Sherrington House Nursing Home

Sherrington House Nursing Home is a care home providing personal and nursing care to older people, younger adults and people with a physical disability. The service accommodates up to 39 people in one adapted building. At the time of the inspection 32 people were using the service.

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

People felt safe living at Sherrington House Nursing Home and told us their personal belongings were safe. Systems were in place to identify and manage the risks associated with people’s care, and accidents and incidents were appropriately reported and recorded. Medicines were managed safely. The provider was improving how they managed topical creams and ‘as required’ medicines. People told us there was enough staff on duty to meet their needs including at night and on a weekend. The service followed safe infection, prevention and control procedures.

People would recommend the service to others. One person said, “It’s 100% good. The care workers are always jolly and it’s a relaxed atmosphere.” People told us they would be comfortable raising concerns and were complimentary about everyone who worked at the service. Systems and processes for monitoring quality and safety were effective. The management team had identified areas for improvement and had started to address these. An example was updating staff training. The service worked closely with other agencies.

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

Rating at last inspection

The last rating for this service was good (published 25 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received over a period of months about staffing, infection prevention and control, and safeguarding people from abuse. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sherrington House is a residential nursing home situated in Bradford. The home provides accommodation, personal care and nursing care for up to 39 people. At the time of the inspection there were 35 people living at the home.

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

People’s care needs were assessed, and they received good quality person centred care from staff who understood their needs well. Staff were aware of people’s needs and life histories and used this information to develop meaningful and positive relationships with people.

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. Improvements were needed to some documentation to fully evidence compliance with the Mental Capacity Act (MCA).

People and relatives said they felt safe. They generally praised the standard of care and said staff were caring and kind. The home was clean, spacious and well maintained.

Staff were knowledgeable about people and the topics we asked them about. They received support and supervision. A wide range of training was provided. This was reviewed regularly to ensure staff had the knowledge and skills to meet people’s needs.

Medication was managed safely. There were close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

Audits and quality monitoring helped drive forwards improvements in the service. The registered manager provided people with leadership and promoted a supportive team culture. They maintained good oversight through communication with people and the team. They were passionate about continuing to improve the service.

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 requires improvement (published 29 November 2018) and there was a breach 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 and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sherrington House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A new manager had taken up post at the home in May 2018 and recently been registered with the Commission (CQC). 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.

This inspection took place on 20 and 23 August 2018 and was unannounced. Our last inspection took place on 25 January 2017 and at that time we found a breach of Regulation 17 (Good governance) of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations.

On this inspection we found a very similar situation and concluded that the service was still in breach of Regulation 17 (Good governance) of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. However, although the registered manager had only been in post a short period of time they had a good oversight of the service and had put an action plan in place to ensure compliance.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. However, we found the service had failed to notify the Local Authority Safeguarding Unit or the Commission [CQC] about two safeguarding incidents.

Risk assessments identified individual risks to people’s health and safety and there was information in each person’s care plan showing how they should be supported to manage these risks. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

Systems were in place to ensure people received their prescribed medicines safely. However, staff did not always follow correct procedures when completing documentation to evidence this.

Staff were being recruited safely and there were generally enough staff to take care of people. Staff received appropriate training and told us the training provided was informative and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

People told us they enjoyed the food and there was a good choice at every mealtime. However, we found the food and fluids charts in place for some people were not always being completed correctly by staff or their weight recorded at the intervals agreed in their care plan.

The care plans and supporting records and reports identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity but they did not always provide accurate and up to date information.

Infection control policies and procedures were in place. However, staff did not always follow the correct procedures when managing clinical waste.

Relatives told us they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relative’s care.

There was a complaints policy available which detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required. However, although the audit systems had identified the shortfalls in the service the registered manager had only been in post since May 2018 and therefore was still in the process of ensuring the systems in place were robust.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance and was a continued breach from the last inspection.

At the previous inspection on 30 and 31 March 2016 we rated the service ‘Requires Improvement’ and identified a breach of regulation relating to the way records and documentation was managed. As part of this inspection, we checked whether improvements had been made.

This was an unannounced inspection which took place on 25 January 2017. On the date of the inspection there were 39 people living in the home.

A registered manager was in place. 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.

Feedback about the service from people and relatives was positive. People said they felt safe in the company of staff and that they had no concerns over the way care and support was provided.

Overall most medicines were managed safely, although as at the previous inspection, the recording of the application of topical medicines such as creams required improvement.

