Archived: Pat Shaw House

Pat Shaw House is a care home without nursing which provides accommodation for up to 38 people across three floors. At the time of our inspection 36 people were living in the home, with 11 on a respite basis which could lead to a permanent placement. People who develop nursing needs have them met by the local community nursing teams. The service does not admit people who are living with dementia but it continues to care for them if they develop the condition once they have moved in.

There was a manager in post at the time of our inspection who had recently completed their registered manager interview process. They were registered shortly after the inspection was completed. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the time of the inspection the service was in a period of transition. A new registered manager was in post who was trying to create a settled environment. People who used the service and their relatives spoke positively about them, and staff felt confident that the appointment could bring a level of stability to the service.

Risk assessments were in place to identify and manage areas of risk to people, which had improved since the last inspection. However, information was not consistent throughout people’s care records as some assessments had not been updated. Some records to document the care of people had not been fully completed.

The management of people’s medicines were not always in line with legislation and best practice as people’s medicines, including topical creams were not always recorded accurately. Medicines were administered and recorded by staff who had received medicines training, with training being refreshed if errors were made. The registered manager was in the process of reviewing their medicines policy.

The provider had reduced the number of agency staff since the last inspection and was still in the process of recruiting to permanent positions. Despite mixed comments from people and staff about staffing levels, the registered manager was aware when extra staff were required and saw they had requested this to help meet people’s needs.

People who used the service and their relatives told us they felt safe using the service and all staff had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with.

The provider took appropriate steps to ensure robust staff recruitment procedures were followed.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent to their care. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and DoLS authorisations.

There was an induction and training programme in place to support staff in meeting people’s needs effectively. New staff shadowed more experienced staff and had their competency assessed before working independently.

We saw that more regular supervisions were now being carried out since the registered manager had started and staff spoke positively about the benefits of them.

Staff told us they contacted other health and social care professionals, such as the GP, occupational therapists and speech and language therapists, if they had any concerns about people’s health. We saw monthly meetings were held to discuss concerns about people’s health and well-being.

People and their relatives told us that staff were kind and caring and knew how to support them. Staff understood the importance of respecting people’s privacy and treating people with dignity and respect.

Care records had been improved since the previous inspection as they had been audited and were more organised. They included person centred information however there were inconsistencies in the files we reviewed as some people’s monthly care plan evaluations had not been regularly updated.

The provider supported people to take part in a range of events held throughout the year. However, people commented that day to day activities were not always available and we observed minimal engagement throughout the inspection.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. Regular residents meetings had started to take place.

We could see that there had been an improved approach to quality assurance since the registered manager had started and audits were in place to monitor the quality of the service, but were not always consistent to monitor the care provided to people. A number of audits to improve the service were in the process of being implemented at the time of the inspection.

The registered manager was aware of their responsibilities in relation to their registration requirements and notifiable incidents, and learning had taken place since the previous inspection.

We made two recommendations in relation to the management of people’s medicines and day to day activities.

Pat Shaw House is a care home without nursing which provides accommodation for up to 38 people across three floors. At the time of our inspection 28 people were living in the home. People who develop nursing needs have them met by the local community nursing teams. The service does not admit people who are living with dementia but it continues to care for them if they develop the condition once they have moved in.

There was a manager in post at the time of our inspection who had applied to the Care Quality Commission to be the registered manager for the service and was waiting for their interview. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the time of the inspection the service was in a period of transition. A consultation period was just coming to an end about staff having to be reassessed and they were concerned about their positions, which led to a feeling of low morale amongst the staff team. Management were aware of this and had meetings to try to reassure staff as best they could.

People told us they felt safe using the service and staff we spoke with had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and the provider wanted all staff to understand their responsibilities in regards to identifying and reporting any concerns.

A new care plan contents page had been designed and was being introduced into people’s care folders. It was detailed with a number of individual care plans, screening tools and risk assessments, however some risk assessments in place to manage the areas of risk lacked detail and had conflicting and out of date information in place which could lead to people not receiving the correct level of care.

The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Due to the upcoming staff reassessment programme the provider was using a higher number of agency staff than normal until they had fully recruited to all positions. They had just started advertising for temporary bank staff to help cover shifts and to reduce their reliance on agency staff.

People who required support with their medicines received them safely from staff who had completed training in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked on a regular basis to minimise medicines errors.

Staff were aware of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood the importance of asking people for consent. However they were unaware when people’s DoLS applications had expired and there was no evidence of another application being made.

Staff were aware of people’s dietary needs and food preferences and had made improvements since the last inspection. People had regular access to healthcare services as a GP visited on a weekly basis and sent medical reports to the service. However this information was not always available in people’s care records for all staff to access. Staff told us they contacted other health and social care professionals, such as occupational therapists and speech and language therapists, if they had any concerns about people’s health.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. All staff understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner. People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence.

An initial assessment was completed from which care plans and risk assessments were developed. We could see that care plans were in the process of being updated but people’s care records were disorganised and information was in several different places that bore no resemblance to the index page. Out of date information that should be archived was placed in front of current information. Of the documents that were hand-written, the level of recording was not consistent throughout files and at times illegible.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. The provider listened to complaints and made sure people were confident their complaints would be taken seriously. There were meetings and surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

There were quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service however they did not always identify the issues related to the quality of care plans, risk assessments and consistency of recording within people’s files.

Despite the low morale within the staff team, they spoke positively about the new deputy manager and felt supported in their work. People and their relatives commented on this and could see improvements were taking place since they started.

Accidents and incidents were logged and followed up however the provider failed to notify the CQC about a death and a safeguarding incident involving the police which is a legal requirement of the provider’s registration.

Whilst we could see that improvements had been made since the last inspection and work was in progress to improve the service, there were still a number of issues which remained.

We identified two breaches of the Regulations in relation to good governance and notifiable events. You can see what action we told the provider to take at the end of the full version of this report.