Archived: Shenleybury House Limited

Shenleybury House Limited is a care home registered to provide accommodation and personal care to up to 15 older people. At the time of our inspection there were 10 people living at the service.

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

People and their relatives told us they felt safe. Staff had received training in safeguarding and felt confident in reporting any concerns. Risks to people’s health, safety and wellbeing had been identified and staff were aware of the action they needed to take to help keep people safe.

Staff were attentive and able to respond promptly to people. The registered manager monitored staff deployment and ensured enough staff were on duty at all times. Staff recruitment was safe and pre-employment checks completed.

Medicines were managed safely and regular audits completed. We were assured by the measures taken to help ensure the prevention and control of infection.

People’s needs and choices were assessed before admission to the service and they were asked to express their views and decisions about their care. Care records showed that people, and their relatives where applicable, were involved in their development and review. Care provided was personalised and considered people’s preferences and wishes.

People were supported by caring, friendly staff who knew their needs well. Staff were trained and felt supported in their roles. People and their relatives described care staff as knowledgeable and skilled and felt that privacy and dignity was maintained and promoted throughout the care provided.

People’s health needs were being met. The service worked closely with health professionals and staff made referrals to external agencies when they identified any changes in people’s health and wellbeing.

People were 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; the policies and systems in the service supported this practice.

People, relatives and staff spoke positively about the management of the service and their openness to feedback. We were told the registered manager was approachable, maintained regular communication and listened to the views of others. The service had a development plan in place which detailed any actions identified in the range of quality assurance processes in place. The registered manager actively sought feedback to monitor and improve safety at the service and the quality of care provided.

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 30 January 2021).

The provider completed an action plan after the last comprehensive inspection (published 22 August 2020) to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer 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 comprehensive inspection.

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 Shenleybury House Limited on our website at www.cqc.org.uk.

Follow up

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

Shenleybury House Limited is a residential care home providing accommodation and personal care to nine people at the time of the inspection. The service can support up to 15 people.

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

The interim manager and staff team had worked hard to address the issues found at our last inspection and to ensure people’s care and support needs were fully met. People’s care plans and associated risk assessments had been reviewed and checks undertaken to ensure that actions required were completed.

Safe recruitment processes were followed, and staffing levels were consistently maintained. Medicines were managed safely.

The service had implemented hygiene practices in accordance with national guidance relating to COVID-19. We saw staff were wearing Personal Protective Equipment (PPE) relevant to the tasks they were completing and demonstrating good hygiene practices. Improvements had been made to the cleanliness of the environment and a re-decoration and maintenance plan for further works was in place.

The interim manager had implemented quality monitoring process that reviewed all aspects of the service provided to people, however these required further time to fully embed. They demonstrated that lessons were learned to make improvements to the service where required.

Relatives gave positive feedback regarding the service and their experiences of the care provided.

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 Inadequate (published 22 August 2020).

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 and the provider was no longer in breach of regulations 12, 15, 17 and 19.

This service has been in Special Measures since 22 August 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 10 March 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve risk and safety management, environment, infection prevention and control, staffing, nutrition and hydration, person centred care and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Shenleybury House Limited is a residential care home providing accommodation and personal care to seven people at the time of the inspection. The service can support up to 15 people.

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

The quality of care had deteriorated since the last inspection.

People’s welfare and safety was placed at risk due to inadequate safety measures in place. This included fire risk assessment and risk assessments that related to the environment. Individual risk assessments for people were ineffective and were not person centred. They failed to provide robust guidance for staff on how individual risks to people could be minimised. Actions which had been identified had not been completed.

The environment was poorly maintained, and many areas of the service were unclean. Equipment was found to be dirty and poorly maintained. This exposed people to the risk of infection and failed to protect their health and welfare.

Medicines were not managed safely, and audits completed were ineffective in identifying issues and concerns found during our inspection. People were exposed to the risk of harm from unsafe practice, due to inaccurate stock levels and a lack of staff training.

Staff were not recruited safely, and robust checks were not completed before staff started working at the service. There was no current training programme in place for staff. No records had been maintained to confirm that staff had received the necessary training to carry out their role effectively and safely. There was also no evidence to confirm that staff’s future training needs had been assessed or identified.

Staff had not been provided with regular supervision. The registered manager had not been provided with supervision since April 2019 when they commenced the role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service also failed to support this practice.

People were not involved in the planning of their care. Care plans took account of people’s needs but lacked detail with regards to people's preferences, choices and individuality. Care plans were inconsistent and did not always give clear instructions to staff on how best to support people.

Quality assurance processes were not robust and were found to be ineffective in improving and further developing the service. The provider and registered manager had not acted upon previous professional feedback relating to the safety and quality of care at the service and ensure compliance with the regulations.

The registered manager demonstrated a lack of knowledge with regards to the systems in place and the processes that should be followed to manage an effective and safe service which achieves good outcomes for people and provides quality care. The registered manager had not been provided with an induction when they first commenced their role in April 2019 and had not been offered the training, support or guidance they required to carry out their role effectively.

The provider had a lack of oversight of the service and the nominated individual at the time of the inspection was not fulfilling the role. A nominated individual is responsible for supervising the management of the service on behalf of the provider. The provider took action to address this following our inspection.