Safeguarding procedures were in place and we saw safeguarding incidents were thoroughly investigated and action had been taken to help prevent a re-occurrence. Incidents and accidents were logged, investigated and analysed for any themes or trends.

Risk assessments were undertaken and these were subject to regular review. However risk assessments did not always contain the required level of detail about people’s care or the equipment they had in place to keep them safe. People were encouraged to maintain freedom and take positive risks.

Overall, we found sufficient staff were deployed to keep people safe. People told us they thought there were enough staff deployed to ensure safe care. We found the staff team were busy and some staff said they could do with an extra pair of hands at times. Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

The premises was safely managed and there was adequate amounts of communal space for people to spend time. The home was clean and hygienic with no offensive odours.

People spoke positively about the food provided by the home. We saw there was sufficient choice and action was taken to support people who were at risk of malnutrition.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards. People were asked for their consent before care and support and their opinions and views respected.

People said staff were kind and caring and treated them well. Staff demonstrated a good knowledge of the people they were caring for and we saw a personalised approach to care and support.

People’s care needs were assessed and plans of care put in place. Although some care plans contained good person centred detail, others lacked the necessary detail required. The recording of care and support interventions on the electronic care recording system was not consistently undertaken. Although this shortfall had been identified by the registered manager it had not yet been fully resolved.

People told us they had access to a range of suitable activities and social opportunities.

People and staff spoke positively about the registered manager and said there was a positive and supportive atmosphere within the home. They said they felt able to raise issues with management and these were usually resolved.

A range of audits and checks were undertaken by the registered manager, who demonstrated a commitment to continuous improvement of the service. Whilst checks were effective in identifying issues, persistent problems relating to the completion of documentation, had yet to be fully resolved.

We found one breach of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

This was an unannounced inspection which took place on 30 and 31 March 2016. On the date of the inspection there were 39 people living in the home. As part of this inspection we checked whether action had been taken to address breaches in regulation we identified during the last inspection on 7 and 8 September 2015.

A registered manager was in place. 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.

At the last inspection in September 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations in relation to medicines management and record keeping.

We found improvements had been made to some aspects of care records with better populated care plans and more robust evidence care was delivered in line with plans of care. However further improvements were required to documentation surrounding medicine management and people’s care and support plans. We identified this was of minor risk and the registered manager assured us it would be addressed.

Overall medicines were managed safely. People told us they received the required support in the administration of medicines

People told us they felt safe in the home. Staff understood how to identify and act on concerns. Risks to people’s health and safety were assessed and plans of care put in place to help manage those risks.

Overall we concluded there were sufficient staff deployed, however staff were stretched and busy at times particularly at lunchtime where the experience in the main dining room could have been improved.

Safe recruitment procedures were in place to ensure staff were of suitable character to care for vulnerable people.

The premises was safely managed. The home was well maintained and regular checks undertaken to ensure it was kept safe.

People spoke positively about the food provided by the home and said they had sufficient choice. Catering staff were aware of people’s nutritional needs and appropriate action was taken to ensure people had sufficient food and fluid.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) with DoLS authorisations made where the service suspected it was depriving people of their liberty.

People and relatives told us that staff treated them with dignity and respect. This was confirmed in the interactions we witnessed between staff and people.

People’s needs were assessed and appropriate plans of care put in place. We saw evidence of care and support being delivered in line with these plans. However there were some inconsistencies in information recorded in care plans which meant there was a risk inappropriate care would be provided.

A programme of activities was in place. We received mixed feedback about the availability of activities. Some people said there was enough to do, but others said they were often bored.

Systems were in place to assess, monitor and improve the service. The manager conducted regular checks and we saw evidence where deficiencies were identified, these were flagged up with staff as part of a system to improve the quality of care.

People’s feedback on the quality of the service was sought through periodic questionnaires, residents meetings and more informally by the manager during daily walkarounds.

We found a breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

treated with respect and because their needs were met. People's comments included: "I like it because I can come and go." "It's brilliant here."

We looked at the care records for four people living at Sherrington House. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people gave informed consent to their care and treatment.

The home had a safeguarding adults procedure that complied with all of the relevant legislation and good practice guidelines. Staff understood their responsibilities to protect people from harm.

A robust staff recruitment process was in place, which helped to ensure that people were supported by staff members who were suitable for their required roles. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We saw that there was a good rapport between staff and people who used the service.

We spoke with two people using the service and they told us;

'They really look after me here.'

'I am treated with respect and dignity and well looked after by the staff.'

This showed that people were happy living at Sherrington House.