Archived: Sherwood Forest Residential and Nursing Home

We carried out an unannounced comprehensive inspection of this service on 6 October 2016. Four breaches of legal requirements were found. This was because the provider had failed to: adequately protect people from potential abuse; promote and respect people’s dignity at all times;

notify us of events and issues they were legally required to; and effectively monitor and assess the quality of the service.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At this inspection we found that action had been taken and all breaches had been met.

Sherwood Forest Care Home is located in Normanton, a suburb of Derby, and provides nursing and personal care for up to 75 older people. Sherwood Forest Care Home has two units, one for people with nursing needs and the other for people living with dementia. At the time of our inspection there were 58 people using the service.

The service has two registered managers. 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 said they felt safe at the service because the staff were competent and caring and the environment secure. Relatives said staff were vigilant about people’s safety and prevented or minimised the risk of falls. Staff protected people from harm and knew who to contact if they had concerns about a person’s well-being.

There were enough staff at the service to meet people’s needs. The number and names of staff on duty each day were displayed on a whiteboard so people could see who they were. The staff employed were suitable and safe to work with people using care services. Staff worked together as a team to ensure people received consistent person-centred care.

The staff were well-trained and knew how to support people effectively. They understood people’s physical, mental health, social and cultural needs and ensured they received a personalised service. For example, staff assisted people to move safely, make choices, and have their medicines when they needed them.

People told us that the food was good, they had a choice, and there was enough food available for them. Menus were based on healthy eating choices and people’s dietary needs and preferences. Mealtimes were relaxed and staff socialised with people while assisting them with their meals. Staff encouraged people to drink and remain hydrated.

Staff supported people to maintain good health and access healthcare services in the local community when they needed to. They understood people’s healthcare needs and knew when to refer them for specialist support. Relative’s said staff kept them informed about their family members’ health and communicated any concerns quickly. Staff knew how to support people if they needed end of life care and understood their roles in providing comfort, mouth and other types of care, and pain relief medicines where necessary.

The premises were purpose-built and accessible to people with limited mobility. There were items of interest and reminiscence in the communal areas and corridors following different themes including gardens and the seaside. All areas were clean, fresh, and hygienic.

The staff were caring and understood the importance of treating people with dignity and respect. They took the time to sit with people and chat to them about the things that were important to them such as their families and the things they liked to do. People’s relatives and friends could visit at any time and were made to feel welcome. Staff understood the importance of seeking people’s consent to care and treatment in line with legislation and guidance.

Information about the service was made available to people in user-friendly formats and staff communicated with people in the way best suited to their needs. People told us that if they had any complaints they would tell one of the staff on duty or a manager. The service’s complaints procedure was displayed at the service and people were also given a copy of this when they began using the service.

People received care that was responsive to their needs. Staff worked in a flexible way in response to people’s needs. This meant that some people did not get up until lunchtime which was their choice. Some people preferred to spend time in their rooms rather than the communal lounge and this was respected.

Staff learnt about people’s needs from reading their care plans and talking with them and their relatives. If people had needs relating to disabilities or sensory loss information about these was included in their care records and care plans put in place where necessary.

People were encouraged to participate in both one to one and group activities depending on their preferences. The service’s activity organisers planned weekly programmes of activities based on people’s choices. Culturally appropriate activities were available. For example, we saw a staff member talking with a person in their native language and looking through a newspaper with them that was also in their native language.

People and relatives told us the service was well-led and the staff provided good quality care. Staff told us morale at the service was high, communication good, and teamwork effective. The atmosphere at the service was positive. The provider had systems in place to quality assure the service and help ensure a high standard of care and support was provided.

Sherwood Forest Care Home provides accommodation and care for up to 75 people, many of whom are living with dementia. At the time of our inspection, there were 60 permanent people and three temporary people in residence across the two units referred to as Forest View and Sherwood View.

The care home had two registered managers in post (one for each unit). 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.

Most people received their medicine as prescribed and when they needed them. However, we found instances that some records were incomplete which may indicate that people had not received their medicine.

