Shangri-La provides accommodation and personal care for up to 26 older people, some of whom live with dementia. Accommodation is arranged over two floors with stair and lift access. At the time of our inspection 20 people lived at the home.

We rated the home ‘Requires Improvement’ at its last inspection in December 2016. At that inspection we identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. These included breaches of Regulation 9, person centred care; Regulation 11, need for consent; Regulation 12, safe care and treatment and regulation 17, good governance.

At this inspection we found the provider had rectified the breaches found at the last inspection; the home is now rated ‘Good’.

There was a registered manager at the home. 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 and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of all oral medicines. However, the system in place to ensure that topical creams were not used beyond there ‘safe to used by date’ was not robust. This was discussed with the registered manager who told us that they would review the current system and take immediate action to ensure that creams were labelled clearly. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Risks to people had been assessed and completed risk assessments contained detailed personalised information about the person and their circumstances. Risks assessments identified the risks along with the actions taken to reduce these risks. Staff were able to explain the risks relating to people and the action they would take to help reduce the risks from occurring.

There was enough staff to meet people’s needs and staff had the time to engage with people in a relaxed and unhurried manner. People received person centred care from staff who knew each person well and understood there needs and personal preferences.

Staff had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Staff developed caring and positive relationships with people and were sensitive to their individual choices, treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were provided with appropriate mental and physical stimulation through a range of varied activities.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs. People and their families were encouraged to provide feedback on the service provided both informally and through quality assurance questionnaires.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

There were systems

This unannounced comprehensive inspection took place on 5 and 6 December 2016. Shangri-La Residential Home provides personal care and accommodation for up to 26 people. On the days of the inspection 24 people were living at the service.

The service had a registered manager. 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 service was last inspected in November 2015 and was rated as requires improvement. Requirement actions were made regarding seven breaches relating to a lack of risk assessments, the deployment of skilled staff, medicine management, the lack of clear personalised records, the lack of staff training and mental capacity assessments. We received an action plan from the provider in December 2015, telling us how they were going to take action to ensure compliance with the breaches.

Staff understood the principle of keeping people safe and were aware of safeguarding protocols. Risk assessments had been completed but had not always been personalised or kept up to date to reflect people’s changing risks. Staffing levels met the needs of people, and staff enjoyed the training programme. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely but records needed to improve.

Staff had a basic knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without their agreement or being in their best interests. People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.

People’s records did not demonstrate people had their needs met in a planned and personalised way. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and were clear about their roles and the values of the home. Records were not always accurately maintained and this was not an effective part of the quality audit process.

We found breaches in 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three of these are repeated regarding risk assessments, records and personalised care. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 12 November 2015. Shangri-La Residential Home provides personal care and accommodation for up to 26 people who are living with dementia or other mental health conditions. On the day of our inspection 26 people were living at the home and one person was in the home for day care.

The service had a registered manager. 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 had risk assessments but these had not always been updated as people’s needs changed. Staffing levels were not consistent and at times there was not enough staff on duty to meet people’s needs. Staff had undergone recruitment checks but attention was needed to ensure all documentation was available and we have made a recommendation about this. Staff had a good understanding of how to keep people safe and what action they should take if they had any concerns. Medicines were not always administered safely but were stored safely.

All staff had not received training to ensure they could meet people’s needs. Staff had a good knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. People enjoyed the meals and were offered a choice at meal times. Records of people’s nutritional intake were not adequate to know a person’s food and fluid intake. People were supported to access a range of health professionals.

People did not always have their individual needs met in a personalised way. People felt confident they could make a complaint and it would be responded to. Complaints were logged but the recording of the investigation and outcome could have been more detailed in their recording.

The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the manager and were clear about their roles and the values of the home and the organisation. Records were not always accurately maintained and this was not an effective part of the quality audit process.

We found breaches in four 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.

People told us they were involved in making decisions regarding the way the home was run and in their day to day decisions. We observed staff interacting with people in a respectful manner. People were involved in choices and had thier privacy respected.

The manager had improved the detail in the care plans, so they accurately reflected the needs of each indivual. People told us their needs were met and they liked the staff. People told us.the staff are "wonderful and very patient".

Medication procedures were well managed in the home.

Staff went through an effective recruitment procedure to ensure people were not placed at risk.

The manager had an effective system to ensure the service it provided to people was monitored and reviewed.

People told us they were treated with respect and their privacy was maintained at all times. Records demonstrated respecting a person's privacy was part of a person's care plan. Care plans where possible had included the person in the development of the plan. One person told us they were very happy at Shangri La and living there had taken their worries away.

Assessments and care plans had been completed. Care plans did not always detail the correct information or explain the identified risks relating to the care plan.

From records regarding the administration of medication it was not always possible to establish if people had received all their medication. Controlled drugs were not being stored appropriately.

Staffing records viewed demonstrated not all the necessary checks had been carried out on staff before they started work in the home. People told us they liked the staff.

Clear information was displayed in the home regarding the complaints procedure. We were able to establish complaints were taken seriously and acted upon.

During the visit we spoke with six people who use the service. People said they felt they were well treated by staff. We were told staff were respectful of them and listened to their requests.

People said they received the care they needed in the way that they wanted it to be provided. People told us staff responded promptly when they were called and helped them to resolve any problems they had.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised.