Shackleton Medical Centre

Shackleton Medical Centre is a care home that can provide accommodation and personal or nursing care for up to 26 people with both nursing and general care needs and end of life care. At the time of the inspection there were 22 people living at the care home.

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

The provider had not always developed risk management plans to provide guidance on how identified risks to people could be mitigated. When an incident or accident had occurred, the investigation did not always identify what lessons could be learned to reduce the risk of reoccurrence. The provider had a process for the reporting of safeguarding concerns, but this was not always followed. The provider had not always followed their processes when recruiting staff to work at the home to ensure they were suitable for the role.

The provider had not always ensured the environment was safe and suitable. They had also not always ensured there was sufficient guidance for staff on how to provide care in a person-centred manner. People’s communication support needs were not always identified. There was a range of quality assurance processes in place, but these were not always robust enough to indicate to the provider where improvements or action were required. Staff had not always completed the training identified as mandatory by the provider or competency assessments such as those with moving and handling before they could work with people.

There was a process for the administration and management of medicines which was followed, but we identified further training and action was required. We have made a recommendation in relation to the management of medicines.

Relatives were overall happy about the care their family members received and told us they felt their family member was safe when they received care in the home. We saw that individually care workers supported people in a kind, caring and respectful way. People’s care needs were assessed before moving into the home. People were supported to assess healthcare when required so they remained as healthy as possible.

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.

Staff supported people to maintain relationships with people who were important to them. The provider responded to complaints in a timely manner.

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 12 August 2021). 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 the provider remained in breach of regulations. This service has been rated either requires improvement or inadequate for the last five rated inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.

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

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

Enforcement and Recommendations

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.

We have identified breaches in relation to person centred care, safe care and treatment, safeguarding services users from abuse an improper treatment, staffing, premises and equipment, good governance and fit and proper persons employed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We found the following examples of good practice.

• The provider had processes in place to manage any outbreaks. This included caring for people in their bedrooms if they tested positive and PPE was available outside the room with a way for staff to dispose of used PPE safely. On the day of the inspection a COVID 19 outbreak was identified and we observed this process had been followed by staff.

• The provider had a process for COVID-19 testing of both people living at the home and staff but the records to show the results of PCR tests were not always completed in full to indicate the outcome and the date received.

• There was a procedure to ensure visitors to the home were prevented from catching or passing on an infection. Visitors could show proof of an COVID-19 test on arrival or do a test at the home and wait for the result.

• The activities coordinator confirmed, during a COVID19 outbreak, they visited each person in their bedroom to identify any one to one activities the person was interested in to reduce the risk of isolation.

Shackleton Medical Centre is a care home that can provide accommodation and personal or nursing care for up to 26 people with both nursing and general care needs and end of life care. At the time of the inspection there were 16 people living at the care home.

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

Individual risks management plans had been developed for specific risks relating to people’s health, wellbeing and care needs but these were not always in place for all identified risks. This meant that staff may not always have adequate information on how they could mitigate possible risks.

The provider had developed a number of quality assurance processes, but these did not always include checks on equipment.

People’s wishes in relation to their end of life were not identified as part of their care plan. We have made a recommendation in relation to recording people’s end of life care preferences.

The provider had processes to monitor and investigate safeguarding concerns, incidents and accidents. There were appropriate processes for the recruitment of staff. Medicines were managed and stored safely with people receiving their medicines as prescribed.

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. An assessment of a person’s support needs was completed before they moved into the home. People were supported to access healthcare and other professionals to meet their care needs.

Staff provided support in a kind and caring way. Staff demonstrated a clear understanding of people’s care needs. The care plans identified people’s religious beliefs and cultural preferences with staff aware of how they could support the person in meeting these needs.

People’s care plans identified how the person wanted their care provided. The provider responded to complaints in a timely manner. People receiving support and staff members felt the home was well run.

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 21 January 2020) and there were multiple breaches of regulation. Targeted inspections were carried out in August 2020 and December 2020 but the service was not rated following these inspections. At this inspection we found there had been improvements made in relation to medicines management, infection control and the need for consent so the provider was no longer in breach in relation to these areas. The provider had not made adequate improvements in relation to risk management and good governance so was still in breach of these regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. 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 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.

Shackleton Medical Centre is a care home that can provide accommodation and personal or nursing care for up to 26 people with both nursing and general care needs and end of life care. At the time of the inspection there were 18 people living at the care home.

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

The provider had developed individual risks management plans for specific risks relating to people’s health and wellbeing but these were not always in place for all identified risks. As a result, nurses and care workers were not always provided with adequate information as to how they could reduce possible risks to people.

Some improvements had been made but processes were still not always in place to ensure infection control practices were implemented effectively.

