Florence Shipley Residential and Community Care Centre

Florence Shipley Residential and Community Care Centre is a residential care home providing personal care to up to 32 people. The service provides support to adults of all ages, people living with dementia and people with mental health needs. At the time of our inspection there were 25 people using the service.

Florence Shipley Residential and Community Care Centre accommodates people in one purpose-built building across four floors. Each floor has communal areas and balcony outdoor space. The Centre offers a range of services including dementia care, long and short-term care and community specialist care, which is a reablement service facilitating discharge from acute hospital settings.

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

People and their relatives told us they felt the service was safe. Staff were recruited safely and there were sufficient numbers of staff to meet people’s needs. Medicines were managed safely and risk that affected people’s daily lives were regularly monitored and assessed.

Assessments of people’s needs had been carried prior to people using the service. People were supported to eat and drink a balanced diet and had a choice of meals, snacks and drinks. Staff training was relevant and up to date. Staff promptly sought guidance from external professionals when required.

People and their relatives consistently told us they were happy with how staff treated people. Staff understood how to promote people’s independence and respected people’s privacy and dignity.

Care plans contained detailed information on people’s life history and included information on people’s memories, employment and family. Staff told us how they used this information to understand people and to plan activities and discussions. People were supported to take part in activities and hobbies both inside and outside of the service.

Since our previous inspection, improvements had been made to quality assurance systems which ensured all aspects of the service were regularly audited. There was a positive, person centred approach to the planning and provision of people's care. This was demonstrated by the staff knowledge and understanding of the people they were supporting.

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 and update

The last rating for this service was requires improvement (published 7 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of any regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Florence Shipley Residential and Community Care Centre is a residential care home that was registered to provide accommodation for up to 32 people. At the time of our inspection there were 18 people living there. The care home has 8 intermediate care beds in the 'Bailey' unit. The aim is to facilitate discharge form acute settings, and to support people to return home or to prevent hospital admission or long-term care. It also has 16 spaces for longer term care across two units called 'Woodside' and 'Coppice' which are on different floors. They specialise in providing care to people living with dementia. A fourth short stay unit which accommodates a further 8 people. Each of these units has separate communal facilities. There are further facilities for people to use such as a restaurant and landscaped gardens.

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

The care people received had improved and there were more effective systems in place to monitor this and react to any areas of concern. However, some management systems required more work to ensure they were effective, and this included the provider oversight. Some working relationships with other professionals required attention and needed to be recognised on the service improvement plan.

The risks to people’s health and wellbeing were assessed and action taken to reduce them. This including supporting behaviours which could be challenging. There were systems to learn from mistakes including when safeguarding concerns were raised. People were supported by staff who understood how to protect them from avoidable harm. There were now enough staff deployed to keep people safe in the home and meet their needs promptly. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection.

Staff received training to enable them to do their jobs well. They understood their roles and responsibilities and there were clear reporting systems in place to share information. People were supported to maintain a healthy diet. Their health and welfare were managed with referrals to other professionals made when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, not all restrictions were assessed to ensure they were legally approved.

There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and that staff respected their wishes. There were opportunities for them to feedback about the home and how they felt. People had care and support provided which met their preferences. Complaints were handled in line with the provider’s complaints policy. People did not currently receive end of life care but had their wishes recorded for this time in their lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) – The last rating for this service was inadequate (published 15 March 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made in all areas but further embedding of governance systems was required and sustained and the provider was still in breach of one regulation.

This service has been in Special Measures since March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to continue to make improvement. Please see the effective and well led sections of this full 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 Florence Shipley Residential and Community Care Centre 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.

People’s experience of using this service:

The overall rating for the service is inadequate and the service will be placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

After the last inspection the provider had provided us with an action plan to manage staffing levels more effectively. At this inspection we found ongoing concerns about the numbers of suitably qualified staff available to meet people’s needs during the day and night. Therefore this plan had not been effective.

Risks associated with people’s care and support were not always managed safely. This put people at risk of harm from falling, choking and from other people’s behaviours. These risks were not always identified or reported to the relevant authorities to safeguard people from abuse.

Staff did not have sufficient training to enable them to provide safe and effective care. People did not always receive enough to drink to maintain their health and specialist diets were not always provided correctly. Relationships with healthcare professionals required improvement to ensure staff in the home were following established guidelines to support people. People’s capacity to make decisions was not always clear. This meant people were not always supported to have maximum choice and control of their lives and staff didn’t always support them in the least restrictive way possible.

Staff did not always protect people’s privacy and dignity when supporting them. People were not always included in making choices in a meaningful way. They did not consistently receive personalised care that met their needs. People were not always provided with opportunities for meaningful activity.

The provider did not review records regularly or listen effectively to staff to ensure that risks to people’s wellbeing were recognised and timely action taken to protect them. Records of people’s care and support were not accurate or up to date.

People received their medicines as prescribed. The systems in place to manage risks associated with them were effective. The home was clean and well maintained. There was good signage and accessibility throughout to support people living with dementia. Safe recruitment practices were followed. There were systems in place to respond to complaints.

Rating at last inspection: Rated as Requires Improvement, report published 28 February 2018.

Why we inspected: This was a scheduled inspection based on the rating at the last inspection.

Enforcement: There are six breaches in regulatory requirements. You can see the action we asked the provider to take at the end of the report.

Follow up: Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report . In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Florence Shipley Residential and Community Care Centre is a large purpose built building which provides a range of facilities including advice, information, day respite, rehabilitation and health support services. They are registered to provide residential care to 32 people within the ‘care home’.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 8 intermediate care beds in the ‘Bailey’ unit. The aim is to facilitate discharge form acute settings, and to support people to return home or to prevent hospital admission or long term care. It also has 16 spaces for longer term care across two units called ‘Woodside’ and ‘Coppice’ which are on different floors. They specialise in providing care to people living with dementia. Each of these units has separate communal facilities. At the time of our inspection they were providing support to 24 people; 8 in each of the three units described. A fourth short stay unit which is registered to accommodate a further 8 people was not currently open.

There was a registered manager in place. 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.

There were not always enough staff deployed in some units to meet people’s needs safely. This also impacted on the fact that there was not always enough support for people to pursue interests and engage in activities.

Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They understood their responsibilities to identify and report abuse. They felt supported by the registered manager and received regular supervisions.

Staff had caring relationships with the people they supported. They understood how people communicated and supported them to make choices about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. They knew people well and provided care that met their preferences. People’s privacy and dignity were maintained at all times. They were supported to have important family relationships.

People were supported to maintain good health and had regular access to healthcare professionals. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible. Risk was assessed, actions were put in place to reduce it and their effectiveness was reviewed. Medicines were administered as prescribed and they were stored safely.

Quality monitoring systems were effective in highlighting errors and implementing actions to ensure that they were addressed. This included infection control measures and processes which demonstrated that lessons were learnt when things went wrong. There was a procedure in place for people to complain; and although no complaints had been received the registered manager resolved all concerns in line with it.

We found a breach 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.