Archived: Shottendane Nursing Home

Shottendane Nursing Home supports up to 38 people who have nursing needs, dementia and require end of life care. At the time of our inspection they were supporting 23 people. Shottendane Nursing Home is a large building with care being provided over three floors and sitting in large grounds.

People’s experience of using this service and what we found

Since our last inspection, improvements to the service had been made, however there were still some areas where further improvements were needed. Checks and audits implemented needed time to be fully embedded to assess their effectiveness, and there were areas such as feedback from relatives and people where further improvements to feedback were needed. Care plans had improved but needed further development as they were not always accurate or detailed enough. Medicines management had improved however some areas still needed improvement.

People and their relatives gave good feedback about the service. Relatives told us, “We cannot fault the care,” and “I have no problems whatsoever, my [loved one] is really happy there. Really happy.” We found that systems in place to safeguard people from the risk of abuse had improved; staff had received training and competency checks. People told us they felt safe living at the service and when staff were supporting them.

Infection prevention and control had improved at the service. Staff were observed using personal protective equipment (PPE) and contaminated laundry was being separated from non-contaminated laundry. There were now sufficient staff to meet people’s needs, and staff had been recruited safely.

Risks to people and the environment had been assessed, and there was guidance in place to inform staff how best to support people. Staff we spoke with understood people’s needs and how best to support them.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Relatives told us the communication had improved. One relative told us, “I think the approachability is even better now. We have been given questionnaires about our loved ones to know more about our loved ones. All around its definitely improved.” People, relatives and staff told us there has been improvements to the culture. A relative told us, “ I can tell a change in atmosphere. Us as visitors we feel more welcome and we now know what’s going on. It’s been much better.” Staff understood their roles and were involved in improving the service. Staff and the manager worked with healthcare professionals to provide joined up care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was inadequate (published 10 September 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however there were still areas where improvements were needed.

This service has been in Special Measures since 29 April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 24 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection on 2 May 2019 to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shottendane Nursing Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Shottendane Nursing Home supports up to 38 people who have nursing needs, dementia and require end of life care. At the time of our inspection they were supporting 36 people. Shottendane Nursing Home is a large building with care being provided over three floors and sitting in large grounds.

People's experience of using this service:

People were not protected from the risk of the spread of infection. Staff did not wear or change their personal protective equipment (PPE) in line with government guidance. The provider did not follow government guidance in relation to visiting or admitting new people into the service.

Risks to people were not always assessed and mitigated. Risk assessments did not contain sufficient information on how to address health risks. Risks relating to thickening powders had not been assessed or mitigated. Environmental risks such as broken window restrictors had not been identified.

There was not sufficient staff; this included nursing, care workers and activity staff. Relatives told us there was a lack of engagement and activities for their loved ones. Some staff lacked understanding of safeguarding principles. When incidents occurred they were not always documented, and action taken to reduce similar incidents re-occurring.

Medicines were not managed safely; there was a lack of guidance to inform staff about some people’s medicines.

The oversight and governance systems were ineffective. Some issues identified in audits – such as window restrictors in other parts of the building had been identified as needing action, however there was no information on what action was taken to address shortfalls. Care plans were basic and in some cases did not contain sufficient information on action to take to reduce risks. There was a lack of learning from incidents and oversight of accidents and incidents was not robust. There was no system in place to review accidents and incidents and incidents reoccurred. When we raised issues with the management team, they took action, for example completing an infection control audit, and an audit on all window restrictors.

Relatives told us they felt well informed of the care their loved ones received, however they had not been kept up to date in other matters. For example, when the registered manager left the home, relatives were not informed until the following month. Communication regarding visiting had not been clear, and some relatives were unaware if they could visit their loved ones.

Staff told us Shottendane Nursing Home was a good place to work. Relatives told us the staff were caring and were kind to their loved ones. Staff and the manager had welcomed support from healthcare professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 30 May 2019).

Why we inspected

We received concerns in relation to safeguarding concerns and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from good to Inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shottendane Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection prevention control measures, medicines, staffing, recruitment of staff and governance systems at this inspection.

Following the inspection, we took immediate action to restrict admissions to Shottendane Nursing Home, and impose urgent conditions on the providers registration in relation to infection prevention and control. We took further action to impose further conditions on the providers registration following the inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

People and their loved ones told us they were supported by committed and compassionate staff. One person said, “I have loved every minute of being here, the staff are so lovely.”

The visions and values of the service put people at the centre of their care and this was shared by all staff.

People were supported by staff who understood how to keep them safe and how to report any concerns. People and their loved ones were involved in planning their care.

End of life care was individualised and based on people’s preferences. People were encouraged and supported to stay well and independent for as long as possible. Staff worked closely with health professionals to manage people’s health conditions.

People told us the food was good and that they had plenty of choice. All staff knew people well including those who worked in the kitchen or laundry. There were affectionate and humorous interactions throughout the inspection.

The registered manager was approachable and open. People, relatives and loved ones told us they could go to them at any time and that concerns would be resolved. There was a culture of learning from concerns or issues which involved all staff.

Rating at last inspection: The service was rated Good at the last inspection, published in October 2016. At this inspection the service remained Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service.

Shottendane Nursing Home is a Grade II listed manor house with extensive grounds in Margate. The service provides accommodation, support and nursing care for up to 38 people with a range of nursing and palliative care needs. At the time of the inspection there were 31 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Shottendane Nursing Home is owned by a provider who regularly visited the service. The day to day running of the service was manged and overseen by a chief executive and the registered manager.

People and their relatives told us they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised would be investigated to ensure people were kept safe.

The provider had a recruitment policy and processes in place to make sure that staff were of good character. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development. There were consistent numbers of staff deployed, day and night, to meet people’s needs.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Some people had an authorised DoLS in place and these were regularly reviewed.

People enjoyed a choice of healthy, home-cooked, food and told us they had enough to eat and drink. Relatives often had meals with their loved ones. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals and followed and guidance given to them to ensure people received safe and effective care.

People said they were happy living at the service and that their privacy and dignity were respected. Staff spoke with and engaged with people in a kind, caring and compassionate way. People were involved in the planning or their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them. People’s religious and cultural needs were recorded and respected.

The provider had a complaints policy and procedure. People knew how to complain and told us they had no complaints about the service received from the staff team.

Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restrictions on the time of day. Staff, including an activities co-ordinator, spent time with people on a one to one basis. People were encouraged to maintain as much independence and choice as possible.

People, staff and health professionals felt the service was well-led. There was effective and regular auditing and monitoring. People, relatives and health professionals were asked their views on the quality of the service provided.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We last inspected Shottendane Nursing Home in November 2013 when no concerns were identified .

We observed staff interacting with the people who used the service in a sensitive manner and saw that they explained the care they delivered at a level each person could understand. We observed People eating their meals at lunch time and found that people had a choice of dishes from the menu and that drinks were readily available throughout the day. We saw that there were enough staff to meet people's needs and that call bells were answered swiftly.

We found that the home was clean and free from infection. Staff were able to demonstrate their understanding of infection control processes and we saw that policies and procedures were followed.

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assisted them to make choices and to remain as independent as possible. A member of staff told us "we encourage people to do as much as possible for themself even if it's only to wash and dry their face."

In order to protect people who used the service, we saw that the home carried out a rigorous staff recruitment process. Staff were knowledgeable about people's needs and preferences and were observed to treat people as individuals and delivered care in a personalised way.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires, regular reviews of their care and one to one discussions.

Relatives we spoke to told us they were very happy with the standard of care. One person told us "staff do anything you ask them to, very respectful." Another told us "staff always talk to them about their care needs and explained the treatment."