We undertook an unannounced inspection of Shackleton Medical Centre on 24 and 25 September 2018.

Shackleton Medical Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Shackleton Medical Centre can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care. At the time of the inspection there were 14 people living at the care home.

We previously inspected Shackleton Medical Centre on 5, 6 and 10 April 2018 and we identified breaches of 10 regulations. These were in relation to person-centred care, need for consent, safe care and treatment of people using the service, safeguarding service users, meeting nutritional and hydration needs, premises and equipment, receiving and acting on complaints, good governance of the service, staffing and fit and proper person employed. The provider was rated inadequate in the key questions of Safe, Effective and Well-led and overall. As a result, the service was placed into Special Measures. We also took enforcement action and issued Warning Notices in relation to person-centred care, safe care and treatment of people using the service, meeting nutritional and hydration needs, good governance of the service and staffing.

At the time of this inspection a registered manager was in post. The registered manager was also a company director. 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 provider was developing a new medicines policy and procedure but staff did not always follow the existing policy which resulted in issues with the management of medicines. Adequate checks were also not carried out to ensure records in relation to the management of medicines were accurate.

Risk management plans for risks identified during people’s needs assessment were not always in place to provide care workers guidance on how to reduce these risks and ensure people’s safety. Processes were not in place to ensure the risk of infection was reduced for people using the service.

The provider had a process for the recording of incidents and accidents but information was not always recorded in relation to the actions taken to reduce the risk of reoccurrence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Policies and systems in the service did not support staff to act in the appropriate manner.

Improvements had been made in relation to staff induction and supervision with some staff still to complete training identified as mandatory by the provider which was being scheduled.

The provider did not always ensure the security of the premises and safety of people while minimising any restrictions on their liberty. We made a recommendation to the provider regarding this.

The furniture used in communal areas of the home had not been assessed as appropriate to meet people’s needs. We made a recommendation to the provider regarding this.

People had access to a GP and other healthcare professionals but where changes to a person’s care had been identified the information from the visit was still not been transferred to the relevant care plan so staff had clear information about meeting the person’s needs.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed.

Although people using the service and staff felt the service was well-led, we found that the provider’s audits and quality assurance checks wer

We undertook an unannounced inspection of Shackleton Medical Centre on 5, 6 and 10 April 2018. The inspection was prompted by a safeguarding concern raised with the local authority.

Shackleton Medical Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Shackleton Medical Centre can provide accommodation and nursing care for up to 26 people with general nursing needs and end of life care.

We last inspected Shackleton Medical Centre on 6 and 12 December 2016 and rated the location as Good.

At the time of the inspection there was a registered manager at the home. The registered manager was also a company director. 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 using the service and staff felt that at times there were not enough staff to provide the level of support people required. Rotas indicated the number of staff allocated per shift often did not meet the numbers the provider had identified as necessary to provide care. The provider did not ensure there were always registered nurses on shifts to provide nursing care. They had allocated senior care workers, who had trained as nurses in their home country but were not registered in the UK, to cover nursing shifts at the home. After the inspection we asked the provider to immediately address this matter, and they sent us duty rosters to confirm they planned to have registered nurses on duty at all times in the home.

The provider’s medicines policy and procedures were not always followed which resulted in appropriate guidance not being in place for staff and checks were not carried out to ensure medicines management was carried out safely.

Management plans to mitigate risks identified during people’s needs assessment were not in place to provide care workers guidance on how to reduce these risks and ensure people’s safety.

Personal Emergency Evacuation Plans did not provide sufficient and up to date information to enable people to be evacuated safely from the home in case of an emergency. The provider had a process for the recording of incidents and accidents but information was not recorded in relation to the actions taken to reduce the risk of reoccurrence

Processes were not in place to ensure the risk of infection was reduced for people using the service. Cleaning and other chemicals were not stored in a safe way to reduce possible risks to people.

People told us they felt safe when they received care at the home but we saw processes for the investigation and review of safeguarding concerns had not been followed. The provider did not have a process to record financial transactions to reduce the risk of possible misuse or misappropriation of money belonging to a person.

The provider had a procedure for the recruitment of care workers but this was not being followed, as the provider did not ensure that appropriate employment references were in place as part of the assessment of applicants’ suitability for the role.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, the policies and systems in the service did not support this practice.

The provider had an induction process, training and supervision but this did not always provide staff with the support and up to date knowledge they required to provide suitable care.

The environment of the building was not designed or maintained to ensure people were kept safe.

People told us they would like more choice for their meals and staff

This inspection took place on 6 and 12 December 2016. The visit on 6 December was unannounced and we told the provider we would return to finish the inspection on 12 December. This was the first inspection after the Care Quality Commission registered the service in October 2016 to reflect the services provided.

Shackleton Medical Centre is a care home providing nursing care for up to 22 people with general nursing needs and end of life care. When we inspected, 20 people were using the service. The provider’s nominated individual is also the 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.

The provider had systems in place to keep people safe and staff had received training to make sure they understood and followed these. There were enough staff to meet people’s care needs and the provider carried out checks before new staff started work in the service. The provider assessed possible risks to people using the service and gave staff clear guidance on how to mitigate any risks they identified. People received their medicines safely.

Staff working in the service had the training and support they needed to care for and support people effectively. The provider understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had applied for DoLS authorisations where required. People’s care records contained information around mental capacity and clearly outlined where a decision had been made in their best interests. We saw no examples of unlawful restrictions placed on people using the service.

People told us they enjoyed the food provided in the service. At lunchtime we saw staff gave people time to make decisions about what they wanted to eat and drink. Where people needed help with eating their meal, staff did this in a patient and caring way.

People using the service and their relatives told us staff were caring and treated them with respect.

Staff spoke fondly about the people they were caring for. They were able to tell us about people's preferences, daily routines and personalities. They knew what made people happy and they wanted to give them good care.

The provider assessed and recorded the care needs of people using the service and involved them in planning the care and support they received.

The provider arranged some activities during the week and supported people to follow their interests and hobbies. People using the service told us they would feel confident making a complaint or raising a concern if they needed to.

The service had a registered manager who told us they were supported by a matron and a team of nurses and care staff.

The provider carried out checks and audits to monitor the service and make improvements.