This unannounced inspection took place on 4 April 2018.

At our last comprehensive inspection in January 2017 we gave the service an overall rating of ‘Requires Improvement’. This was because medicines and risks to people were not always appropriately managed and the provider’s audits had failed to detect this. We served the provider with warning a notice. In May 2017 we carried out a focused inspection of the service. Whilst we found improvements were made we did not improve the service's overall rating. This was because the provider needed to demonstrate consistent good practice in all aspects of the care over a longer period of time.

Shirley View Nursing Home 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 service is registered to provide accommodation, nursing and personal care for up to 22 people. At the

time of our inspection there were 11 people using the service.

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.

People received their care and support safely. People’s risks were assessed and reduced by staff who understood how to protect people from improper treatment. People’s medicines were stored securely and administered in line with the prescriber’s instructions. Staff followed appropriate personal care and food safety practices to prevent infection.

Staff were supported in their role by the registered manager who delivered supervision and appraisal and coordinated staff training. People’s needs were assessed and they received the support they required to eat and drink. Staff delivered care in line with the principles of the Mental Capacity Act 2005 and people accessed healthcare services whenever required.

Caring staff maintained people’s privacy and dignity. People were supported to maintain relationships with relatives and friends. Visitors were made to feel welcome and people were supported to practice their faith.

People had personalised care plans which detailed how they wanted staff to meet their individual needs. Keyworkers were allocated to support the implementation of people’s personalised care. A range of activities were provided by staff for people to participate in. Information was available for people to access the provider’s complaints procedure. The registered manager understood the provider’s procedure for handling complaints that we saw was clearly documented.

The registered manager had improved quality assurance processes and brought the service out of regulatory breach. There was an open culture at the service and the views of people, relatives and staff were gathered. The service worked in partnership with other agencies to secure positive outcomes for people.

At an inspection of this service in January 2016 we found the provider to be in breach of three regulations in relation to staffing, good governance and notifications of incidents. We carried out a focused follow-up inspection on 5 and 8 July 2016 and found these breaches of regulations had been resolved. However, we also found the provider to be in breach of the regulation in relation to safe care and treatment because fire doors were not closing properly and medicines were not always stored securely.

At our most recent comprehensive inspection of the service on 11 and 13 January 2017 we found the provider had resolved the issue with fire doors not closing properly, although there continued to be concerns with the way they managed medicines. Specifically, cupboards and refrigerators used to store medicines were not kept locked and there were not always sufficient instructions for staff about when to give people certain medicines or what to do if people declined to take their medicines. We also found that some risks were not managed adequately, including some risks presented by the home environment and other risks that were specific to individuals, such as the use of bed rails. In addition, the provider’s checks and audits to help them monitor and improve the quality of the service were still not sufficiently robust, as they had failed to identify all the issues described above.

We served the provider with a requirement notice for the breach of regulations in relation to good governance and a warning notice for a repeated failure to meet the regulation in relation to safe care and treatment. The provider wrote to us in March 2017 to say what they would do to meet legal requirements in relation to the breaches described above. We undertook an unannounced focused inspection of the service on 16 May 2017 to check the provider had followed their action plan and now met legal requirements.

This report only covers our findings in relation to the breaches we found at the last full comprehensive inspection of this service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Shirley View Nursing Home’ on our website at www.cqc.org.uk’

Shirley View Nursing Home provides accommodation, nursing and personal care and support for up to 22 people. The home specialises in supporting older people living with dementia. There were 14 people living at the home when we inspected.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our inspection, we found that the registered provider had made the improvements they said they would in the action plan they had sent us; most notably in the way the managed medicines and the risks people might face, and monitored the quality and safety of the care and support people living at Shirley View Nursing Home received. However, while improvements had been made we have not revised the service’s overall rating which remains 'Requires Improvement'. To improve the service’s overall rating would require the provider to demonstrate consistent good practice in all aspects of the care they provide over a longer and more sustained period of time.

The provider had improved the way they managed people’s medicines. Medicines were now managed safely and people received them as prescribed. We saw robust systems were in place to ensure medicines were stored, administered, recorded, reviewed and handled safely by competent staff.

We saw the way in which the provider assessed and managed individual risks to people’s health and safety had been significantly improved. Staff knew how to minimise and manage these risks in order to k

This inspection took place on 11 and 13 January 2017 and was unannounced.