People told us they felt safe at the service and were happy with the care they received. People were supported to make choices in relation to their food and drink and received support from health and medical professionals when required. Staff were seen to be kind, caring and committed to the people they were supporting.

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

Rating at last inspection

The last rating for this service was Good (published 12 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, staffing, the management of the service and a lack of provider oversight. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

Enforcement

We have identified breaches in relation to staffing, medicine management, risk management, infection control, premises and equipment and the overall management and governance of the service at this inspection.

We are mindful of the impact of 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.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Shenleybury house is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation and treatment for up to 15 people. At the time of our inspection 14 people were accommodated at the home.

At our last inspection on 30 June 2017, we rated the service Requires Improvement. At this inspection, we found evidence that improvements had been made in all areas and the service was rated Good overall. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

The home had a registered manager. 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.

People told us they felt safe at the service and there were appropriate risk management arrangements in place to help keep people safe. We observed people being supported safely. There was a robust recruitment process in place and sufficient staff members deployed to ensure that people’s needs were met in a timely way.

Staff received an induction to the service when their employment commenced and they continued to receive regular training and updates as required. Staff demonstrated they had the necessary skills and information they needed to support people safely and effectively.

People`s medicines were managed safely by staff who had received training and had their competencies checked. Care plans contained sufficient detailed information to enable staff to support people as they wished. People, where they were able, and or family were involved in the development and review of people's care plans.

People were asked for their consent before they were provided with support. Where people were unable to consent verbally, staff took time to get their consent through other means such as eye contact or body language. The management and staff worked in line with the Mental Capacity Act (MCA) principles and associated Deprivation of Liberty Safeguards DoLS.

People and their relatives told us staff were kind and caring and we observed staff supported people with compassion and clearly knew people well. Staff were aware of people`s likes, dislikes and preferences and delivered care and support in accordance to people`s wishes.

People were provided with opportunities to engage in social activities of interest to them. The environment and the grounds were well maintained and provided people with opportunities to utilise the surrounding outside areas. People’s bedrooms were personalised and people had their own furniture and soft furnishings as well as family photos and memorabilia.

The registered manager worked tirelessly to ensure people received good care in a homely environment. The management was open, transparent and inclusive and we observed visible and effective leadership within the service. The registered manager was supported by deputy manager who worked well as a team.

The management team provided people with a range of opportunities to provide feedback and comment upon the service; in order to continually make improvements. Records were being developed to make them more robust and consistent. They demonstrated a ‘people first’ approach and improvements required within records did not impact on the care people received. There was a comprehensive range of quality monitoring checks completed with an action plan in place to address any shortfalls.

Shenleybury house provides accommodation for up to 15 people with residential care needs. It does not provide nursing care. At the time of this inspection there were 12 people living at Shenleybury house.

There was a manager in post who had registered with CQC. 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.

When we last inspected the service on 12 August 2015 we found the provider was meeting the regulations. At this inspection although we found that the provider meeting the regulations, improvements were required to continue to meet the required standards.

People told us they felt safe living at Shenleybury house. Staff understood how to keep people safe and risks to people's safety and well-being were assessed and kept under review to help to keep them safe. People's medicines were managed safely, by staff who had received training. However we found some discrepancies in the medicine administration records (MAR) charts that had been completed.

People had their needs met in a timely way, by staff who demonstrated they knew people well. We observed there were adequate numbers of staff available to support people at all times.

Staff had received training and had the right skills and knowledge to support people safely. The recruitment process was not robust or consistent and this was an area that required improvement.

Staff were well supported and attended regular team meetings and individual one to one supervisions with their line managers. Staff told us they felt they were valued and listened to and worked well as a team.

People were supported to eat and drink sufficient amounts to maintain their health and wellbeing and were offered a choice of foods. People had access to a range of healthcare professionals when required to help maintain their health.

People, their relatives and staff were positive about the management at the service. We observed staff to be kind and caring and knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People were asked for their consent and they or their relatives where appropriate had been involved in the planning and review of their care.

People were supported to participate in activities that were provided. There were arrangements in place to receive feedback from people who used the service and their relatives. People were confident they would be listened to if they raised any concerns.

Systems were in place to monitor some aspects of the service and to check that people were happy with the quality of the care and support they received. However this was an area that required improvements as the systems that were in place did not identify some of the shortfalls we identified as part of our inspection.

During this inspection, we reviewed the supervision records, appraisals and training provided for staff. We spoke with people who use the service, staff members and one family member. One person said "I like the staff, they feel like friends. The staff speak to me with respect and call me by my preferred name". Another person said "Staff are fine, they meet my needs and I am perfectly happy". A family member said "I am happy because my mum is happy". Staff told us "They felt supported in their work, they had received appraisals and formal supervision'. Another member of staff said "I am having some training organised for me, this has happened through the supervision I received".

People told us that they enjoyed their meals which were cooked freshly daily and were offered choices. Suitable arrangements were in place to assess people's nutritional needs and ensure they received the food and fluids they needed.

There were robust recruitment procedures in place and staff received regular training.

We observed that people were living in a fresh, clean environment. People had their own furniture and personal items such as pictures in their rooms. All rooms had ensuite facilities and some had baths depending on people's assessed needs.