27 June 2017
During a routine inspection
Shottsford House is registered to provide personal care with accommodation for up to 10 adults. At the time of the inspection four people were living at the service. There were two units on the ground floor with five ensuite bedrooms in each. There was a communal lounge and dining room. Shottsford House supported people with learning disabilities, autism and personality disorder.
The service had a Registered Manager in place. 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.
Staff did not consider that there were sufficient staff to support people safely should more than one person require support to manage their behaviour. Staffing levels were assessed as part of people’s pre-admission assessments. The service had a number of vacancies which the provider was actively trying to fill. The registered manager told us that they used agency staff to cover vacant shifts and tried to block book staff to ensure consistency, however this had not always been possible. On occasion agency staff had not reported for duty.
We recommend that the provider reviews their processes for assessing and monitoring staffing levels at Shottsford House.
On day one of the inspection we found that three fire doors in Shottsford House had been broken and removed following an incident involving a person who lived at the service. We were told that this had happened approximately six months ago. This had put people, staff and the service at an increased risk harm during this period of time. We reported this to the fire officer at Dorset and Wiltshire Fire and Rescue who told us they would arrange for a fire audit to take place.
Information was not always provided in an accessible way to enable people to be involved about decisions about their care. Agreements had been signed in relation to restricted areas of the home. Two people told us that they preferred information to be bullet pointed short, simple sentences. They said that sometimes pictures help. The agreements were written in long sentenced paragraphs with no bullet points or pictures to aid understanding. The registered manager told us that these agreements had been put in place in the short term following findings of a recent provider audit and that the restricted areas were under review.
People told us that they did not have the choice to eat meals in other areas of the service and staff confirmed this. We noted that one person shouted a lot and required staff support. People told us that this disturbed their meal time experience. One person told us that they were sensitive to noise and that the shouting made them anxious.
People’s privacy and dignity was not always respected by staff. People were often interrupted by staff when they met with CQC and other health and social care professionals. We noted that people had holes in their bedroom doors which allowed observation of them from outside the room and that hourly observations took place.
Shottsford House did not always provide personalised care and support which was responsive to people’s needs. We found that people who were working towards living in their own flats in the community did not have plans to support them become more independent.
Individual assessments had not been completed to ensure that the environment met everyone’s needs. We found that everyone had restricted access to the kitchen, laundry, exiting the home and to one door to the lounge. We were told that people could have a drink or food but would need to find staff and ask them for access into the kitchen.
People were not actively involved in the reviewing of the care and support. Staff and people told us that feedback was not sought prior to multi-agency review meetings. Professionals, relatives and people told us that there were often communication breakdowns at the service which meant that peoples changing needs were not always responded to efficiently.
People were not regularly supported to access meaningful occupational activities either inside or outside of Shottsford House. People attended community meetings with staff where topics were discussed. However, people were not always listened to nor did the service actively learn from people’s experiences.
Shottsford House was not always well led. Staff and professionals feedback demonstrated a mixed understanding of the services purpose. The registered manager told us that the services Statement of Purpose was due for review.
Staff told us that the registered manager was not always visible and that their office location took them away from what was happening in the service. Communication was not always effective between the management and staff. Quality monitoring systems did not capture people’s experiences and quality questionnaires had not been submitted to people or stakeholders.
Medicines were managed safely, was securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.
Staff were aware of risks people presented to themselves and others. Risk assessments formed part of peoples care and support plans.
Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, personality disorder, intervention and learning disabilities.
Staff told us they received supervisions which were carried out by management. We reviewed records which confirmed this.
People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had received food hygiene training.
People were supported to access healthcare appointments as and when required and staff followed health professional’s advice when supporting people with ongoing care needs.
People told us that some staff were caring. During the inspection we observed some positive interactions between staff and people.
There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them.
Some staff and people told us that they found the registered manager to be good. One person said, “The registered manager is really sweet and caring. They seem to genuinely care about us all and want’s what is best for us”.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
We found a number of breaches 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.