Some people were not adequately protected from potential abuse. We saw incidents had happened in the home and there were no evidence of how risks were managed to prevent occurrence of any future events. These issues had not been notified to us or the local authority.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider was meeting the requirements of DoLS because the registered manager had applied to authorise the deprivation of liberty for some people using the service. Staff had a variable understanding of the Mental Capacity Act 2005 (MCA). Records did not demonstrate that people's rights had been protected when they were assessed to lack capacity to make decisions regarding their care and treatment.

The registered managers had not carried out regular supervisions of staff had proper support and relevant competencies to care for people using the service.

People’s dignity and privacy was not always respected or promoted. We observed sensitive personal topics being discussed by staff within a communal area. People requested assistance but staff had not responded in a timely manner, which compromised people’s dignity. People who required glasses to maintain their vision were not provided with these.

People's care had been planned but the monitoring in place did not demonstrate that support had been consistently delivered. For example, whether they were supplied with drinks and had their weight monitored.

The registered managers had carried out audits to monitor the quality of the service and to make improvements. However these did not always demonstrate what action had been taken to address any shortfalls identified.

The registered managers did not always notify us of events and incidents that they are legally required to do.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Health and Social Care Act 2008 (Registration) Regulation 2009. You can see what action we have told the provider to take at the back of the full version of the report.

People enjoyed the food and were offered choices. Staff used visual prompts to support people to understand choices available to them.

People told us they felt safe at the home.

People felt able to raise any concerns and were confident that the registered managers would take action.

Sherwood Forest Care Home provides nursing and residential care for up to 75 people many of whom are living with dementia. At the time of our inspection there were 65 people in residence. Accommodation is divided into two units, referred to as Sherwood View which provides general nursing care and Forest View which provides care to people living with dementia. Each unit has their own communal areas and bedroom facilities.

The service had two registered managers, one for each unit. 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 provider had systems in place to identify how many staff was needed to support people with their care. The provider was unable to demonstrate how staff shortages were covered which meant there may not have been enough staff to meet people’s needs.

People’s consent to care and treatment was not fully sought in line with legislation and guidance. There were people at the home who were subject to the Deprivation of Liberty Safeguards (DoLS). Some staff had an understanding of the requirements of the Mental Capacity Act 2005 and DoLS. We spoke with staff about mental capacity and staff were unable to consistently describe what this meant in terms of people’s care.

People's nutritional needs were not always met. People received additional health care support when required. However care was not always provided in line with people’s care plans to minimise risks to people’s health and wellbeing.

Records we looked at showed there were systems in place to assess and monitor the quality of the service. Care plans did not always state when people received care.

People were treated with dignity and respect. Staff supported people to maintain their independence by encouraging them to care for themselves whenever possible.

Staff received regular supervisions and appraisals, which meant that staff were properly supported to provide to people living at Sherwood Forest Care Home.

We saw medicines were managed safely at the home which meant that people received their medicines when they needed them.

People we spoke with told us they knew how to complain. We saw there was a complaints procedure in place which was displayed in the home which detailed how complaints would be handled appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

Our inspection on date 1 October 2013 found people's personal care needs were not always met for example their nail care was not always attended to and other professionals were not always being asked for advice and help when required. Facilities around the home were not reported when they did not work. The gardened areas could not be used because they were not safe for people to access. People were not always supervised and the communal areas were not free from odours. Staff training was not up to date and because of this people were in danger of receiving care that was unsafe. The manager was not being sufficiently supported and had fallen behind in her managerial responsibilities to people at the home. Staffing levels were in need of reviewing to ensure there were sufficient staff to meet people's daily needs including domestic cover arrangements.

During this inspection many of the issues found at the last inspection had been addressed but areas of record keeping were still in need of further attention.

Is the service safe?

