Archived: Shakespeare House Care Home

The home was managed by the provider who is in day to day charge and worked alongside staff in order to provide care to people. The provider is a registered person and 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 our last inspection to the service in December 2015 we found two breaches of regulations. The provider had not ensured that the premises were safe to use for their intended purpose and in a safe way. Also service users were not always treated with dignity and respect and the provider did not always support their autonomy and independence. We asked the provider to take action and the provider sent us an action plan In February 2016 which told us what action they would be taking. At this inspection we found that improvements had been made and the regulations were now met.

People told us they felt safe with staff. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff were provided with training and supervision which quipped them with the skills to look after people effectively. Peoples healthcare needs were met and people were supported to attend regular health screening and checks such as with their GP, the optician and dentist as well as with mental health services.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Three people living at the home were currently subject to DoLS. We found the provider understood when an application should be made and how to submit one. We found the provider was meeting the requirements of DoLS. People were generally able to make day to day decisions for themselves. The manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were acted on appropriately. People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s personal histories had been recorded and their preferences, likes and dislikes were documented so that staff knew how people wished to be supported. There was a variety of activities and outings on offer which people could choose to do. Complaints were dealt with in line with the provider’s complaints procedure.

Weekly and monthly checks were carried out to monitor the quality of the service provided. Feedback was sought on the quality of the service provided through survey questionnaires. The provider told us that she met with people on a one to one basis to discuss issues relating to the home. These meetings enabled the provider to monitor if people’s needs were being met.

The home worked with health and social care professionals such as community psychiatric nursing services to meet people's needs. We spoke to a community psychiatric nurse and a GP and asked them for their views of the service provided by Shakespeare House Care Home. They told us the standard of care at the home was good and that people's quality of life had markedly improved since they were placed at the home. Comments from these professional included, 'It's a brilliant place. The care is excellent. People engage well with the staff.' Another professional said, 'It's a first class home.'

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

The home had policies and procedures regarding the safeguarding of vulnerable adults. Staff were aware of the need to protect vulnerable people from possible harm and knew what to do if they had any concerns about the welfare of people.

Risk assessments and care plans were completed so people were safe, although we identified areas where these could be developed so more detailed information was available. For example, where someone was identified as needing support to manage their money the support provided by staff was not fully recorded.

Care plans identified the signs and symptoms when people became unwell and what staff needed to do to ensure people got the right care.

The home had sufficient numbers of staff to keep people safe.

The premises were well maintained. Checks and maintenance work were carried out on appliances and equipment.

Is the service effective?

At the previous inspection it was identified that staff were not supported with training so they had the skills to meet people's needs. The provider sent us an action plan of how this was to be achieved. At this inspection we saw there was a comprehensive programme of relevant courses for staff to attend.

Care records showed people were supported to attend health checks and treatment such as with the dentist and optician. The service worked with community health services regarding the care and treatment of people's mental and physical health needs.

Is the service caring?

People told us they were treated well by the staff and were involved in decisions about their care. We saw people were involved in reviews about their care.

Staff and the manager demonstrated they were committed to the care and welfare of people.

The service promoted people to maintain their independence and to develop new skills. People were able to have a key to their bedroom door so they could exercise privacy and secure their belongings.

Is the service responsive?

People's needs were assessed and they were consulted about their care needs. Care plans were personalised to reflect individual's needs and preferences. People said they felt able to raise any issues or concerns they had. For example, one person said there were regular 'house' meetings where they discussed activities and domestic arrangements at the home.

The service supported people to attend community activities and to maintain relationships with their family and friends.

Is the service well led?

The provider lived on the premises which meant she was able to monitor and check people's needs and the quality of the service provided. People were asked to give their views on the service they received by completing a survey questionnaire.

There were recording systems to monitor any incidents or accidents in the home.

Health and social care professionals told us the registered manager and staff worked with them to meet people's needs.

We spoke with the staff and observed they had a good relationship with the people who used the service.

We gathered evidence of people's experience of living at the home and looked at a variety of records, including care records, minutes of meetings, financial records and staff files. We found improvements were required to records to ensure care staff had up to date information to follow with regard to the care to be delivered.

Care records demonstrated that people had given consent to the care they had received.

We found improvements were required in record keeping in order that people are protected from the risks of inappropriate care and treatment because accurate and appropriate records were not maintained.

We found that improvements were required to ensure that staff were properly trained, supervised and appraised in order to deliver appropriate care and treatment.

We found that there were not effective systems in place to regularly and assess and monitor the quality of the service provided.

We found that care records kept electronically could not be accessed during our inspection and may not have been saved. This meant records could not be located promptly when needed.

We made observations throughout the visit and saw people going out to undertake activities and tasks. Rooms we saw were personalised.

They also confirmed that they found staff were competent and skilled when providing for their needs.

One person told us, "It is alright here. Another person said, "I am quite well looked after. My room is kept clean and someone helps me with my money."

We spoke with the member of staff who was on duty. They informed us that they had received training that provided them with the necessary skills to deliver the care and support to people that was required. They also said they felt well supported by the manager in their work.

The atmosphere throughout the visit was good. It was calm, friendly and homely. Christmas decorations had been put up which added to the homely feel. Staff were observed to have a good relationship with the people living there. When talking to people, staff were friendly and professional. They spoke clearly to ensure they were understood and listened carefully to make sure they knew what was expected of them.