The inspection took place on 27 September 2018 and 2 October 2018 and was unannounced.

At our previous inspection completed in May 2016, the service was rated as Good. This is the first time the service has been rated Requires Improvement.

Shamrock 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.

The home is registered to provide accommodation for up to 17 people whose main need is in relation to their mental health. 16 people received a service at the home during our inspection.

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. The registered manager was not clear about their roles and responsibilities. They had not submitted all notifications or displayed the rating from the previous inspection in the home as they are required to do as part of the legal registration with the CQC.

Staff had received some training to safeguard people from abuse. Where concerns were raised these were investigated. However, training was not always up to date and staff did not have access to an up to date policy to ensure they followed best practice guidance.

People’s needs were assessed and risk assessments were in place. However, where reviews highlighted people were at a high-risk, support plans had not always been updated to ensure information was available to manage the risks and provide people with safe care and support.

Systems and processes in place to maintain and improve the safety of the environment were not effective to ensure the home remained clean and free from hazards and appropriate maintenance carried out.

People were at risk from not receiving their medicines as prescribed. There was no record to evidence staff remained competent or that they had received up to date training to administer people’s medicines. The policy and procedure was not up to date or reflective of the service.

Systems and processes in place failed to ensure staff received appropriate supervisions and support to carry out their role. The register manager had signed up to a new training provider but there was no training plan in place to ensure staff remained up to date or competent to carry out their role and meet people’s individual needs.

There was a staffing structure in place. However, staff were not always clear about their roles and responsibilities.

Everybody had a care plan. Assessments had been completed to determine people’s capacity to understand and consent to their care and support. However, the provider was not always adhering to the Mental Capacity Act which meant people may not always receive care and support that was the least restrictive or in their best interest. There was limited evidence of people being involved in the planning or consenting of their care. Information was not always available to ensure people were supported to improve their lives by monitoring outcomes for independent living skills.

During our inspection we found staff had limited knowledge of the Mental Capacity Act and the Mental Health Act which may impact on how people received safe care and support and have access to appropriate pathways of care to meet their needs. There was no evidence of a record of a health care plan to monitor if the recommended annual health check were completed or actions to support the person to achieve successful outcomes.

Care plans contained details of people's preferences and any specific dietary needs they had. For example, whether they were diabetic, had any allergies or religious needs. However, records di

This inspection took place on 23 March 2016 and was unannounced. We previously visited the service on 10 April 2014 and we found that the registered provider did not meet all of the regulations we assessed. We carried out a follow up inspection on 25 September 2014 and found that the registered provider had met the regulations.

The home is registered to provide accommodation for up to 17 people whose main need is in relation to their mental health. On the day of the inspection the home was fully occupied. The home is situated in Goole, in the East Riding of Yorkshire; it is a short walk to town centre amenities and the bus and rail stations. There are two communal areas and bedrooms are located on all three floors of the premises. There is no passenger lift or stair lift so people who live at the home have to be physically able to manage the stairs.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following the home's recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at the home.

People told us that they felt safe whilst they were living at Shamrock House. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people had no concerns about how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff and that their care plans were reviewed and updated as needed. People's nutritional needs had been assessed and people told us they were very happy with the food provided.

There had been no formal complaints made to the home since the previous inspection but there was a process in place to manage complaints should they be received. There were also systems in place to seek feedback from people who lived at the home, relatives and staff.

Care staff and people who lived at the home told us that the home was well managed. Quality audits undertaken by the registered manager were designed to identify any areas of improvement to staff practice that would promote safety and optimum care to people who lived at the home. Staff told us that, on occasions, the outcome of surveys and audits were used as a learning opportunity.

Shamrock House is a care home that provides accommodation and support for 17 people with a diagnosed mental health condition. The home has seven single rooms and five shared rooms; six rooms have en-suite facilities. The home is close to the town centre and local amenities. 

There was a registered manager in post as the time of this inspection. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

At the last inspection on 26 November 2013 we asked the provider to take action to make improvements to the safety and suitability of the premises and assessing and monitoring the quality of service provision. This action had been completed.

There were five shared rooms at the home and staff told us that people had chosen who to share with. However, some people who occupied these rooms expressed concern about the lack of privacy and we have asked the provider to take action to address this. You can see what action we told the provider to take at the back of the full version of the report.