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. The home catered for older people and people with dementia. At this inspection we focused on the dementia unit. The environment was uncluttered and enabled people to move around the home freely whilst maintaining their safety. One person told us 'It's nice here and I have a nice bedroom'. People we spoke with told us they were satisfied with their rooms and we found that people's rooms were clean and tidy, although not always odour free.

During the day time to ensure people were safe, staff were in the lounge area. When reviewing staffing we found that people were supported during the day and provided with activities that they could do. One person told us they loved living at the home and said the care they received was 'wonderful'. Comments from relatives included, 'It is nice here and staff helpful and quite friendly'.

We found that when facilities were not in working order around the home, the equipment was labelled to identify that it was not currently available for use. On the day of the inspection this included a downstairs shower room. This meant that action was taken to identify and rectify facilities that were not working.

Is the service effective?

We found that staff were supported to receive training so that they could help provide care to meet people's needs. We found people were cared for by staff whose training was reviewed and supervisions were carried out. This was to ensure staff were working to an acceptable standard.

Is the service caring?

Throughout the day we observed staff interacting and supporting people. Staff had a good rapport with people using the service and demonstrated a positive attitude towards them.

Is the service responsive?

When people needed further support and help staff responded to them in an appropriate way to help them. One relative told us a hairdressing service was provided at the home on a regular basis. From observations made throughout this visit, people were supported well by staff to maintain their personal appearance. We observed staff checking, cleaning and cutting people's finger nails and they engaged in the activity. They discussed their preferred nail varnish and involved people in the activity.

Is the service well led?

People we spoke with told us they would discuss any concerns with staff or the registered manager and felt they could air their views. Relatives who spoke with us told us that they were mainly satisfied with the service but they found their relatives belongings went missing. When it was reported and found, items would go missing again. This could lead to a lack of confidence in the service to maintain improvements. We spoke with the registered manager about this who confirmed this to be an area for on going improvements. We saw this was discussed at staff meetings and at resident meetings to find ways to improve this situation.

We saw the provider had a range of quality assurance procedures that included monthly audits of key records such as regular meetings with staff, reviews of the support people using the service received and a clear complaints procedure.

Records we saw confirmed that audits for medication, service records; fire safety and an infection control audit were up to date. However, care records did not always contain sufficient detail including records for the total amounts taken for food or fluids or end of life arrangements to check the effectiveness of the care provided.

People who were able to express their views told us they liked the staff that supported them. Most relatives and people spoke highly of the commitment of staff in meeting peoples' needs. Peoples' comments included 'I get very good care here; I'm well looked after, no complaints from me; they're here to look after you and they do it very well; I've got my special chair and I can sit here quite comfortable; it can be noisy sometimes, but you get used to it.'

We found that people generally received care and treatment that met their needs, although effective communications and concise care records were not in place to ensure their welfare and safety.

Most people said that they felt that they received the help they needed as there was usually enough staff on duty, although three people and two relatives said that they felt that more staff were needed at times. We found that the provider had not taken appropriate steps to ensure there were sufficient staff at all times to meet peoples' needs.

Most relatives and people we spoke with told us they were generally happy with the care and service. People also said that they felt listened to and able to raise any concerns about the service with the staff.

Effective systems were not in place to assess and monitor all aspects of the care and service, to protect people against the risks of inappropriate or unsafe care and treatment.

People said they were always cared for respectfully. For example, we saw one staff member assisting a person to have their lunchtime meal. We heard excellent communication and saw the assistance given was at a pace suitable for the person eating the meal.

People did not raise any concerns about their care. Some care plans were generalised and did not provide detailed guidance on how to deliver the care people wanted and needed. People's capacity to make decisions had not been recorded.

We saw that people received their medication as prescribed. Systems were in place for the safe storage of medication.

No one raised any issues about staffing levels. The rotas showed the planned staffing levels were not always being met. Staff training was not up to date. Staff did not receive training specific to the needs of people who used the service, for example dementia awareness training. In addition, staff practice was not supervised.

Systems in place to review the quality of the service provided were not used effectively. Health and safety issues were not always identified and acted upon.