Archived: Sherwood Grange Care Centre

Sherwood Grange is a residential care home providing personal and nursing care for people at the time of the inspection 32 people were using the service. The service can support up to 45 people.

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

At our previous inspection the service was rated as requires improvement at this inspection. At this inspection there had been improvements made to the service in relation to the management of medicines and improvements in the assessments of people mental capacity. These improvements had a positive effective on the care people received.

People were provided with safe care, staff understood their responsibilities in relation to protecting them from potential abuse, and the risks to people safety were assessed with measures in place to mitigate the risk. People were supported by adequate numbers of staff, and safe recruitment practices were in place to ensure people were supported by suitable staff. People’s medicines were well managed, and they were protected from the risks of infection through safe staff practices.

People were supported by staff who had received appropriate training for their roles. Their nutritional and health needs were supported. The environment people lived in was in the process of a refurbishment plan and we were able to see the improvements made since our last visit. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who were caring, people trusted and liked the staff who supported them and felt their views on their care were considered. Staff worked to maintain people’s privacy, dignity and independence.

People received personalised care from staff who knew their needs. They were supported to undertake a range of social activities and there was an activities program in place. People told us the provider listened to their concerns or complaints and dealt with any issues of concern quickly.

People at end of life received personalised and compassionate care, and there was information in people’s care plans about their wishes in relation to their end of life care.

We were told the management team were open and approachable. Governance systems and audits were in place and used regularly to maintain good standards of care for people. There was engagement with people through questionnaires and individual meetings, and people felt listened to. Staff were supported with regular supervisions and staff meetings. The management team worked with external professionals to improve the quality of the service.

Rating at last inspection

The last rating for this service was requires improvement (17 April 2018). At this inspection we found improvements had been made and the provider had improved their rating to good.

Why we inspected

This was a planned inspection based on the previous rating.

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

At our last inspection in September 2017 the provider was in breach of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment of people at the service and included the lack of appropriate risk assessments in place for people, resulting in staff’s lack of knowledge of people’s needs. There was a lack of staff training, lack of adequate numbers of staff to support people and staff recruitment processes were not always safe. The management of medicines was poor. The service had not adequately supported people who lacked mental capacity and required help to make decisions about their care. There was also a lack of oversight of the service and quality monitoring systems to measure standards were lacking. The service was rated as inadequate and was placed in special measures.

Following the last inspection, we met with the provider and asked them to complete an action plan to show what they would do to improve the issues identified above. This inspection was undertaken to check if the provider had made the necessary improvements to the service. We found the provider had made significant progress in addressing the issues we found previously. Although there were still further improvements to be made at the service and we needed to be sure these improvements would be sustained by the provider.

At the time of our inspection there was not a registered manager in place. However, the present manager was in the process of applying to the Care Quality Commission (CQC) to become the registered manager for the service. 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 staff at the service understood their role in protecting people from abuse. They were able to recognise the different forms of abuse people could be exposed to and there were clear processes in place for staff to report any concerns. The manager worked with the relevant local authority teams to address any safeguarding concerns, and ensured there was learning from any safeguarding incidents at the service.

While there had been improvements in the management of risks to people’s safety, we found a small number of risks had not been assessed to ensure safe care and one risk assessment tools used was not a nationally recognised tool. This was addressed by the manager. However, staff were able to discuss how they managed the different risks to people’s safety. Staffing levels met the needs of people at the service and there were safe recruitment processes in place.

People’s medicines were not always managed safely, there were a lack of protocols in place for medicines given on an ‘as required’ basis and we found some gaps on medicine administration records (MAR) for medicines given as required.

People were protected from the risks of infection as staff had the knowledge and equipment to manage any infection control issues.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. People felt staff understood how to support them effectively.

People lived in an environment that met their needs. however signage at the service could be improved. People’s health and nutritional needs were well managed and staff acted on advice given to them by health professionals.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice The manager had worked to improve the way people who lacked capacity were supported to make decisions about their care. However further improvements were required for this aspect of care.

People were cared for by staff who showed kindness and consideration of their needs and had knowledge of their preferences and views on their care. They were supported with respect by staff who maintained their privacy and dignity whilst encouraging and supporting their independence.