Medicines were not always managed in a safe way to ensure they were administered appropriately and as prescribed. We identified one issue in relation to the administration of medicines. Medicine care plans were in place for some people which included risk assessments and measures to mitigate the risks.

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 did not support this practice.

Records relating to the care of people using the service did not always provide accurate and up to date information as they were not always updated following an incident and accident or a change in care needs. This meant there were risks that people’s needs would not always be met.

The provider had a range of quality assurance processes, but these did not always assist the provider to identify areas requiring improvement. The provider was in the process of reviewing and developing new quality assurance processes.

Staff had completed training identified as mandatory by the provider. Training in relation to specific specialist support needs was being organised and staff competency had been completed. There were occasions when staff on the rota did not have specific skills to meet people’s care needs. We have made a recommendation in relation to ensuring appropriately skilled staff are on the rota.

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 21 January 2020) and there were multiple breaches of regulation. We carried out a targeted inspection on 18 August 2020 (published 7 October 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of regulation in relation to Regulations 9 (Person Centred Care), 11 (Need for Consent), 12 (Safe Care and Treatment), 17 (Good Governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of regulation in relation to management of risk, infection control, medicines management, mental capacity assessment, person centred care planning and quality assurance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Shackleton Medical Centre is a care home that can provide accommodation and personal or nursing care for up to 26 people with both nursing and general care needs and end of life care. At the time of the inspection there were 13 people living at the care home.

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

The provider had developed plans about how individual risks would be managed but these were not always in place for all identified risks. As a result, staff were not always provided with adequate information as to how to reduce risks to people.

Robust processes were not always in place to ensure infection control practices were implemented effectively.

Staff had completed training identified as mandatory by the provider, but some nurses and care workers had not completed training to meet the specific needs of people using the service.

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 did not support this practice.

Care plans did not always provide accurate and up to date information relating to a person’s care needs. This meant there were risks that people’s needs would not be met.

The provider had a range of quality assurance processes in place but some of the checks in relation to these did not provide robust information to identify areas requiring improvement.

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 21 January 2020) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of regulation in relation to Regulations 9 (Person Centred Care), 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of regulation in relation to management of risk, infection control, mental capacity assessment, person centred care planning and quality assurance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Shackleton Medical Centre is a care home that can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care. At the time of the inspection there were 11 people living at the care home.

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

The provider had developed plans about how individual risks would be managed but these did not always provide staff with adequate information as to how to reduce any risks. We saw some improvements had been made but further work was still required.

Staff did not always complete training identified as mandatory by the provider. Nurses had not always completed training to meet the specific needs of people using the service.

Care plans did not always provide accurate and up to date information relating to a person’s care needs.

The provider had a range of quality assurance processes in place but the checks in relation to care plans and training records did not provide robust information to identify areas requiring improvement.

Improvements had been made to the recording and investigation of incidents and accidents with any actions taken being recorded.

There was now a robust recruitment process in place to help ensure suitably skilled staff were employed to meet people’s care needs.

There had been improvements in the management and administration of people’s medicines.

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.

Staff supported people in a kind and caring manner, with positive and respectful interactions between staff and people using the service and relatives.

People knew how to raise complaints or concerns and the registered manager responded to them appropriately.

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 25 June 2019) and there were multiple repeated breaches of regulation. This service has been in Special Measures since June 2019. 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

The inspection was scheduled in line with the enforcement process as the location was in special measures following the last inspection which requires us to carry out an inspection within six months of the publication of the last inspection report.

Enforcement

We have identified breaches in relation to person centred care, safe care and treatment, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Shackleton Medical Centre is a care home that can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care. At the time of the inspection there were 12 people living at the care home.

People’s experience of using this service:

The provider had not always developed plans about how individual risks to people would be managed. During this inspection we saw there had been some improvements in relation to the development of risk management plans, but we saw plans were still not in place for everyone with identified risks.

The provider had not always updated care plans, risk assessments and risk management plan following accidents and incidents. This meant the provider could not ensure the learning from the investigation into incidents and accidents was used to reduce the risk of reoccurrence.

Medicines were not always stored safely. There had been some improvements to the administration and recording of medicines.

The provider had recruitment procedures, but these were not always followed to ensure new staff had the appropriate skills for their role and they were working while respecting and having regard to any conditions issued as part of a work visa.

Staff did not always complete training identified as mandatory by the provider. Nurses had not always completed training to meet the specific needs of people using the service.

Although there had been some improvements to the format of care plans, the information provided in the care plans was not always accurate or up to date. This meant there was a risk people may not receive the care they required to meet their needs. We also saw meaningful activities were not being provided for people living at the home to help them lead as fulfilling a life as possible.

The provider had introduced new systems and processes for auditing the service, but these still did not always provide information to enable them to identify areas which required improvement.

