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Inspection carried out on 2 November 2020

During an inspection looking at part of the service

Shedfield Lodge accommodates up to 34 people, some of whom may be living with dementia.

Shedfield Lodge 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.

We found the following examples of good practice.

• People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection.

• Information was easily accessible on arrival, or before visits, to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control.

• Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using video calls or visiting in the communal garden. People had access to a telephone and staff were available to support if required.

• All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home, alongside having their temperatures taken. Visitors had no contact with other residents and had minimal contact with care home staff.

• Facilities were in place to wash hands for 20 seconds, or to use hand sanitiser, on entering and leaving the home.

• A screen was provided in the entrance porch of the home showing visitors how to wash their hands properly.

• There was prominent signage and instructions to explain what people should do to ensure safety.

• Admissions from hospital or interim care facilities, and new residents admitted from the community, were isolated for 14 days within their own room.

• People were assessed regularly for the development of a high temperature (37.8°C or above), a cough, as well as for other signs such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting.

• All staff in high risk groups such as Black, Asian and minority ethnic (BAME) had been risk assessed, and adjustments had been made.

• All members of staff worked in only one care setting, this included part-time and agency staff.

• Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading to other people and staff members.

• Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

• Staff had received training from an Infection Prevention and Control (IPC) specialist.

• A testing scheme for all staff and residents had been implemented, known as ‘whole home testing’. The provider had tests for regular 'whole home testing' as well as tests for any suspected or symptomatic residents or staff.

• Staff wore a fluid repellent surgical mask, gloves and apron when delivering personal care to all people. Use of personal protective equipment (PPE) was in accordance with current government guidelines COVID-19 PPE. We observed staff to be wearing PPE as per guidelines. Disposal of used PPE prevented cross-contamination as it followed local protocols, in particular single use items and how PPE is disposed of safely.

• Communal areas such as outdoor spaces and garden areas were used creatively to help with IPC. The provider had identified a specific outside paved area at the front of the premises to support people to have visits safely with their relatives whilst enabling their rear gardens to be utilised as a safe outside space for people to access independently and safely.

• The provider had encouraged people and visitors to provide feedback about their well-being and how they have felt during the pandemic, including anything they had found difficult or any suggestions they had for improving practices.

• Effective cleaning schedules were in place in all areas of the service.

•The provider ensured that current guidance was shared in a timely way with the service. When the guidance was updated the risk, parameters were revi

Inspection carried out on 16 October 2017

During a routine inspection

The inspection took place on the 16 and 17 October 2017 and was unannounced.

We last inspected the service in March 2015 and rated the service as good. This inspection found that the service remained good.

The service had a registered manager. 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.

Shedfield Lodge is registered to provide accommodation and support for up to 34 older people who may also be living with dementia. The home has permanent residents but also provides respite care. This home is not registered to provide nursing care. On the day of our visit 28 people were living at the home. The home is located in a rural area two miles from the town of Wickham, Hampshire. The home has a large living room, conservatory, dining area and kitchen. People's private rooms are on both the ground and first floors. There is a stair lift and passenger lift to the first floor. The home has a garden and a patio area that people are actively encouraged to use.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles.

The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People and where appropriate their relatives were involved in their care planning, Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

Inspection carried out on 19 and 20 January 2015

During a routine inspection

Shedfield Lodge is registered to provide accommodation and support for up to34 older people who may also be living with dementia. On the day of our visit 31 people were living at the home. The home is a grade 2 listed building and is located in a rural area approximately four miles from the town of Fareham. There is no public transport nearby. The home has a large living room, conservatory, two dining rooms and a kitchen. There are seating areas around the home where people can rest and relax. People’s private bedrooms are on both the ground and first floors. There is a passenger lift and stair lift to the first floor. The home has a garden with a fish pond and a patio area that people are actively encouraged to use.

We undertook an unannounced inspection on 19 and 20 January 2015.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

Staff understood the needs of the people and we saw care was provided with kindness and compassion. People, relatives and health and social care professionals told us they were very happy with the care and described the service as very good. People were supported to take part in activities they had chosen. One person said, “I love living here. The staff are lovely people and are always so bright and cheerful”. Staff spoke with people in a friendly and respectful manner. Staff told us they were encouraged to raise any concerns about possible abuse. One member of staff said, “The home is managed well. If we have concerns we can speak to the manager or deputy manager about them”.

