Shannon Court

Shannon Court is a care home providing accommodation and personal care for up to 53 people, some of whom may be living with dementia. The service is divided into five separate living areas, each with their own dining room and lounge. In addition, there is a large communal lounge area on the ground floor, together with extensive grounds and smaller courtyards for people to sit in. At the time of our inspection, 40 people were living at the service.

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

People were not always 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 best practice.

The service followed a recruitment process for prospective staff, although we did find a couple of documents missing for two staff members. We have issued a recommendation in relation to this to the registered provider.

We saw care being provided to people from a sufficient number of staff at the time of inspection. However, we received mixed views from people and relative about staffing levels. We discussed this with the registered manager who took immediate action to address our observations on one unit, where more staff were needed.

People received the medicines they required and they told us they felt safe living at Shannon Court and that the service was always clean. Our observations confirmed this as we saw housekeeping staff cleaning throughout the day. We also observed staff wearing their PPE in line with Government guidance.

People told us staff were kind and caring towards them and people were enabled to retain as much independence as they wished. Staff treated people with respect and took time to engage and socialise with them.

People were provided with sufficient food and drink and where they required health care professional input staff supported them to access this.

People lived in an environment that was suitable for their needs. It had adaptations and equipment appropriate for people and for those living with dementia we observed sensory areas, and sufficient space so people could walk when they wished.

People were provided with a range of activities. These were slowly increasing as the service came out of a COVID-19 outbreak. Outdoor activities and outings were being planned and these would be helped by the improvements being made to the external grounds.

Although the service was not providing care to anyone with a learning disability, we expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they would meet the underpinning principles of Right support, right care, right culture should they provide care to an autistic person or someone with a learning disability.

Right support:

Model of care and setting maximised people’s choice, control and independence;

People were given choice and were involved in decisions around their care.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights;

Due to the quality of people’s care plans and staff’s knowledge of people, there was evidence to suggest people would receive person-centred care.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives;

There were systems in place to help ensure that the values and culture was such that people could automatically expect a high quality, person-centred service.

Staff felt supported and they were provided with appropriate and sufficient training to enable them to carry out their role. They had the opportunity to meet with their line manager regularly to discuss their role or any concerns, and staff meetings were held where they could talk about all aspects of the service.

There was a clear governance process in place and the registered manager had identified areas that required further work and was working to an action and continuous improvement plan. The management team worked well together and had a clear vision on how they wished the service to look in the future. They were being supported by external agencies in order to achieve this.

Complaints and concerns were listened to and responded to and where incidents and accidents occurred learning took place.

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

We last inspected this service in November 2019. The last rating for this service was Requires Improvement (report published 2 June 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 Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we identified a new breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – need for consent. We also found that recommendations we had made to the registered provider had been addressed. These related to staff training, the environment and care plan reviews.

Why we inspected

This inspection was prompted in part due to concerns received about a high number of falls occurring, a lack of robust diabetes management, insufficient staff, lack of following the principles of the Mental Capacity Act 2005 and poor practices in relation to the use of medicine patches for pain control on people.

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 found the provider had identified shortfalls and had taken action to mitigate risks to people as well as address the concerns that had been highlighted to us. However, we have found evidence that the provider needs to make improvements to their processes in relation to consent and the Mental Capacity Act 2005. Please see the key question of Effective of this full report.

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

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 the need for consent at this inspection.

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.

Shannon Court is a care home without nursing for older people some of whom are living with dementia. At the time of the inspection the service was supporting 53 people.

Not everyone who used the service received support with their personal care as they could manage this independently. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The home was comprised of two wings specialising in providing care to people living with dementia. There was also a main house that was comprised of three floors. Accommodation was provided over these three floors, each providing kitchen and communal areas.

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

Risks to people were not always identified, assessed or documented in people’s care files. This led to limited guidance for staff to know how to support people safely.

People with complex needs such as those living with dementia did not always have their needs effectively managed.

The registered manager was working with the provider to develop a person-centred culture within the service. However, the outcomes for people did not fully reflect this and more work was needed to embed this way of thinking within the team. Further improvement was needed to ensure risk assessments and care plans were accurate and sufficiently detailed to ensure people were cared for safely and effectively. We have made a recommendation regarding this.

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.

There had been a lack of managerial oversight in relation to systems in place to identify any issues and monitor the quality of the service. For example, quality checks on care plans had not identified the concerns found at this inspection in respect of people’s care.

Staffing levels were seen to be adequate and staff were available to people when they required assistance with standard support, however, we saw that staff did not have time to talk to people in a way that was meaningful to them.

People were supported to have enough to eat and drink. However, some concerns were raised around conflicting information in people’s care plans and as to whether people should be on specialised diets, such as softened diets. As a result a referral to the Speech and Language Therapist (SALT) team was made immediately after the inspection by the management team.

People received their medicines as prescribed. Staff sought assistance from health professionals where people needed this support and routine health appointments were made for people.

There were effective systems in place to safeguard people from abuse. There was a complaints procedure and policy in place to ensure any concerns raised by people or their relatives were addressed as quickly as possible. People told us that they had total faith in the staff that any concerns they raised would be dealt with immediately.

People told us that they were supported by kind and caring staff. Staff had supervisions to discuss their progress and training in subjects considered mandatory by the provider to develop their skills and knowledge. However, it was identified that not all training had appeared effective in preparing staff for all areas of their roles.

