Archived: Sheldon Lodge

There was a registered manager in place who was also one of two providers whose legal entity was a partnership. 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.

Prior to this inspection concerns were raised to us about people's safety. We found the provider had not responding appropriate to an allegation of abuse. People were not protected from the risk of harm due to the lack of timely medical intervention and people were placed at risk due to unsafe moving and handling practices by staff.

People received their medicines on time and medicines were stored safely. However, the provider did not follow the least restrictive action when administering medicines.

There was a lack of activities and meaningful occupation and there was no documentary evidence that the activities which did take place were planned and evaluated for their effectiveness.

We saw some positive interactions between staff and people however there were some staff practices which demonstrated a lack of empathy.

People had a care plan in place however we found they were not involved in the review of their care plan. Care plans and other documents were not being updated in order to ensure current information was accessible, particularly when providing guidance to staff.

The provider had failed to notify the Commission when required to do so, in relation to a change in their legal entity and notifications in regarding incidents.

Staff training had fallen behind as had staff supervision. Staff had received an annual appraisal.

The provider was not adhering to the principals of the Mental Capacity Act 2005 and we found that people were not involved in the decision making process.

The provider had a system in place for auditing the quality and standard of the service they provided, however these had not been completed to highlight potential shortfalls in the delivery of the service. People and families were not involved in how the service was run and were not asked for their opinion about this.

Staff reported they felt well supported by the provider and were able to approach them if they had any concerns.

Following the inspection, the provider notified us they were closing the service and submitted the relevant notifications to the commission as required.

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.

Sheldon Lodge provides care and accommodation for up to nine older people. Some people living in the home had mental health support needs and some were living with a form of dementia or cognitive impairment. At the time of our inspection there were nine people using the service.

There was a registered manager in place 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 2008 and associated Regulations about how the service is run.

There were sufficient staff numbers to enable them to perform their roles effectively during our inspection and the rota that we viewed. However some staff told us occasionally they could do with another member of staff at busy times, we discussed this with the provider and the staff on duty. The provider confirmed they lived and so worked every day in the home. They also confirmed staff called them when extra help was required. The provider agreed to discuss this with the whole team at a team meeting to reinforce their availability.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Relevant training was provided to ensure staff’s knowledge was up to date.

Staff understood people’s individual needs and their daily routines. Care was delivered to people in a person centred way.

People’s rights were protected in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s capacity was considered in decisions being made about their care and support and best interest decisions were made when necessary. Staff received training to help them understand their obligations under the Mental Capacity Act 2005 and how it had an impact on their work.

We found the provider had systems in place that safeguarded people. Policies and procedures were in place to guide staff to make referrals to the relevant external agencies if the need arose. Staff we spoke with demonstrated an understanding of the process.

Safe systems were in place to safely manage people’s medicines. A policy was in place to guide staff through the process of ordering, stock control and the disposal of any unused medicines. Staff also received regular training in this area to ensure they were competent to administer people’s medicines.

People were involved in reviews of their care needs to ensure that staff had up to date information about how to meet people’s needs. People’s records demonstrated their involvement in their support planning and decision making processes. One person we spoke with confirmed their involvement in the process and how staff respected their wishes.

Support plans and risk assessments were representative of people’s current needs and gave detailed guidance for staff to follow. Staff understood people’s individual needs and preferences which meant that they received care in accordance with their wishes.

People, relatives and friends that we spoke with told us people received a good quality of care and support and felt welcomed when they visited the home. People were supported to maintain relationships that were important to them.

Staff we spoke with felt the service was well led and the registered manager was available and visible in the home. Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded. Staff felt they worked well as a team and responded to the direction of senior staff.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. There were systems in place to obtain the views of people who used the service and their relatives.

It was a positive visit and we could see that people were well cared for, supported and loved.

People told us they were happy living at the home and received 'wonderful care'. During the day people moved around the home freely, joined in a singalong session or went out. Staff were dedicated and caring. It was evident through observation and in discussions that they enjoyed working in the home and supporting people.

Part of the inspection was to follow up two outcome areas where improvements were required. We found the provider had carried out improvements to the infection control procedures and to the quality assurance systems.

People using the service said that staff were 'really kind' and one person commented that they were 'very happy.' A relative described how 'staff do all that they can'.

Records showed that people, or those acting on their behalf, were supported to make decisions. Staff considered people's preferences and described how they enabled people to make choices.

The needs of people using the service were assessed and identified in a person-centred way. Staff worked in partnership with people and their families.

The home was observed to be clean. Staff were aware of the importance of hand hygiene. Systems for managing and monitoring the prevention and control of infection were limited.

Staff reported that there were always enough staff on duty during the day. The provider explained that there were no staff awake on duty at night. The provider wrote a risk assessment for one person during the inspection, regarding how risks were being managed. Staff reported that they had received 'lots of training'.

Current systems for seeking feedback would not meet the needs of some people using the service. Audit systems were limited. The home had been awarded five stars by Environmental health for excellent standards of food safety.