Archived: The Shieling

Updated 24 February 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

The Shieling is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. Instead there was an interim manager in place. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. We have referred to the interim manager as ‘the manager’ throughout this report.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or their representative would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with three service users and received feedback from three relatives about their experience of the care provided. We spoke with ten members of staff including a managing director, an associate director of quality, an operations manager, the manager, two deputy managers, one senior care staff and three care staff.

We reviewed a range of records. This included four people’s care records and 10 medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the managing director and the director of quality to validate evidence taken away from the service and sent to us.

Updated 24 February 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

The Shieling is a residential care home providing personal care to up to ten people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were ten people using the service.

The Shieling accommodates people in one adapted building.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

People lived in a clean, comfortable and homely environment, but some aspects of it were unsafe. Such as, sharp edges in one of the bathrooms and people were not always protected from the risk of potential harm from accessing cleaning materials that could be hazardous.

Once our concerns were brought to the senior management’s attention; immediate action was taken to reduce the risk to people and make the environment safe.

Not everyone was being supported in a way that enabled them to have choice and control in their daily lives.

Right Care

People’s care, treatment and support plans did not always reflect people’s up to date needs, and the current support being given. People had not received health care reviews and hospital passports were out of date. This did not promote their well-being and enjoyment of life.

People received their medicines as prescribed, but staff did not follow the provider's medicine policy and procedure around record keeping and working practice.

People who had individual ways of communicating, using body language and sounds, could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them. However, people's care plans were not updated to reflect people's communication methods accurately.

People could take part in activities and pursue interests that were tailored to them. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

There was a lack of visible leadership and staff were reluctant to report incidents. The quality assurance and audit systems in the service were not used effectively. Shortfalls in quality and practice were either not identified or not acted upon. Therefore, people’s health and safety was put at risk.

People experienced a risk of harm because of a lack of protection, when staff did not report a safeguarding incident appropriately. Once the management team were made aware of the issue then appropriate action was taken to report the incident to the authorities, obtain treatment for the person and conduct an internal investigation.

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 22 January 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture.

We received concerns in relation to staffing, infection prevention and control and a lack of effective management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 The Shieling 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 safeguarding and good governance, due to a lack of reporting and disregarding a person’s need for care and treatment, a lack of effective oversight and mitigation of risk and poor record keeping.

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 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.