnt were considered and shared with the team to prevent any reoccurrence.

Risk assessments were in place and these contained sufficient detail about how staff should support people, in line with their needs. However, there were inconsistencies between paper care records and the electronic care planning system. In addition, behavioural support plans varied in detail and contained insufficient guidance about how to support people effectively in different situations.

There were several environmental concerns at Shulas, which had been identified by the provider and were in the process of being addressed. However, we saw evidence that these issues had been ongoing for a significant period of time. The registered manager explained how these had been raised with the provider on several occasions but had not been addressed in a timely manner. This meant people had been living in unacceptable living conditions, with potential risks to their health and safety.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions of safe and well-led, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Shulas is a domestic property, with the building fitting into the local residential area and there was nothing outside to show it was a care home. People were provided with care that did not consistently promote their dignity, privacy and human rights. The provider had not fully considered how to maximise people’s choice, control and independence. Work was required to identify and support people to achieve their goals and aspirations.

We have recommended the service reviews the ‘Right support, right care, right culture’ guidance and considers the ways in which it can further promote person-centred care, which promotes choice, inclusion, control and independence.

Staff had received safeguarding training, were able to identify different types of potential abuse and knew how to report any concerns both internally and externally. Staffing levels were sufficient, and medicines were managed appropriately.

People, relatives and professionals provided us with positive feedback about the registered manager. Staff told us they felt well supported.

We were somewhat assured the service was managing infection prevention and control risks, in relation to COVID-19 appropriately and in line with guidance.

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 good (published 05 September 2017).

Why we inspected

We received concerns in relation to the provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

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 the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to the environment and premises and good governance at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.