Sheerwater House

Sheerwater House is a residential care home providing support to older people and people living with dementia. The service is registered to provide support to up to 20 people and there were 14 people living at the service at the time of our inspection.

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

Since the last inspection in November 2019 improvements had been made to the care received by people living with dementia. The registered manager and provider had taken steps to make the environment dementia friendly. Staff had been working in partnership with the mental health team to better understand how to support people during times of distress. However, further work was required to the provision of activities and ensuring that people have access to activities that are stimulating and engaging.

Person-centred care plans were in place which provided detailed guidance for staff on how the person wished to be supported. Systems were in place to involve people and staff in the running of the service. People were at the centre of decision making about their care. One person told us, “The staff here are ever so helpful, kind and friendly. They involve me in everything.”

Staff were caring in their approach to the people they supported and at this inspection we saw people were treated with respect and dignity. People and visitors to the service were consistent in their views that staff were kind, caring and supportive. One relative told us, “I cannot praise the service enough.”

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.

The registered manager and the staffing team knew their responsibilities and worked well with health and social care professionals. People, relatives and staff reported feeling confident in raising concerns with the management team. Relatives told us they were involved in people's care planning and were kept up to date with any changes. One relative told us, “I can’t thank the owner enough for what he does and how he keeps us updated with any changes or anything he thinks we need to know.”

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 Requires Improvement (published 9 January 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This was in relation to dementia care and support and governance of the service. This focused inspection looked at the key questions of ‘Responsive’ and ‘Well-led’. 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.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sheerwater House 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.

Sheerwater House is a residential care home providing support to older people and people living with dementia. The service is registered to provide support to up to 20 people and there were 15 people living at the service at the time of this visit.

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

People told us they felt safe living at Sheerwater House. Relatives told us they felt their loved ones were safe and well cared for by kind and caring staff. People and relatives told us that staff had the appropriate skills and training to be able to support people.

People had their medicines administered in safe way and medicines were stored correctly and as per the recommended guidelines.

The provider had improved the way risk was assessed for people. People had appropriate guidance in place around risk to ensure it was robustly managed and reduced. People had specific guidance in place around any specific conditions which enabled staff to have the most up to date information to be able to support that person. Staff had good knowledge of people and their needs.

Staff received appropriate training and support in their role. This included specialist training specific to the needs of the people using the service. They were also actively looking for additional training which they felt would be beneficial to support people more effectively.

People received opportunities in developing the menu and their nutritional and hydration needs were met and independence was promoted. People were supported with their health care needs and accessed external healthcare professionals and services. Information was shared with external healthcare agencies to support people to receive consistent care.

Staff had access to policies and procedures that reflected legislation and current best practice. The manager and nominated individual were enthusiastic and had a positive approach to developing the service and looked towards continued improvement.

People lived in an environment that was maintained and cleaned to a good standard. People and relatives told us they could remain independent. However, people living with dementia did not always have a suitable environment that considered their needs or offered stimulation. We have made a recommendation to the provider to seek best practice guidance around dementia care and the environment.

People’s care plans were detailed and staff used these to understand the care people required. However, we did find some areas of documentation that required improvement in terms of ensuring care plans were reviewed and developed consistently across the service. The manager had started to review all care plans prior to our inspection. We observed an example of a care plan that had been reviewed and contained all the required information in terms of personal life history, likes and dislikes.

People had access to a variety of activities and we observed some people taking part in the activities. However, for people living with dementia there was not enough in the way of activities to keep them stimulated or engaged with activities.

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 given privacy when they wished, but also enabled to move around freely and independently in a safe way.

Quality monitoring and audits were robust and monitored every aspect of the service. These were carried out by the manager who also shared involvement of the process with staff. This ensured that if an area of the service required attention, this was done immediately as through the auditing, every aspect of the service was continually under scrutiny. This was something that the manager had brought in after taking on the role of manager to improve quality monitoring.

The manager and nominated individual were open and honest during the inspection. They had made improvements across the service since the last inspection and as a result these changes were starting to show improvements to the quality of life of people living at Sheerwater House. Both the manager and the nominated individual were open about there still being some work to improve the service to bring in everything they want to achieve. These changes will need to be embedded and maintained.

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 04 June 2019).

Following the last inspection, we asked the provider to complete an action plan to tell us how they planned to address the shortfalls. At this inspection we found sufficient improvement had been made and the provider was no longer in breach of regulations. The service will still be rated as requires improvement overall as it will need to show the changes made can be maintained over a longer period of time, but now has a good rating in three key questions (Safe, Effective and Caring).

