We inspected Shipley Hall Nursing Home on 9 May 2017.This was an unannounced inspection. The service provided accommodation, nursing and personal care for up to 30 older people with a range of age related conditions including frailty and dementia. On the day of our inspection there were 24 people using the service, including one person who was in hospital.

Our last inspection took place on 24 & 27 May 2016. At that time there was no registered manager in place and we identified concerns relating to inadequate levels of infection control. This was a breach of Regulation 12 (Safe Care and Treatment) Health and Social Care Act 2008 (regulated activities) Regulations 2014. Following this inspection we asked the provider to send us an action plan detailing how they would address these issues. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made regarding infection control procedures and the service was no longer in breach.

However we identified other concerns regarding the culture of the service, which was not always open and inclusive. We also found communication was inconsistent and staff did not always feel valued by the provider.

There was still no registered manager in post on the day of the inspection. 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 received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected from the risk of harm or abuse by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored, administered safely by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to help ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The service acted in people’s best interests and maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

This inspection took place on 24 and 27 May 2016 and the first visit was unannounced. At our last inspection on 8 July 2014 the home was compliant in all areas.

Shipley Hall Nursing Home is in a quiet village in open grounds. It provides accommodation for up to thirty people who require care, including diagnostic and screening procedures and treatment of disease, disorder or injury. The accommodation comprises of eighteen single rooms and six shared rooms. On the day of our inspection twenty two people were living in the home. One additional person had been admitted to hospital.

Shipley Hall Nursing Home is required to have a registered manager, however, there was no registered manager at 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. The provider had recently recruited to the manager position but the post holder had now left.

Staff undertook an induction and training was carried out to support them in their role. However, robust recruitment checks were not undertaken and one member of staff had commenced employment before their Disclosure and Barring Service (DBS) checks were returned to the home. DBS checks are a way of helping to ensure the staff employed to care for people are suitable.

Some parts of the home were not clean and quality assurance systems were not effectively monitoring the quality of cleanliness and hygiene in the home.

There were sufficient numbers of staff on duty most of the time, however, during times of staff sickness people told us they sometimes had to wait for assistance. Medicines were managed and administered safely.

People at the service felt safe. They were supported by staff that understood their responsibilities to identify and report any signs of abuse using the provider's safeguarding procedures. Staff were aware of risks associated with people's care and support and people were supported to make personal choices.

When we spoke with staff and managers they were aware of their responsibilities under the Mental Capacity Act.

People had enough to eat and drink and they were provided with a balanced diet. People were also helped to have access to healthcare services when these were required.

People were supported by caring staff who helped them maintain their dignity and express their views. Also, people were supported to be part of the community inside and outside of the home and undertook activities that interested them. The provider had a complaints policy available to people.

Staff at the service were well supported by their line managers and the provider was an active member of staff who was well known in the home. However, staff did tell us they did not always receive regular supervision. The provider was aware of their responsibilities and had a strong commitment to ensuring the safety and comfort of the people who were cared for.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We met eight people that lived in the home and two staff as well as six visitors. Some of the people we saw in the home had memory problems or difficulty with communicating their needs. We spoke directly with five people living in the home, they were happy with the care they received and with the staff who cared for them.

If you want to see the evidence supporting our summary please read the full report.

At our inspection we gathered evidence that helped answer our five questions.

Is the service safe?

The people who used the service told us they felt safe in the home and trusted the staff. People told us. “Staff are lovely, really friendly" and "I like all the staff."

Another person said. “Staff listen to me, I am quite happy here and I feel well cared for.”

We had received information of concern that people were not receiving the care and support they needed. We looked at support plans and spoke with people who used the service. People told us they were well looked after.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The people who used the service told us they liked living at Shipley House. One person said “If I don’t feel well they call a doctor for me.”

We looked at how the staff supported people with diabetes and saw they received suitable chiropody treatment as well as a suitable diet. Staff also contacted the necessary healthcare professionals for advice when they needed to.

Is the service caring?

