The inspection took place on the 19 and 21 September 2017 and was unannounced.

Shire House Care Home provides residential care without nursing for up to 22 older persons. There were 17 people living at the service when we visited some of whom were living with dementia.

A registered manager was employed to manage 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.

We previously inspected the service in May 2016 and found breaches of regulation related to staffing, risk management and care being person centred. The provider wrote and told us about improvements they would make to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They told us they would make these improvements by the end of August 2016. At this inspection we found that these improvements had been made.

People were supported by staff that understood how to recognise signs of abuse and the actions they needed to take if they suspected abuse. The staff also put an emphasis on the need not to go to external authorities without talking to the management team first. The registered manager and nominated individual checked this understanding with the staff team and addressed the importance of whistleblowing during our inspection.

Healthcare professionals had been concerned about some aspects of risk management. The provider organisation had changed ownership in August 29017 and the new owner had discussed concerns with the district nurse team and plans were in place to ensure these issues were acted upon.

People received their medicines as prescribed. Records, however were not always accurate and stock levels of one medicine were unnecessarily high. The registered manager and nominated individual addressed these issues immediately and put measures in place to ensure they would not be repeated.

The risks people lived with had been assessed and were reviewed regularly. Staff understood the actions in place to minimise these risks. Staff had a good knowledge of the risks people lived with and their role in reducing these risks.

Where people needed to be deprived of their liberty to live in the home, applications for Deprivation of Liberty Safeguards (DoLS) had been made. One DoLs that had been authorised had expired. This was rectified during our inspection and a system put in place to ensure this would not be repeated.

Staff were supporting people in line with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s ability to make decisions about specific aspects of their life were regularly assessed and kept under review. When people could not make decisions for themselves this was done in line with the principles of the MCA.

People were supported by enough staff to meet their needs. Staff had been recruited safely which included checks that they were suitable to work with vulnerable people. Staff had the appropriate skills and training to support people safely and effectively. Staff felt supported and received regular supervision and an annual appraisal.

Staff understood people’s eating and drinking requirements, likes and dislikes. There were systems in place to ensure that risks associated with eating and drinking were managed effectively.

People had access to healthcare for ongoing and emergency treatment, This included GP’s, district nurses , dentists and opticians.

People were supported by staff who knew them well and understood their history , likes, dislikes and preferences. Staff were caring when they spent time with people and spoke about them with warmth

The inspection took place on the 10, 11 and 12 May 2016 and was unannounced. We previously inspected the service on 10 January 2014 and found all requirements were met.

Shire House Care Home provides residential care without nursing for up to 22 older persons. There were 21 people living at the service when we visited.

A registered manager was employed to manage 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 registered manager was available on the first day of the inspection, but was due to do night duty on the second day so was not available on this or the third day. The registered provider supported the inspection on the second and third day.

Prior to the inspection we received information of concern about staffing levels. We found there were not enough staff to look after people safely. People were at risk of not having their needs met, falling and of having their dignity compromised. Staff were moving people unsafely as there was not always another staff member who could work with them to support moving or caring for people. This was even when care records clearly stated two staff had to do this. The provider and registered manager had not acted when staff had raised a concern about this. We requested the provider took immediate action to ensure there were enough staff to meet people’s needs safely. The provider responded to this request by ensuring four care staff were available between 8am and 8pm. They also agreed to review how they calculated what number of staff were required according to people’s needs. We also had concerns about the emotional and physical safety of staff so we spoke with the environmental officer to advise them of our concerns in respect of staff health and safety. The environmental health officer visited on the second day of the inspection and communicated with the provider.

People gave us mixed accounts of whether they felt staff were caring. People explained staff were really busy and they did not want to be a nuisance. People said both positive and negative things about the staff. Staff told us eight people living with dementia were deliberately targeted so they were ready for bed by the time they night staff came on duty at 8pm. This was because these people were unable to communicate they did not want to go to bed. The provider agreed to review this practice.

