Shire House Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

During handover at the start of each shift, information was shared with staff. This included actions to be taken by staff as a result of lessons learned in areas of activities, incidents and accidents.

The registered manager ensured all incidents were reviewed; actions were taken such as referrals to healthcare professionals that were indicated when incidents were investigated, and learning was shared with staff and relatives as appropriate.

The provider worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services. The registered manager described positive working relationships with district nurses and the Frailty Team who attended the service at least weekly.

People were fully assessed before admission to Shire House Care Home, and in the event any challenges following admission, advice was sought from relevant professionals.

People had ‘hospital packs’ available on the electronic care (eCare) record system to transition important information about a person’s health needs in the event of a hospital admission. Staff there were briefed on their needs and wishes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were protected from the risk of harm and abuse; safeguarding processes were clear and robust. There was a safeguarding reporting system in place that staff expressed full confidence in using. Safeguarding referrals had been made as necessary, including notifying CQC of specific events as required.

Staff were trained in safeguarding and were confident about what to report and actions they should take.

People were not lawfully deprived of their liberty. The registered manager submitted appropriate Deprivation of Liberties Safeguarding (DoLS) applications to authorise any restrictions on people’s liberty. These were accompanied by Mental Capacity Act (MCA) assessments. MCA assessments were also completed when best interest decisions were needed because the person lacked capacity to make choices.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed a range of different risk assessments including for example, falls and choking risk assessments. The choking risk assessment for a person had identified a risk. They were referred to Speech and Language Therapy, (SaLT) for assessment and advice and now had meals prepared to a modified texture and thickened fluids. These actions had been included on their risk assessment and mitigated the identified risks.

Everyone we spoke with told us they, or their loved one felt safe, and that staff knew people very well. Relatives described the staff as being, “Kind, amazing and do a pretty good job.” Staff described the checks they carried out to ensure people were safe, such as checking equipment was in order before using it.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We inspected after receiving an enforcement notice from the fire service as a result of them finding numerous shortcomings in fire safety at Shire House. All of these areas were in process of being fixed to achieve full compliance.

We reviewed all other areas of premises’ safety including water hygiene management, electrical safety and hoists. We found all risk assessments, actions, services and checks had been completed according to a strict timetable. Areas needing improvement were fixed in a timely way.

However, we did see some areas of concern, including radiator cabinet covers that were not securely fixed to the wall. There was also furniture that did not have anti-tip brackets or straps to prevent them potentially tipping onto a person. There had been no incidents involving these items and the registered manager noted them for repair when we informed them.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were sufficient staff deployed to meet people’s needs. The registered manager and deputy manager told us they had either 4 or 5 staff on shift in the morning. The management team were in the process of reviewing their staffing levels to improve continuity of care.

Staff completed a thorough induction and were supported to access courses that would provide them with health and social care qualifications. They were also enabled to join organisations such as NAPA, an organisation supporting activities coordinators in care settings, in order to promote them developing skills.

Staff also participated in 1-to-1 supervision sessions with the registered manager and in an annual appraisal. The registered manager was visible around the service and joined the staff team daily for lunch where they could discuss the day. A staff member told us, “The management team giving a huge support for me, they are always encouraging me to develop my skills.” A relative said, “All the staff / carers have been helpful, caring, attentive and cheerful.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Infection prevention and control measures were in place; however audits had not identified some concerns we found. For example, the toilets in one communal shower room and an ensuite shower room had been fixed onto raised plinths in order for people to more easily access them without using additional equipment such as toilet raiser seats. These were made of wood covered with plastic; however areas of the wood were bare, meaning porous areas where germs could be absorbed were below both toilets. We did not check each toilet in the service however action should be taken to ensure the wood is sealed on these and any others affected. We also noted 2 cantilever tables had begun to wear away, again leaving bare wood which could not be kept hygienically clean. Doorframes also had scrapes from use and again, bare wood was on show. The registered manager told us action would be taken to resolve these shortfalls.

Staff were aware of the importance of IPC protocol including correct hand washing, use of personal protective equipment (PPE) and disposal of waste products.

There were dedicated domestic staff who followed cleaning schedules to ensure areas of the home were clean. Relatives confirmed the home was clean and tidy whenever they visited their loved one. We found the service appeared clean and there were no malodours.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Records showed that people received their medicines safely and as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. Audits were completed to ensure medicines were managed safely, including reviewing the storage and safe disposal of unused medicines.

Staff completed regular competency checks when handling medicines. We observed staff administer people’s lunchtime medicines in a safe and orderly way. This included people’s ‘as and when needed’, (PRN) medication. Staff asked people if they needed their PRN medicines. For example, staff asked if people required any pain relief. They described how they would recognise if a person was experiencing pain if they were not able to say so for themselves.

Staff had ‘protected time’ when administering medicines in order to help them concentrate on the task without being disturbed.