Shearwater

We found the following examples of good practice.

The home had a current outbreak of COVID-19 and were not allowing visits to people living in the home, this was in accordance with latest best practice. However, protocols were in place for all visitors to prevent the spread of infection and prior to the outbreak people were supported to receive visits in a safe way. Processes in place for any visitors were clearly displayed on entrance to the home, and included a temperature check, hand sanitiser and a questionnaire to identify any previous contact with COVID-19. Appropriate PPE was available for use.

New admissions to the service were supported in line with best practice guidance. When someone new was admitted to Shearwater they were required to provide recent COVID-19 test results. People were further tested by the service following admission and isolated upon arrival for 14 days to minimise the risk of infection to existing people.

Staff had received training on COVID-19, infection control and the use of Protective Personal Equipment (PPE), including the correct way to put on and take off PPE. Throughout our inspection staff were wearing the required levels of PPE and maintaining social distancing as much as possible.

Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

The premises were clean, hygienic and well ventilated. Additional cleaning schedules had been introduced since the beginning of the pandemic. For example, high touch areas such as door handles and light switches were regularly cleaned throughout the day. Adaptions had been made to the environment to support people and staff to socially distance and work safely.

Clear policies, procedures and contingency plans were in place regarding COVID-19 and infection control. Audits were undertaken, and actions were taken to ensure improvements were made. The management team understood where to find updated best practice guidance and where they could go for support should this be required.

Shearwater is a care home registered to provide accommodation for up to 60 people. The service provides care to older people living with a cognitive impairment. Care was provided in a safe and dementia friendly environment. At the time of our inspection there were 48 people living in the home. The home provided support to people within smaller environments over three floors, with each floor having its own dining area, lounge and quiet social space. Regular staff and an assistant unit manager worked on each floor. However, people living at the service could access all three floors of the home if they wished to.

People’s experience of using this service:

The environment was warm and homely. Communal areas of the home had recently been re-decorated using calming colours and photographic wall paper to provide an environment that promoted people’s wellbeing.

People told us they were happy living at Shearwater. The staff team worked well together and knew people well. One person told us, “The staff are great.”

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

Individual and environmental risks were managed appropriately. People had access to appropriate equipment where needed, which meant people were safe from harm.

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

Staff recognised people’s individual needs and supported them to make choices in line with legislation.

Staff were motivated and proud of the home. Continuous learning was embedded in the home's culture.

There were meaningful activities available to people and research had been used to develop new ways of working that enhanced people’s wellbeing.

People and their families were involved in the development of personalised care plans that were reviewed regularly.

The registered manager and provider carried out regular checks on the quality and safety

of the service.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 27 June 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

The home is registered to provide accommodation for up to 60 people some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. There was a good choice of communal spaces where people were able to socialise and all bedrooms had en-suite facilities. At the time of our inspection there were 34 people living at the home.

The inspection was conducted on 9 and 14 May 2018 and was unannounced.

At the time of the inspection there was not a registered manager in post at the service, there was a manager who had taken over the overall running of the service and was planning to apply to become registered to manage the home.

At our last inspection, in September 2017, we identified breaches of Regulation 12; Safe Care and Treatment, Regulation 18; Staffing, Regulation 17; Good Governance and Regulation 9; Person Centred Care, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in the service receiving an overall rating of 'Inadequate' and being placed in special measures.

At this inspection the service received an overall ‘Requires Improvement’ rating and was removed from special measures. We recorded one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the Need for Consent. You can see what action we told the provider to take at the back of the full version of this report.

Improvements had been made in the quality assurance processes within the home and we saw robust audits were completed for most areas. However, we found further work was still required in some areas including working within the principles of the MCA and ensuring that all medicine was managed safety.

We found that in the main improvements had been made that had resulted in people receiving safer, more effective, person centred care. A range of processes and procedures had been put in place and were followed to help ensure staff followed best practice guidance when providing care and support to people.

People told us that they received their medicines safety and on time. However, medicines were not always stored safety and where people were prescribed topical creams there was not clear and robust systems in place to ensure these were given appropriately.

Risks to people were assessed and managed effectively. Staff were provided with clear guidance on how risks should be managed and demonstrated an understanding of specific risks to people.

Where accidents and incidents had occurred, these were clearly logged, reviewed and analysed to see if there were any common themes and if there could be any learning from these events.

There was enough staff deployed to meet people’s needs and keep them safe. The staffing level in the home provided an opportunity for staff to interact with the people they were supporting in a relaxed and unhurried manner.

Staff had the knowledge and confidence to identify safeguarding concerns and acted to keep people safe. Staff had received training in safeguarding, which helped them to identify, report and prevent abuse.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed. People's needs were met by staff who were competent, trained and supported appropriately in their role.

People were supported to have enough to eat and drink and had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Staff showed care, compassion and respect to the people. There was a relaxed and calm atmosphere within the home. People were cared for with dignity and respect and their privacy was respected.

People were encouraged to be independent and the staff supported people to meet there cultural and spiritual needs.

