Archived: The Shires

Updated 1 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection took place on the 5 and 8 March 2018 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the service, including safeguarding’s and notifications which had been sent to us. A notification is information about important events which the provider is required to tell us about by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with 14 people living in the home and six visitors. We spoke with the provider, both assistant managers, seven care staff and two health and social care professionals.

We observed the care and support provided, at mealtimes and during activities. We observed medicines being given out and looked around the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked at a range of documents related to the care provided and the management of the home. These included four care plans, medicine records, three staff files, supervision and appraisal records, accident/incidents, complaints and quality assurance audits.

We asked one of the assistant managers to send us copies of records after the inspection including policies and procedures for equality and diversity, safeguarding and infection control. These were sent to us as requested.

Updated 1 June 2018

We inspected The Shires on 5 and 8 March 2018. The inspection was unannounced.

At the previous inspection of this service in December 2016 the overall rating was requires improvement because we found the provider in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured staff had been supported through relevant training, supervision and appraisal of their practice and, the quality assurance and monitoring system was not robust; as it had not identified the areas where improvements were needed.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm that the service now met legal requirements. We found improvements had been made, the provider had met the legal requirements and the overall rating had improved to Good. Although, we identified areas that needed further improvement and others needed time to be embedded into day to day practice.

The Shires is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Shires is registered to provide personal care and accommodation for up to 27 older people with dementia and mental health needs. At the time of the inspection there were 21 people living there. They had range of health care needs including diabetes and mental health needs and some people were living with dementia. Accommodation was provided in a converted building on two floors, with lifts that enabled people to access all parts of the home.

The service is not required to have a registered manager in place. There is a registered provider, supported by two assistant managers. One was the designated 'care manager' and responsible for the provision of care for people on a day to day basis. The other was the 'general manager' responsible for recording and updating financial issues at the home. 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.

The quality assurance system had been reviewed and areas for change had been identified and an action plan had been produced to prioritise these and drive improvement. The management had carried out regular audits, including medicines, care plans, health and safety and infection control. However, some areas needed additional work, such as the maintenance records. These had not been consistently filled in and failed to evidence work that had been completed. Including the weekly fire alarm tests.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. The management had produced details of each person’s needs and these had been included in the care plans for people to take with them if they have appointments outside the home. However staff had not attended training in and we have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

Staff had a good understanding of the Mental Capacity Act 2004 and Deprivation of Liberty Safeguards and, referrals had been made to the local authority as required to ensure restrictions were safe and appropriate. Staff had received essential training as well as training specific to people’s needs, such as dementia awareness and, they had a good understanding of their roles and responsibilities. The provider supported staff to develop their professional practice through supervision and yearly appraisals.

People and their relatives said people were safe. Risk had been assessed and staff provided support to ensure people could move around the home safely. Safeguarding training had been provided and staff had a good understanding protecting people from harm and what action they would take if they had any concerns. Infection control policies were in place, there were regular health and safety checks of the environment and, emergency procedures were in place to support people if they had to leave the building.

People were encouraged to make decisions about the care provided; staff had a good understanding of their needs and how they could enable people to be independent and make choices. There was a choice of food and drinks throughout the day. People were supported to eat a nutritious diet and drink enough fluids and staff assisted people as required. Staff monitored people’s health and ensured people could access healthcare professionals and services, to maintain their health and well-being.