Shirley View is registered to provide accommodation, nursing and personal care for up to 22 people. At the time of our inspection there were 15 people using the service. 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.

At our last comprehensive inspection on 26 January 2016 we found three breaches of regulations in relation to staffing, good governance and notifications of incidents. We carried out a follow-up inspection on 5 and 8 July 2016 and found these problems had been resolved. However, we also found the provider was in breach of the regulation in relation to safe care and treatment because fire doors were not closing properly and medicines were not always stored securely.

At this inspection, we found the provider had resolved the issue with the fire doors. However, there were still problems with medicines management. Cupboards and refrigerators used to store medicines were not kept locked, although these were kept in a lockable room. There were not always sufficient instructions for staff about when to give people certain medicines or what to do if people declined to take their medicines.

We also found that some risks were not managed adequately, including some risks presented by the home environment and some risks that were specific to individuals, such as the use of bed rails. However, there were detailed risk management plans to help staff protect people from other risks, such as those of falling or developing pressure ulcers.

The provider had checks and audits to help them monitor and improve the quality of the service, but these were not sufficiently robust as they had not identified the issues described above.

We found two breaches of regulations. We have served a requirement notice for the breach of regulations in relation to good governance. We are taking further action against the provider for a repeated failure to meet the regulation in relation to safe care and treatment. Full information about our regulatory response is added to reports after any representations and appeals have been concluded.

People had care plans covering areas where they needed care and support. However, these were not always sufficiently personalised and did not contain information on people’s likes, dislikes and preferences about how they wanted their care delivered, or about how to meet people’s emotional and psychological needs. Although the staff we observed appeared to know people well and we saw staff supporting people appropriately, there was still a risk that new or temporary staff would not have the information they needed to respond to people’s needs.

The provider had appropriate policies and procedures in place for reporting alleged or suspected abuse. Staff were familiar with how to recognise and report abuse and people and their relatives felt they were safe at the home. There were enough staff to keep people safe and the provider carried out appropriate checks when recruiting staff to help ensure they were suitable to care for people.

Staff received the training and support they needed to do their jobs well, including specialist support in caring for people living with dementia. Staff had opportunities to learn about specific health conditions people had and to discuss good practice as a team.

Staff were aware of their duties in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation intended to ensure that where people are unable to consent to the care and treatment they need, this is only provided in their best interests and in such a way as to ensure their rights

The last inspection of this service was carried out on 26 January 2016 when we found the provider was in breach of the regulations. This was because the provider had failed to ensure staff received appropriate support through regular supervision and appraisal of their work performance, operate effective governance systems to routinely monitor the quality and safety of the service and notify the Care Quality Commission (CQC) in a timely way about incidents involving people using the service.

After the service’s last inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to all the breaches described above. We undertook an unannounced focused inspection of the service on 5 and 8 July 2016 to check the provider had followed their action plan and now met legal requirements.

We also received concerning information from the London Fire and Emergency Planning Authority (LFEPA) who last inspected Shirley View Nursing Home in February 2016 who found the provider in breach of fire safety regulations. During this inspection we also checked the provider had complied with the requirements they had received from the LFEPA following their last inspection of the service.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Shirley View Nursing Home’ on our website at www.cqc.org.uk’

Shirley View Nursing Home provides accommodation, nursing and personal care and support for up to 22 people. The home specialises in supporting older people living with dementia. There were 19 people living at the home when we inspected the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our inspection, we found that the registered provider had implemented the action plan they had sent us in February 2016. Specifically, we saw the provider now gave staff on-going support through regular supervision, operated effective governance to monitor the quality and safety of the service people received and informed the CQC without delay about the occurrence of any incidents that might have adversely affected the health, safety and welfare of people living at the home.

However, while we saw the provider had made improvements, we identified one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. This related to the providers failure to manage risks in the event of a fire by making sure their fire safety equipment was always well maintained and fit for its intended purpose. Specifically, not all fire doors would fit properly into their frames when closed. You can see what action we told the provider to take in relation to this breach of regulations, at the back of the full version of the report.

This inspection took place on 26 January 2016 and was unannounced. The last Care Quality Commission (CQC) inspection of the home was carried out on 4 July 2014, where we found the service was meeting all the regulations we looked at.