People received individualised care from staff and majority of the information they required to provide that care was in people’s care plans. People were supported to take part in a range of social activities and maintain relationships that were important to them. People were comfortable when raising concerns or complaints and felt issues raised were addressed to their satisfaction. People’s wishes in relation to their end of life care were supported with care and empathy.

There had been improvements in the oversight of the service, and the manager was supported by the management consultant employed by the provider. The service undertook a robust auditing process to maintain the quality of the service. The manager worked with people, relatives, staff and external professionals to provide an open and transparent service for the people who lived there.

The service had 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.

Whilst staff at the service showed a good understanding of their roles in relation to reporting any safeguarding issues, we found there were safeguarding incidents where the correct action had not been taken to protect people. This related to recommendations made by health professionals who investigated the safeguarding issues.

People’s risks were not always fully assessed, up to date and information in them did not reflect their needs. The recommended staff levels were not always met and as a result staff sometimes struggled to meet people’s needs. The staff recruitment processes in place were not always safe and robust. Medicines were not always managed safely and we found a number of errors relating to the administration of these.

Staff received training when they first started at the service but there was a lack of adequate mandatory training updates in place. Some staff who were providing practical training had not received the necessary training updates to show they were competent to deliver this training.

The principles of the mental capacity act were not always followed where people lacked the capacity to make their own decisions. Decisions had not always been made in people’s best interests involving professionals and the person closest to them. There was a lack of information around advocacy for people in the service.

People’s nutritional needs were not always met and although the health professionals we spoke with told us they had good relationships with staff we found some recommendations were not always followed.

Staff at the service treated people with kindness and respect and managed their privacy and dignity well. There was a lack of evidence to show people had been involved in developing their care plans although people and relatives told us they had some involvement in developing these. The care plans did not always contain sufficient detail of people’s individual needs and staff felt information around changes in people’s care was not always communicated to them in a timely way.

The activities for people at the service had been limited for a period of time prior to our visit and there was a lack of engagement with people who spent a lot of time in their rooms.

The complaints procedure was not displayed in the service. The company’s complaints procedure had not always been followed when people raised concerns and complained to the registered manager.

The service lacked robust systems and processes to effectively monitor the quality of the service. This included effective supervision of staff, auditing processes related to medicines, care plans, infection control, health and safety and the environment. There was a lack of engagement from the provider which resulted in a lack of support for, and oversight of the registered manager.

As a result of the above findings the provider was in breach of multiple regulations 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.

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 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 felt safe living at the care home and staff knew how to protect people from the risk of abuse. The risks to people’s health and safety were not always properly assessed and steps to reduce risks were not always taken.

There were not always enough staff to meet people’s needs in a timely way. People received their medicines as prescribed and they were safely stored.

People were cared for by staff who felt well supported but who had not received all of the training relevant to their role. We found the Mental Capacity Act (2005) (MCA) was being used correctly to protect people who were not able to make their own decisions about the care they received.

Sufficient quantities of food and drink were provided and people were generally positive about the quality of food. However, people did not always receive timely assistance to eat their meals. People received support from health care professionals such as their GP and district nurse when needed.

People were positive about the relationships they had developed with staff and felt well cared for. People were able to be involved in the planning and reviewing of their care and we saw they were able to make day to day decisions. People were treated with dignity and respect by staff.

There was a risk that people may not receive care in line with their changing needs because information about them was not always up to date or available. A range of activities was provided for people. However, people spent periods of time without any activity or stimulation. People were not aware of the complaints procedure but did feel able to approach the registered manager about any concerns they may have.

There was a positive and transparent culture in the home, people who used the service and staff felt able to raise any issues with the registered manager. However, there were limited opportunities for staff to meet and discuss the running of the service. The registered manager led by example, but did not always have sufficient time and support to carry out their duties. Systems were being reintroduced to enable people and relatives to give their feedback about the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people. We spoke with ten people who used the service and three visitors to establish their views on the quality of service provision. We also spoke with the manager and two staff. We looked at some of the records held in the service which included care plans. We observed the support people received and carried out a brief tour of the building.

