Shaldon House 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.

This inspection was carried out on the 09 January 2018. Shaldon House provides accommodation and personal care for 10 people. There were nine people living in the home at the time of the inspection. People who live at the Shaldon House have a learning disability. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

The service was last inspected in November 2017 when it was rated as requires improvements overall. This was due to a shortfall in staff training and staff supervision. These shortfalls had not been picked up and addressed by the providers own audit systems at that time. At this inspection we found that action had been taken and the shortfalls we had found had been fully addressed.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager for the service. 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.

As was applicable at our last inspection we found there were enough staff supporting people who lived at the home.

People continued to be protected from the risk of abuse. This was because there were still clear procedures in place to recognise and respond to abuse. The staff had been trained in how to follow the procedures. Systems were still in place to ensure people were safe. These including risk management, checks on the equipment, fire systems and safe recruitment processes. People still had a care plan that set out how they wanted to be supported in a person-centred way

Systems to support staff such as one to one meetings were now happening at regular intervals and, there were now annual appraisals of staff’s performance. Training lapses had now been addressed and staff had started or now completed a full range of training while working at Shaldon House.

People continued to have access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive about the staff’s approach to people and the way they delivered care.

People continued to be supported with a range of meaningful activities in their home and the community. People were still able to maintain contact with friends and family.

People continued to be treated in a kind respectful and dignified way. This showed that people’s rights were still protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision-making process. The provider had submitted applications for a deprivation of liberty to the relevant authorities. This was to ensure people were not deprived of their liberty without authorisation.

People’s views were sought through house meetings and annual surveys. It was evident that people were happy at Shaldon House and felt it was their home. The registered manager promoted stable leadership and a calm, positive place to work and live. This benefitted people who lived at the home. People were supported to make decisions about the way the service was run.

This inspection was carried out on the 12 and 14 December 2017. Shaldon House provides accommodation and personal care for 10 people. There were nine people living in the home at the time of the inspection. People who live at the Shaldon House have a learning disability. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There had been a recent change in management. The registered manager had not worked in the home since 3 August 2017. A new manager had been appointed and had started at the end of September 2017. They were in the process of submitting an application to register. 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 changes of management have had an impact on the way the service was operating. This was because the previous registered manager had not completed what was expected of them in respect of completing staff supervisions, monitoring staff training and ensuring risk assessments were up to date. The new manager and the provider had devised a robust action plan. The newly appointed manager was committed to implementing the action plan to address these shortfalls to ensure ongoing compliance.

There was sufficient numbers of staff supporting the people living at the service. Systems to support staff such as one to one meetings were not happening at regular intervals and, there were no annual appraisals of staff’s performance. Training had lapsed throughout the year for staff and some staff had not completed the care certificate when they had first started working in Shaldon House.

People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive in respect of the staff’s approach to people and the delivery of care. People were supported with meaningful activities in their home and the community. People were supported to maintain contact with friends and family.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.

People had a care plan that described how they wanted to be supported in an individualised way. The newly appointed manager was planning to introduce a new planning tool in the new year. The manager had reviewed risk assessments as a matter of priority.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. The provider had submitted applications to the appropriate authorities to ensure people were not deprived of their liberty without authorisation.

People’s views were sought through house meetings and annual surveys. It was evident that people saw Shaldon House as being their home.

There were systems for checking the quality of the care and service. Shortfalls in the way the service was run had been picked up by recent audits. People and the staff spoke positively about the newly appointed manager and the changes

We carried out a focused inspection of Shaldon House on 8 November 2016. Prior to this inspection we had received a safeguarding concern from a third party relating to the health, safety and welfare of a person living at the service. Additional agencies, including the local safeguarding authority and the police were also involved in responding to this information. The safeguarding concerns were unsubstantiated.

We undertook this focused inspection to ensure that people living at the service were safe, that they were well cared for and that the leadership of the service ensured people’s care provision needs were met. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Shaldon House on our website at www.cqc.org.uk

The service is registered to provide accommodation and personal care for up to 11 people. People who use the service live with a learning disability and/or have mental health needs. At the time of our inspection there were eight people living at the home.

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.

People at the service told us they felt safe. Within people’s care records we saw there was risk management guidance where necessary and staff were observed following this guidance. Accidents and incidents were recorded and where necessary action was taken that aimed to reduce the risk or reoccurrence. People told us staff were caring and we made observations that supported this. Feedback about the management of the service was positive from both people and staff. There were systems that monitored the quality of service provision.

We inspected the service on 16 January 2016. This was an unannounced inspection. The service was last inspected in January 2014. It was compliant with the regulations at that time.

The service is registered to provide accommodation and personal care for up to 11 people. People who use the service live with a learning disability and/or have mental health needs. At the time of our inspection there were 10 people living at the home.

