Archived: Sheiling Living

Updated 18 September 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 6 and 9 July 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. The inspection was undertaken by one inspector.

Prior to the inspection we reviewed the information we held about the service, including statutory notifications submitted about key events that occurred at the service. We did not request a Provider Information Return for this service. 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. We gathered this information during the inspection.

During the inspection we spoke with four members of staff, the house manager, lead manager for the service and the nominated individual. We spoke with two people and four relatives about their views on the quality of the care and support being provided. Some people using the service were unable to speak with us, therefore we observed interactions between staff and people using the service. We also spoke with two health and social care professionals.

We looked at care documentation relating to four people, medicine administration records, four staff personnel files, staff training records and records relating to the management of the service including quality audits.

Updated 18 September 2018

This inspection took place on 6 and 9 July 2018 and was announced.

This service provides care and support to adults with a learning disability and autism living in a supported living setting, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. There were four people being supported by this service at the time of the inspection.

The registered manager had recently resigned from their post and the nominated individual told us they would be applying to cancel their registration. The nominated individual told us another manager was now managing the service and would be applying to register to manage the regulated activity. 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.

This was the first inspection of the Sheiling Living service since it was registered in September 2017.

Robust governance and quality monitoring systems were not being completed regularly, established or embedded within the service. This meant that some areas for improvement to keep people safe had not been identified. This was a breach of the regulations. The nominated individual shared with us their plan to improve arrangements for governance to ensure standards were met and people received a quality service.

Incident reporting systems were not always effective to ensure all required actions were taken and support required by staff was given. This was a breach of the regulations.

We had not received notifications regarding safeguarding concerns that the provider had responded to. A notification is how providers tell us important information that affects the running of the service and the care people receive. This was a breach of the services registration requirements.

Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Professionals, staff and relatives told us they had no concerns relating to abuse or safeguarding. The management team had followed their internal safeguarding protocols following incidents and actions had been taken to safeguard people. However, the provider had not reported the incidents to the local authority in line with safeguarding vulnerable adults' procedures or informed CQC. This was a breach of the regulations.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines. Some improvements were required to checks of the temperature of medicine storage areas.

There were sufficient numbers of safely recruited staff at the home however some concerns were shared with us that staff were not always directed effectively to meet people’s needs.

There were arrangements in place for infection control and food hygiene.

Lessons had been identified when things went wrong. This included identifying changes required to meet people’s needs in the future.

Improvements were required to ensure all staff were supported to carry out their roles. The majority of staff told us they had felt more supported recently and they were now receiving supervision and morale had improved.

Improvements were required to the arrangements for mental capacity assessments and best interest decisions to ensure the service meets the requirements of the Mental Capacity Act 2005. We have made a recommendation about arrangements for recording consent to care.

People were supported to access healthcare appointments as and when required and staff followed health care professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, and a specialist healthcare consultant.

People were supported to eat and drink and staff followed any dietary advice from healthcare professionals.

People’s relatives gave us mixed feedback about staff approach. One relative told us, “Some staff are excellent, some aren’t”. Improvements were required to ensure people were always treated with dignity and respect. For example, some staff removed people’s possessions for periods of time as a sanction or sent people to their bedrooms in response to concerns about their behaviour.

We observed positive interactions between staff and people. We observed positive staff practice that focused on supporting people’s independence.

People had their care and support needs assessed before moving into the service. Concerns were shared with us by some relatives that they were not always involved.

Improvements were required to how people were supported to engage in meaningful activities that met their needs. The provider told us they were taking action to address this.

The service was meeting the requirements of The Accessible Information Standard. Staff understood people’s communication needs and preferences.

There was a system in place for raising complaints and relatives told us that complaints had been responded to. Improvements were required to how concerns raised were recorded and how people were supported to raise concerns.

People’s relatives and health and social professionals told us that the management team were at times hard to contact and communication required improvements.

Improvements were being made by the provider on how staff were supported to meet people’s needs and care documentation. Improvements were required to the monitoring systems used within the service and the provider’s governance. The current systems in place were not always effective to ensure adequate governance and to ensure people received safe care.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach under Health and Social Care Act 2008 (Registration) Regulations 2009.