Care Management Group (CMG) Shardeloes is a care home for up to nine adults with learning and physical disabilities. Some people were very independent and needed little support from staff, while others were essential wheelchair users, or were blind or partially sighted. At the time of our visit nine people lived here.

The premise is presented across two floors with access to the first floor via stairs. People’s bedrooms are single occupancy. Communal space consists of a lounge area and dining room. There is a large private garden with a patio at the rear of the property.

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 2008 and associated Regulations about how the service is run.

The home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid people’s mobility needs. The home had a homely feel and reflected the interests and lives of the people who lived there.

The inspection took place on 16 September 2016 and was unannounced. At our last inspection in October 2015 we identified two breaches in the regulations, and areas of the home that required improvement. The registered manager and provider gave us an action plan on how they would address these issues. At this inspection we found that all the areas of concern had been addressed, and people had a more pleasant experience living at CMG Shardeloes. There was positive feedback about the home and caring nature of staff from people who live there.

People were safe at CMG Shardeloes. There were sufficient numbers of staff deployed to meet the needs and preferences of the people that lived there. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks, without restricting people’s freedom. Staff understood their responsibilities should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of medicines. Their competency to give medicines to people was regularly checked.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. These procedures were regularly discussed with people to ensure they knew how to respond in an emergency. An alternative location for people to stay was also identified in case the home could not be used for a time.

Some people did not have the capacity to understand and make decisions about their care and support. The registered manager and staff had a good knowledge of what would need to be done if people did not have the capacity to understand or consent to a decision. They followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Staff were heard to ask people for their permission before they provided care.

People whose freedom may be restricted to keep them safe, had their human rights protected. The Staff and management had a good understanding of the requirements of the Deprivation of Liberty Safeguards (DoLS). Applications to the relevant authority had been made, and staff were seen to provide care and support in a manner that matched with the DoLS application.

People had enough to eat and drink, and received support from staff where a need ha

Shardeloes is a care home for up to nine adults with learning and physical disabilities. Some people were very independent and needed little support from staff, while others were essential wheelchair users, or were blind or partially sighted. At the time of our visit nine people lived here.

Care and support are provided on two levels. Communal areas include a large lounge and separate dining area.

The inspection took place on 16 October 2015 and was unannounced. At our previous inspection in November 2013 we had not identified any concerns at the home.

There was not a registered manager in post. They had left in July 2015. 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 lack of good leadership after the departure of the registered manager had an impact across three of the five key areas we looked at. It affected the safety of the home, how effective the home was at meeting people’s needs, and how well the home was led.

There was positive feedback about the home and caring nature of staff from people and their relatives. One person said, “The staff are nice, they will get me anything I want. There is nothing they could do better for me.” A relative said, “I think my family member is leading a very good life here.”

People were not always safe at Shardelos. The home had not been well maintained and was not always clean. Cleanliness needed to be improved around the home and hand washing facilities such as soap and hand towels were not always available to people, unless they asked. Lack of maintenance left items such as walls and furniture difficult to keep clean.

Adjustments to the environment to better suit the needs of individuals had not been assessed. At least two people were blind or partially sighted, but no reasonable adjustments had been made to the home. People had to rely on staff leading them around the home, rather than having adaptations that may help them to help themselves.

Where people did not have the capacity to understand or consent to a decision the provider had not followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had not been completed. People told us that staff did ask their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Staff’s understanding of their roles and responsibilities within the DoLS was not effective.

The staff were kind and caring and generally treated people with dignity and respect, but areas for improvement were identified. Staff’s practice around confidentiality needed to improve, for example talking about people in communal areas where others could hear. Some good interactions were seen, such as friendly banter with people, or staff taking the time to sit and play cards with people.

There were enough staff to meet the needs of the people. How staff are deployed to best support the people that live here could improve. There were a number of times during the day were staff were talking amongst themselves and people were left with no interaction apart from the television. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home.

The training and induction processes for staff needed to improve. New staff had not received an effective induction in accordance with the provider’s policy. Training around new approaches to support had not been given to staff, for example new guidance on preventing and managing choking had been issued by the local authority but staff were unaware of this. Some staff had not completed mandatory training, such as moving and handling. Whilst they knew they were not able to support people until they had done the training, it did impact on the effectiveness of the staff in being able to support people.