People told us that they felt safe living at the home. There were sufficient numbers of staff on duty and staff had undertaken training on safeguarding adults from abuse. They displayed a good knowledge of the action they would need to take to manage any incidents or allegations of abuse. There were appropriate risk assessments in place that allowed people to take responsibility for their actions, be as independent as possible but remain safe.

There were comprehensive care planning documents in place that described people’s individual lifestyles and support needs. Staff demonstrated a good knowledge of the physical and emotional needs of each person who lived at the home and we observed good rapport between people and staff. Staff told us that they worked well as a team.

People told us that they had good access to health care professionals and we saw that all contacts were appropriately recorded.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted. People were encouraged to make decisions about their day to day lives and best interest meetings had been held when people needed support with decision making.

People had the opportunity to express their views about living at the home in meetings and at care plan reviews. Staff also had the opportunity to share their views at staff meetings and supervision meetings. There was a consistent staff group in place and this meant that staff were well informed about the individual needs of the people who lived at the home. 

The registered manager had undertaken audits of care plans and medication systems to monitor that they were being adhered to by staff. Any areas that required improvement had been recorded in an action plan and we saw that issues had been dealt with appropriately. People told us that they were aware of the complaints procedure and we saw that there had been no formal complaints made to the home since the last inspection in November 2013. 

On the day of the inspection there was a calm atmosphere throughout the home. The home was well managed although some concerns were raised about the registered manager not being accessible to staff and people who lived at the home. One reason given for this was that their office was on the second floor of the premises, away from communal areas of the home.

Shamrock House is registered to provide accommodation and personal care for 17 people who have a mental health related condition. The service is located in a residential area of Goole in East Yorkshire and is within a ten minute walk to local shops and amenities.

At the previous inspection of the home in April 2014 we found that privacy and dignity had not been promoted for each person who lived at the home, as there were no privacy screens in some shared rooms. We issued a compliance action for this breach of regulation. This was a responsive inspection to check that the breach of regulation had been complied with.

Our inspector visited the service and the information they collected helped answer one of our five 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 our observations during the inspection, speaking with people using the service and speaking with the registered manager and registered provider. If you want to see the evidence supporting our summary please read the full report.

People who spoke with us had a good relationship with the staff. People told us that the staff encouraged them to be independent but were available for support when needed. People said "We are well looked after here. The food is good and the staff are really nice all the time” and “You cannot fault the staff at all. We get plenty of food, drinks when we want them and we can go out into town when we like.”

People told us they felt safe in the home and the care was good. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.

Our observations of the service showed us that the staff were very kind and caring and all the people who spoke with us were very happy with their care. One person said “The staff are very good, they listen to what we say”, another person said “The staff look after us well, nothing is too much trouble.”

People said they were happy with their rooms and the communal areas. However, we had a number of concerns about the environment and fire safety practices within the service.

We saw that staff had appropriate training and development, but staff supervisions and appraisals were not all up to date.

We found that improvements were needed to the quality assurance system to ensure people’s health, safety and care was monitored effectively and that appropriate action could be taken where necessary to make changes in the service.

When we visited the service in October 2012 people who used the service were satisfied with the care they received and their homely environment. We chatted briefly with people during this visit but their comments to us did not relate to the outcome we were inspecting.

We found that improvements had been made to medication practices and record keeping within the service. The provider and staff had acted on the information in the report from October 2012 and made positive changes to working practice, staff training and the medication system.

People who spoke with us told us that they had a good relationship with the staff. People told us that the staff encouraged them to be independent but were available for support when needed.

People we spoke with said “Staff are friendly, supportive and caring” and “We are consulted about our care and we can make our own decisions about life in the home.”

People said “The food is good and that the choice of food, for each meal, is flexible.”

People told us they felt safe in the home and the care was good. People said they were aware of their rights and choices and were confident in the systems set up by the service to enable them to voice any concerns.

We have raised concerns in this report about poor staff practices with regard to medication and we have asked the provider to take action to ensure people receive their medication safely and as prescribed.

We spoke to people living at the home, both individually and as a small group of six residents. Everybody we spoke to felt they were involved in aspects of their care and were able to express their preferences. People complimented the quality and choice of food, general appearance of the environment and attitude of staff.