Staff were appropriately trained and skilled to ensure the care delivered to people was safe and effective. They all received a thorough induction when they started work at and fully understood their roles and responsibilities.

The registered manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs. Each person and relative told us they were continually asked for feedback and encouraged to voice their opinions about the quality of care provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. People’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. A visiting GP told us, “I have no concerns at all over the safety and welfare of people living at the home. People are very well cared for and the staff work extremely hard”.

Inspection carried out on 16 June 2014

During a routine inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 16 June 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, with carers and / or family members the registered manager, care staff and a visiting health care professional.

We considered our inspection findings to answer questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Is the service safe?

The service was safe because each person had a support plan which identified their individual needs before they came into the home, an assessment of possible risks to the person and a description of the person�s needs for support and treatment.

People living at Shedfield Lodge had a Personal Emergency Evacuation Plan (PEEP) in place. This gave clear and concise instruction on the level of assistance needed to evacuate people from the home in the event of a fire.

People were safe because staff received safeguarding training during their induction and it was updated regularly. We saw training included the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff we spoke with were able to identify different types of abuse and knew the correct procedures to follow if they had any concerns.

There were effective systems in place to make sure the premises provided a safe environment. We looked at the fire log book and saw inspections of the fire safety system were taking place to the required timescales.

People were safe because the provider had arrangements in place that ensured equipment was checked, serviced and if necessary repaired or replaced.

The provider ensured appropriate checks were undertaken before staff started work. We looked at the recruitment records of four care workers. We found photographic identification present on each care worker file. Disclosure and Baring Service (DBS) checks were undertaken on new staff. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted the provider was working with the local authority to ensure proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

The service was effective because care plans were reviewed monthly by the registered manager or their deputy. Family members confirmed that they were kept informed of any changes in their relatives� health.

The equipment and aids that helped promote people�s independence and welfare included mobile hoists; slings: stand-aids/rotundas: walking frames: walking sticks; wheelchairs: specialised seats: raised toilet seats: and specialist cutlery. We also looked at records and documents that showed the provider had arrangements in place for regular servicing of lifting equipment. For example, lifting hoists, lifting hoist slings and standing transfer aids.

Is the service caring?

The service was caring. During our visit we looked at four care plans. We talked with people and one visiting relative who told us they were involved in planning their relatives care and support. The relative told us: �We talk about how mum likes things and they do their best to accommodate�.

Care records showed healthcare professionals were involved when people needed them.

Is the service responsive?

The service was responsive. We spoke with one visiting health care professional who said: �I have been visiting the home for the past two years. I have no undue concerns about the care people receive. There is a very low incident of falls within the home and very few skin related issues. The staff are very proactive in identifying concerns and calling us for advice�

In each person�s room there was a �Remember I�m me� care chart. This gave staff an overview of things that were important to people using the service.

Is the service well led?

The service was well led. In two care plans we reviewed we saw people had attended the local eye hospital recently for tests in relation to macular degeneration. The hospital discharge notes included an electronic print to demonstrate to staff how that person�s vision was impaired [blurred]. The registered manager told us: �We included this in the care plan so that staff could see and have an understanding of how visual impairment can affect people� One member of staff said: �Knowing how people�s vision can be affected helps us to understand their needs and give the best care we can�.

The provider ensured staff received regular training and development. We saw recent staff training certificates that included: food hygiene and safeguarding vulnerable adults. The manager showed us the training schedule which recorded the training care workers had undertaken and when refresher training was due.

Inspection carried out on 5 June 2013

During a routine inspection

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. There was information in records about people's health and care needs. Risks to their welfare were documented. One relative we spoke with said: �I have to say that since my relative has been at Shedfield Lodge she has done so well. I firmly believe that is because the care workers are attentive and patient�.

During our inspection on 13 February 2013 we judged that people were not protected from the risk of infection. We arrived at Shedfield Lodge at 9am on the day of this inspection. We toured the premises and found that all of the areas of the home to be in a clean condition. The actions taken by the provider to improve the service and meet this regulation following our inspection in February 2013 had been met.