Shirley View provides accommodation, nursing and personal care for up to 22 people. The service specialises in supporting older people who are living with dementia. There were 17 people residing at the home when we visited.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had failed to notify the CQC without delay about all the incidents and events that had affected the health, safety and welfare of people living at the home. This had included several falls which had resulted injuries to people and the authorisation of applications by the local authority to deprive people of their liberty. This meant the CQC could not follow up what action the provider took in relation to these incidents because we had not been made aware of their occurrence.

The provider did not always operate effective governance systems to assess, monitor and improve the quality, safety and experience of people using the service. Although the owner, manager and senior staff all told us they regularly carried out a range of checks to assess and monitor standards within the home, we found no recorded evidence that demonstrated these audits were documented along with any actions taken by the provider to remedy any issues they had identified.

The provider’s arrangements for ensuring staff were suitably supported by their managers were inconsistent. We found that most staff had not attended individual supervision (meetings) with their line manager for over six months or had their overall work performance appraised yearly. This meant staff might not have enough opportunities to reflect on their working practices, discuss work related issues or concerns and any learning and development needs they felt they had.

We identified three breaches of the Care Quality Commission (Registration) Regulations 2009 and the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

We have also made a recommendation about the home’s environment and design not being as dementia ‘friendly’ as it could be.

People were happy with the standard of care provided at Shirley View. We saw staff looked after people in a way which was kind and caring. Our discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were also respected. When people were nearing the end of their life they received compassionate and supportive care.

People were safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The service also managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies.

We saw people could move freely around the home. The provider ensured regular maintenance and service checks were carried out at the home to ensure the building was safe.

The provider had carried out appropriate checks to ensure they were suitable and fit to work at the home. There were enough suitably competent staff to care for and support people. The manager continuously reviewed and planned staffing levels to ensure there were enough staff to meet the needs of people u

A single inspector carried out this inspection. We visited the home on 4 July 2014 and spoke with two people who lived at Shirley View, a visiting GP, the registered manager and the owner. We toured the premises and looked at all the homes’ bathrooms. Before our inspection, we reviewed the information we held about the home.

Our previous inspection of Shirley View found that the provider had breached regulations relating to availability of essential equipment to ensure people needs were met. We were concerned that two baths had not been appropriately maintained, which meant people living in the home did not have access to suitably adapted bathing facilities. We asked the provider to send us an action plan outlining how they would make improvements.

When we inspected the service again in July 2014 we found the provider had installed two new baths on each floor of the home.

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with three people using the service, three of their visiting relatives and four members of staff; and, from looking at various care and staffing records.

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

We considered our inspection findings to answer five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

We observed the way staff interacted with the people using the service and saw they treated people with respect and dignity. People we spoke with told us they felt safe living at Shirley View nursing home. This was confirmed by discussions we had with visiting relatives. One person said “I have always felt safe here”. Another person told us “I have no doubt that Shirley View is a very safe place for my relative to live”.

We found the services safeguarding procedures were robust and staff understood how to safeguard the vulnerable people they supported. The home had proper policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood when an application should be made, and how to submit one. This means that people will be safeguarded as required.

We saw staff regularly assessed potential risks to people’s health and welfare both within the home and in the community. There was appropriate guidance for staff on how to manage these risks and keep people safe.

There were enough staff on duty to meet the needs of the people living at the home. The registered manager sets the staff rota and we found they take account of people’s care needs when making decisions about the numbers, skills and experience of the staff required to cover each shift in the home. This helps to ensure that people’s needs are always met.

Is the service caring?

People we spoke with told us they were satisfied with the care and support provided by staff who worked at Shirley View. Typical comments we received included, “I like living here. It’s a nice place”, “the care is fabulous here and so are the staff” and “I think my mother is very happy here… We think it’s the best home around”. We saw people using the service were supported by kind and attentive staff. We found people’s diverse needs had been recorded and saw that care and support was provided in accordance with people’s wishes.

People told us they felt able to provide feedback about the quality of the care and support provided at Shirley View and were confident their views were taken into account. People felt where they had raised issues the provider had listened to them and taken appropriate and timely action. People said they felt involved in helping staff to improve the home by regularly attending care plan reviews, having meetings with the manager and by completing the provider’s annual satisfaction surveys.

Is the service responsive?

People’s needs were assessed before they moved into the home and were reviewed on a regular basis.

We found staff continually monitored people’s condition and where necessary sought the assistance of other health and social care professionals.

Is the service effective?

