Shearwater is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide accommodation for up to 60 people some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. There was a good choice of communal spaces where people were able to socialise and all bedrooms had en-suite facilities. At the time of our inspection there were 34 people living at the home.

The inspection was conducted on 9 and 14 May 2018 and was unannounced.

At the time of the inspection there was not a registered manager in post at the service, there was a manager who had taken over the overall running of the service and was planning to apply to become registered to manage the home.

At our last inspection, in September 2017, we identified breaches of Regulation 12; Safe Care and Treatment, Regulation 18; Staffing, Regulation 17; Good Governance and Regulation 9; Person Centred Care, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in the service receiving an overall rating of 'Inadequate' and being placed in special measures.

At this inspection the service received an overall ‘Requires Improvement’ rating and was removed from special measures. We recorded one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the Need for Consent. You can see what action we told the provider to take at the back of the full version of this report.

Improvements had been made in the quality assurance processes within the home and we saw robust audits were completed for most areas. However, we found further work was still required in some areas including working within the principles of the MCA and ensuring that all medicine was managed safety.

We found that in the main improvements had been made that had resulted in people receiving safer, more effective, person centred care. A range of processes and procedures had been put in place and were followed to help ensure staff followed best practice guidance when providing care and support to people.

People told us that they received their medicines safety and on time. However, medicines were not always stored safety and where people were prescribed topical creams there was not clear and robust systems in place to ensure these were given appropriately.

Risks to people were assessed and managed effectively. Staff were provided with clear guidance on how risks should be managed and demonstrated an understanding of specific risks to people.

Where accidents and incidents had occurred, these were clearly logged, reviewed and analysed to see if there were any common themes and if there could be any learning from these events.

There was enough staff deployed to meet people’s needs and keep them safe. The staffing level in the home provided an opportunity for staff to interact with the people they were supporting in a relaxed and unhurried manner.

Staff had the knowledge and confidence to identify safeguarding concerns and acted to keep people safe. Staff had received training in safeguarding, which helped them to identify, report and prevent abuse.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed. People's needs were met by staff who were competent, trained and supported appropriately in their role.

People were supported to have enough to eat and drink and had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Staff showed care, compassion and respect to the people. There was a relaxed and calm atmosphere within the home. Peop

Shearwater provides accommodation and personal care for up to 60 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 52 people lived at the home.

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.

At our last inspection, in January 2017, we identified breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure adequate systems and processes were in place to assess, monitor and mitigate the risks associated with people's care and ensure the safety of the services they provided. There was a lack of clear guidance in place for the safe use and administration of some medicines to ensure the safety and welfare of people. Risk assessments associated with people's care did not provide sufficient detail as to how staff could reduce risks to ensure people’s safety and welfare. Records held in the service were not always accurate and complete. At this inspection we found continued breaches of these regulations, together with other concerns.

The provider has a history of not being able to make and sustain improvement in this home and has been in breach of regulations at every comprehensive inspection of the home since 2012. These breaches have often related to the same shortfalls.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider’s quality and safety monitoring systems had not been effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision.

Risks to people had been assessed; however information within people’s risk assessments and care records was inconsistent and conflicting. Important and relevant information about people’s changing needs was not always robustly shared with staff. This could result in ineffective and inappropriate care being provided to people, which would place them at risk of harm or injury.

Care plans were not person c

We carried out a comprehensive inspection of this service in September 2015 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who use the service. Risks associated with people’s care had not always been assessed, people had not always consented to the care they received, records held in the service were not always secure, accurate and complete and staff did not always receive adequate supervision to support them with their working role. The registered provider sent us an action plan detailing how they would address these concerns and said they would be compliant with the Regulations by 1 November 2015. We carried out an unannounced inspection of the home on 25 and 26 January 2017 and found, whilst the provider had made improvements in some of these areas they were not fully meeting all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home provides accommodation and personal care for up to 60 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 52 people lived at the home.

A registered manager was not in post 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. A registered manager left the service in March 2016. A unit manager was employed at the home at the time of our inspection and recruitment processes were underway to employ a manager to the home who would register with the Commission. A deputy manager in post had been in the service for more than three years and provided some consistency in leadership in the home.

Medicines and prescribed substances were not always managed in the home in a safe and effective way. Risks associated with medicines and prescribed substances had not always been identified and actions taken to reduce these risks.

Risks associated with people’s care had mostly been identified and plans of care were in place, however the risks associated with the safe evacuation of people in the event of an emergency had not been assessed and plans of care were not in place to reduce these risks.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Staff recruitment processes were robust and staff received sufficient support and supervision in the home. However staff lacked training in some areas such as first aid and in the use of some medicines.

People received freshly prepared nutritious food in line with their preferences although further work was required to support people who lived with diabetes. We have made a recommendation about this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans mostly reflected the individual needs of people and the risks associated with these needs, although some information lacked consistency.

People were supported to participate in a wide range of events and activities of their choice.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns an

In this report the name of a registered manager appears who was not managing the regulatory activities at this location at the time of our inspection. A registered manager from another Portsmouth City Council home was overseeing the management of the regulated activities at the time of our inspection. We have been informed this is a temporary arrangement.

One inspector carried out this inspection. At the time of our visit 50 people were being accommodated at the home over three floors.

The focus of this inspection was to follow up a warning notice which had been served following our last inspection with respect to outcome 21 and the management of records at the home. We checked the provider had ensured people received safe or appropriate care by the maintenance of accurate records and documentation in relation to the care they received.

During this inspection we found the provider had taken appropriate action and records reflected people received safe and appropriate care.

