The Shores

About the service

The Shores is a residential care home registered to provide accommodation and personal care for up to seven people diagnosed with a learning disability. At the time of this inspection there were six people living at the home.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Right support

Staff understood people and their individual needs well. People were supported by appropriate numbers of staff on each shift to ensure people’s safety and meet their needs. Staff knew people well and provided kind, caring, person-centred care and support. People received care and support in an environment that was safe, clean and well maintained. People could express choice about their living environment and were supported to personalised their bedrooms reflecting their choice of furnishings and items that were important to them.

Right Care

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Care plans and risk assessments were detailed and person centred ensuring people were supported to live full, active lives.

Right culture

There was a relaxed, friendly and welcoming atmosphere at The Shores. Staff demonstrated good understanding around providing people with person centred care and spoke knowledgably about how people preferred their care and support to be given.

The management team promoted an open and honest culture and staff had confidence in the leadership of the service and felt the service was well led.

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 requires improvement (published 7 October 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for this service has changed from requires improvement to good based on the findings at this inspection.

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

Follow up

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

The Shores is a residential care home registered to provide accommodation and personal care for up to seven people diagnosed with a learning disability. At the time of this inspection there were five people living at the home.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There was a relaxed, happy and welcoming atmosphere at The Shores. People were supported by appropriate numbers of staff on each shift to ensure people’s safety and meet their needs. Staff knew people well and provided kind, caring, person-centred care and support.

Staff received their rotas in advance to ensure each shift was covered by adequate levels of appropriately trained staff. Staff told us and records showed the staff rota and shift system was managed well and worked effectively. People were fully supported to maintain their independence in ways that suited them by a consistent team of staff who knew them and their needs well.

The provider was in the final process of recruiting additional staff. This meant they would be able to reduce the use of agency staff and ensure people were provided with more consistent staff support.

There was a robust system of recording and reporting incidents and accidents to ensure necessary preventative action had been taken to maintain people’s safety. The manager explained they were in the process of developing an additional analysis tool to ensure detailed analysis of incidents and accidents would be completed to further highlight emerging trends.

People, staff and visitors to The Shores were protected from risks of infection as policies and staff practices were reflective of current best practice guidance. Staff had access to personal protective equipment. People and staff were offered and encouraged to take part in the whole home testing in response to the coronavirus health risk.

There was a clear management structure and people, relatives and staff spoke highly of the registered manager who ensured there was an open, supportive, friendly culture at the home. One staff member told us, “It’s a happy place to work, we all support each other and work well together, I love working here.” Staff and relatives told us about the positive management changes the registered manager had made to the home and spoke highly of their leadership skills. Extensive refurbishment and decoration had been completed over recent months, which helped provide a light, airy and comfortable atmosphere.

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 requires improvement (published October 2019). We identified the following shortfalls: inconsistent staffing and processes regarding lessons learned, low levels of activities for people to take part in and the culture of the service.

Why we inspected

We undertook this targeted inspection to monitor the service to check the provider had addressed the shortfalls identified in the previous inspection. This targeted inspection found improvements had been made in all areas where shortfalls had previously been identified.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at entire key questions, only the part of the key question we are specifically concerned about. Targeted inspection do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe and Well-Led sections of this report.

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.

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.

The Shores is a residential care home providing personal care for up to seven people with learning disabilities. At the time of our inspection five people were using the service.

The service is a detached two-story building with enclosed gardens.

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

There were enough staff on duty to safely meet people’s needs on the day of our inspection and records showed these staffing levels had recently been routinely achieved. However, relatives, staff and managers constantly reported that the service had been significantly understaffed from January to April 2019. Comments received in relation to staffing level included; “We are approximately four staff short at the moment”, “They seem to have a lot more staff in now. That has changed significantly since the new manager came in” and “Staffing is a lot better.”

Some people’s behaviour was adversely impacting on others within the service. These issues had been identified by staff and managers, who were working with commissioners to identify how they could be resolved. Plans were being developed but were not yet successfully in resolving the situation and there were ongoing impacts on people’s wellbeing.

Medicines were managed safely, and necessary staff pre-employment checks had been completed. The service was clean and risks had been appropriately assessed.

Staff received regular training updates to ensure they had the skills necessary to meet people’s needs and new staff received appropriate induction training. Staff supervision meetings had been recently reintroduced and annual performance appraisals completed.

The service was reasonably maintained, and communal areas were being redecorated during the inspection. People’s bedrooms were personalised and individually decorated.

