Sherwood Lodge Independent Healthcare

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of the legal regulation in relation to safeguarding, staffing and the premises and equipment. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.
 

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty.

Staff listened to concerns about safety and investigated and reported safety events. Staff told us they completed incident forms and we saw these had been reviewed by the registered manager. Incidents and concerns were discussed in handovers and team meetings.

Staff felt accidents and safety events were investigated well and staff and people were supported with post-incident reflection and debriefs. The registered manager kept logs to establish themes or patterns and escalated concerns to other agencies when needed. Actions were shared with staff and lessons were learnt to identify and embed good practice.

Professionals told us staff prioritised safety at Sherwood Lodge and described changes the staff team had made to improve the service. This included modifications to the environment and changes to the support people received.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Referrals, admissions and discharges were planned with people and other partners to ensure continuity of safe care. When people were admitted to the service, visits were arranged to help people cope with moving to a new home and all staff could contribute to documents which were then developed into initial care plans.

When people received support from other services, staff advocated for them when necessary. They ensured individuals received the support they needed with a joined-up approach to safety and effective care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe when they were being supported by staff. One person said, “The staff are alright. I don’t have any worries when the staff are there.”

Staff received training in safeguarding and were able to describe the action they would take if they had concerns. Information was displayed around the service, and a policy provided guidance. All the staff we spoke with were clear that they would raise concerns and escalate these further if necessary. They were confident that people were safe.

The provider had effective safeguarding systems and processes to make sure people were appropriately protected from abuse. Safeguarding concerns and referrals were raised as necessary and staff collaborated with other professionals to keep people safe. The registered manager had good oversight of potential safeguarding concerns or risks.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). The service had made improvements and was working within the principles of the MCA and managed DoLS to ensure any restrictions or limits on people were the least restrictive possible and in the individual’s best interest. Staff told us, “We have made changes about the restrictions we place on people. All restrictions and responses are care planned. We make sure they are the least restrictive.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Individual risk assessments were in place, up to date and available to staff. These included details such as the risk of falls, fire risks, healthcare conditions and risks of self-neglect. People were involved in reviews of risk assessments as much as possible. Risk assessments helped staff to understand and respond to changes to or posed by people who lived at the service.

Staff knew people well, and this enabled them to anticipate, de-escalate and manage behaviour or expressions of emotion which were challenging. Risks and changes to people’s needs were clearly communicated to staff. The team were supported by other professionals, which helped staff review and manage risks. A professional told us, “Staff at Sherwood Lodge appear to have a very good knowledge of their residents and work skilfully to manage difficult and challenging situations when they arise.” Relatives told us staff balanced the needs of their family members with safety and risk management. They felt staff knew people well and kept them safe.

The service had a focus on positive risk taking and supporting people to stay safe if they made unwise choices. For example, when accessing the community or people’s decisions about smoking or alcohol.

The registered manager had changed the training and approach used to support people in distress. There was less focus on physical intervention or restraint, and instead staff used positive behaviour support and de-escalation to support people and protect their rights and dignity. Individual behaviour support plans provided staff with guidance about how to recognise and respond to people’s agitation or distress.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

At the last inspection some bedrooms were separated by a partition, and some areas required redecorating. At this inspection, we found all bedrooms were now private spaces, and people decorated these as they wished. Some bedrooms were small, but the people we asked about this were happy with their rooms. Male and female areas were at opposite sides of the home, further promoting people’s privacy and dignity.

Most people had a key and could access their bedroom at any time. If people did not have their own key, this was described in care records and reflected the risk of fire presented by individuals. Staff supported these people to access their bedroom at any time.

Risks in the environment were detected and controlled by regular checks of equipment and building safety. Repairs were actioned promptly where possible, and staff encouraged people to keep the home tidy and well presented. Communal areas were well maintained overall, and people had been involved in decorating the outdoor space. We received some negative feedback about parts of the service not feeling ‘homely’, although all the people who expressed this also recognised the difficulty of making changes and the importance of being able to clean and maintain the service effectively.

In a routine check, the registered manager had identified that 2-way radios would support staff communication and safety throughout the building. The radios had recently been purchased, and staff told us these would help them day to day.

A fire risk assessment had been completed and was up to date but was due to be repeated by an external agency to ensure full compliance with all legislation. Personal emergency evacuation plans described the support individuals would need in an emergency and a 'grab bag' and business continuity plan were available for staff.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The staff team included registered nurses and support workers as well as activity co-ordinators, housekeeping and catering staff. Several staff had worked at the service for many years, and this meant people had continuity of care and consistency from a regular staff team.

People and relatives told us there were usually enough staff, and they felt they were good at their jobs. Relatives described staff as kind and caring, and said they treated people with dignity and respect. A staff member told us, “Yes, we are always busy but there are enough of us to spend time with people and get things done properly.”

Agency staff were sometimes used when staffing levels could not be met, but the registered manager always tried to use agency staff who were familiar with the service.

At the last inspection, there were gaps in staff training and supervision. Improvements had been made and compliance was now good. Staff told us they were happy with the training they received, and believed that if they asked to attend additional training to develop their skills, this would be agreed. A staff member said, “There is lots of support. I have regular supervision, but I can chat to any of the senior team anytime.”

Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The registered manager took the lead for infection prevention and control.

Housekeeping staff followed schedules to ensure the service was clean and a continuous programme of deep cleaning supported this. Relatives gave positive feedback about the cleanliness in the home.

Staff understood the importance of food safety and hygiene when preparing or handling food. They followed required standards and practice and this was reflected in the service’s food hygiene rating.

People were supported to maintain their own personal hygiene in line with their needs and preferences and to be aware of their own environment. This could be challenging for some people, but staff provided sensitive support.

Staff were seen to be following the provider’s infection prevention and control policy and wore personal protective equipment (PPE) appropriately.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored securely and there were regular checks to identify concerns or shortfalls. These had been improved since the last inspection to ensure all aspects of medicines management were reviewed. This included medicines administration records, stock monitoring, temperature checks, medicines errors and ‘when required’ (PRN) medication. Medicines which needed additional security were managed in line with legislation. Body maps were included for topical medicines and drops, and creams and liquids were dated when opened and monitored to ensure compliance.

Only registered nurses administered medicines. They were knowledgeable, and their competency was regularly checked. No-one living at the service administered their own medicines at the time of our visit.

People had regular appointments with the GP practice and specialist health professionals. The registered manager had regular contact with the pharmacy who fulfilled people’s prescriptions. This helped ensure people’s medicines continued to meet their needs.

Staff’s knowledge of people helped them balance individual preferences with safe medicines management. For example, one person did not want to take white tablets, and staff advocated for an alternative to be prescribed which was a different colour. This continued to meet their needs, and they were happy to take the new medicine.

Policies and procedures provided guidance for staff and reflected current best practice so that medicines were ordered, administered, recorded, stored and disposed of safely.