There was a registered manager for the service. 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 lack of guidance for staff to ensure that medicines procedures were fully safe for the administration of medicines. There was also a lack of up to date current guidance regarding the medicines and what side effects they may cause. Food hygiene systems in the kitchen were not always safe. This meant there were potential risks to peoples’ health and safety.

People were given the support they needed at mealtimes. Food and drinks provided for each person were based on their preferences.

Staff demonstrated that they understood their responsibility to protect people from possible abuse. They were able to tell us how to recognise abuse and report concerns following the providers safeguarding procedure.

Staff were kind and caring in their approach to people. People were encouraged and supported to live a varied and fulfilling life in the home and the community. Staff had a good understanding of the people they supported and how to provide them with effective care that met their needs.

People had access to health professionals and were supported to attend appointments. Care plans clearly explained how to meet people’s range of care needs, and included detailed life histories about each person. This helped staff to gain an insight into each person and to provide them with personalised care.

Staff understood what the requirements of the Mental Capacity Act (MCA 2005) meant for people at the home. When it was needed, the service worked with people, relatives and social care professionals to assess people’s capacity. This was in relation to specific decisions in their life, such as going out into the community. Staff understood the importance of seeking consent before providing people with all aspects of care. People were supported by staff to make decisions in their daily lives.

There was a system for checking the quality of the care and service people that was provided. Shortfalls in the way the service was run had been picked up by recent audits of the service. People and the staff spoke positively about the registered manager who they described as very kind and supportive to them at all times.

We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the home when we met with the people who used the service and with members of the staff and management team. Not everybody who used the service was able to express their views verbally and our observations in the home helped us to make judgements about the support that people received.

Please read the full report if you want to see the evidence supporting our summary.

Is the service caring?

Staff we spoke with had a good awareness of individuals' needs and treated people in a warm and respectful manner. During our observations we saw people were receiving care and support in a sensitive way.

Jovial interactions were observed between staff and people that used the service. Interactions were appropriate and people appeared to enjoy the banter as they were visually animated and relaxed around staff.

Is the service responsive?

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people’s files held information and advice sought from the community learning disability team and joint initial assessments took place before people came into the service.

People’s needs had been assessed before they moved into the home. The registered manager told us people met with their key workers monthly to discuss their support plan and things may wish to achieve.

Records confirmed people’s preferences, interests, aspirations and needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important and meaningful to them and had been supported to maintain relationships with their friends and relatives. For example, the staff supported one person to ‘Skype’ their family member on a weekly basis.

Is the service safe?

People we spoke with told us they felt safe with the staff that supported them. Observations that we made also indicated people felt comfortable in the company of staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, policies and procedures were in place to support staff should the need arise. Relevant staff have been trained to understand when an application should be made, and how to submit one.

People were safe from the risks of harm because risk assessments were used to identify the safest and least restrictive ways of supporting people. Risk assessments were reviewed on a monthly basis to ensure they remained up to date.

People’s safety was protected and promoted because the service sought expertise and support from other health and social care services that people required in order to meet their needs effectively.

The registered manager sets the staff rotas, they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people’s needs are always met.

Is the service effective?

We saw that the individual needs of people using the service were met because staff were familiar with their support plans. We saw examples of people receiving support in line with the information recorded about them.

It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well.

Is the service well led?

People that used the service and their relatives completed a satisfaction survey once a year. The registered manager told us if any concerns were raised these would be addressed promptly. One follow up comment from a relative related to ‘terms of endearment’ used to their family member. This was followed up immediately by the registered manager, who confirmed the person was happy with the term used and recorded this accordingly.

There was a well-established management team in place. Staff understood the ethos of the home. The registered manager told us “people are asked what they want to do and achieve and we support them to do it”.

Some people we spoke with were able to tell us their experience. They confirmed they felt listened to and were involved in resident’s meetings called “our voice”. We saw records that confirmed this.

Staff told us they were clear about their roles and responsibilities. They said the management team and the provider were supportive. They told us “there is always someone available for support”.

At the time of our inspection there were nine people living in Shaldon House. During our inspection we spoke with people living in the home, staff and examined the care records for people living in the home to see how their care was provided.

Most of the people living in the home were able to tell us what it was like at the home and if they were happy with the service they received. People appeared happy and relaxed in the company of the staff and were seen engaged in activities and conversations during our inspection.

We looked at people’s personal care files to see if people’s care and support documentation reflected their needs. We spoke with six people who used the service and three staff during our inspection.

Overall people’s comments were positive about living in the home. Comments included; “its ok here, I’ve been out today”. “It’s good living here, I’m very happy I don’t want to move”. “They are nice here”. “I have a cat and his name is sooty”.” We have meetings with the manager and my keyworker. Its good and I have my own key”.

Earlier this year the service had a change of provider and is now owned by Positive Care. People we spoke with during our inspection told us, the new provider had visited the home and spent time speaking with them to find out their views. People who used the service told us the recent changes, had no impact on the care they received.