Archived: The Shrubbery Nursing Home

Updated 3 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The Shrubbery Nursing Home is a ‘care home’ that provides nursing care. 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.

Inspection site visit activity started and ended on 6 June 2018 and was unannounced. The inspection team consisted of one inspector, a specialist nurse advisor and an expert by experience who had experience of residential care settings. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. As part of the inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us by law. We also reviewed the information the provider had sent us each month following the inspection in August 2017. We contacted the local authorities who are responsible for funding some people’s care for information.

During the inspection, we spoke with seven people who lived at the home and six visiting friends and relatives. We also spoke with six staff, the wellness manager, one nurse, the chef, the registered manager and the provider.

We reviewed the risk assessments and plans of care for two people and looked at their medicine records. We also looked at audits for reviewing people’s care, the home environment and maintenance checks, three Deprivation of Liberty authorisations, complaints records, an overview of the last two months incident and accident audits, staff dependency tool, care staff rotas, staff meeting minutes, ‘residents’ meeting minutes and two staff recruitment files.

Updated 3 August 2018

We carried out an unannounced comprehensive inspection of this service on 6 June 2018.

The Shrubbery Nursing Home 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. A maximum of 38 people can live at the home. There were 25 people living at home on the day of the inspection, a number of whom lived with dementia. Nursing care is provided.

In August 2017 we inspected and rated the service as Inadequate. We placed the service into Special Measures. This was because the provider had failed to ensure systems and processes were in place to assess, monitor and mitigate risk to people living in the home. The provider had a condition placed on their registration to provide us with a monthly review to demonstrate how they were working towards making the required improvements. This was to ensure people living at the home remained safe while improvements were made. The provider sent an action plan to show what they would do, and by when, to improve the quality and safety of the service.

At this inspection the provider demonstrated to us that a number of improvements had been made, therefore the service is no longer in Special Measures. However, some areas of the service required further improvements to be made and improvements to be further embedded.

There was a registered manager in post. 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 access to other healthcare professionals that provided treatment, advice and guidance to support their health needs, however records did not reflect guidance needed to support people and accurate records of care provided were not always kept.

The registered manager had a range of audits that had been implemented to demonstrate how they monitored the quality and safety of people’s care and support. The provider’s planned improvements will need to demonstrate that continued improvements are sustained over time.

The registered manager had started to make improvements to the overall leadership of the home and both people and the staff team told us there were now opportunities to raise concerns and issues which were listened to.

We will check these improvements have been sustained during our next planned comprehensive inspection.

People’s incidents were now being recorded by staff and a new reporting process had been implemented. People living in the home, their friends and relatives told us that staff support and guidance had improved. Staff understood how they were able to minimise the risk to people’s safety.

We saw staff helped people and supported them by offering guidance or care that reduced their risks of harm. Care staff now had a clearer understanding of their responsibilities in reporting any suspected risk of abuse to the management team. Overall, staff were available for people and had their care needs met in a timely way. People told us their medicines were managed safely and administered for them by staff. Staff wore protective gloves and aprons to reduce the risks of spreading infection within in the home.

People told us staff acted on their wishes and their agreement had been sought before staff carried out a task. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems supported this practice.

Staff had been provided with training that reflected the needs of people who lived at the home. The training information showed that staffs’ knowledge was being updated. People told us and we saw their privacy and dignity were respected and staff were kind to them.

People told us they liked the staff and felt they knew how to look after them and were included in day to day decisions about their care and support. People were supported to eat and drink enough to keep them healthy.

People were involved in planning their care and if requested their relatives were involved, which include end of life planning. The care plans reflected people’s life histories, preferences and their opinions. People told us staff offered encouragement to remain active and try activities on offer. People also told us they enjoyed the social aspect of the home and the activities offered.

People were aware of who they would make a complaint to if needed. People told us they were happy to talk through things with staff or the registered manager if they were not happy with the care.