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Sherrington House Nursing Home Good

Reports


Inspection carried out on 19 November 2019

During a routine inspection

About the service

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.

Inspection carried out on 20 August 2018

During a routine inspection

Sherrington House Nursing Home is a purpose-built care home accommodating up to 39 people over three floors. There is a lounge and dining area on each floor and disabled toilet and bathing facilities. The home is situated in the Heaton area of Bradford with good access to local amenities and public transport.

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 s

Inspection carried out on 25 January 2017

During a routine inspection

Sherrington House is a purpose built care home offering care for up to 39 people over three floors. There is a lounge and dining area on each floor and disabled toilet and bath facilities. The home is situated in the Heaton area of Bradford with good access to local amenities and public transport.

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 th

Inspection carried out on 30 March 2016

During a routine inspection

Sherrington House is a purpose built care home offering nursing care for up to 39 people over three floors. There is a lounge and dining area on each floor and disabled toilet and bath facilities. The home is situated in the Heaton area of Bradford with good access to local amenities and public transport.

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 (

Inspection carried out on 7 and 8 September 2015

During a routine inspection

Sherrington House Nursing Home provides accommodation and nursing care for up to 39 people accommodated over three floors. This includes care of people with learning disabilities or physical health needs.

This was an unannounced inspection which took place on 7 and 8 September 2015. 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 20 January 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.

People told us they felt safe and secure in the home and did not raise any concerns over their safety. Staff understood how to identify and act on any concerns.

Following the previous inspection in January 2015, we found improvements had not been made to the way medicines were managed. People did not always receive their medicines when they needed them and in a safe way.

Safe recruitment procedures were in place to help ensure staff were of suitable character to work with vulnerable people.

At the last inspection in January 2015, we found staffing levels were not consistently maintained to ensure safe care. At this inspection we found a greater level of consistency with regards to staffing levels. Although we found staffing levels were safe, staff were busy and did not always have sufficient time to meet people’s social needs.

Following the last inspection, improvements had been made to the training management system. Staff received a range of suitable training in ensure they had the correct skills and knowledge for their role.

People reported the food in the home was good and said there was sufficient choice. We found people were provided with sufficiently quantities of suitably nutritious food and appropriate hydration. Nutritional risks to people were well managed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home’s environment focussed on ensuring the least restrictive options, for example in free movement around and outside the home. The manager had made a number of DoLS applications and was awaiting feedback from the supervisory body.

We observed care and found people were treated with dignity and respect by staff. People told us that staff were always kind and treated them well.

A system was in place to ensure people knew how to complain and ensure any complaints were dealt with appropriately.

The home utilised an electronic care record system. However there was a lack of evidence that people had received care and support for example pressure relief in line with the requirements of their care plans.

Since the last inspection in January 2015, the manager had made improvements to the quality assurance system and robust checks in areas such as nutrition, weight management and pressure relieving mattresses were carried out. However improvements were needed to some audit systems, such as care plans and medication checks to ensure they were sufficiently robust to pro-actively identify and rectify risks.

Systems were in place to seek people’s feedback on the quality of the service and involve them in decisions relating to the running of the service.

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

Inspection carried out on 9 July 2014 and 20 January 2015

During an inspection to make sure that the improvements required had been made

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Sherrington House Nursing Home provides accommodation and nursing care for up to 39 people accommodated over three floors. This includes care of people with learning disabilities or physical health needs. On the day of the inspection 34 people were living in the home.

Comprehensive Inspection 9 July 2014

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’

The experiences of people who lived at the home were positive overall. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. People remarked that the food was particularly good.

However, we found systems and processes to keep people safe required improvement. The home did not have suitable quantities of staff with the required skills and experience. Vacant posts needed to be recruited to, to ensure consistent staffing numbers were maintained. This meant people may experience inconsistent levels of care and support. We found that there was a high turnover of staff and people reported to us that new staff did not always have the skills and experiences to care for them safely. This is a breach of Regulation 22, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Recruitment processes required improvement to ensure all the required background checks on new staff members were consistently applied. For example, staff who had recently been employed at the home did always have references from their last employer. The lack of robust recruitment procedures risked that people were being cared for by unsuitable staff. This is a breach of Regulation 21, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Medicines were not managed safely, as we found examples where people had not received their medication which could have resulted in unnecessary discomfort. This is a breach of Regulation 13, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The home met people’s nutritional needs and people reported that they had a good choice of food. Links with healthcare professionals was good and they all stated that the home followed their advice and delivered appropriate care.