This service has been in Special Measures. During this inspection the provider demonstrated that Improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

People’s experience of using this service:

People told us that they felt safe living at Sheerwater House, but this inspection found that the legal requirements were not met. Planning in response to risk was inconsistent and we identified shortfalls in how people’s medicines were managed and administered. The assessment process was not robust and we identified instances where important information about people’s needs and preferences was missing from care records. The service was clean but we identified one instance where appropriate food hygiene measures were not being followed.

There were continued shortfalls in the governance of the service, as records relating to staff training lacked accuracy and audits had not identified and addressed concerns we found during this inspection. There had been a continued failure to implement and sustain improvements in response to previous inspections. The provider’s action plans had identified very specific examples but had not ensured all the legal requirements of the regulations were met.

People got on well with the staff who supported them and told us they got on well with the registered manager. Improvements had been made to the systems to gather and respond to complaints or suggestions. People told us they liked the activities and the provider involved them in choosing them. People said they liked the food that was prepared for them and their food preferences were documented.

People had consented to their care and there were systems in place to seek people’s feedback and suggestions about their home. Staff ensured people accessed healthcare professionals when required and we saw evidence of work alongside other agencies. Staff were respectful of people’s privacy and dignity and there had been improvements to the way care was planned to promote people’s independence.

Rating at last inspection: Inadequate (Published 12 October 2018)

Why we inspected: This was a planned inspection carried out in line with our policy.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: We will request further action plans from the provider and continue to monitor the service closely.

The overall rating for this service is 'Requires Improvement' with a rating of ‘Inadequate’ in the Well-led domain and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

Sheerwater House is registered to provide accommodation for up to 20 older people who require residential or nursing care. At the time of our inspection there were 16 people living at the home.

The inspection took place on 29 August 2018 and was unannounced.

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 last inspection of Sheerwater House was undertaken in March 2017 and the service was rated as ‘Requires Improvement’. We found at this inspection despite receiving an action plan from the provider telling us how they would address these shortfalls, the service had not improved.

Risks to people were not always effectively monitored or managed. Emergency plans were not always accurate or updated and medicine records were not always managed in line with best practice. People were not always protected from infection at the service. Accidents and incidents were recorded and reported but there was no overview or analysis of the data by the registered provider. This meant that opportunities to identify patterns or trends were missed. The premises were not completely adapted to meet the needs of people living with dementia.

There were not enough staff to safely and effectively care for people which affected the quality of care they received. Staff were not able to spend time with people as they were focused on their tasks.

Peoples’ independence was not always maintained as they did not have frequent access to baths and showers. Staff did not always respect people’s privacy and dignity. People did not have access to sufficient meaningful activities throughout the week and care plans were not person centred or detailed to include peoples’ preferences. Complaints were not recorded and the process for complaining was not clearly displayed or communicated.

The registered provider had not implemented strategies for person-centred care or enabled continuous development or learning at the service. Quality assurance and audits had not been effective or robust in identifying issues or improving the service. People were not always effectively engaged by the service although there were meetings, surveys and a social media page.

People had enough to eat and drink and received support from staff where a need had been identified. People's individual dietary requirements where met. The Mental Capacity Act (MCA) was adhered to and staff always asked for people’s consent.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Staff induction and ongoing training was tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff recruitment procedures were safe to ensure staff were suitable to support people in the service. End of life care was provided sensitively and in line with people's needs and preferences to ensure people had a pain free and dignified death.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

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.

During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the first time that the service has been rated Inadequate. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection in June and July 2015 we found a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to medicines and activities records not being maintained. We found at this inspection this Regulation continued to be breached but for different reasons. We also identified some new concerns.

Sheerwater House is a care home providing residential care for up to 20 older people, some of whom are living with dementia. At the time of our inspection there were 18 people living at the service.

There was 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.

People and their relatives told us that they felt safe. However, people were not always protected from the risk of infection and people were not receiving support with oral health care.

People felt there were in-sufficient staff to meet people’s needs. There was a shortage of cleaning staff resulting in care staff having to do cleaning and laundry tasks.

People's rights were not always protected because the staff did not act in accordance with the Mental Capacity Act 2005. The home had CCTV in place in the communal areas and had a closed Facebook page for relatives to access. No-one had consented to the use of these.

People were not living in an environment that was always appropriately maintained. Some areas were not clean and odour free.

Peoples care was not always planned and plans lacked the detail required for staff to know what care to provide to people.

