Archived: The Sheridan Care Home

We carried out an unannounced comprehensive inspection of this service on 21 and 22 October 2014. Breaches of legal requirements were found and we issued warning notices for repeated breaches in care and welfare of people who use service and in records. The provider was required to meet the regulations relating to care and welfare and to records by 31 January 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches in the regulations relating to assessing and monitoring the quality of the service, managing medicines, consent to care and treatment, requirements relating to workers and supporting staff.

We undertook an unannounced focused inspection on 23 February and 6 March 2015 to check they had taken action to meet the regulations relating to care and welfare and to records and to confirm that they now met legal requirements. We also checked that they had followed their action plan in relation to the breaches in managing medicines, consent to care and treatment, and requirements relating to workers. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Sheridan Care Home on our website at www.cqc.org.uk.

You can read a summary of our findings from both inspections below.

The Sheridan Care Home is registered to provide personal care and accommodation for up to 30 people. These are mainly older people who are living with dementia. Nursing care is not provided. The home is a converted period property with a modern, purpose-built extension. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The home has 26 single bedrooms and two twin-bedded rooms, which two people can choose to share.

Comprehensive inspection on 21 and 22 October 2014

This was an unannounced inspection.

There were 29 people living at the home at the time of our inspection. The home had a registered manager. 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 and associated Regulations about how the service is run.

At our previous inspection on 2 and 11 September 2014, we asked the provider to take action to make improvements to care and welfare, staffing levels and record keeping. They sent us an action plan that stated they would meet the relevant legal requirements for staffing levels and record keeping by 8 October 2014, and for care and welfare by 20 October 2014.

After that inspection we received information about further concerns in relation to the home. As a result we undertook the comprehensive inspection. During the comprehensive inspection we looked to see if these improvements had been made. The action in relation to improved staffing levels had been completed, but the actions in respect of care and welfare and record keeping remained outstanding.

We identified five further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People and their visitors were broadly pleased about the service they received, but expressed reservations about people having meaningful activities to occupy them. Our observations and the records we looked at did not always match the positive views we heard.

People’s care was not planned or delivered consistently. Care plans did not reflect people’s interests and personal histories, and were not always reviewed or updated when their needs changed. Weight loss was not always promptly followed up. There were not enough meaningful activities for people.

Some records were inaccurate and incomplete, which meant that staff did not have all the information they needed in order to provide the care people needed.

Visitors told us they thought people were safe at the home. However, we found that people’s safety was compromised in some areas, including out-of-date risk assessments, staff recruitment checks and handling medicines.

The home’s systems to assess and improve the quality of its service were not effective. There was no system for obtaining and recording people’s views about the home and using these to drive improvement. There had been no residents’ or relatives’ meetings, and people’s views had not been gathered and recorded by any other means. Learning from accidents and incidents was not systematically shared with staff. Quality assurance checks had not been completed, other than for medicines.

The home is a specialist dementia care home, yet staff had not received training, beyond basic awareness training, in dementia, managing behaviours that challenge others, and the Mental Capacity Act 2005. They had not taken steps to make best interest decisions in line with the Mental Capacity Act 2005, when people lacked the mental capacity to give consent to aspects of their care.

Additionally, we identified areas where improvements could be made.

Whilst staffing levels were sufficient for staff to provide basic care, there was no system to assess staffing levels and adapt them according to people’s changing needs. This meant the home’s managers could not be sure that there would always be enough staff to meet people’s needs.

Snacks and drinks were not to hand for people to help themselves to between meals. It is good practice in dementia care to ensure that people have access to food and drink between meals, when they wish.

People’s independence had not been promoted through involving them in the daily routines of running the home or through the provision of equipment that might help them eat meals independently.

Focused inspection on 23 February and 6 March 2015

After our inspection of 21 and 22 October 2014 we served warning notices on the provider and registered manager in relation to care and welfare of people who use the service and to records. These required the service to meet these regulations by 31 January 2015. We undertook this unannounced focused inspection 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.

There were 26 people living at the home at the time of our inspection. The home had a registered manager.

We found a number of repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People told us, and we observed, that people had little access to activities they enjoyed and found meaningful. Care was still not planned or delivered consistently. There had been a delay in assessing one person’s needs when they moved into the home. Pain was not adequately assessed, leaving people at risk of insufficient pain relief. Some people lacked care plans that fully addressed their needs, including one person’s diabetes and agitation that could be challenging for others, and another person’s foot care. Staff did not support people effectively when they became distressed, reflecting their lack of understanding of dementia and people’s personal histories.