People were supported to have 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 were caring and compassionate. They responded promptly to people’s needs and respected their decisions and choices. Relative told us, “They have a lot of very caring people there” and “I feel [my relative] has some really good people looking after him.”

People’s care plans were accurate and provided staff with enough guidance to enable them to meet people’s needs. Information provided to staff about people’s communication preferences was accurate and useful. Complaints received had been appropriately investigated.

Current staffing level enabled people to access the community when they wished and the service was now providing personalised care that reflected the principles of and values of Registering the Right Support. During our inspection we saw people were able to choose how to spend their time and were able to go out when they wished.

The provider’ quality assurance processes had identified significant concerns in relation to the service’s performance in April 2019. As a result, management changes were made and additional support and resources provided to improve the quality of care people received. Relatives and staff were complimentary of these changes and the new manager approach. Their comments included, “I have noticed things have changed”, “I feel positive towards the new manager” and “[The new manager] has been a massive help and is doing really well”.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

Rating at the last inspection

The last rating for this service was good. (Report published 22 February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme to ensure improvements in the service’s performance and made and sustained. If we receive any concerning information we may inspect sooner.

There was a registered manager in post. They were also the registered manager for another learning disability care home for four people in the local area. 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.

The Shores is a care home without nursing for up to seven people with learning disabilities in Poole. There were six people living at the home at the time of the inspection.

Three people were able to tell us their experiences. Where people communicated differently we saw they were content, relaxed and free to move about the house as they wished. They smiled and laughed with staff and each other.

People received care and support in a personalised way. People had support and care plans in place. Staff knew people well and understood their needs and the way they communicated. We found that people received the health, personal and social care support they needed. People’s health conditions were monitored to make sure they kept well.

People and a relative told us they and their family member felt safe at the home. Staff knew how to recognise and respond to any signs of abuse.

Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP. Staff knew when they should administer PRN ‘as needed’ medicines.

People were supported to make decisions and their rights were protected when they lacked mental capacity to make a specific decision.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People had access to the local community and had individual activities provided.

Staff were committed to meeting to people’s needs and improving their lives. They responded quickly to any requests for help or support from people.

There were a range of systems in place to protect people from risks to their safety. These included premises and maintenance checks, regular servicing and checks for equipment and risk assessments for each person living in the home. Staff knew how to support people with positive behaviour support plans in place. However, this was not recorded in one person’s plan. The registered manager took immediate action and updated the person’s plan.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. However, some staff needed specialist training to be able to support people with positive behaviour support plans. The registered manager and provider took immediate action to arrange the training for the beginning of February 2017. Staff were recruited safely.

The culture within the service was personalised. There was a clear management structure and people, relatives and staff felt comfortable raising any issues. There were systems in place to monitor and drive improvements in the safety and quality of the service provided.

People we spoke with told us they liked living at The Shores and that they got on well with staff. One person said, 'They take care of me well', and another person said, 'We do nice things'.

People experienced care and support that met their needs and protected their rights. This was because staff knew how to meet people's care and support needs and these were assessed and planned for.

People who used the service were protected from the risk of harm because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

People were cared for and supported by, suitably qualified, skilled and experienced staff.

T here was an effective system in place to regularly check and monitor the quality of the service people received.

On the day of the inspection there were six people living at the home.

We spoke with three people, observed care workers supporting four people and spoke with the manager, the regional manager and two care workers.

People were supported to be independent and had their privacy respected. The introduction of a photographic staff rota meant people knew who was working that day.

People's care plans were up to date and clear so that staff knew how to support them.

People were protected from inappropriate restraint as the use of the calming/relaxing room had been withdrawn. Physical intervention was no longer included in people's behaviour management plans.

Medicines were safely administered, recorded and stored. Staff were trained to administer medicines.

There were systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of them had complex needs which meant they were unable to tell us about themselves.

We spoke with two people, observed care workers supporting four people and spoke with the manager, the regional manager and five care workers.

Two people we spoke with told us that 'like' The Shores and the staff at the home. One person told us that they have 'service user meetings' once a month.

We saw that care workers knew each person's likes and dislikes and had good relationships with the people they cared for. They understood how people communicated and responded to people's non verbal cues and gestures. People freely approached care workers and sought their company.

Care workers told us that they had staff meetings, handovers and support meetings with their line manager.

During this inspection we identified serious shortfalls in medication management. We identified further shortfalls with maintaining people's privacy and independence, care planning, safeguarding, the managing of risks to people and monitoring of the quality of the service provided to people.