During our inspection on 13 February 2013 we judged that the provider did not operate an effective system to regularly assess and monitor the quality of service and to identify and manage the risks to the health, welfare and safety of people. A new computer based system for monitoring compliance and quality assurance has recently been installed by the provider. The manager was in the process of receiving training for this and told us: �Going forward this will ensure that we address areas that we need to improve on".

Inspection carried out on 13 February 2013

During an inspection looking at part of the service

We visited the service to follow up where we had previously identified areas of improvement or non-compliance during a visit on 15 October 2012. We had received an action plan from the provider following the last visit which detailed the improvements they had made and this was discussed during the visit.

We found the provider to be in the process of reviewing all care plans and had employed an independent consultant to support the process. The quality improvement officer for Hampshire County Council was also providing support to the home. We looked at three care plans that had been reviewed. They were detailed and contained a range of information relating to the individual and how the home would manage their care.This meant that people�s personal records including medical records were accurate and fit for purpose.

People we spoke with said they were happy living at Shedfield Lodge and that their needs were met. One person said "I am happy here and staff care about me."

Systems to monitor the cleaning of the home had been introduced by the provider and a new bathroom installed. However, some areas of the home were not clean and Infection control practices needed improvement to meet national guidance.

The provider had introduced some systems since the last inspection to monitor the quality of care and service provision .However,some improvements were required to ensure the systems were effective .

Inspection carried out on 15 October 2012

During a routine inspection

In this report the names of both the current and the previous registered manager are shown. The previous registered manager's name appears because they were still on our register at the time of our inspection.

For this inspection we reviewed four essential standards where we had previously identified areas of improvement or non-compliance. We also looked at other standards relating to quality and safety of care.

Staff treated people with dignity and respect. People were given time to express their needs and were listened to by staff. Before people received care they were asked for their consent and the provider acted in accordance with their wishes.

People�s needs were assessed and care was planned and delivered in line with their individual care plan.

We found that some areas of the home were not clean. Infection control practices did not comply with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance.

Staff told us they felt supported, and had access to training, advice and opportunities for shared learning.

There was not an effective system to monitor the quality of the service to ensure improvements were identified and implemented. This meant that people were not always protected from risks.

Care records viewed required further work to ensure they were accurate and detailed how decision making was reached.

Inspection carried out on 6 March 2012

During an inspection in response to concerns

People able to speak to us were positive about the food they had eaten at lunchtime during our visit. People, who were able, told us they were able to get the help they needed when they needed it. One person said that they were happy due to some changes in their health needs that they had received help with.

Inspection carried out on 19 December 2011

During an inspection looking at part of the service

The provider had arrangements in place to assess the quality of the service provided, to identify risks and had made improvements. This included seeking the views of people who use the service and staff. Overall, we found that Shedfield Lodge was meeting this essential standard.

Inspection carried out on 20 June 2011

During an inspection in response to concerns

During our visit we received positive views about care from people living in the home. One person thought they had the help they needed and gave examples of the support they had received. They said the staff were �nice and caring�, �there were a lot of them�, and they �had a nice room�. Another said that the staff were �alright �, they �sometimes did some singing�, but were �sometimes a bit bored�.

We spoke with some relatives. They were mostly positive about people�s needs being met and about the activities provided. One raised a concern which was referred to the manager.

We received mixed views from relatives about the cleanliness of the home. Some said that it was clean and another said that it was not generally to an acceptable standard.

A social service care professional told us they had recently reviewed some care practices and had not found evidence to support concerns that had been raised by a third party.

Staff told us that they are receiving training in moving and handling and there is one system of care planning. They also told us that reviews of people�s care are more regular. They said they helped people with eating, but when we asked a member of staff member about nutritional assessments, they were not aware of them.

Inspection carried out on 20 January 2011

During a routine inspection

People we spoke with at the service were positive about the care that they received. They were less aware of care plans and records but they said that they were looked after, that they were comfortable and warm. They said that staff helped or looked after them and that they listened. They were mostly confident that they would be helped if they needed it. Comments about the food and choices were positive.

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