Sheraton Court

Sheraton Court provides accommodation and personal care for up to 80 people, some of whom are living with dementia. At the time of the inspection there were 77 people living in the home.

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

People felt very safe living in the home and with the support they received from staff. People and relatives were complimentary about the staff, describing them as “friendly,” “approachable” and “caring.” Comments included, “It is a wonderful place for the likes of me” and, “The way they (staff) care for [family member] is the best thing, they are genuinely caring people.”

Staff safeguarded people from abuse. Risks to individuals and the environment were well managed. There were enough staff to meet people’s needs. A relative said, “When I visit, I always feel there are enough staff and if we need them, they are available.” The provider learned from accidents and incidents to mitigate future risks. Medicines were safely managed. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices. A relative said, “The home is very clean and there is always someone there cleaning.”

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The home was well managed. The provider, acting manager and staff promoted a positive culture in the home. People and relatives were complimentary about the home and care people received. The provider had an effective quality assurance process in place which included regular audits. People, relatives and staff were regularly consulted about the quality of the service through regular communication, surveys, meetings and reviews.

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 21 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we decided to undertake 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. The overall rating for the service has remained good based on the findings of this inspection. 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 Sheraton Court on our website at www.cqc.org.uk.

Follow up

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

Sheraton Court is a ‘care home’. People in care homes receive accommodation and 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. Sheraton Court accommodates up to 80 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of this inspection 79 people were in receipt of care from the service.

At the last inspection in June 2015 we found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Sheraton Court as ‘Good’ overall and good in four domains but noted improvements were needed to ensure staff always treated people with dignity and respect. We rated the service as ‘Requires improvement’ in one domain, namely 'caring’.

On 25 January 2017, the registered provider changed their name from Helen McArdle Care to HC-One Beamish Limited.

The registered manager had been in post since 2008. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 this inspection we found that the registered manager was a driving force for improvement at the service and was totally committed to delivering personalised and effective care. The registered manager researched how to provide high quality care for people who used the service. The registered manager had consistently ensured that all people who used the service, families and staff had significant involvement and input into how the service has been developed. Everyone was encouraged to share any thoughts, ideas and innovations on a monthly basis. All of the people and professionals we spoke with told us this was positive example of the changes made to the service, which benefitted people who live at the service and also all who visited.

We found staff were exceptionally caring and dedicated to ensuring people experienced high quality care. We heard how staff treated people, very much as individuals and both welcomed them to the service and showed a great deal of respect when people passed away. One relative, who worked as a nurse, told us they were extremely impressed with how staff care for people at the end of their lives. They told us their relative could not have experienced a more dignified end and they were taken aback by the care shown them when staff lined up to pay their respects to their relative. We found that people who used the service and relatives routinely nominated staff for the provider’s ‘Kindness and Care’ award as did the manager. We saw that each month at least two staff received such an award.

We found staff drive and passion had created an exceptionally dynamic and vibrant service. The culture embedded in the service was of total commitment to delivering a service that focused wholly on the wants and aspirations of the people who used it. The team worked collaboratively with people and their relatives to ensure the care provided met each person's needs. We saw that staff always engaged people in conversation and outlined the actions they were proposing to take to assist people with all of their care and support.

Staff were devoted to ensuring each individual found their lives were enriched. The relatives and visiting healthcare professionals told us the service provided care that was exceptional and contrasted dramatically from any other provision they had experienced or visited. They described the service as one that had dramatically improved people’s quality of life.

We found that the registered manager’s management style had led to people who use the service and staff feeling that they were an integral and essential partner in the operation and enhancement of the service.

The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. This was reflected in the care and support that people received. Staff supported people to make decisions for themselves and spoke with people about their wishes and preferences. We found staff empowered people to voice their wants and aspirations for their lives and then supported them to achieve these goals. It was evident that people’s voice was heard. Following feedback from people, decisions were made about who was employed to work at the service, trips were scheduled and activities were organised.

Staff received supervision on a monthly basis and they received annual appraisals. Staff were respected within the organisation and were provided with comprehensive training including specialist training. People who used the service also provided sessions on what it was like to need and receive care. We found there was a culture within the organisation of striving for excellence and assisting all to reach their maximum potential. Staff were supported to achieve excellence in their roles by attending specialist training around working with people experiencing a variety of conditions and by becoming champions within the service.

We found staff had an understanding of safeguarding and how to whistle blow. The registered manager was aware of risks within the service and was undertaking an analysis of risks. The service had emergency plans in place and took action when they became aware someone was at risk.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. Staff safely managed medications. People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it. Recruitment checks were carried out. People who used the service were actively involved in interviewing prospective staff and determining if the individual would be suitable to work at the service. Most of the staff had worked at the service for many years, which provided consistency for people using the service.

