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Shiels Court Care Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 March 2019

Shiels Court 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 care home accommodates up to 40 people in one adapted building. At the time of this inspection there were 37 people living in the service. The service provides accommodation and personal care to people living with dementia and mental ill-health.

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.

When we completed our previous inspection on 13 and 14 February 2018 we found concerns relating to the deployment of staff throughout the home. We also found that staff were unclear when and how to apply the Mental Capacity Act (MCA) 2005.

At this inspection we found ongoing concerns relating to staffing, training and the application of the MCA. People using the service had been diagnosed with dementia or mental ill-health and most were unable to make safe choices relating to their wellbeing. Care plans did not show how decisions had been reached to ensure they were kept safe. Staff continued to show limited understanding of the relevant procedures and legislation. Some staff had still not received training to ensure they had the right skills and knowledge to meet the needs of people using the service.

We identified concerns around the management of people’s safety. Risk assessments relating to people’s care needs lacked detail and were not routinely updated. Measures identified to reduce certain risks in the home, such as exposed hot pipes, had not been put in place. Staff recruitment and safeguarding reporting was not consistently robust. Medicines were administered safely but medicine records were not always accurate. Staffing levels did not enable appropriate levels of support at meal times.

The provider had failed to respond to an action plan arising from the previous CQC inspection. This demonstrated shortfalls in the leadership of the service. The service’s governance systems required improvement to manage risks and drive improvement. Management did not routinely seek feedback on the service.

Staff did not always have time for meaningful interactions with people. For example, at lunchtime some people did not receive encouragement and support to ensure they ate their food. Care plans were not always up to date and did not contain information about people’s end of life care preferences.

Staff sought people’s consent before undertaking tasks and they offered people choice with their care. Staff also supported people to be independent where possible. Staff worked well with other healthcare professionals to ensure people’s health care needs were met. Referrals to specialist health care agencies were made promptly, as required. People and relatives reported that staff were kind and caring and they delivered care which responded to people’s needs and wishes.

We found four breaches 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.

This is the third time the service has been rated Requires Improvement.

Inspection areas

Safe

Requires improvement

Updated 30 March 2019

The service was not consistently safe.

Risk assessments relating to people's care were not regularly updated.

There were some environmental risks which could place people at risk of harm.

Recruitment procedures needed to be more robust. Staffing levels did not always enable people to receive enough support.

People received their medicines safely, however, some records were not accurate.

Records relating to safeguarding incidents were incomplete and some incidents were not correctly reported.

Effective

Requires improvement

Updated 30 March 2019

The service was not always effective.

Some staff members had not undertaken training relevant to their roles or received regular supervisions.

Staff supported people to access healthcare professionals when needed.

Staff were aware of people�s nutritional and hydration needs. People did not always receive enough support at lunchtime.

There were no records relating to people's mental capacity assessments or best interest decisions. Applications to restrict people�s liberty for their own safety were poorly documented and managed.

Caring

Good

Updated 30 March 2019

The service was caring.

People and their relatives felt staff were kind and caring. Staff knew about people�s wishes and preferences.

People were able to make choices about their care. People were encouraged to be independent.

People and their relatives were involved in making decisions about people�s care.

There was some evidence that staff treated people with dignity.

Responsive

Requires improvement

Updated 30 March 2019

The service was not always responsive.

Care plans did not always contained uptodate guidance for staff on meeting people's individual needs and preferences.

People�s end of life care wishes were not documented.

People�s needs and preferences were usually met by staff.

Staff supported people to engage in activity.

Well-led

Requires improvement

Updated 30 March 2019

The service was not always well-led.

The manager and provider had not responded to the previous CQC inspection report as required.

There were quality assurance systems in place but these were not always effective.

Staff expressed mixed views on the leadership of the service.

The service worked well with external health agencies.