The Sheiling

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.

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

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right support: People had some control and choice over their lives. There was a core team of staff who knew people’s needs well and how they liked to be supported in line with their needs. However, the service has been impacted by the COVID 19 pandemic which has affected people’s opportunity to go out. At least one person was now experiencing some anxiety when accessing the community and although this was being addressed the service had not sourced external support.

Appropriate finance to access activities was in place to meet people’s needs but people were not engaging in activities as they were before the COVID 19 pandemic and clear objectives were not set to measure people’s progress towards desired goals.

The environment was clean but poorly maintained with some overdue refurbishment. Statutory requirements in relation to health and safety, fire and servicing of equipment was in date.

Medicines were not managed safely. Staff received training and their medicine competencies were assessed. However, some staff competencies checks had expired. On the day of inspection there was no record of the temperature medicines were being stored at to ensure medicines remained effective. This was brought to the providers attention. We also recommended that the provider review the storage of medicines in line with best practice.

Right care: Care records did not clearly record people’s involvement in their plan of care or whether people have the ability to consent to their care and treatment. Care records were being reviewed and family members were being invited to contribute.

People’s dignity, privacy and human rights were not always being upheld. People were supported to have choice and control of their lives, and we saw people moved freely around their home and were able to access the kitchen, request a drink and go out in the garden. However, some recorded decisions about how to manage risk had not considered, specifically if it was the least restrictive or in the persons best interest. For example, the use of monitors and door alarms. People were kept under surveillance without evidence that other means of keeping people safe had been considered.

We were not assured staff had the necessary skills and competencies. Although very caring and committed staff did not have consistent management and training in line with people’s needs. Training had been delivered through the companies training portal and staff had not had opportunity to complete any recent face to face training or to fully develop their skills.

Right culture: There had not been consistent oversight and leadership of the service, after the previous manager left. There had been a lack of provider support and the manager had been ‘firefighting’ for a long time. The new manager has started to stabilise the service and recruit additional staff whilst using agency staff to fill staffing gaps. The manager had clear expectations of staff and we observed good care and support being provided. Records and governance were still very poor and there was limited evidence of collaborative working.

We have recommended that the service evidence how they engage with other health and social care professionals to provide collaborative care. Rating at last inspection and update

This service was registered with us on 15 July 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, published on 26/04/2019.

Why we inspected

The inspection was prompted in part due to concerns received about the providers oversight of this service, and in response to some incidents that had happened. A decision was made for us to inspect and examine those risks.

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.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, risk, privacy and dignity, consent and governance at this inspection.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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