People told us they felt safe living in Shackleton Medical Centre. The provider had procedures to investigate and respond to any concerns raised regarding the care provided.

There were appropriate numbers of care workers deployed around the home to ensure people’s support needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were able to access a range of healthcare professionals to support their care needs.

People were happy with their care and felt their privacy and dignity were respected as well as being encouraged to be as independent as possible.

People knew how to raise a concern or complaint regarding the care they received.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (Report published 19 January 2019) The service was previously rated as Inadequate following an inspection in April 2018.

Why we inspected: The inspection was scheduled in line with the enforcement processes as we issued the provider two warning notices following the inspection in September 2018 requiring them to comply with the Regulations by 31 January 2019.

Enforcement: Full information about CQC’s regulatory responses to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: 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 six months to check for significant improvements.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

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

Shackleton Medical Centre 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. Shackleton Medical Centre can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care. At the time of the inspection there were 14 people living at the care home.

We previously inspected Shackleton Medical Centre on 5, 6 and 10 April 2018 and we identified breaches of 10 regulations. These were in relation to person-centred care, need for consent, safe care and treatment of people using the service, safeguarding service users, meeting nutritional and hydration needs, premises and equipment, receiving and acting on complaints, good governance of the service, staffing and fit and proper person employed. The provider was rated inadequate in the key questions of Safe, Effective and Well-led and overall. As a result, the service was placed into Special Measures. We also took enforcement action and issued Warning Notices in relation to person-centred care, safe care and treatment of people using the service, meeting nutritional and hydration needs, good governance of the service and staffing.

At the time of this inspection a registered manager was in post. The registered manager was also a company director. 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 provider was developing a new medicines policy and procedure but staff did not always follow the existing policy which resulted in issues with the management of medicines. Adequate checks were also not carried out to ensure records in relation to the management of medicines were accurate.

Risk management plans for risks identified during people’s needs assessment were not always in place to provide care workers guidance on how to reduce these risks and ensure people’s safety. Processes were not in place to ensure the risk of infection was reduced for people using the service.

The provider had a process for the recording of incidents and accidents but information was not always recorded in relation to the actions taken to reduce the risk of reoccurrence.

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. Policies and systems in the service did not support staff to act in the appropriate manner.

Improvements had been made in relation to staff induction and supervision with some staff still to complete training identified as mandatory by the provider which was being scheduled.

The provider did not always ensure the security of the premises and safety of people while minimising any restrictions on their liberty. We made a recommendation to the provider regarding this.

The furniture used in communal areas of the home had not been assessed as appropriate to meet people’s needs. We made a recommendation to the provider regarding this.

People had access to a GP and other healthcare professionals but where changes to a person’s care had been identified the information from the visit was still not been transferred to the relevant care plan so staff had clear information about meeting the person’s needs.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed.

Although people using the service and staff felt the service was well-led, we found that the provider’s audits and quality assurance checks were still not always effective. The provider continued to breach regulations and in some cases the audits and checks had not identified the areas where improvement was required.

People told us they felt safe when they received care and due to a reduction in the number of people using the service the staff to person ratio had improved. Staff therefore had more time to engage and interact with people using the service.

The provider had made improvements to their recruitment process, the recording and investigation of complaints and the monitoring of DoLS applications.

Personal emergency evacuation plans had been reviewed to provide appropriate and up to date information to enable people to be evacuated safely from the home in case of an emergency. Cleaning and other chemicals were stored in a safe way to reduce possible risks to people.

People told us the care workers were kind and caring and treated them with dignity and respect when providing care. The care plans identified each person’s cultural background, personal history and any religious beliefs.

Staff were supported to provide a range of activities for people at the home but activities were not in place for people who were cared for in their bedrooms when they were unable to join other people in the communal areas.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person centred care (Regulation 9), safe care and treatment of people using the service (Regulation 12) and good governance of the service (Regulation 17). You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to these concerns will be added to the report after any representations and appeals have been concluded. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Shackleton Medical Centre 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. Shackleton Medical Centre can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care.

We last inspected Shackleton Medical Centre on 6 and 12 December 2016 and rated the location as Good.

At the time of the inspection there was a registered manager at the home. The registered manager was also a company director. 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

People using the service and staff felt that at times there were not enough staff to provide the level of support people required. Rotas indicated the number of staff allocated per shift often did not meet the numbers the provider had identified as necessary to provide care. The provider did not ensure there were always registered nurses on shifts to provide nursing care. They had allocated senior care workers, who had trained as nurses in their home country but were not registered in the UK, to cover nursing shifts at the home. After the inspection we asked the provider to immediately address this matter, and they sent us duty rosters to confirm they planned to have registered nurses on duty at all times in the home.