Is the service safe?

We found people received care in an environment that was maintained to a clean standard and we found auditing procedures were in place to identify where improvements to the environment were required.

People told us that their individual needs were being met by staff who were attentive and considerate. Furthermore they said there was always sufficient staff to meet their needs in a timely manner. One person told us, 'I think the staff are all very good at what they do, I have no concerns at all'. Another person said, 'I feel very well looked after, there is always plenty of staff about, and they all seem to be well trained.'

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise. We were also told that a business continuity plan was in place to manage foreseeable emergencies.

We found that staff personnel records contained information required by the Health and Social Care Act to ensure that staff employed to work at the home were suitable and had the skills and experience needed to support the people.

Records showed that staff were able, from time to time, to obtain further relevant qualifications. This was confirmed by staff, they told us that in their opinion the training programme ensured they were appropriately qualified to perform their duties in a safe and competent manner.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted the manager told us that a lead clinician had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Systems were in place to ensure that people's care and support needs could be identified and delivered in such a way as to meet the individual needs and preference of people. Furthermore, our observations, throughout the day of the inspection, demonstrated that staff had a good understanding of people's individual needs and how they were to be met.

Is the service caring?

People told us that staff were respectful and caring at all times. One person told us, 'Respect seems to be at the heart of the service here. All the staff are very kind and considerate.' A visitor to the home also told us that they felt the staff were proactive in promoting the respect and dignity of people.

As part of our inspection process we observed the interactions between the staff and people residing at the home. We saw staff being attentive to people's individual needs and were utilising effective listening skills, especially if people had communication difficulties. All observed interactions were undertaken in a considerate manner and promoted the dignity and respect of people.

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed when people expressed a desire to move into the home. The manager told us that they would utilise information from people's relatives and professionals such as social workers so as to build a comprehensive picture of people's holistic needs.

We found that people's support plans were being reviewed and amended to ensure they highlighted people's individual needs and preferences. We also found that risk assessments had been undertaken to promote peoples safety.

We found that people had access to an activities programme both within the home and the broader community and the manager was in the process of developing these further.

Is the service well-led?

Staff told us they received appropriate support and direction from the management team. Furthermore they told us that formal supervisions sessions were now in place to ensure they could express their views in a confidential manner. We also found that staff meetings were performed to provide a forum to discuss any developments within the home.

Records showed that people had been supplied with a satisfaction survey in July 2013 so they could make comments about the quality of the service they received. The manager told us that the consultation process would be repeated in May 2014 and would include people's relatives.

We saw the provider had also initiated a suggestion box which was on display in the foyer of the home. This provided an additional, confidential facility for staff and visitors to contact the provider directly to highlight any areas of service provision which they felt could be improved upon.

We visited the home whilst night staff were on duty. We spoke with the nurse in charge, three night care staff, one day care staff and the registered manager. We also did a tour of the building and spoke with five people who used the service, and looked at care files for three people.

People who used the service told us they received a choice of what time they got up. One person told us it was her preference to get up early which was normally about 4am, she stated that the staff had never forced her to get up and she enjoyed the quiet time to have a cup of tea and watch TV.

Another person said that he was never forced out of bed, but got up when he decided. He stated later in the day that he was happy at the home and felt safe and well cared for.

We found that proper steps were not taken to ensure that people who used the service received appropriate care and support during the night.

From the sample of care files we looked at, we found night profiles did not include people's preference to what time they got up. All care staff spoken with told us they had read four or five care files out a total of 33.

People we spoke with told us they felt their needs were well met. Comments included, 'I'm asked how I feel about things and if I'm happy or want anything. I have a choice of meals, what time I get up and go to bed. There are activities but I don't always choose to take part.'

We asked people about their experience of the meals provided. Comments included, 'The food is good, there is always a choice and it's plentiful, if anything, too much.'

The relatives and friends of people who used the service described staff as obliging, helpful and pleasant. Comments included, 'The communication is good, if we have any problems we raise it with the matron.' And, 'The girls (staff) are brilliant, they look after mum well.'

We looked at the internal audit systems in place. We saw people who used the service and their representatives were asked for their views and opinions.