People had detailed care plans in place which were reviewed with them and their representative. Staff said they read and understood the care plans but were unable to always follow them as they were too busy. Staff told us they had to make decisions about limiting people’s choices and preferences due to the lack of staff. Staff wanted this to change and felt people living at the service deserved better.

The provider had systems in place to judge the quality of the service but as they believed there were enough staff, the issues identified on inspection were not reviewed as part of that auditing process. Staff felt the culture of the service was task focused. They felt they were not always listened to when suggesting changes.

People were at risk due to staff delivering care whilst also making people’s tea time meal. Staff were wearing the same uniforms and inadequate cover to prevent cross contamination. Staff told us they washed their hands before returning to food preparation. The person completing the medicine round was also called away to help with care. People’s medicines were administered safely but interrupting the round can increase the possibility of mistakes taking place. We have asked the provider to review the latest guidance in respect of this and also review how they rotate and manage the stock of medicines.

People

During our visit we spoke with three people who live in the home. We also observed people taking lunch in the home, and observed people who were involved in a board game activity in the afternoon.

People told us that they felt positive about the quality of care they received and with their relationships with the staff. We saw people moving freely around the home and interacting with the staff in a relaxed way. A person told us, “We are well catered for here. The food is good. We get a glass of wine with lunch -- We’re a very happy bunch.”

People told us that they were asked for their consent when making choices and decisions about their daily lives; and that their choices and decisions were respected by the staff. A person told us, "They do ask before they do anything.”

The home had procedures in place to ensure that people received their medicines as prescribed. Medicines were handled in a secure way. The registered manager told us, "The owner is a qualified pharmacist."

We found that there were sufficient numbers of staff, with the right competencies. A person told us, "The staff are kind and helpful -- There are enough staff here -- I feel safe here.”

The home was taking account of people's comments or complaints. People told us that they could be sure that their comments were listened to, and responded to appropriately.

We spoke with people who told us they were “very happy” with the home and the level of care they received. One person told us they were “nice and happy” and another said “the staff can’t do enough for you."

People told us the food was “very, very good” and that they had a “good choice of food”. People said that they felt safe in the home and one person described the staff as “very kind and patient.”

We saw that the staff were supported by the provider through regular training and that staff were encouraged in their professional development.

The home had suitable systems to monitor the quality of the service provided and to assess and manage risks to the health, safety and welfare of people using the service and others.

We talked to four people in their rooms and spent time hearing about their experiences of living at Shire House. They were all able to answer direct questions about the home and seemed at ease and happy to share their views. People told us about their own individual daily routines, and how they made choices about where they spent their time. They told us that staff supported them to maintain friendships.

One person told us that the carers knew them very well, and that a member of staff wrote the care plan with them. We saw that they had signed their own care plan.

We also met seven other people during our visit as they made their way into the dining room or as they waited for the lunch. They told us that there was a choice of meals, and explained that they could make specific requests for meals.

People were all able to answer direct questions about their care and well-being. One person told us that a group of the staff were ‘‘born carers’’ and that the staff were ‘’delightful’’. Another person said they felt that their loss of physical independence was tempered by being treated as an equal by staff. A third person said that staff were ‘’OK’’ and a fourth said that the staff had literally saved their life and that they were ‘’wonderful’’. A fifth person told us that they were ‘’wonderfully cared for’’. People felt they knew who to talk to if they had a complaint or a concern.

People told us that their environment helped maintain their well-being, such as being able to bring in their own furniture and being able to receive visitors in their rooms. Four people told us their beds were very comfortable and that they were warm. People told us that their large bed sit style bedrooms gave them a feeling of independence. Nearly all were personalised with people’s own furniture, such as three piece suites, pictures, plants and ornaments. People told us this was important to them.

People told us that they had good contact with health care professionals and could give us examples of the type of care they received, which was reflected in their care records.

People told us about how they had moved to the home, although some were unclear about the specifics as they had been quite ill at the time and had to leave the choice to their spouses or relatives.

People spoke to us generally about the home, which they felt was well run and they told us that they felt well cared for. One person said they would like to see the manager more as they spent time in their room and therefore did not see her in the communal areas but they were clear that they could speak to other staff members if they had a problem.