The provider’s medicines policy and procedures were not always followed which resulted in appropriate guidance not being in place for staff and checks were not carried out to ensure medicines management was carried out safely.

Management plans to mitigate risks identified during people’s needs assessment were not in place to provide care workers guidance on how to reduce these risks and ensure people’s safety.

Personal Emergency Evacuation Plans did not provide sufficient and up to date information to enable people to be evacuated safely from the home in case of an emergency. The provider had a process for the recording of incidents and accidents but information was not recorded in relation to the actions taken to reduce the risk of reoccurrence

Processes were not in place to ensure the risk of infection was reduced for people using the service. Cleaning and other chemicals were not stored in a safe way to reduce possible risks to people.

People told us they felt safe when they received care at the home but we saw processes for the investigation and review of safeguarding concerns had not been followed. The provider did not have a process to record financial transactions to reduce the risk of possible misuse or misappropriation of money belonging to a person.

The provider had a procedure for the recruitment of care workers but this was not being followed, as the provider did not ensure that appropriate employment references were in place as part of the assessment of applicants’ suitability for 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, the policies and systems in the service did not support this practice.

The provider had an induction process, training and supervision but this did not always provide staff with the support and up to date knowledge they required to provide suitable care.

The environment of the building was not designed or maintained to ensure people were kept safe.

People told us they would like more choice for their meals and staff did not adequately monitor people’s food and fluid intake by keeping good records about what they ate and drank to identify if a person was at risk of malnutrition or dehydration.

Staff were individually kind and caring when providing support for people using the service but the provider overall did not demonstrate the service was caring because they did not ensure people received a good enough standard of care and were not placed at risk of harm.

Pre-admission assessments identified the person’s religious and cultural needs but this information was not always reflected in the person’s care plans so staff were clear how to meet these needs.

People had access to a GP and other healthcare professionals but where changes to a person’s care had been identified, the advice and information from the visit had not been transferred to the relevant care plan. There was therefore a risk the person might not receive the care they needed.

People’s care plans were not written in a way that identified the person’s wishes as to how they wanted their care provided. Records did not provide up to date information relating to people’s care. There were no structured activities planned that met people’s interests and were meaningful to them.

Complaints were not reviewed to understand any learning which could be used to improve the service.

The provider did not ensure the service was well-led and provided to an appropriate standard and that people received safe care and treatment. They had audits and some systems to monitor the quality of the service and to ensure the safety of the people using the service but these did not identify areas where improvements were required or where these were identified, little or no action was taken to address these.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person-centred care (Regulation 9), need for consent (Regulation 11), safe care and treatment of people using the service (Regulation 12), safeguarding service users (regulation 13), meeting nutritional and hydration needs (Regulation 14), premises and equipment (Regulation 15), receiving and acting on complaints (Regulation 16), good governance of the service (Regulation 17), staffing (Regulation 18), fit and proper person employed (Regulation 19) and requirement to display performance assessments (Regulation 20A). There was also a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 relating to failure to send notifications to the CQC.

After the inspection we wrote to the provider to ask them about the action they had taken to address the most serious concerns we had identified. They provided us with an action plan and some evidence of the action taken to address the concerns raised which showed some of the risks identified at time of inspection had been mitigated. We considered this information when deciding what action we took against the provider. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Shackleton Medical Centre is a care home providing nursing care for up to 22 people with general nursing needs and end of life care. When we inspected, 20 people were using the service. The provider’s nominated individual is also the registered manager. 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 provider had systems in place to keep people safe and staff had received training to make sure they understood and followed these. There were enough staff to meet people’s care needs and the provider carried out checks before new staff started work in the service. The provider assessed possible risks to people using the service and gave staff clear guidance on how to mitigate any risks they identified. People received their medicines safely.

Staff working in the service had the training and support they needed to care for and support people effectively. The provider understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had applied for DoLS authorisations where required. People’s care records contained information around mental capacity and clearly outlined where a decision had been made in their best interests. We saw no examples of unlawful restrictions placed on people using the service.

People told us they enjoyed the food provided in the service. At lunchtime we saw staff gave people time to make decisions about what they wanted to eat and drink. Where people needed help with eating their meal, staff did this in a patient and caring way.

People using the service and their relatives told us staff were caring and treated them with respect.

Staff spoke fondly about the people they were caring for. They were able to tell us about people's preferences, daily routines and personalities. They knew what made people happy and they wanted to give them good care.

The provider assessed and recorded the care needs of people using the service and involved them in planning the care and support they received.

The provider arranged some activities during the week and supported people to follow their interests and hobbies. People using the service told us they would feel confident making a complaint or raising a concern if they needed to.

The service had a registered manager who told us they were supported by a matron and a team of nurses and care staff.

The provider carried out checks and audits to monitor the service and make improvements.