Sheldon Ridge

Sheldon Ridge provides nursing and accommodation to up to 13 people who have a learning disability and complex needs. On both days of our inspection, 11 people were living in the home. Accommodation is split into 2 ground floor units each containing single occupancy bedrooms. Each unit has its own dining and lounge area.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: 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. People were empowered to make decisions they were able to. Where people were unable to verbally express their preferences, staff told us they made a decision for them based on their knowledge of the person’s likes and dislikes and observed for their reaction. Where needed, they offered alternatives to people, which we saw during this inspection.

Right Care: An experienced and knowledgeable staff team provided effective care to people. Relatives consistently provided positive feedback about the quality of care provided by the staff team. Care was person-centred and put people and their families at the centre of their care planning. Staff were attentive to people’s needs and skilled in identifying what people wanted. People’s protected rights were understood and met by the staff team who showed a strong insight into their care and support needs.

Right Culture: There was a positive culture within the service. The management team expected an open and honest working environment and looked to improve the service and learn from mistakes. Diversity and inclusion was celebrated. Relatives and staff felt engaged and listened to. Relatives told us communication from staff about their loved ones was effective. Staff worked with a range of partners in the community to provide safe spaces for people to go to.

The management team developed a stable workforce which helped make for a positive culture. Staff felt supported through a program of induction, training and regular supervision meetings. They felt able to discuss their own wellbeing as well as talking about the needs of people living in this home. Effective systems of governance meant the provider had oversight of the running of the home.

The home was found to be clean, although some communal areas looked worn. Staff were actively working with the landlord to arrange repairs. Adaptations had been to the premises to meet people’s needs. We identified PRN (as required) protocols needed strengthening, to which the management team responded by immediately beginning this work. People received their medicines as prescribed. Staff received training in medication management and were assessed as competent to administer.

There were sufficient numbers of safely recruited staff to care and support people. Risks to people had been assessed, monitored and reviewed. People were supported to maintain a healthy and balanced diet. Dietary risks were understood and people’s nutritional needs were being met. Staff knew how to recognise and respond to signs of ill health and were able to share examples with us.

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 rated good (published 14 September 2018).

At our last inspection we recommended the registered manager review the skill mix and staff deployment to ensure people were provided with the care and support they need at all times. At this inspection we found the registered manager acted on this feedback and had made the necessary improvements.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

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

Sheldon Ridge is located in the Bierley area of Bradford and provides nursing and accommodation to 12 people who have a learning disability and complex needs. Accommodation is split into two ground floor units each containing single occupancy bedrooms. Each unit has its own dining and lounge area. To the exterior of the building there is a communal garden.

Sheldon Ridge is a ‘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 service was working in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

People who used the service were unable to verbally communicate with us therefore we observed people’s gestures and body language to determine their level of engagement with staff. People appeared comfortable and relaxed in the company of staff and staff clearly understood people’s individual methods of communication.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected.

The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

From our observations it was clear staff knew individual people well and were knowledgeable about their needs, preferences and personalities.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Each person had a support plan that was person centred and sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff on duty to support people when they needed assistance. However, the deployment of staff and the skill mix on some shifts was not always appropriate to meet people's needs.

The registered manager followed a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

Appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness. The home was reasonably clean and tidy. However, staff were not always following the infection control policies and procedure in place.

There were a range of leisure activities for people to participate in, including both activities and events in the home and in the local community and it was apparent people enjoyed a full and active social life.

We saw the complaints policy was available in both a written and easy read [Pictorial] format. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

We found all fundamental standards were being met. Further information is in the detailed findings below.

The inspection was unannounced and took place on 14 and 15 December 2015.

A registered manager was 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. The registered manager was responsible for the strategic oversight of the home, with a home manager in post, who was responsible for the day to day running of the home.

People who used the service were unable to verbally communicate with us, however we extensively observed care and support including people’s gestures and body language. We observed kind and caring interactions between staff and people who used the service. People appeared comfortable and relaxed in the company of staff and staff understood people’s individual methods of communication.

Relatives told us that people using the service were safe and did not raise any concerns with us.

Staff had a good understanding of how to identify and act on allegations of abuse and we saw examples where action had been taken following incidents to keep people safe.

Medicines were safely managed. People received their medicines as prescribed and at times that met their individual needs.

There were sufficient numbers of staff deploy to ensure safe care and support. Staff were safely recruited to help ensure they were of suitable character to work with vulnerable people.

The service adopted a personalised approach to risk management. Risks to each individual were thoroughly assessed by the service and a highly individualised plan of support put in place to help keep people safe.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People were supported appropriately to eat and drink and maintain good nutrition. People’s weights were regularly monitored and health professional input sought where risks were identified.

Staff received a range of training which was kept up-to-date. Staff we spoke with demonstrated a good understanding of the people and topics we asked them about indicating this training had been effective.

Relatives we spoke with said staff were kind and caring and praised the high level of attention to detail and personalised support provided by the service. Relatives told us staff had gone the extra mile in ensuring individualised support and activities were provided to people. Staff displayed an excellent understanding of the people they were caring for and a motivation and passion to providing a caring service.

The service had put considerable time and resources into providing creative care solutions to identified problems such as privacy, dignity and distress. We saw these had been effective in improving people’s care and support outcomes.

People’s needs were fully assessed and a range of care plans put in place. Staff we spoke with were knowledgeable about people’s plans of care and we saw examples of these plans being followed.

A range of activities were provided to people which met their individual needs. We found documentation of the activities people had been involved in was not consistently in place, although plans were in place to address.

The service had not reported all statutory notifications to the Commission as it had not notified us of all safeguarding referrals made to the local authority.

A range of audits and checks were undertaken by the service to monitor , and improve the service. We saw evidence these were identifying and rectifying issues. However there was a lack of accountability for some boxed medication as stock levels were not routinely monitored.

Relatives and staff spoke positively about the home manager and said they were effective in dealing with any concerns or queries. Staff reported that morale was good.

The home manager demonstrated a commitment to continuous improvement the service. A number of initiatives were planned to further improve the service over the next year.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

Some people who lived at Sheldon Ridge, due to their complex health needs, were unable to tell us their experiences. So we observed how staff talked with people and provided their care and support. We observed lunch time and saw staff were warm and accepting of people. They explained their actions to people and provided them with choices. Our observations demonstrated to us people who lived at Sheldon Ridge experienced care, treatment and support which met their needs.

We talked with a relative of a person who used the service, they told us they were satisfied with the care and treatment their relative had received. They told us staff were respectful and responded promptly when their relative needed help. The relative said "the staff were so lovely and really good".

We found safeguarding processes were in place and staff understood the different types of abuse and how to report any concerns.