People told us that they were happy with the care they received at Shirley View and felt their needs were met. It was clear from speaking with staff that they understood people’s care and support needs, and were familiar with their likes and dislikes. We saw people using the service and their relatives were involved in helping staff plan peoples care plans. Their views and experiences were used to develop their care plan.

We saw people were supported to eat and drink sufficient amounts of nutritionally well-balanced food and drink that met their needs. The feedback we received from people about the quality of the food they were offered at Shirley View was positive. One person told us “food is very good here”, and another person said “you can choose what you eat and the meals are usually okay”.

We found staff had received training to meet the needs of all the people using the service and were well supported by the homes management. Staff we spoke with were also clear about their support worker roles and responsibilities.

Is the service well-led

The home had a registered manager who was experienced and knew the service well. People using the service, staff and relatives we spoke with said the leadership of the service was excellent and it was a good place to work.

The provider carried out regular checks to assess and monitor the quality of service provided. The views of people using the service and the staff that cared for them were taken on board by managers. The provider had listened to feedback and made changes that improved the overall quality of the care and support people received. This meant people could be confident the quality of the service was being assessed and monitored.

We found there were sufficiently robust systems in place to ensure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and safeguarding investigations. This reduces the risks to people and helps the service to continually improve.

At our previous inspection we identified that action needed to be taken by the service to improve the range of social and leisure activities the people who lived at Shirley View had the chance to participate in each day. During this review we found evidence that showed us appropriate action had been taken by the provider to improve activities at the home.

We spoke with two out of the seventeen people who lived at the home. They told us they were happy with the care they received from staff and felt there were usually enough interesting activities for them to participate in, if they chose to. One person said “I am one hundred per cent happy living here. I never get bored because there’s always something going on” and another individual told us “the staff are smashing. I like to read, but if I wanted to join in some of the group activities I could”.

However, although people we spoke with told us they were happy living at Shirley View and felt well supported by the staff who worked there; we found that the service had not provided the people who used the service and their representatives with enough easy to understand and accessible information about the providers complaints system. This meant that people who used the service and their representatives may not know how to make a complaint if they had any concerns.

We used a number of different methods to help us understand the experiences of people who lived at Shirley View nursing home because not everyone was able to talk to us. During our inspection we spoke with three people who used the service and two of their visitors. We also examined three support plans, ten stakeholder comment cards, the homes complaints log, and a random sample of staff files and Medication Administration Record sheets.

Visitors we met told us the staff were always kind and compassionate and that they were satisfied with the overall standard of care and support provided at the home. One visitor told us “The staff are great. They treat my mother with the respect and dignity she deserves”. Another visitor said “The staff are really nice here. Always welcoming and most of them are pretty good at what they do”.

However, although visitors we met said they were generally happy with the care and support the people they represented received; we found people’s needs and wishes may not always be fully met because individuals social interests and wishes had not been properly assessed or planned for by the service. There was a lack of opportunities for people to participate in fulfilling and interesting activities.

At the time that we visited there were thirteen people living in the home. We spoke with four of them although some people found it difficult to communicate with us or contribute towards the inspection process because of their ill health or dementia.

We also spoke with the relatives of two people who lived at the home.

They told us that staff were kind and caring. Typical comments we received from people we met, included: “The home is very nice”, “The staff are lovely”, and “The food is good. I like living here”. We also saw staff support being provided in a way that protected the dignity of people using the service.

However, although the people receiving services in the home told us they were happy and we saw that they were well supported; we found that failures to ensure the environment was appropriately maintained and kept in a good state of repair may have adversely affected the health and welfare of the people use the service.

People that we spoke with told us” it’s alright here” “staff are nice” and “I’m alright, quite happy”. Those who were unable to talk with us looked comfortable.

They told us they enjoyed the food that was served. Comments included “its always very nice, I don’t know what lunch will be but its always good”,

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practicing professional.

We used the Short Observational Framework for Inspections (SOFI).SOFI is a specific

way of observing care to help us understand the experience of people who could not talk with us.

At the time that we visited there were 13 people living in the home. We spoke with several of them although some people found it difficult to communicate with us or contribute towards the inspection process because of their ill health or dementia. We also spoke with the relatives of two people who use the service. Comments we received included "the home is fantastic" and “staff are lovely and always treat my mother with respect". People also told us "the food is good” and "there's usually a good choice of meals here".