People told us they were pleased with the staff at Shipley Hall. One person said. “They treat me like a queen; I couldn’t be better looked after.” We observed staff throughout the day. They did not rush people and took their time when providing support, which was done with dignity and respect.

Is the service responsive?

We had received information of concern saying the home had had an infestation of cockroaches. We looked at records and saw that as soon as this was identified the provider brought in a specialist pest control company to deal with the problem. They also had retained the company to carry out three monthly checks to ensure they remained free from infestation.

Is the service well-led?

The registered manager has been in post for just over a year and is slowly making changes to the support plans and improving the environment. Staff spoke positively about the registered manager and were able to tell us what improvements the registered manager had made.

We discussed how people who used the service and their relatives were involved in the running of the home. We were shown a quality questionnaire but there was no response recorded as to actions taken. The registered manager told us they had carried out improvements as a result of comments and would record these in future.

We had received information of concern saying that people were frightened to complain to the provider. We spoke with people who used the service and they told us they felt confident to speak to the registered manager. One person told us. “Staff listen to me, I am quite happy here and I feel well cared for.” However when we spoke with visitors three out of the six visitors said they did not feel able to raise any concerns with the provider due to their previous negative experience.

We looked at the audits of the building and associated activities, we found they had not been recorded since April 2014, however the registered manager was able to send us evidence following the inspection to show they had been carried out but recorded separately. We also asked the registered manager if they had an annual routine maintenance plan for the service. We were told that they did not have but refurbished rooms as and when they thought they needed to do it. The provider sent us evidence following the inspection to show that they visited the service regularly and carried out audits from which repairs and maintenance actions were carried out.

We spoke with ten people who used the service and five relatives.

People able to express their views told us they were happy with the care they received, and felt that their needs were being met. They also said that they liked the staff that supported them. Comments received from people included ''it feels like home; it is a good place to live, everything about the service is brilliant, I can’t fault the staff, I enjoy the activities and the routines are flexible; I can do as I like’’.

Relatives told us they were happy with the care their family member received, and felt involved in decisions about their care and treatment.

We found that people experienced care, treatment and support that met their needs. People were supported to have sufficient to eat and drink and they were offered a suitable choice of food, which reflected their preferences and needs.

The majority of people said that they liked most of the meals. People also said that they received enough to eat and drink. Two people said that they felt that the quality of some meals could be better.

People's medicines were handled safely and they received them at the times they needed them.

Staff worked well together as a team, and felt supported by senior staff. People were cared for by staff who were supported to deliver care and support safely.

Effective systems were in place to monitor the quality of the service and to identify and manage risks relating to people's welfare and safety.

We spoke with nine people using the service, three relatives and a close friend.

People able to express their views told us they were happy with the care and service they received, and felt that their needs were been met. People had agreed to their care and treatment. One person told us “the staff are great: they will do anything for you.’’ Another person told us ‘’I enjoy the activities and outings and the food is very good.’’

People told us they liked the staff as they were friendly and helpful. People felt that they received the help they needed as there was usually enough staff on duty to meet their needs.

People felt safe and able to raise concerns with staff if they were unhappy.

Relatives we spoke with told us they were happy with the care and support their family member received, and felt involved in decisions about their care and treatment. One relative told us ’’ the staff team are caring and attentive to peoples needs.’’ Another relative told us ‘’the service provides high standards of care and the facilities and the gardens are lovely.’’

People told us they had been involved in their care plans and that they were happy with the support they received from the staff team.

People told us that they felt there was enough staff on duty to support them. Comments regarding the staff team were positive. One person said, “ they’re very friendly and always available if you need them”

People told us that the meals provided were enjoyed. They said that there was plenty of variety and choice.

People told us that activities were available if they wanted to join in this included sensory therapies, arts and crafts and nail painting. One person told us that they went out on a regular basis both with their family and for local walks with staff support.

People that we spoke to told us that they got on well with the staff. They told us that the staff were friendly and they felt safe at the home

People told us that they would speak to the manager if they had any complaints. One person said “I’m sure they’d sort things out if there was a problem, they’re very good” another person said,” No complaints, I’m very happy here”.