Archived: The Shires Care Centre

The Shires Care Centre can accommodate up to 42 people with personal care and nursing needs. At the time of our inspection nursing care was not being provided at the service. 17 people with a range of needs including physical needs, mental health needs and people living with a learning disability were living at the service.

A registered manager was in post who had been registered since October 2016. 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.

During our previous inspection on 12 and 13 April 2016 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; how risks associated to people’s needs were assessed and planned for, how the principles of the Mental Capacity Act 2005 was adhered to, staff received insufficient training and support, people did not receive a personalised service and the systems in place to monitor safety and quality were insufficient.

During this inspection we checked to see whether improvements had been made. We found improvements had been made in all the breaches identified at our last inspection. A robust action plan was in place to fully complete the action required that would ensure sustainability. New systems and processes required further time to fully embed.

People told us they felt safe living at the service. Staff understood how to identify and report allegations of abuse. Risks associated to people’s needs had been in the main assessed for, but risk plans were variable in detail and guidance for staff. A new falls audit had been introduced but other incidents lacked detail and analysis. The internal and external environment people lived in was safe.

People’s emergency evacuations plans and the provider’s business continuity plan were being updated. This was to ensure staff had the required information in the event of an incident affecting the safe running of the service.

There was a system used to review and monitor people’s dependency needs. There were sufficient staff available to meet people’s needs and safety. Staff had been appropriately recruited; checks had been completed in relation to safety and suitability before they commenced their employment.

People received their prescribed medicines safely and their medicines were stored and managed appropriately.

Staff required additional support to fully understand and implement the principles of the Mental Capacity Act 2005. Some people experienced periods of heightened anxiety that could result in behaviours that were challenging to themselves and others. Staff had limited information and guidance available about how to support people effectively at these times.

Improvements had been made to the support and training offered to staff to enable them to carry out their role effectively and safely.

People’s nutritional needs had been assessed and planned for and people were supported to maintain their health. Staff worked well with external health professionals and followed recommendations made in supporting people with their health needs.

People were supported by kind, caring and compassionate staff that showed dignity and respect.

People did not have access to independent advocacy information should they have required this support. People were involved in regular reviews of their care to ensure the support provided met their needs.

People were supported by staff to participate in activities of interest to them. Information available for staff about people’s needs, routines and preferences was limited in parts. People reported that they had to wait to have their requests for assistance responded to.

Systems were in place for receiving, handling and responding appropriately to complaints. People had regular opportunities to provide feedback on the care and support they received in order to continue to drive forward improvements in the service.

Improvements had been made with regard to the quality assurance systems in place to ensure that people received high quality, safe and effective care and support. Whilst improvements had been made, further time was required for systems and processes to fully embed.

The Shires provides accommodation for up to 42 people with varying support needs including nursing and people living with learning disabilities and physical disabilities. On the first day of our inspection there were 23 people living at the service and the second day 22 people.

The Shires is required to have a registered manager. 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. A registered manager was in place.

Risks to people had not always been assessed appropriately, and the control measures identified to reduce risks had not always been in place. Risk plans lacked detailed information for staff and were not robustly monitored, reviewed or evaluated.

Accident and incidents were not always recorded appropriately, and there was a lack of analysis to consider patterns, trends and lessons learnt to reduce further reoccurrence.

Staff were aware of the provider’s safeguarding policies and procedures and their role and responsibilities in keeping people safe. The provider was working with the local authority in investigating some current safeguarding concerns.

Safe recruitment practices were in place to reduce the risks of unsuitable staff working at the service. Staffing levels were identified as a concern; people did not always have their needs met in an appropriate time, impacting on their well-being and preferences. People’s dependency needs were being assessed and this was completed as a matter of urgency, as a result staffing levels increased with immediate effect.

People received their medicines as prescribed but the handling and recording of some medicines did not follow good practice guidance and protocol.

Staff induction, training and support opportunities were not sufficient in ensuring staff had the required skills, knowledge and support to provide effective care and treatment.

Staff did not always gain consent from people before providing care and treatment. Where people lacked mental capacity to make specific decisions about their care and treatment, The Mental Capacity Act (2005) was not fully adhered to. The provider had failed to appropriately assess people’s mental capacity in relation to restrictions of their freedom and liberty. Staff had poor understanding of the principles of The Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.

Some safety concerns and appropriateness of some aspects of the environment were identified. This included people’s personal evacuation plans being out of date. Bathing opportunities were limited; there were ongoing problems with the lift not being in full working order, and equipment not in a good state of repair or suitable for people’s needs.

Staff showed a caring and compassionate approach when talking about people they cared for. However, the quality of care and support provided was at times task focussed and interactions with people were not always respectful.

People did not have available information about independent advocacy services should they have required this support. Information about the complaints procedure was not displayed easily for people to see and was not in an appropriate format for people with communication needs.

Staff had limited information available about people’s individual needs, routines and preferences this impacted on their ability to provide effective and responsive care. People’s needs were being reassessed and there was an ongoing plan to involve people in a review of their care and treatment.

People received opportunities to participate in activities but these were not always appropriate for the needs of all people who used the service.

The inconsistency in leadership had impacted on the development of the service. The registered manager had not been at the service on a regular basis. Action was taken by the provider during our inspection to immediately improve this. This resulted in the registered manager being full time at the service with the support of a full time operations manager. The quality assurance systems in place to monitor quality and safety had not been completed consistently within the service. The provider did additional checks and identified improvements required. The provider was working with commissioners and produced weekly action plans to show what action was being taken to improve the service. Whilst this had been slow this had started to improve since our inspection.

We found the service was in breach of five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.