Archived: The Sheridan Care Home

Updated 25 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15 and 16 March 2016 and was unannounced. Two inspectors completed the inspection on both days.

Before the inspection we reviewed the information we held about the home, including notifications of incidents since our last inspection in August 2015. We also spoke with the local authority contract monitoring and safeguarding teams and sought feedback from GP surgeries who had involvement with the home. We requested and received a Provider Information Return (PIR) from the provider before the start of this inspection. A PIR is a form that asks the provider to give some key information about the service, what it does well and improvements they plan to make.

During the inspection we met and spoke with eight of the nine people living at the home and also spoke with three visiting relatives and a visiting healthcare professional. Because most people were living with dementia we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with all four of the staff on duty during the two day inspection, the registered manager, a representative of the management consultants and the cook.

We looked at six people’s care and support records and care monitoring records, all nine people’s medication administration records and a selection of documents about how the service was managed. These included three staffing records, three weeks of staffing rota’s, audits, meeting minutes, premises maintenance records, quality assurance records and a selection of the provider’s policies.

Updated 25 January 2017

This comprehensive, unannounced inspection took place on 17, 18 and 19 August 2015.

The Sheridan Care Home is a dementia specialist care home without nursing for up to 30 older people living with dementia. There were 11 people living at the home during our inspection.

There was a registered manager in post, as required by the home’s conditions of registration. The registered manager is also the representative of the registered provider. 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. The provider had appointed a home manager in June 2015 and they plan to register as the manager.

After our inspection of 21 and 22 October 2014 we served warning notices to the provider and registered manager in relation to care and welfare of people who use the service and records. These required the service to meet these regulations by 31 January 2015. We undertook an unannounced focused inspection on 23 February and 6 March 2015 to check that these breaches of the regulations had been addressed. We also checked whether the provider had followed their action plan in relation to the breaches in managing medicines, consent to care and treatment, and requirements relating to workers. These regulations were not met and we took enforcement action.

We have imposed a condition on the provider’s registration. This means further people cannot move into the home without our agreement.

At this inspection we identified repeated breaches and five new breaches of the Regulations.

Where providers are not meeting essential standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

During this inspection we raised safeguarding alerts with the local authority who are responsible for investigating any allegations of abuse. This was because of our concerns about the safety of some people living at the home. This was in relation to an unidentified person staying at the home, fire safety, some people’s weight loss and the lack of staffs’ knowledge about the medical emergency procedures for one person.

People were not kept safe at the home. An unidentified person had been staying at the home without full information as to their identity. This placed people living at the home at risk. This was a new breach of the regulations.

Risks to people were not fully assessed and management plans were not always in place to minimise these risks. This was repeated breach of the regulations. For example, some staff were not aware that one person had epilepsy and the plans in place did not describe the person’s seizures.

People’s care plans were not updated or did not include all the information staff needed to be able to care for people or staff did not always deliver the care. People did not always receive the care they needed. Their health care needs were not always met because the healthcare support they needed was not delivered. People who were living with dementia, needed support to move, were at risk of falling, had vulnerable skin and or had lost weight were particularly at risk. These were repeated breaches of the regulations.

Medicines were not managed safely because some medicines were being administered without consultation with a pharmacist, some creams were not correctly labelled and some people did not have plans for their as needed medicines. This was a repeated breach of the regulations. The stock management for medicines had improved.

Staff did not know enough about people as individuals to be able to provide personalised care.

People’s mealtime experiences were varied. Some people were supported sensitively whilst others were not given the support they needed to eat. People did not all receive the fortified fluids and food they needed to increase or maintain their weight. This was a new breach of the regulations.

The service was not fully meeting the requirements of the Mental Capacity Act 2005. Staff were not fully aware of the principles of the Mental Capacity Act 2005, making best interest decisions. They did not know which people were being deprived of their liberty and who had Deprivation of Liberty Safeguards (DoLS) applications or authorisations in place. People were being deprived of their liberty unlawfully because the managers were not aware of or met the conditions in place. This was a repeated breach of the regulations.

Other risks to people in the home were not managed. Fire and emergency systems were not safe and rooms with hazards in them were left unlocked. The registered provider took action to address these shortfalls during the inspection. Other environmental hazards had also not been addressed. This was a new breach of the regulations.

Most staff did not have the knowledge, experience or communication skills to be able to understand and communicate effectively with people who were living with dementia. Staff were not confident in how to safely move people. This was a repeated breach of the regulations.

Records about people were not accurate, some were not dated or named or stored securely. This was a repeated breach of the regulations.

The home’s rating was displayed in the main foyer of the home but it was not displayed on the home or landing page of the website for the home. The information not being displayed on the homepage of the website was a new breach of the regulations.

The registered manager/provider had not notified us about the safeguarding allegations and all of the people who had been deprived of their liberty. This was a new breach of the regulations.

The home was still not well-led and the management culture was not open and transparent. The registered manager/provider had been providing us with a monthly action plan as to how they were going to meet the regulations. The systems in place for assessing and monitoring the quality and safety of the service were still not effective. This was because although we saw some improvements in people’s experiences, the shortfalls we found had not been identified by the registered manager/provider.

Staff knew how to report any allegations of abuse but the policy needed to be updated.

Staff were recruited safely and following the increase of staff during the inspection there were enough staff on duty during the day to meet the needs of people. However, there was not any way of assessing staffing levels to meet people’s needs. Staff told us they were well supported and had one to one support meetings with the home manager.

People and relatives spoke highly of the caring qualities of the staff. Overall, we saw that staff treated people kindly. However, staff did not always respect people’s privacy and dignity and promote their independence.

There were activities provided for people to participate in should they wish.

Relatives knew how to make a complaint and complaints were investigated. However, it was not clear how learning from complaints was shared with staff.

Staff and relatives meetings were held. Staff and relatives had an opportunity to be consulted and involved in the home.

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.