The service was responsive to people's needs. Care files were person centred and contained consistent and relevant information about people. Staff demonstrated that they know people well, understood their needs and had knowledge of their likes and dislikes.

People had access to a range of varied activities they enjoyed. People were listened to by staff and their views and wishes were respected.

People, their families and staff had the opportunity to become involved in developing the service.

There was an open and transparent culture within the home and people and families confirmed they felt able to approach the manager at any time.

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 2008 and associated regulations about how the service is run.

At our last inspection, in January 2017, we identified breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure adequate systems and processes were in place to assess, monitor and mitigate the risks associated with people's care and ensure the safety of the services they provided. There was a lack of clear guidance in place for the safe use and administration of some medicines to ensure the safety and welfare of people. Risk assessments associated with people's care did not provide sufficient detail as to how staff could reduce risks to ensure people’s safety and welfare. Records held in the service were not always accurate and complete. At this inspection we found continued breaches of these regulations, together with other concerns.

The provider has a history of not being able to make and sustain improvement in this home and has been in breach of regulations at every comprehensive inspection of the home since 2012. These breaches have often related to the same shortfalls.

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.

The provider’s quality and safety monitoring systems had not been effective in identifying and directing the service to act upon risks to people who used the service and ensuring the quality of service provision.

Risks to people had been assessed; however information within people’s risk assessments and care records was inconsistent and conflicting. Important and relevant information about people’s changing needs was not always robustly shared with staff. This could result in ineffective and inappropriate care being provided to people, which would place them at risk of harm or injury.

Care plans were not person centred and care monitoring records such as repositioning charts, food and fluid charts and body map’s had not been put in place or were not completed to an appropriate standard. This meant we were not assured people always received the correct care and that the support they received was consistent, person centred and appropriate.

There were not enough regular staff deployed to meet people’s essential care needs and to ensure people’s safety. People with cognitive impairments were left unsupervised with no access to staff. The registered manager and the provider’s representative were unable to provide the rationale for the current staffing levels at the home and the service was heavily reliant on agency staff.

People told us that they received their medicines safety and on time. However, where people were prescribed ‘as required’ medicine to help with anxieties there was not clear and robust systems in place to ensure these were given appropriately.

People told us they had enough to eat and drink and enjoyed the food. However, the system in place to monitor food and fluid intake was not robust.

Staff received an appropriate induction and on-going training to enable them to meet the needs of people using the service.

Staff sought verbal consent from people before providing care and followed legislation designed to protect people’s rights.

Staff developed caring and positive relationships with people and were sensitive to their individual choices. They treated people with dignity and respect. People were encouraged to maintain relationships that were important to them.

There was an opportunity for people and their families to become involved in developing the service; they were encouraged to provide feedback on the service both informally and formally.

People were provided with appropriate mental and physical stimulation through a range of varied activities.

People and their families felt the home was safe. Staff were aware of their responsibilities to safeguard people. Environmental risks were assessed and managed appropriately.

We are currently considering our regulatory approach in relation to the breaches identified at this inspection.

The home provides accommodation and personal care for up to 60 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all areas. At the time of our inspection 52 people lived at the home.

A registered manager was not in post 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. A registered manager left the service in March 2016. A unit manager was employed at the home at the time of our inspection and recruitment processes were underway to employ a manager to the home who would register with the Commission. A deputy manager in post had been in the service for more than three years and provided some consistency in leadership in the home.

Medicines and prescribed substances were not always managed in the home in a safe and effective way. Risks associated with medicines and prescribed substances had not always been identified and actions taken to reduce these risks.

Risks associated with people’s care had mostly been identified and plans of care were in place, however the risks associated with the safe evacuation of people in the event of an emergency had not been assessed and plans of care were not in place to reduce these risks.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Staff recruitment processes were robust and staff received sufficient support and supervision in the home. However staff lacked training in some areas such as first aid and in the use of some medicines.

People received freshly prepared nutritious food in line with their preferences although further work was required to support people who lived with diabetes. We have made a recommendation about this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans mostly reflected the individual needs of people and the risks associated with these needs, although some information lacked consistency.

People were supported to participate in a wide range of events and activities of their choice.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

Whilst the service had a good staffing structure which provided support and guidance for people, staff and their relatives, there was a lack of management leadership in the home. Further work was required to ensure senior staff had a good understanding of their roles and responsibilities.

There was a lack of systems and processes in the home to assess, monitor and mitigate the risks associated with people’s care and ensure the safety of the service provided.

We found two repeat breaches and two new breaches within two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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One inspector carried out this inspection. At the time of our visit 50 people were being accommodated at the home over three floors.

The focus of this inspection was to follow up a warning notice which had been served following our last inspection with respect to outcome 21 and the management of records at the home. We checked the provider had ensured people received safe or appropriate care by the maintenance of accurate records and documentation in relation to the care they received.

During this inspection we found the provider had taken appropriate action and records reflected people received safe and appropriate care.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff who supported them and records we looked at. During this inspection we looked at the care records of twelve of the 54 people living in the home.

