Sheldon House

Sheldon House is registered to provide accommodation and personal care for up to six people with a diagnosis of mental health related issues. The service is based in a large terraced house within the community. At the time of our inspection six people were living at the service. One person was visiting relatives at the time of our inspection. Staff employed at the home were multi lingual and spoke English, Punjabi and Urdu so they could communicate effectively with all the people they were supporting.

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

There was a strong, visible person-centred culture. The service ensured that staff in all roles were highly motivated and offered care and support that was exceptionally compassionate and kind. All the people and staff we spoke with gave us positive feedback about the caring nature of the service, quality of the staff and thoughtful support they received. Care records showed people had been supported to be actively involved in all aspects of their care planning and their own risk management.

Respect for privacy and dignity was at the heart of the service’s culture and values. We saw that was fully embedded in everything the service and staff did. People and staff felt respected, listened to, and influential.

People we spoke with told us they felt safe. People had individual risk assessments in place so staff could identify and manage any risks appropriately.

Safeguarding procedures were robust and staff understood how to safeguard people.

Systems were in place to make sure managers and staff learned from events such as incidents, concerns and investigations.

There were enough staff to ensure people’s care and support needs were met.

The provider completed appropriate pre-employment checks for new staff, to check they were suitable to work at the service.

Medicines were managed safely at the service.

The service was clean and had a welcoming homely atmosphere.

We saw the service had received compliments from relatives about the care provided at the service. Relatives described how the compassionate care provided at the service had transformed their family member’s life, health and mental wellbeing since they had come to live at the service.

Staff had undertaken training which was regularly updated to ensure they had the skills and knowledge to support people effectively.

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 made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated.

People were supported to maintain their independence and engage in activities of daily living such as, cooking, food shopping and cleaning their room. People's support also focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were encouraged and supported to engage in activities within the community.

There was a robust complaints process in place at the service. We found the service had responded to people’s and/or their representative’s concerns and taken action to address any concerns.

Staff spoken with made very positive comments about the staff team, registered manager and nominated individual.

There were planned and regular checks completed at the service to check the quality and safety of the service provided.

Rating at last inspection:

At our last inspection Sheldon House was rated good (report published 16 March 2017).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

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.

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

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Sheldon House took place on 30 December 2015. The service was rated as Requires Improvement. We found breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulations 12: Safe care and treatment, 17: Good governance and Regulation 18 of the Registration Regulations 2009 Notifications of other incidents. Requirement notices were given for these breaches in regulation. The provider sent an action plan detailing how they were going to make improvements. At this inspection we checked improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the regulations.

This inspection took place on 27 February 2017 and was unannounced. This meant the people who lived at Sheldon House and the staff who worked there did not know we were coming. On the day of our inspection there were five people living at Sheldon House.

At the time of this inspection the people living at Sheldon House did not speak English as a first language. Staff employed at the home were multi lingual and spoke English, Punjabi and Urdu so that they could communicate effectively with the people they were supporting. Whilst we were able to communicate with the people living at Sheldon House, staff assisted some of our discussions by translating some conversation. People spoken with had requested this support from staff.

People told us they felt safe and they liked the staff.

We found systems were in place to make sure people received their medicines safely so that their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff were provided with supervision and appraisal at appropriate frequencies for their development and support. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

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

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity were respected and promoted. Staff understood how to support people in a sensitive way.

People were supported to access a range of leisure opportunities so that their choices were respected and their independence was promoted.

People said they could speak with staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Sheldon House is registered to provide accommodation and personal care for up to six women with a diagnosis of mental health related issues. Accommodation is based over three floors and accessed by stairs.

The home had a 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.

People who used this service were not always safe the home did not always ensure the proper and safe management of medicines. You can see what action we told the provider to take at the back of the full version of the report. The care staff knew how to identify if a person may be at risk of harm and the action to take if they had concerns about a person’s safety. They also assessed the risks to the health and safety of people receiving care.

The care staff knew the people they were supporting and the choices they had made about their care and their lives. People who used the service, and those who were important to them, were included in planning and agreeing to the care provided. The decisions people made were respected. People were supported to maintain their independence and control over their lives. People received care from a team of staff who they knew and who knew them.

Staff were well supported through a system of induction, training, supervision, appraisal and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

People who used the service and their families were asked for their views of the service and their comments were acted on. There were systems in place for care staff or others to raise any concerns with the provider.

The service was not consistently well-led. Audits and quality systems were in place but were not always completed with the provider’s intended frequency or efficiency.

The provider did not always fulfil its legal obligation to notify the CQC without delay about incidents that adversely affect the health and welfare of people.

You can see what action we told the provider to take at the back of the full version of the report.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People supported by the service, or their representatives told us they felt safe.

We observed, and people told us they felt their rights and dignity were respected.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

Policies and procedures were in place in relation to the safe management of medication. Staff that administered medication had been provided with training in the safe handling of medication. This meant that people's health and safety was promoted.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People's health and care needs were assessed with them and their representatives, and they were involved in writing their plans of care. Specialist needs had been identified in care plans where required.

Staff were provided with training to ensure they had the skills to meet people's needs. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised. The manager was accessible to staff for advice and support.

Is the service caring?

We asked people using the service for their opinions about the support provided. Feedback from people was positive, for example, 'they (staff) are good, very good,' 'they (staff) give me the help I need, I am happy here,' 'it's good. I am all right' and "happy, fine".

Two relatives spoken with said they were satisfied with the care and support their relative was receiving. Their comments included "I can't fault them. They are absolutely brilliant' and 'they (staff) always keep us informed, (my relative) is very happy'.

When speaking with staff it was clear that they genuinely cared for the people they supported and had a detailed knowledge of the person's interests, personality and support needs.

People using the service and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's individual choices regarding how they spent their day were supported by staff.

People spoken with said they had no worries about living at Sheldon House. Information on how to make a complaint was provided to people and staff were aware of the procedure to support people if they wanted to make a complaint. We found appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that if shortfalls were identified they were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

During the inspection we were able to observe people's experiences of living in the home. The interactions between people living at the home and staff appeared positive. Staff spoken with knew the people living at the home very well. We found that care and support was offered appropriately to people.

We found that people's care and welfare needs were assessed and each person had a written plan of care that set out their identified needs and the actions required of staff to meet these.

We found that suitable arrangements were in place to ensure people were safeguarded against the risk of abuse and their rights were upheld. Staff had received training on safeguarding people so that they were aware of the actions to take if they suspected abuse, or if an allegation was made.

We found that sufficient numbers of staff were provided to meet people's needs. Staff were provided with relevant training to maintain and update their skills and knowledge.

We found that procedures were in place to audit and monitor systems within the home.