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 7 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Shannon Court is a care home providing accommodation and personal care for up to 53 older people, some of whom are living with dementia. At the time of our inspection there were 49 people living at the service.

There was not a registered manager in post. 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 manager had started their employment in December 2016 and was undergoing the registration process.

At our last inspection we found the provider was breaching five Regulations of the Health and Social Care Act 2008. Risks to people were not well managed and the provider had not always gained people’s consent to their care. There were not always enough staff available to meet people’s needs. Staff had not been supported through individual supervision. Care plans were not always in place to meet people’s needs. The provider had not established effective systems to ensure good governance of the service.

At this inspection we found the provider had taken action to address these breaches. Risk assessments identified any risks involved in people’s care and the actions needed to reduce these. There were enough staff on each shift to meet people’s needs and staff received regular supervision. The provider had implemented a system of regular quality checks. Some care plans still required review but this had been identified by the manager, who had plans in place to address this.

Temperatures of medicine cabinets in peoples’ rooms were monitored weekly. However, there were two weeks in February where records were not kept. This meant that staff could not be assured that medicines had always been stored at manufacturers’ recommended temperatures and that they were safe to use. We have made a recommendation about this.

Staff had a good understanding of how to protect people from abuse. All staff had received safeguarding training and had access to the homes safeguarding policy. Safeguarding notifications had been submitted to the local authority safeguarding team and CQC in a timely manner. The provider followed safe recruitment practices.

People told us they felt safe. Accidents and incidents were documented with actions taken to prevent a recurrence. People’s medicines were managed and administered safely. People had Personal Emergency Evacuation Plans (PEEPs).

Staff worked in accordance with the Mental Capacity Act 2005 (MCA). Mental capacity assessments had been completed and best interest decisions made. Relatives as well as staff and professionals were involved in best interest decisions. Applications for DoLS authorisations had been made where required.

People were supported by staff who had supervisions (one to one meetings) with their line manager. Staff had received induction training and regular refresher training.

The staff met people's dietary needs and preferences. Information on food preferences and dietary requirements were in people’s care plans.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

People and their relatives told us that staff were caring. Relatives and friends were able to visit at any time.

Staff treated people with dignity and respect and knew people well. People were encouraged to be independent. Care records contained information on how staff could communicate with people.

People were involved in the planning of their care. People had a range of activities they could be involved in and their spiritual needs were met.

People and their relatives knew how to complain. Complaints were responded to and outcomes recorded.

Regular residents’ meetings were held and people felt they were listened to. Regular relatives’ meetings were also held.

Audits were frequent and thorough. The manager had completed a full care plan audit. The manager had an improvement plan in place for the service. The provider had completed an audit of the service in October 2016.

Electronic care plans were accessible 24 hours a day in each unit. We observed that recording on these was up to date.

People thought the home was well managed and staff spoke positively about the management of the home. Staff were valued by the manager and were involved in the running of the home.

The inspection took place on 14 June 2016 and was unannounced.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager was not available on the day of the inspection. We were supported by the deputy manager and members of the senior leadership team.

Sufficient staffing levels to meet people’s needs were not provided throughout the service. In some areas we found that staffing levels were adequate and people received their support in a responsive and timely manner. In other areas of the service sufficient staff were not available to ensure that people received the support they required. There was a high level of agency staff used which people told impacted on the care they received.

Staff did not always identify and act promptly to safeguarding concerns. When concerns were reported to the registered manager appropriate action was taken to minimise the impact on people. Risks to people’s safety were not always identified and actions were not always taken promptly to mitigate risks.

The provider had not acted in accordance with the requirements of the Mental Capacity Act 2005and Depravation of Liberties Safeguards. People’s capacity to make decisions had not been assessed and there was no evidence that meetings had been held to ensure that decisions taken about people who lacked capacity were made in their best interests.

Whilst each person had an individualised plan of care, the information recorded was not always reflective of people’s current needs. Care plans were not always completed and reviewed in a timely manner which meant staff did not always have access to the most up to date information relating to people’s care needs. Records relating to people’s care were difficult for staff to access due to technical difficulties with the electronic recording system.

There was a system in place to deal with people's comments and complaints however we found that the registered manager had not investigated, recorded and dealt with complaints a timely manner.

Regular audits were completed to monitor the quality of the service provided. However, these were not always effective in identifying areas which required improvement. The registered manager had responsibility for the managements of two services which both staff and people felt had an effect on the management oversight of Shannon Court.

Medicines were managed well and risk assessments were in place to mitigate the risk of mistakes being made. People were supported to maintain good health and had regular access to a range of healthcare professionals.

The provider’s recruitment procedures were robust, which helped to ensure that only suitable staff were employed. Staff attended an induction when they started work and had access to on-going training.

People told us they enjoyed the food provided. They said they had a choice of dishes at each meal and had access to drinks and snacks outside mealtimes. People’s dietary need were known by staff and support was offered to people in a dignified manner.

People and relatives told us that staff were caring. However ther were instances where people were not teeated with compassion. The permanent staff took time to communicate with people and ensure that support was offered in the way people preferred. Personal care was provided discreetly and people’s dignity and privacy was respected.

There was a wide range of activities offered both within the community and when people were at home. There was a Masonic lodge at the service and the involvement of ‘Friends of Shannon Court’ ensured people were able to maintain their links with the masonic community.

People and relatives were regularly asked to give feedback on the service provided.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.