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Shawe Lodge Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 31 March 2017

We undertook this inspection of Shawe Lodge Nursing Home on 6 and 7 December 2016. The inspection was unannounced which meant the provider did not know we were coming on the first day of the inspection.

Shawe Lodge Nursing Home is located in Urmston, Manchester and provides nursing care for up to 41 people who live with dementia. Accommodation is provided on three floors. All bedrooms are single rooms and are accessible by a passenger lift. There is a designated unit on the second floor, which supports male residents only with complex needs. Communal rooms are available on the ground and second floors. There is an enclosed garden area and parking for several cars.

At the time of our inspection there were 41 people living at Shawe Lodge. This had steadily increased since our last inspection and the home was now at full capacity. A nurse form the Care Commissioning Group we spoke with said the home supports people with complex needs, some of whom have moved from other services who were not able to meet their needs.

The service had a registered manager in place. 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. The registered manager was supported by a clinical lead.

At our last inspection in November 2015 we identified breaches of the regulations in relation to the administration and recording of medicines, accurate monitoring records of the care and support provided, consent, monitoring and mitigating environmental risks and not having an effective audit system.

At this inspection we found improvements had been made in some areas such as medicines management and consent. However we identified continuing breaches in monitoring records and the lack of robust audit systems in place to monitor and improve the service. New breaches were identified for staff training and regular checks on the fire alarm system were not being completed. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have also made a recommendation about using best practice guidance to plan the environment suitable for people living with dementia and that all sluice, cleaning room and store cupboards are kept locked.

People we spoke with, and their relatives, were complimentary about Shawe Lodge. They said they felt safe, the staff knew their needs well and there were enough staff on duty to meet their needs. Staff were positive about their role.

Staff knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the registered manager or clinical lead would act on any concerns raised.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed. Care plans were in place for the support people wanted as they came to the end of their lives.

People we spoke with told us that the staff at Shawe Lodge were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service.

Staff had received training, however this needed refreshing. Supervisions took place in response to an issue and were not planned throughout the year to support the staff team. Staff meetings were held for the ground floor staff team. A new unit manager had been appointed for the second floor and had started to engage the staff team to gain their ideas and input for the unit.

People received their medicines as prescribed and the nurses had received relevant medicines administration training. Guidelines for the use of ‘as required’ medicines were not always in place. Care staff added thickeners to food and drinks to reduce the risk of choking; however trained nurses signed the medicine administration charts.

Care plans and risk assessments were in place to help ensure people’s health and nutritional needs were met. Monitoring records for food and fluid intake, personal care were inconsistent and not always completed in a timely manner. The layout of the lounge areas on the ground and second floors and the number of people using these spaces, especially at meal times, meant staff had to sometimes stand up when supporting people with their food because there was not enough dining facilities, especially on the second floor. This may be intimidating to someone living with dementia and shows a lack of dignity and respect. Records we reviewed showed that staff contacted relevant health professionals to help ensure people received the care and treatment they required.

We found the service was working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support.

All required checks with the disclosure and barring service (DBS) were made when recruiting staff and two references were obtained. However the gaps in one person’s employment history had not been explored and accounted for.

An activities officer was in post at the home. Regular activities included an entertainer and a pub night. One to one games and crafts were undertaken with people. Memory boxes were being made to assist people to be able to identify their own rooms.

All areas of the home were seen to be clean. Procedures were in place to prevent and control the spread of infection. Improvements had been made in the management of clinical waste. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

Tests of the fire safety system had not been completed as planned since the service’s handyman had left three months before the inspection. Maintenance of the home had also lapsed during this period. A new handyman had started work at the home the week of our inspection.

A complaints procedure was in place. People we spoke with said the staff and registered manager dealt with any issues they raised verbally without needing to use the formal complaints process. This was confirmed by the staff and registered manager.

Audits were completed by the registered manager. However these were not consistently completed and were in response to issues identified by external audits and checks rather than being proactive and being used to drive improvements within the service. The registered manager said they were planning to have a set timetable for completing audits.

Inspection areas

Safe

Requires improvement

Updated 31 March 2017

The service was not always safe.

Regular checks of the fire alarm and fire doors had not been completed since the handyman had left the service in September 2016.

People received their medicines as prescribed. Care staff added thickeners to food and drinks but nurses signed the medicine administration charts. Guidelines for the use of ‘as required’ medicines were not always in place.

Sufficient numbers of staff were on duty to meet people’s needs. Staff had risk assessments and guidelines to mitigate the identified risks.

Effective

Requires improvement

Updated 31 March 2017

The service was not always effective.

The service was working within the principles of the Mental Capacity Act.

Staff said they felt well supported. We found refresher training courses and training for new staff needed to be arranged and supervisions were re-active to address identified issues and not planned throughout the year.

People received support to meet their dietary requirements. The space available in the lounges, especially on the second floor, meant staff often had to stand up when supporting people with their food, which people living with dementia may find intimidating.

Caring

Good

Updated 31 March 2017

The service was caring.

Staff were kind and caring when supporting people. Staff knew people’s needs well.

Staff maintained people’s privacy and dignity when providing support.

People’s wishes for the care they wanted at the end of their life were recorded. The service had been awarded the ‘Six Steps’ award which recognises the support provided at the end of people’s lives.

Responsive

Requires improvement

Updated 31 March 2017

The service was not always responsive.

Care plans gave detailed information to guide staff when supporting people.

Monitoring sheets were not completed in a timely or consistent manner.

An activities officer was in place who was organising a programme of activities for the home. Memory boxes were being made so people could more easily identify their own rooms.

Well-led

Requires improvement

Updated 31 March 2017

The service was not always well led.

The service had a registered manager in place as required by law.

Not all breaches identified at the last inspection had been remedied and a new breach in staff training and supervision had been identified.

Some audits were completed. However they were not completed on a regular basis, were often in response to external audit findings and had not identified the issues found at this inspection.

Surveys and meetings were undertaken to obtain the views of people living at the service and the staff members.