The inspection team was made up of one inspector and one specialist advisor. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff who supported them and records we looked at. During this inspection we looked at the care records of twelve of the 54 people living in the home.

During this inspection we were looked at the progress the provider had made to meet the two warning notices and one compliance action from our last inspection in January 2014. We found the provider had made good progress with the two outcome areas where warning notices had been served. However we found that the record keeping in the home had not improved.

At the time of our visit the registered manager for Shearwater was not managing the service. The home was being managed by a registered manager for another of the provider’s homes.

Is the service safe?

We found that there were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and investigations. Whilst staff were able to explain to us about the principles of the Mental Capacity Act we found there was a lack of consideration with regard to people’s capacity to make decisions in their individual records.

People spoke highly of the staff group and observations showed staff were kind, respectful and knew people well.

Is the service effective?

Assessments and care plans had been completed. We found that some people’s care records were clear and an accurate reflection of people’s needs. However for other people we found their care plans were not reflective of their current needs. Records did not demonstrate that all people received effective care.

Is the service caring?

We saw that people were supported by kind and attentive staff. Efforts had been made to record people’s preferences, and interests. We found evidence that people using the service and their relatives had completed an annual satisfaction survey.

Is the service responsive?

We found that staff responded to people quickly and efficiently. People had access to some activities, but these were dependent upon staff and relatives being able to organise them. Surveys had been completed by people regarding the service provided by Shearwater. The manager had recognised that the surveys did not reflect people’s views on living at Shearwater and was thinking of a more effective way to reflect this. We were able to see that staff had arranged meetings with people and their relatives on each of the three floors.

Is the service well led?

The home had an interim manager in post and a new deputy. The manager had introduced several initiatives to improve people’s care and support, which had a beneficial impact on the care and support people received. The service had an effective quality assurance system. Staff told us that they were able to give feedback to the manager and that she was very approachable.

We inspected this service to assess what action the provider had taken with regards to the three outstanding areas of non-compliance we found at our previous inspections. We received an action plan from the provider telling us how and when they would be compliant with these three areas of non-compliance. They told us they would be complaint by the end of December 2013.

During this inspection we spoke with 13 people, four of whom at that time were not able to sustain a conversation. We also spoke with five relatives and eight members of staff. We looked at the records of ten people. We spent time discussing the action plan sent by the provider and our findings with the registered manager.

People spoken with told us they were happy with the care they received. They told us they were aware of their care records and most relatives told us they had attended a review regarding their relatives care. None of the people spoken with knew they had a ‘link’ staff member. However they told us they would be happy discussing a concern with a staff member.

We found that records regarding people’s care were incomplete, contradictory and not reflective of people’s needs. We could find no audits of people’s records to ensure there was consistency across the home. We were told the home had introduced a new system for care planning and the recording of people’s needs. However, we found that this had not been completed and had not been introduced across the home. We found when looking at some of the new records they gave a more comprehensive picture of people’s needs. As a result of the poor records and lack of clear plans of care we could not be assured people received safe care.

We observed that staff were polite, respectful and assisted people in a dignified manner. Members of staff spoken with were enthusiastic about their roles and told us they had worked hard to improve the record keeping in the home.

We found that there was a lack of overall monitoring in the home and we could not be assured people received safe and appropriate care.

The people living at Shearwater were unable to answer direct questions due to them having a diagnosis of dementia. It was difficult to establish if people were satisfied with the care they were receiving. We spent a lot of time on one floor of the home and witnessed some interactions between staff and people. These interactions were not always positive. Staff told us they were very busy and could not always meet the needs of people in a way they wanted. We spoke with five visitors, who had a mix of comments regarding the staff in the home. All felt the permanent staff in the home worked hard. However, all agreed there were not enough staff in the home to meet the needs of people. One visitor told us, “Activities are non existent, people just sit”. Visitors told us staff are always rushed and never stop. Two visitors told us they felt their relative had received good care, but were concerned other people did not.

This inspection was unannounced and took place on the 10, 11 and 14 September 2015.  Shearwater is registered to provide accommodation and personal care for up to 60 people and specialises in caring for people living with dementia. The home has three floors, with a lift which gives access to all floors. On the day of our inspection 56 people were living at the home.

The home 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 felt safe. Individual’s risk assessments had not always been recorded to ensure staff knew the risk and how the risk could be minimised. Staff were aware of the differing types of abuse and of the policies and procedures to keep people safe. Whilst the service had no tool to link staffing levels to the needs of people, staffing levels were adequate to meet the needs of people.

Recruitment checks were thorough to ensure the safety of people. Medicines were managed well and people received their medication on time.

Staff felt supported in their role but all staff did not receive supervision on a regular basis.  People did not always have their capacity assessed to ensure they could or could not consent to decisions which restricted their freedom of movement. Staff received a good induction and a training programme was available to staff. People’s nutritional needs were met and people had access to a range of professionals, to ensure their needs were met.

Staff had a good relationship with people and knew people’s individual needs. Staff treated people with respect and people’s dignity was promoted. Whilst care plans were not always reflective of people being involved with the planning of their care, observations showed us people were given choices on all aspects of their daily living. 

Assessments and care plans had been completed. Relatives told us they were kept well informed of their relative’s changing needs. There were opportunities for people to make comments and raise complaints which had been addressed by the management team. 

Staff, professionals and relatives felt the home had improved over the last year. The home had an open and positive culture and all had confidence in the management team. There was a range of quality assurance processes in place to monitor the quality of care provided. Record keeping in the home needed to improve to reflect the care provided.

We found four 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