This was an unannounced inspection which took place on 13, 14 and 16 August 2018.

The service was last inspected in October 2016 when we found Shepley House was in breach of three regulations. These related to the safety of medicines management, control of substances hazardous to health, use of equipment, staffing levels and good governance. We also made two recommendations in relation to respecting people’s belongings and Deprivation of Liberty Safeguarding (DoLS) authorisations. At this inspection we found that the breaches identified had been met.

Shepley 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.

Shepley House is registered to provide accommodation for up to 43 people who require support with personal care.

There was a registered manager in place at Shepley House. 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 present during the inspection. They were supported in the day to day running of the service by two deputy managers.

Improvements had been made to the systems in place to ensure the safe handling of medicines.

Improvements had been to the cleanliness of the environment and systems were also in place to reduce the risk of cross infection in the service.

Staff had received training in safeguarding adults. They could tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager.

Systems were in place to ensure staff were safely recruited. Staff told us they received the training and supervision they needed to be able to carry out their roles effectively.

The registered manager had taken appropriate action to apply to lawfully restrict people and where necessary decisions were made in people’s best interests.

Improvements had been made to the home including making it more friendly for people who lived with dementia.

People and relatives spoke positively about the staff and the atmosphere at the home was warm, friendly, calm and relaxed.

Care plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Care plans were regularly reviewed to address any changes in a person’s needs.

We saw that the home was part of an activities group. The activities co-ordinator was enthusiastic about their role and was supported by a small number of volunteers and the staff team to carry them out. The home was working hard to maintain and develop links with the local community.

People who used the service had opportunities to comment on the support they received. We saw that their views had been taken seriously and acted upon in order to improve their experience in the service.

We found improvements had been made to the staff culture at the home to help ensure people received person-centred care to meet their individual needs.

We found the registered manager demonstrated a commitment to continuing to drive forward further improvements in the service.

Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the registered manager.

Quality assurance systems were in place including regular audits and checks completed by the registered manager and an external management.

This inspection took place on 4 October 2016 and was unannounced. This meant that the provider and staff did not know that we would be visiting. We carried out a further announced visit on the 5 October 2016 to complete the inspection. We last carried out an inspection in October 2013, where we found the provider was meeting all the regulations checked at that time.

Shepley House is situated in a residential area of Hazel Grove in Stockport. It is a purpose built with accommodation spread over two floors. The home is registered to provide accommodation and personal care for up to 43 people. At the time of the inspection, 42 people were living at the service, some of whom were living with a dementia related condition. Some bedrooms have ensuite facilities. There are communal areas, including a range of lounges, dining areas and a large garden for people to use which has a summer house situated at the centre and is used for a variety of activities. The provider informed us that the service is earmarked for a major transformation/refurbishment by the local authority, who owns the building, by the end of 2020.

The service had 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.

We found concerns with the safe administration of medicines. Staff did not always follow safe working practices or followed correct procedures. For example, we saw two staff members in different parts of the service administer medicines to people without waiting to check they had taken their medicines. When we checked people’s records we found that no person at the service self-administered medicines, so this should not have occurred. We also found medicines trolleys were not always locked when not in use and medicines administration records were not always fully completed.

There were processes in place to monitor and review the safety and general maintenance of the premises. However, we found a number of safety issues with the premises and safe working practices. Upper windows did not have restrictors, to limit their opening that met with current Health and Safety Executive guidance. We found a number of products, including cleaning materials that were not locked away or supervised when being used, particularly in relation to the dementia unit. This meant there was a potential for people to be harmed.

We spent time in various parts of the service, observing care. At times, staff levels were not sufficient to meet people’s needs fully. The registered manager told us that she used her experience of working in care to assess the number of staff required and did not use any monitoring tools, meaning we could not be sure appropriate levels of staff were always available. Following our inspection, the manager told us that she was now completing a new form to enable an assessment of staffing levels which would show that they were staffing the home with suitable numbers of staff. She also said she had been given confirmation that more staff could be employed on the dementia unit in particular.

People said they felt safe living at the home and said the staff treated them well. Staff had received training regarding safeguarding and the protection of vulnerable adults. They said they would report any concerns to the registered manager.

Staff told us they felt supported and well trained and we confirmed that staff supervision had taken place regularly and training was up to date. We noted, however, that staff had only started to receive an appraisal in this current year having not received one previously with the provider. Not all appraisals were completed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Cap

As part of our inspection we spoke with six people who used the service, three members of staff, two visiting relatives and both the registered manager and deputy manager of the home. We also spent time looking at care plans, staff files and policies and procedures.

Overall, we found people were happy living at the home and felt well cared for. Comments from people who used the service included; “The staff are fantastic.I really can’t complain” and “The care is good. The staff look after me and give me my medication. If I use my call bell the staff always respond” and “It’s not home but it’s the next best thing. We are looked after and treated well by all of the staff” and “Absolutely great. I love it. I can do bits and pieces of things myself but if you are struggling with anything all I have to do is ask”.

We looked at the measures in place to safeguard people from abuse and we found there were appropriate systems to enable this. Each person we spoke with told us they felt safe and secure living at the home. Relatives told us they were aware of the safeguarding procedures.

We looked at staff personnel files to ensure staff had been recruited appropriately and safely. Each file we looked at contained two references from previous employers and a CRB reference number.

We found there were effective systems in place to monitor the quality of service provision. This was done with the use of audits, surveys and the monitoring of accidents and incidents.

We looked at the care people received and found that they were well cared for and consistently supported with their needs. We observed that people were supported in a dignified and timely way by the staff. We also saw that staff were courteous and positively engaged with individuals.

We looked at the care records and found that assessments and care plans were in place. We saw that they were regularly reviewed to make sure that people’s needs were met.

We toured the communal areas and some of the bedrooms and found that all areas were comfortable and well furbished. We also found that there was no malodour throughout the building.

We also looked at staff support and training. We saw that staff records and found the staff were well trained and there were good systems in place to ensure they were well supported in their work.

We found that people had good information and support to make decisions about their care or air their views about the home. We also found that good systems were in place to support people living at the home and the staff to raise concerns or complaints.

We spoke to family members, people using the service and staff during our visits on the 24 and 30 June 2011. They all told us that on the whole they were satisfied with the service. Comments that were made to us included:- “have nothing to grumble about”; “well looked after, have no complaints about the service”; “very nice, always made to feel welcome, can stay as long as I want to, had Christmas dinner with my mother”. One person was at the home for a few weeks respite care. They told us; "I have enjoyed my stay very much and am thinking that I might stay".

People had been visited by a senior care worker who had completed an assessment of their care needs. The managers of the home also received a support plan of a persons care needs from social workers. During the assessment people were asked what they wanted and their choices were recorded on the assessment form. The person who was to use the service or a family member/advocate was asked to sign the assessment record and the care plan to confirm that they agreed to what was to be provided. A care file/care plan was kept in their bedroom.

A small number of people did tell us that they thought the food could be better such as; “some dinners are better than others”; "had sausage, mash and peas for lunch, the mash was a bit wet”; “don’t seem to cook things enough”; "get a lot of sandwiches for tea – fed up with them”. However other people told us that the food was good and that most of the time they were happy with what was provided.

We asked both family members and people using the service if they had any complaints or concerns about the staff team. Everyone said that the staff were really good for instance; “keep me informed – ring me up if they are worried about anything”; “no complaints about the staff”; “like living at Shepley, staff ok and food ok”; “staff quite nice”. One person did however say that they were not always happy with agency staff. This was because the regular staff always told their relative what they were going to do but the agency staff did not always do this.

We had been told that the quality of information and recording in the care plans could be better. We therefore looked at a small number of care plans and did find some inconsistency in the information provided. We also found that the daily record keeping of peoples care needs and how these had been met required improvement. We discussed these areas of concern with the manager who told us that meetings had already taken place in order to improve the information.

We also received information from the local authority contracts and compliance department and the district nurses. The district nurses told us that they had no concerns about Shepley House. There had been a complaint made to Stockport MBC and a monitoring visit had taken place by a contracts and performance officer. The complaint was investigated and the company had responded to the contracts and compliance team. The company had accepted that parts of the complaint were substantiated or partially substantiated. The manager was addressing these matters and putting in place training to prevent any further occurrences of unsatisfactory practice.

The care workers who we spoke with told us that they received ongoing training which included; moving and handling, first aid, health and safety and infection control. People were also encouraged to take a National Vocational Qualification (NVQ) in health and social care. We asked them if they knew what to do should they witness or suspect that abuse was taking place. Everyone had received training and was aware of procedures to follow. They also knew that they could seek guidance from other agencies outside of the company such as social services. None of the care staff had any complaints about the service.