Quality assurance processes had not been effective at improving the home for the people who live here, or supporting staff in the absence of a manager. Regular audits were completed around the home by staff and visiting senior managers. Items identified as requiring action had not always been completed within the timescales set by the provider. Some care records were not completed fully, or had conflicting information. These had not been identified by the provider’s internal checks. Accident and incident records were kept, and they were analysed and used to improve the care provided to people.

People and staff did have the opportunity to be involved in how the home was managed. People told us that they had regular residents meetings where they could talk about the home and their care. Staff had meetings with their manager, but these had stopped when the registered manager left. Improvements identified at these meetings had not always been implemented by the provider. The provider had also not always feedback to people why these suggestions had not been done, so people were left waiting, not knowing if anyone had listened to them.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. However important information about people’s support needs was not always clear in the files, so some staff had been unaware of those needs. People told us they were involved in the review and generation of these plans. People received the care and support as detailed in their care plans.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

People received their medicines when they needed them. Staff managed medicines in a safe way and were trained in the safe administration of medicines. One area for improvement was identified. This was around staff monitoring the temperature of the cupboard where medicines were stored to ensure it was maintained at a temperature that would not affect the medicines.

People had access to activities that met their needs. They had access to the local community and could attend a variety of activities and clubs. More individualised activity plans were being developed with people by the staff, so that people’s dreams and new interests could be supported.

People had enough to eat and drink, and received support from staff where a need had been identified. Specialist diets to meet medical, religious or cultural needs were available should they be required. People were involved in what they ate, and told us they had a good variety and choice.

People knew how to make a complaint. Documents recorded that complaints had been responded to in accordance with the provider’s policy.

We identified two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of this report.

This was a follow up inspection to look at whether the service had sufficient levels of staff that met peoples’ needs.

We found that there were the appropriate levels of staff on duty on the day that we inspected. We saw that people were able to attend their outside activities and staff supported them when they were at home.

We saw that for any new member of staff they were given the opportunity to familiarise themselves with the service. They were also given an opportunity to read peoples’ care plans and risk assessments before they started to provide care.

Agency and bank staff were required to read a summary of peoples’ care and sign to say that they had read this before they started their shift.

We spoke with four people who lived at the service who all told us that they were happy living there. One person told us they had a variety of things to do each day. We also spoke with three members of staff.

During our inspection we saw that people were treated with kindness, dignity and respect and there was a happy and relaxed atmosphere.

We found that care plans had been reviewed and that there were up to date risk assessments for most people who used the service. We saw from the activities schedules that people took part in a variety of outings and in door activities which people told us they enjoyed.

On the previous inspection in January 2013 we found that some mandatory training was not up to date for staff. We also found that staff did not feel supported. On this inspection we saw that most staff were up to date with their mandatory training and that staff felt supported by their manager.

We found that on the inspection in January 2013 there were not enough staff to support people’s needs. On this inspection we were told and we saw that there were still shortages in staff.

We spoke with four people who lived at the service who all told us that they were happy living there. One of them told us that they were able to make choices about what they would like to do each day.

We also spoke with two relatives and one advocate of people who lived at the service who all told us that they felt that people were well looked after. One relative told us that the home was relaxed and the staff were “Absolutely wonderful.”

Relatives told us that they felt involved in the development of their family members care plans and were kept informed of any changes.

During our inspection we saw that people were being treated with respect and there was a happy and relaxed atmosphere.

We found that that care plans had not been reviewed. However, there were up to date risks assessments for most people who used the service. Staff told us that care plans were not up to date as they had not had the time to do them but that these were being changed to improve the layout.

During our inspection we saw several examples of staff who acted in a caring and supportive manner and assisted people to make choices about what they wanted to do. However, it was not clear how often people were able to undertake activities, supported by staff, outside of the home.

We saw that some training was not up to date for staff. Most members of staff had appraisals with their managers to discuss any concerns they had.

Some of the people who use services at Shardeloes are not able to use verbal forms of communication. Observation showed that some people used single words and some sentences and other people had their own style of communicating, for example, the use of body language, facial expressions or other forms of behaviour which staff clearly understood and responded to.

We observed that people who use services were always given time to express their needs, were involved in making day to day decisions and supported in a way that was mindful of their rights to respect, dignity and privacy. People using services appeared relaxed, content and at ease in their surroundings.