The Sheiling

Updated 15 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

The Sheiling is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Sheiling is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A manager came into post in September 2022 and are not yet registered with CQC.

Notice of inspection

We gave the service less than 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 1 March 2023 and ended on the same day.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used all this information to plan our inspection.

During the inspection

We observed the care people received and spoke with 2 people using the service. We spoke with the deputy manager, the senior member of staff and the regional manager. We reviewed 2 care plans, and other records to do with their care, support and medication. We spoke with 1 professional.

We reviewed records relating to the oversight and management of the business and maintenance of the service. We continued to seek further clarification following the inspection

Updated 15 April 2023

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.

About the service

The Sheiling is a residential care home providing personal care and support to up to 3 people with a learning disability and, or, autistic people. At the time of our inspection, 3 people were using the service. The service consisted of 3 single bedrooms, a bathroom, and a downstairs toilet. There was a large garden, and the house next door was another registered service with the same provider. The manager was responsible for both services.

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

Right support: At our last inspection we identified concerns with the service being provided. At this inspection care records had been updated, staff training had improved, and environmental improvements were noted. Goals for people had recently begun to be re-established to show how people’s needs and preferences were being met and show their progression.

People were mostly 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; however, the policies and systems in the service did not fully support this practice. Records needed to clearly reflect how people were supported in their best interest.

Right care: Some factors had impacted upon people's care and support including the community presence of COVID-19 and the recruitment and retention of staff limiting people's opportunities to go out. At this inspection we saw activities were taking place with more regularity than our previous inspection. This was still dependent on having the right numbers of core staff as agency staff were not taking people out by themselves. This could be impacted further as two core staff were leaving and recruitment was yet to pick up despite best efforts from the provider.

Improvements had been made to medicines records to make sure all staff were clear as to when to administer certain types of medicines.

Right culture: At our last inspection the manager was new to post, and we had identified areas requiring improvement. The provider had not sufficiently invested in the property to ensure it remained safe and in line with people's needs. Records and governance were found to be poor. At this inspection we found some environmental changes particularly downstairs which had been repainted and furniture replaced. People’s records had mostly been updated and staff training had been completed in line with people’s needs.

We had identified that staff were observed to be professional, kind, and caring but they felt their efforts and hard work had not been recognized and rewarded. Staff had been working for an extended period picking up overtime and some were experiencing low morale. We found staffing levels were improving but the staffing situation was still fragile.

People's dignity, privacy, and human rights were not being fully upheld at the last inspection, and staff were not always demonstrating how they were acting in people's best interest. Records had improved at the time of our latest inspection and other options were being explored to enable staff to remotely monitor a person at night to keep them safe.

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 22 September 2022) 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 but the provider was still in breach of regulations.

Why we inspected

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

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

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.

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

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment and good governance.

Follow up.

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