Records, including care plans, remained inaccurate and incomplete. This placed people at risk of unsafe or inappropriate care.

Medicines were not recorded and administered safely. One person had not received all of the tablets prescribed for an infection, yet staff had signed to say they had given the tablets. There were insufficient instructions regarding how to apply skin creams and gels, and some people received creams only twice a day whereas their prescription stated the creams could be applied more often if necessary. Guidelines for staff administering ‘as needed’ medicines did not contain all the information needed, such as maximum doses, to ensure these were given safely.

People were not asked to give consent to their care plans and other aspects of their care. If people may not have been able to consent to particular aspects of care, the process for assessing their mental capacity and making a best interest decision did not follow the principles of the Mental Capacity Act 2005.

The home’s systems to assess and improve the quality of its service were still not effective. Following the inspection in October 2014 the provider had returned an action plan that was due to be completed by 31 March 2015. We inspected before this date, however the failure to act on the warning notices for care and welfare and for records and to address other breaches of the regulations reflected continuing shortcomings in the assessment and monitoring of the quality of the service.

Relevant checks had been completed before staff started working at the home, hence systems were in place to protect people from individuals who were known to be unsuitable.

We will undertake another unannounced inspection to check on the outstanding legal breaches and to review the home’s ratings.

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.

This was a comprehensive inspection, carried out over two days on 21 and 22 October 2014. The first day was unannounced.

The Sheridan Care Home provides accommodation for up to 30 people who need support with their personal care. These are mainly older people who are living with dementia. The home is a converted period property with a modern, purpose-built extension. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor. The home has 26 single bedrooms and two twin-bedded rooms, which two people can choose to share.

There were 29 people living at the home at the time of our inspection. The home had a registered manager. 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 and associated Regulations about how the service is run.

At our last inspection on 2 and 11 September 2014, we asked the provider to take action to make improvements to care and welfare, staffing levels and record keeping. They sent us an action plan that stated they would meet the relevant legal requirements for staffing levels and record keeping by 8 October 2014, and for care and welfare by 20 October 2014.

After that inspection we received information about further concerns in relation to the service. As a result we undertook this comprehensive inspection. During this inspection we looked to see if these improvements had been made. The action in relation to improved staffing levels had been completed, but the actions in respect of care and welfare and record keeping remained outstanding.

At this inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People and their visitors were broadly pleased about the service they received, but expressed reservations about people having meaningful activities to occupy them. Our observations and the records we looked at did not always match the positive views we heard.

People’s care was not planned or delivered consistently. Care plans did not reflect people’s interests and personal histories, and were not always reviewed or updated when their needs changed. Weight loss was not always promptly followed up. There were not enough meaningful activities for people.

Some records were inaccurate and incomplete, which meant that staff did not have all the information they needed in order to provide the care people needed.

Visitors told us they thought people were safe at the home. However, we found that people’s safety was compromised in some areas, including out-of-date risk assessments, staff recruitment checks and handling medicines.

The home’s systems to assess and improve the quality of its service were not effective. There was no system for obtaining and recording people’s views about the home and using these to drive improvement. There had been no residents’ or relatives’ meetings, and people’s views had not been gathered and recorded by any other means. Learning from accidents and incidents was not systematically shared with staff. Quality assurance checks had not been completed, other than for medicines.

The home is a specialist dementia care home, yet staff had not received training, beyond basic awareness training, in dementia, managing behaviours that challenge others, and the Mental Capacity Act 2005. They had not taken steps to make best interest decisions in line with the Mental Capacity Act 2005, when people lacked the mental capacity to give consent to aspects of their care.

Additionally, we identified areas where improvements could be made to the service.

Whilst staffing levels were sufficient for staff to provide basic care, there was no system to assess staffing levels and adapt them according to people’s changing needs. This meant the home’s managers could not be sure that there would always be enough staff to meet people’s needs.

Snacks and drinks were not to hand for people to help themselves to between meals. It is good practice in dementia care to ensure that people have access to food and drink between meals, when they wish.

People’s independence had not been promoted through involving them in the daily routines of running the home or through the provision of equipment that might help them eat meals independently.