There were mixed views on the activities available to people. Some people did not think there was enough for them to do.

The provider did not have effective systems in place to monitor the quality of the service. Some quality assurance systems were in place but these did not identify that people were not being protected against the risk of harm, that not all care was planned, that care plans lacked detail, or that people did not have mental capacity assessments in place for the use of CCTV and social media.

The registered manager had not notified CQC about a significant event. This involved someone making threats to the management and the home. When people had accidents, incidents or near misses these were recorded, but not monitored to look for developing trends

People’s medicines were managed and administered safely, and people received their medicines on time.

Staff had a good understanding of how to protect people from abuse and knew how to report safeguarding concerns. The provider followed safe recruitment practices.

Care records contained up to date risk assessments to guide staff in how to keep people safe.

The risk of fire had been assessed and plans were in place to minimise these risks. Regular fire drills were being completed and all staff had received fire training. Personal Emergency Evacuation Plans (PEEPs) were in place for every person.

People were supported by staff who had received training to carry out their roles. Staff received induction, regular mandatory training and other training required to meet the specific needs of people and were regularly supervised and appraised.

The staff met people's dietary needs and preferences. People were offered choice and meals were nutritious and well presented. Staff members provided support to people who required it.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

People and their relatives told us that staff were caring, respected their dignity and promoted their independence.

People were involved in the running of their home. Regular bi – monthly meetings were held where people could contribute. People knew how to complain.

The provider had sent out quality assurance questionnaires and encouraged people and their relatives to review the service on an industry wide web site.

People and their relatives felt the manager was approachable and available. The manager and the provider were involved in the running of the home.

All staff said they felt support and valued by the registered manager and the provider. Staff told us they worked well together and communicated with each other. Regular team meetings were held and staff said they were confident to speak up in these and make suggestions

During the inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made four recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager at the service. 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe? We found that people's medicines were not handled safely.

You can see our judgements on the front page of this report.

We spoke to the provider and registered manager and looked at two care plan folders. On this occasion it was not necessary to speak with people who used the service.

We found the provider had ensured that records held related to people who used the service were up to date and fully completed.

During this inspection we spoke with three people who lived at the home and two people who were visiting. We spoke to five members of staff which included the manager.

We found that the provider had put new recording systems in place and had made improvements to their record keeping. However, we noted that there was still work to do.

We looked around the home and found it to be clean and tidy. People told us that they had no concerns about cleanliness. One person told us 'The cleanliness is fine.' We saw that the provider had systems in place to monitor the cleanliness of the home.

During our visit we saw that the provider had taken a number of steps to improve the record keeping at the service. We noted that staff files were now complete and up to date. However, we noted that there was still some information left to be completed on resident's files.

During our discussions, we were told that there had been another change to the management of the home. A new deputy manager had started in April 2013 to support the manager who was there at the time. However, both the manager and deputy manager had now left and a new manager had taken up post. We were told that this had impacted on the provider's ability to make all of the improvements required by the time of our inspection on 2nd October.

We spoke to three people who used the service who told us that they liked living at Sheerwater House. We spoke to a relative who was visiting who told us 'The staff are fantastic'.

The manager had been in post since March and had reviewed each person's care needs. We saw that staff treated people kindly and attended to people's needs promptly. We noted that throughout the day people were smiling and seemed happy and relaxed.

We saw that the home was clean, tidy and well organised. One person told us 'It's well kept. They clean every day'.

We saw that most staff training was up to date and most staff had received supervisions. Staff told us that the new manager had made improvements and that they 'Felt better equipped to carry out their duties'.

We saw that the provider had systems in place to monitor the quality of the service and there was a complaints log to record any complaints received.

We saw that the provider had made several improvements in record keeping, however not all records were up to date.

We spoke to six people who used the service, and two relatives. Each person we spoke with was happy with the care and treatment they received. Comments were positive and included 'The staff are quite good', 'It's like my home'; 'If we want anything we have it'.

Throughout the day we saw that staff interacted with people well and spoke to them with kindness and respect.

People told us that they could make choices about what they did and where they spent their time. However, people were not always given choice. For example there was no menu choice and people were not informed of the meal that would be served in advance. However comments about the food were mainly positive.

People who used the service and their relatives told us they felt safe at the home and they knew what to do and who to speak to if they wanted to raise a concern. People told us 'staff are kind', 'I'm well looked after' and 'I like it here'.

Staff were not up to date with training and there were no training records available.

People told us they were happy at the home and they would talk to the manager if they wanted to raise a complaint.