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Shawe House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 August 2017

We undertook this inspection of Shawe House Nursing Home on 20 and 22 June 2017 and was unannounced on the first day. The inspection team consisted of one adult social care inspector, a bank inspector and an expert by experience on the first day of the inspection. The inspection was unannounced which meant the provider did not know we were coming on the first day of the inspection.

Shawe House Nursing Home is located in Flixton, Manchester and provides nursing care for up to 33 people who live with dementia. Accommodation is provided on two floors. All bedrooms are single rooms and those on the first floor are accessible by a passenger lift. There is an enclosed garden area and parking for several cars at the front of the property.

At the time of our inspection there were 27 people living at Shawe House. The local authority had placed a temporary suspension on new admissions. It was envisaged that this suspension would be lifted once the home could demonstrate adequate improvements with regards to people's safety and the quality of care delivered.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 our last inspection in October 2016 we identified breaches of the regulations in relation to the safe care and treatment of people, person-centred care, consent, premises and equipment, staffing and the governance of the service. The home was placed in special measures as a result of the breaches identified at the last inspection and we served three warning notices.

At this inspection we found improvements had been made in all areas. We found the service was now working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support although we judged that the service needed to improve with regards to correctly recording people’s consent to aspects of their care.

People received their medicines as prescribed and the nurses had received relevant medicines administration training. Protocols for the use of ‘as required’ medicines were in place. The temperature of the medicines fridge had not been recorded for two days as this was reported as broken. A representative from the pharmacy came out to the home and addressed this on the first day of inspection. Staff were reminded to also record the temperature of the medicines room so that the effectiveness of medicines stored there was not reduced.

People we spoke with and their relatives were complimentary about Shawe House. Relatives told us they considered their family member to be safe, the staff knew people’s needs well and there were enough staff on duty to meet those needs.

There was less reliance on agency staff and staff appeared more confident and positive about their role. The registered manager had made new appointments that benefitted the home and was supported by a new deputy manager and a clinical lead.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed.

Care plans were in place for the support people wanted as they came to the end of their lives and the home had been awarded The Six Steps to End Of Life Care accreditation certificate. Relatives were kept informed about the programme.

Appropriate referrals were made to the Speech and Language Tea

Inspection areas

Safe

Requires improvement

Updated 15 August 2017

The service was not always safe.

Risk assessments had been completed for some aspects of care. However people did not have access to call bells due to the increased risks. There were no assessments on file to reflect these risks.

There were now sufficient numbers of suitably qualified, skilled and experienced care staff to support people living in the home safely. There was less reliance on the use of agency staff.

The home had recruited additional staff to deal with maintenance issues and cleaning. The home environment was much improved and was cleaner.

Effective

Requires improvement

Updated 15 August 2017

The service was not always effective.

The home was operating in line with the Mental Capacity Act. Best interest decisions were now recorded in the care files that we looked at and applications for DoLS authorisations made. The home needed to improve with regards to gaining and recording consent.

The atmosphere at mealtimes was relaxed and appropriate music was on in the background. Staff need to be more mindful of where residents sit during meal times based on their dietary requirements.

Improvements had been made to the physical environment to make it more dementia friendly.

Caring

Good

Updated 15 August 2017

The service was caring

Staff attitudes had improved. We observed staff treat people with kindness and respect and interactions between people and the care staff were warm and positive.

The service was signposting people to advocacy services and was therefore helping to promote their rights and independence.

The home had been awarded the Six Steps to Success in End of Life training. The service was involving relatives and informing them about the process and planned to update them further at the next relatives meeting.

Responsive

Requires improvement

Updated 15 August 2017

The service was not always responsive.

We saw care plans were reviewed monthly or following any changes in people�s needs. Staff were documenting when people refused aspects of personal care however it was not clear what actions, if any, staff took to encourage people to comply with care.

Care workers were now documenting in progress notes for those people they had assisted with personal care.

Relatives meetings were held monthly and were attended by a core group of relatives. There had been a suggestion at the last meeting to hold these meetings every three months and relatives were happy with this arrangement.

Well-led

Requires improvement

Updated 15 August 2017

The service was not always well led.

Audits and checks were completed on a range of areas, for example medicines, care plans, accidents and incidents, mattresses and aspects of the environment. Some areas for improvement identified during audits had not been acted upon in a timely manner.

The registered manager had introduced support mechanisms for staff such as a rolling rota, supervisions and staff meetings. Return to work interviews following absences due to sickness were still not undertaken.

The registered manager felt fully supported with the restructured management team and recognised that the improvements to the service now needed to be developed and sustained.