The management of care records required improvement. We found there were two formats of care records in use at the home and the information contained in them was not consistent. This meant people may be put at risk, as staff may not have the most up-to-date information on people’s care. This is a breach of Regulation 9, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People and staff spoke positively about the new manager at the home and told us they listened and acted on comments and concerns.

Quality assurance processes required improvement; the issues we found had not been identified by the provider’s own monitoring and audit processes. This is a breach of Regulation 10, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found two notifications which should have been submitted to the Care Quality Commission (CQC) had not been. This is a breach of Regulation 18 Health and Social Care Act 2008 (Registration Regulations) 2010. We spoke with the manager about this and warned them we would take further action if future notifiable incidents were not reported to CQC.

Focused inspection 20 January 2015

Following the previous inspection , the registered manager had left. A new manager had been recruited and was in the process of applying for the registered managers post.

After our inspection of 9 July 2014 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. We undertook this unannounced focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to; care and welfare of people who use services, management of medicines, requirements relating to workers, staffing and assessing and monitoring the quality of service provision.

We found the provider had made some improvements in relation to the management of medicines. Protocols had been introduced to assist staff in the administration of “as required” medicines. However, although the recording of medicines had improved we still found some gaps in medication records, and some medicine stock levels did not concur with amounts recorded on documentation. This meant there was a lack of accountability for some medicines.

We found some improvements had been made to staff skill and knowledge and more consistency to staffing levels during the daytime. However we had concerns that staffing levels were not always maintained during the night and documentation was unable to provide evidence that night-time staffing levels were consistently maintained.

We found the service was meeting people’s care needs and people told us they were well cared for. Care records were being transferred to a computerised system and the process was nearly complete. However, we found there were some shortfalls in the care records which created a risk of people receiving care that was unsafe or inappropriate.

Although the manager had plans to implement a robust quality assurance system we found audits in areas such as medication, staffing levels/dependency, infection control, care quality and care records were not yet taking place which meant risks in these areas were not always being routinely identified and rectified.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the end of the report

Inspection carried out on 9 July 2014

During a routine inspection

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Sherrington House Nursing Home provides accommodation and nursing care for up to 39 people accommodated over three floors. This includes care of people with learning disabilities or physical health needs. On the day of the inspection 34 people were 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.’

The experiences of people who lived at the home were positive overall. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. People remarked that the food was particularly good.

However, we found systems and processes to keep people safe required improvement. The home did not have suitable quantities of staff with the required skills and experience. Vacant posts needed to be recruited to, to ensure consistent staffing numbers were maintained. This meant people may experience inconsistent levels of care and support. We found that there was a high turnover of staff and people reported to us that new staff did not always have the skills and experiences to care for them safely. This is a breach of Regulation 22, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Recruitment processes required improvement to ensure all the required background checks on new staff members were consistently applied. For example, staff who had recently been employed at the home did always have references from their last employer. The lack of robust recruitment procedures risked that people were being cared for by unsuitable staff. This is a breach of Regulation 21, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Medicines were not managed safely, as we found examples where people had not received their medication which could have resulted in unnecessary discomfort. This is a breach of Regulation 13, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The home met people’s nutritional needs and people reported that they had a good choice of food. Links with healthcare professionals was good and they all stated that the home followed their advice and delivered appropriate care.

The management of care records required improvement. We found there were two formats of care records in use at the home and the information contained in them was not consistent. This meant people may be put at risk, as staff may not have the most up-to-date information on people’s care. This is a breach of Regulation 9, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People and staff spoke positively about the new manager at the home and told us they listened and acted on comments and concerns.

Quality assurance processes required improvement; the issues we found had not been identified by the provider’s own monitoring and audit processes. This is a breach of Regulation 10, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found two notifications which should have been submitted to the Care Quality Commission (CQC) had not been. This is a breach of Regulation 18 Health and Social Care Act 2008 (Registration Regulations) 2010. We spoke with the manager about this and warned them we would take further action if future notifiable incidents were not reported to CQC.

Inspection carried out on 29 October 2013

During a routine inspection

We talked with two people who used the service and three people who worked in the home. People who used the service told us they liked living at the home because they were

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.

Inspection carried out on 26 September 2012

During a routine inspection

During the inspection we saw the home was clean, well staffed and people were actively doing what they wanted where they wanted. We saw that care records were of a good standard and people told us they thought the care was very good. We saw people were involved in their care at all levels from individual activities through staff interactions to how the home was run through residents meetings.

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.

Reports under our old system of regulation (including those from before CQC was created)