Staff knew the people they were supporting well. Care plans were personalised and had been regularly reviewed, to ensure they reflected people’s current needs and preferences. People and their relatives told us staff at the service provided personalised care. People were supported to access a wide range of activities in and outside of the service that they enjoyed.

Staff treated people with dignity and respect. People were supported to be as independent as possible and could access advocacy services if needed. Procedures were in place to investigate and respond to complaints.

People, relatives, visiting healthcare professionals and staff all described the registered manager, as being a strong, effective leader who ensured the service consistently operated to a high standard. Staff told us the manager supported them to constantly develop their practices and included them in the running of the service. Staff told us that they felt empowered to contribute their ideas and that these were taken on board. They described how they were encouraged to critically review the service and determine where improvements could be made and that this led to them never becoming complacent. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found '

Is the service caring?

Staff we spoke with were able to describe the type and frequency of care people received and also talk about their individual backgrounds, likes and dislikes. People who used the service told us, 'I've no complaints at all. The girls are alright. I think I am lucky to be here'; 'The girls are alright; they look after me well. They will sit down and have a talk with you' and 'I am happy with everything. I've lived here for three and a half years. The staff are lovely; I can't grumble.'

We saw care staff interacted well with people, were warm, supportive and spent individual time with them during meal times. We observed staff delivering care were patient and compassionate and supported people to be as independent as possible, or addressed people's needs where they were unable to do so themselves.

Is the service responsive?

Care plans contained details of people's personal preferences such as what time they liked to retire to bed, what foods they liked and whether they preferred male or female care staff to support them. We saw call bells were answered in a timely manner and care was delivered when staff responded to people's calls for assistance.

We saw people's general care needs were addressed and they had appointments with dentists, chiropodists and opticians. We noted that where people's care needs changed then action was taken. A general practitioner told us, 'What I've seen so far the staff act appropriately. They approach us if people have chest infections or other complaints.'

We observed a range of activities happening in the home including a group making Christmas decorations and a group partaking in a quiz. People were supported to engage in the activity and there was a good level of conversation and laughter.

Is the service safe?

We saw the registered manager completed a wide range audits on both a weekly and monthly basis, as well as requiring members of her senior team to check practices within the home. We saw, for instance, that people's care records, medicines, falls, weight and skin integrity were monitored regularly by the registered manager and staff. Also kitchen staff completed regular audits and the maintenance staff routinely checked health and safety within the home. We found the registered manager proactively ensured any action and issues identified were resolved.

People's individual risks were assessed and monitored. We saw there were regular reviews of people at risk of falling, risk of weight loss and poor diet and the risk of them developing skin damage. Where concerns were identified then action was taken

Is the service effective?

Staff we spoke with told us they had received training in relation to the Mental Capacity Act (2005) (MCA) and understood about the need to consider when actions needed to be considered under the issue of best interests. We found people's care plans contained assessments of people's capacity to make decisions to be cared for at the home, receive personal care and take their medication.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us there were currently 46 people living at the home who had been assessed as having their freedom restricted in relation to DoLS. We saw appropriate assessments and applications had been undertaken and copies of reports and authorisation were available.

Is the service well led?

We saw the registered manager completed a wide range audits on both a weekly and monthly basis, as well as requiring members of her senior team to check practices within the home. We saw, for instance, that people's care records, medicines, falls, weight and skin integrity were monitored regularly by the registered manager and staff.

We found the registered manager routinely obtained feedback from people who used the service. This included information from sources such as 'residents' and relatives' meetings, complaints and questionnaires.

We looked at records which showed there were regular staff meetings and saw quality issues were raised and discussed. We spoke with staff about these meetings and they all told us they had regular staff meetings and the opportunity to contribute their views.

Staff told us that they had undertaken additional training on mental capacity. One person told us, "I think more training would be good for us".

Some of the people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times, to have a conversation. So that we could understand the experiences these people had of care and support, we carried out a structured observation during our inspection called a Short Observational Framework for Inspection (SOFI).

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and there were enough qualified, skilled and experienced staff to meet people's needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Where people did not have the capacity to consent, the provider had failed to develop systems to ensure that they acted in accordance with legal requirements.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained and the provider had an effective system to regularly assess and monitor the quality of service that people receive.

Risk assessments were carried out and care was delivered in line with people's needs. Appropriate action was taken when people's needs changed and health professionals and others were involved whenever they were needed.

On the whole, medication was dispensed safely and there were processes in place to ensure this. There were some concerns about the records held by the service because these were sometimes out of date and didn't reflect the support people received. Recording related to some medication also needed to be improved.

Sheraton Court ensured that a robust recruitment process was followed and all staff had appropriate qualifications and experience to be able to deliver care and support to the people who lived there.