Shaftesbury House Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Shaftesbury House Residential Care Home accommodates up to 28 older people in one adapted building. During our comprehensive unannounced inspection of 30 January 2019, there were 23 people using the service, some living with dementia.

At our previous inspection of 27 November 2017, this service was rated requires improvement overall. The key questions safe, effective, responsive and well-led were rated requires improvement and the key question caring was rated good. There was a breach of Regulation 12: Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service wrote to us to tell us what improvements they had implemented to meet the requirements of Regulation 12.

At this inspection of 30 January 2019, we found that the service had made some improvements, but we found further shortfalls during our inspection. The service continued to be rated requires improvement overall and in safe, responsive and well-led. The rating of good had been sustained in caring and improvements had been made in effective which was now rated good. The service was no longer in breach of Regulation 12.

There was a registered manager in place. 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.

There had been changes in the management team for the service. There was a programme of audits which assessed and monitored the service provided. However, whilst some improvements had been made since our last inspection, further improvements were needed.

Improvements had been made in how risks of pressure ulcers developing were assessed and staff were guided how to reduce these risks. However, risks associated with choking were not robustly assessed and reduced.

There were systems in place designed to safeguarding people from abuse, however, we had received a concern from a person which had not been appropriately acted upon. This was addressed swiftly by the registered manager when we had reported what we had been told.

Improvements were needed in how people’s care was planned for and met. People’s choices were not always documented about how they wanted to be cared for at the end of their life.

People’s had access to social activities to reduce the risks of isolation and boredom. However, there was limited information about the one to one time provided to people when they chose to spend their time in their bedrooms.

People were provided with their medicines when they needed them. There were systems in place to manage people’s medicines safely. Improvements were ongoing in how the staff recorded how people were provided with medicines prescribed to be administered externally, including creams.

There were systems to ensure that there were sufficient numbers of care staff to meet people’s needs. Staff recruitment processes reduced the risks of staff being employed in the service who were not suitable. Staff were provided with training to meet people’s needs. Improvements had been made in the provision of one to one supervision meetings for staff.

There were infection control systems to reduce the risk of cross contamination. The environment was well maintained and suitable for the people using the service.

People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. Improvements had been made in ho

Shaftesbury House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Shaftesbury House accommodates up to 28 older people in one adapted building.

There were 26 people living in the service when we undertook this comprehensive unannounced inspection on 27 November 2017.

There was not a registered manager in place. 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. There was a new manager working in the service and their registered manager application was being processed at the time of our inspection.

This service was rated as Good at our last inspection of 9 November 2015. During this inspection of 27 November 2017 we found that the service had not sustained the previous Good rating. The overall rating was now Requires Improvement. The key questions Safe, Effective, Responsive and Well-led were rated as Requires Improvement. We found a breach of Regulation 12; Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Caring was rated as Good.

Improvements were needed in people’s care plans to identify how people were provided with person centred care which was tailored to meet their specific needs. There were some inconsistencies in care records which needed attention to ensure that staff were provided with the most up to date guidance on how people’s needs were met. The new manager and the regional manager had identified improvements needed in the care plans and had an action plan in place to address this. However, this was not yet fully implemented.

There were systems in place to provide people with their medicines, which were prescribed to be administered orally safely. However, improvements were needed in how staff recorded when people had been provided the medicines that were prescribed for administration externally, such as creams. This includes the application of barrier creams, used to reduce the risks of pressure ulcers. The records for when people repositioned did not identify that guidance in the care plans had been followed.

The ways that the service assessed risks to people and actions taken to reduce the risks required improvement to provide people with safe care at all times.

People’s nutritional needs were assessed. However, the systems in place for monitoring what people had to eat and drink were not robust.

There were systems in place designed to keep people safe, this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse. However, there had been an incident which had not been reported appropriately until we had advised the service to do so.

The environment was clean and hygienic and there were infection control systems in place. However, there was a toilet in the lounge area, which was open plan with the dining room. The door to the toilet opened into the lounge. This was a potential risks to infection control and was not respectful of people’s privacy. There was a programme of refurbishment and redecoration in the service planned.

There were some staff vacancies which were being covered by existing staff and agency staff. The service was actively recruiting to these vacant posts. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

Staff spoke about people in a caring and compassionate way. People had positive relationships

Shaftesbury House Residential Home provides accommodation and personal care for up to 28 older people, some living with dementia.

There were 28 people living in the service when we inspected on 9 November 2015. This was an unannounced inspection.

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. There was a manager working in the service and they were in the process of completing their registered manager application.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments were in place to guide staff on how risks to people were minimised. People were provided with personalised care and support which was planned to meet their individual needs.

People, or their representatives, were involved in making decisions about their care and support. The service was up to date with the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and met. Where concerns were identified about, for example a person’s food intake, appropriate referrals had been made for specialist advice and support.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were able to work in the service.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

We spoke with 12 of the 27 people who used the service. They told us that they were happy living in the service, the staff listened and acted on what they said and treated them with kindness and respect. One person said, “It is perfect.” Another person said, “I can't complain about anything, I'm very happy.” Another said, “They (staff) are ever so helpful.”

We saw that the staff were attentive to people's needs and they responded to requests for assistance promptly. We saw that the staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of three people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. The provider worked with other professionals who were involved in people's care and support which ensured that people were provided with a consistent service which met their needs. We found that people's comments and complaints were acted upon in a timely manner.

Discussions with staff and the training records that were seen showed that people were supported by sufficient staff numbers who were trained to meet their needs.

We looked around the service and found that people were provided with a clean and hygienic environment to live in. Equipment, such as hoists and portable electrical appliances, were regularly checked to ensure that they were fit for purpose and safe for people to use.

We spoke with ten of the 28 people who used the service. They told us that the staff always treated them with respect. One person said, "We have a lovely bunch of carers." Another person said, "The staff treat me right, I have all I need." Another said, "The carers are very kind."

People told us that they were consulted about the care and support they were provided with and the staff listened and acted on what they said. One person said, "They (staff) always ask me what I want and how I want it." Another person said, "The manager spoke to me and my (relative) before I moved in about what I needed."

People told us that they felt that their needs were met. One person said, "If I need help I just have to ask and they do it for me." Another person told us that the staff knew them well and supported them in the ways that they preferred. Another person said, "You won't find anything wrong here, it is a very good place."

During our visit we spoke with seven people who lived in the home. They told us about how they spent their day and how staff helped them. They were positive about staff and got on with them well. Two people told us they had a “good laugh” with staff and looked forward to activities and events that were organised by the home. Another told us they had been helped to regain some independence which meant they were able to continue taking part in activities outside of the home within the local community.

People told us they liked the choice of food and drinks on offer. They gave examples where a cook had prepared particular meals for people when they said they liked something that was not on the menu.

People living in the home told us they were able to spend their time as they wanted. One person showed us the activities schedule for the week and told us what they would take part in. We were unable to speak with some people living in the home because of their deteriorating physical and/or mental health. We observed how staff responded to their needs and saw they did this with dignity and respect. We saw two members of staff positively engaged with people by encouraging them to take part in activities and discussion.