During this inspection we were looked at the progress the provider had made to meet the two warning notices and one compliance action from our last inspection in January 2014. We found the provider had made good progress with the two outcome areas where warning notices had been served. However we found that the record keeping in the home had not improved.

At the time of our visit the registered manager for Shearwater was not managing the service. The home was being managed by a registered manager for another of the provider's homes.

Is the service safe?

We found that there were systems in place to make sure that the manager and staff learned from events such as accidents and incidents and investigations. Whilst staff were able to explain to us about the principles of the Mental Capacity Act we found there was a lack of consideration with regard to people's capacity to make decisions in their individual records.

People spoke highly of the staff group and observations showed staff were kind, respectful and knew people well.

Is the service effective?

Assessments and care plans had been completed. We found that some people's care records were clear and an accurate reflection of people's needs. However for other people we found their care plans were not reflective of their current needs. Records did not demonstrate that all people received effective care.

Is the service caring?

We saw that people were supported by kind and attentive staff. Efforts had been made to record people's preferences, and interests. We found evidence that people using the service and their relatives had completed an annual satisfaction survey.

Is the service responsive?

We found that staff responded to people quickly and efficiently. People had access to some activities, but these were dependent upon staff and relatives being able to organise them. Surveys had been completed by people regarding the service provided by Shearwater. The manager had recognised that the surveys did not reflect people's views on living at Shearwater and was thinking of a more effective way to reflect this. We were able to see that staff had arranged meetings with people and their relatives on each of the three floors.

Is the service well led?

The home had an interim manager in post and a new deputy. The manager had introduced several initiatives to improve people's care and support, which had a beneficial impact on the care and support people received. The service had an effective quality assurance system. Staff told us that they were able to give feedback to the manager and that she was very approachable.

During this inspection we spoke with 13 people, four of whom at that time were not able to sustain a conversation. We also spoke with five relatives and eight members of staff. We looked at the records of ten people. We spent time discussing the action plan sent by the provider and our findings with the registered manager.

People spoken with told us they were happy with the care they received. They told us they were aware of their care records and most relatives told us they had attended a review regarding their relatives care. None of the people spoken with knew they had a 'link' staff member. However they told us they would be happy discussing a concern with a staff member.

We found that records regarding people's care were incomplete, contradictory and not reflective of people's needs. We could find no audits of people's records to ensure there was consistency across the home. We were told the home had introduced a new system for care planning and the recording of people's needs. However, we found that this had not been completed and had not been introduced across the home. We found when looking at some of the new records they gave a more comprehensive picture of people's needs. As a result of the poor records and lack of clear plans of care we could not be assured people received safe care.

We observed that staff were polite, respectful and assisted people in a dignified manner. Members of staff spoken with were enthusiastic about their roles and told us they had worked hard to improve the record keeping in the home.

We found that there was a lack of overall monitoring in the home and we could not be assured people received safe and appropriate care.

People living at Shearwater had cognitive impairments which made it very difficult for them to tell us what they thought about the care they received. One person who had recently moved in to Shearwater told us they were being well looked after. We spoke with three relatives who were happy with the care people received at the home. We spoke with a community nurse who told us staff called them appropriately and were able to follow their instructions on caring for a person's medical needs.

Observations showed us people were treated with respect and had their privacy respected. For example, at a meal time we saw the majority of people were given choices, support and were treated with respect. Permanent staff knew and treated people as individuals. They had a good rapport with people.

Care records for people in certain areas of their care were not up to date and did not reflect the associated risks.

Permanent staff members working in the home were positive about their role. They told us they felt motivated and were supported by the management in the home.

We found there had been improvements in the storage and administration of medication.

Improvements had been made in some areas of monitoring and reviewing the quality of service provision. We however found there were still improvements needed in the monitoring and reviewing of records directly relating to the care people received.

During this inspection we visited on the night of 2 July 2013 and the day of 3 July 2013 to check if the service had met the warning notice. We found that most of the warning notice had been met. Concerns remain on how staff were deployed around the three floors of the home and whether these were organised to meet the needs of people.

Staff we spoke with told us the staffing levels had much improved, and this had improved things for people living at the service. One carer visiting their relative in the home told us they had noticed the changes in the staffing levels and told us the home had a much calmer atmosphere.

We saw a general improvement in the way care plans were written. Records still lacked some vital details needed to ensure people were safe. People and relatives told us there was a lack of social activities in the home and the records we saw confirmed this. People told us they were bored and two people thanked us for talking to them.

In some areas medication procedures had improved. We still found concerns with the medication procedures. It was noted the morning medication could take so long to complete, it was not always safe to administer the person's next round of medication.

Staff members on duty were continuously busy and tried to meet people's needs. It was clear on all shifts there was not enough staff to meet the needs of people in the home. Staff were task orientated and at times the core values of privacy, respect and dignity were not met. We observed on all shifts staff were busy and task orientated and at times the core values of privacy, respect and dignity were not met.

From our observations and findings it was not possible to establish the home had an effective quality assurance programme to ensure people received safe and effective care.