Archived: The Shieling

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 People had not received health care reviews and hospital passports were out of date.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.

The Shieling is a care home for up to 10 people who are over 18 years old and are living with a learning disability, or autism or who may also have a mental health condition. Nine people lived in the service when we inspected.

Although the number of people accommodated exceed published guidance the service met the values that underpin the ‘Registering the Right Support’ and other best practice guidance such as ‘Building the Right Support’. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People told us they liked living at The Shieling. Staff focused on providing people with good quality, consistent care. Comprehensive assessment and care planning ensured people’s goals and aspirations were central to their care.

Staff were recruited safely and were well trained and skilled. Staff knew people well. They had a good understanding about people’s individual care needs including people who sometimes displayed their needs non-verbally. People had the opportunity to maintain and develop their skills and independence. The consistent use of positive behaviour management approaches meant staff knew how to support people effectively to reduce their anxiety and distress.

People were fully involved in their care and support through one-to-one sessions with their keyworker, informal discussions and group meetings. Staff supported people to experience new things, maintain positive relationships with friends and family and develop community links.

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.

Effective management systems were in place to protect people and promote their wellbeing. Since the last inspection a new registered manager had been appointed. The registered manager and staff worked together to support people to lead full, active lives and to be safe.

The culture of the service was one of continual improvement and the registered manager was eager to make improvements for the benefit of people living at The Shieling.

Rating at last inspection: Good (published 19 May 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

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

The Shieling is registered to provide accommodation and personal care for up to 11 people with learning disabilities. The service is a converted house with a private garden close to local amenities. On the day of the inspection there were 10 people living at the service.

There was a registered manager in place. 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 who lived at the service and staff told us people were safe. There were systems and processes in place to protect people from the risk of harm. These included thorough staff recruitment, staff training and systems for protecting people against risks of coming to harm.

People told us there were enough suitably trained staff to meet their individual care needs. We saw staff spent time with people and provided assistance to people who needed it. Staff were available to support people to go on trips or visits within the local and wider community.

People were supported to keep healthy. Any changes to their health or wellbeing were acted upon and referrals were made to social and healthcare professionals to help keep people safe and well. Accidents and incidents were responded to quickly. Medicines were managed safely and people had their medicines at the times they needed them.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005. This is legislation that protects people who are not able to consent to care and support, and ensures people are not unlawfully restricted of their freedom or liberty.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions.

People’s health and social care needs had been appropriately assessed. Care plans provided detailed information for staff to help them provide the individual care people required. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

Staff were patient, attentive and caring in their approach; they took time to listen and to respond in a way that the person they engaged with understood. They respected people’s privacy and upheld their dignity when providing care and support.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. People at the service, their relatives and staff were provided with opportunities to make their wishes known and to have their voice heard. Staff spoke positively about how the registered manager worked with them and encouraged team working.

There were effective systems in place to monitor and improve the quality of service through feedback from people who used the service, staff meetings and a programme of audits and checks.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the Service safe?

We found that people were supported to make choices and preferences about their care and support, and people experienced care and support that met their needs.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about applications that had been submitted. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

People were protected from the risk of infection because staff followed good infection control practice and these practices were monitored regularly.

There were sufficient care workers to respond to people's health and welfare needs. We reviewed people's daily records and could see that people were supported to attend and complete activities of their choice.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in decisions about how their care and support was provided.

New staff had received relevant induction training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

People's preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people's wishes.

People we spoke with said that staff were kind. One person said "I love this house. This is where I want to be.'

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service assisting people in achieving their aspirations; for example attending college courses.

There were sufficient staff available to meet people's needs; staffing was arranged flexibly in order that people could be supported in activities of their choice. Staff completed specialist training in order to enhance their skills and knowledge and met individual's needs.

The service carried out an annual satisfaction survey. Results were collated and analysed and action plans in response were agreed and actioned.

People we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good

understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

We spent time with people and we observed staff being warm and friendly. People appeared relaxed and comfortable with their surroundings; with staff and the activities they were engaged in.

One person told us 'I like living here.' Another person said 'The staff are really good and help me, I really like to go out and I do that quite a lot.'

The provider had clear systems in place for supporting people with medication and staff were trained in the safe handling of medicines.

The home had recently been refurbished and redecorated which had improved the environment people were living in.

The provider had a robust recruitment process in place which meant that only suitable people who had had appropriate checks carried out worked for the service. All of the staff we spoke with told us the induction they received had been a good grounding in care work and relevant to their role.

There was a complaints procedure in place which included an easy read accessible format for people with communication difficulties.

One person told us their care needs were met and that they were 'alright' with the support and care provided at The Shieling. We saw that other people were calm and relaxed with staff and that support was given in a caring and professional way.

During our inspection we used the Short Observational Framework for Inspection (SOFI). This is a specific way of observing care to help us understand the experience of people who could not speak with us. We used SOFI to observe how people were feeling and their engagement with staff. We found that overall staff had a good understanding of the individual needs of people who used the service and had received appropriate training to enable them to understand and meet those needs.