Archived: Shawcross Care Home

We found the following examples of good practice:

At the entrance of the home, information was displayed to inform visitors about any infection control procedures to be followed. Temperature checks were taken and questionnaires completed, asking people about any possible symptoms of COVID-19, or if they had felt unwell. Lateral flow (a COVID-19 test where the results can be obtained quickly) testing was carried out as needed.

Various methods had been used to enable people to keep in touch with their family and friends during the pandemic. This included video calls and window visits.

Zoning arrangements were used when people had tested positive for COVID-19 and needed to self-isolate in certain areas of the home and for staff entering and leaving the building. COVID-19 testing was in place for both staff and people using the service. People living at the home, where they had chosen too, had all received their first dosage of the COVID-19 vaccination.

Appropriate arrangements were in place for new admissions to the home, such as requesting confirmation of a negative COVID-19 test before each person moved into Shawcross Care Home.

Enough personal protective equipment (PPE) was available and we saw staff wore it at all times during our visit. Hand sanitizers were distributed throughout the building to promote proper hand hygiene practices.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Windows were opened at various times during the day to assist with ventilation and outdoor facilities were used when better weather allowed.

There were enough staff to care for people safely, with staff receiving additional infection control training from the local authority during the pandemic. Additional hours had been worked by domestic staff during the pandemic to keep on top of cleaning work within the home. An employee assistance programme was in place for staff during the pandemic and counselling services were available to support wellbeing.

Risk assessments were completed where certain groups may be at higher risk of contracting the virus. An appropriate infection control procedure was in place and regular infection control audits were undertaken to ensure standards were maintained. Continency planning arrangements had also been put in place to help reduce the likelihood of any future COVID-19 cases and promote learning.

Shawcross Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in Ashton in Makerfield and provides residential and nursing care. The home is divided into two separate units, one for nursing care and one for people living with a diagnosis of dementia. The home can accommodate up to 50 people. At the time of the inspection there were 48 people living at Shawcross Care Home.

The home was last inspected on 19 July 2017, when a focussed inspection was carried out, which looked at the key questions of safe and well-led. This was because during the last comprehensive inspection carried out on the 20 and 22 March 2017, we identified two minor breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the management of medicines and good governance. We returned on the 19 July 2017, to check the progress the provider had made. During the focussed inspection, we found the provider had made the necessary improvements and was meeting all the regulations. As a result, we improved the ratings in the key questions safe and well-led, as well as the overall rating from requires improvement to good.

At this inspection we found the evidence continued to support the overall rating of good. However, we received mixed feedback about staffing levels and noted some discrepancy between the number of staff deployed each day and the amount the home indicated was required to meet peoples needs. As a result we had made a recommendation for the home to look at the allocation of staff on each unit, to ensure people’s needs are met both timely and safely.

At the time of the 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 2008 and associated Regulations about how the service is run.

People and staff provided mixed feedback about the number of staff deployed to meet needs. The home used a system to work out the number of staff required to safely meet needs based on people’s dependency levels, these are sometimes called dependency tools. We noted staff numbers allocated on the nursing unit were less than had been recommended by the dependency tool. Observations during inspection also showed staff struggled at times to meet needs, including their own need for a break, due to the number of staff deployed..

People we spoke with told us they were happy living at Shawcross Care Home, and aside from some concerns with staffing levels, felt safe. Checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people.

Staff were knowledgeable about the different types of abuse, how to identify these and report any concerns. The home had appropriate safeguarding policies and reporting procedures in place, which had been followed consistently. Accidents and incidents had also been logged, with actions completed to minimise the risk of reoccurrence.

The home was clean, well maintained with appropriate infection control processes in place. Staff had access to and wore personal protective equipment (PPE) to prevent the spread of infection. Checks and servicing of equipment, such as for the gas, electricity, fire safety, passenger lift and hoists were up-to-date.

Medicines were stored, handled and administered safely and effectively. Staff responsible for administering medicines were trained and had their competency assessed annually.

Staff completed both e-learning and practical training sessions. Staff spoke positively about the training provided, confirming they completed regular sessions. Staff also received supervision, albeit we found some inconsistencies in the frequency of completion. We saw the registered manager was taking steps to address this and ensure all staff were up to date.

The home was adhering to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. Where people lacked capacity to consent to care and treatment and did not have a legal representative to make decisions on their behalf, best interest meetings and decisions had been completed.

People spoke positively about the food and drink provided, with choices offered and people’s preferences catered for. Meal times were observed to be a positive experience, with people being supported to eat where they chose. People who required a modified diet, such as soft or pureed, received this in line with guidance from professionals, such as dieticians or speech and language therapists.

Staff were reported and observed to be patient, caring and kind. They knew the people they supported and how they wanted to be cared for. People told us they were treated with dignity and respect and offered choice within the daily lives. Staff were aware of the importance of promoting independence and encouraged people to do as much as they could for themselves.

Care files contained detailed care plans and risk assessments, which described how people wished to be cared for and helped ensure their needs were being met and their safety maintained.

The home provided a range of daily activities and events for people to participate in, facilitated by two activity coordinators. Activities were advertised on noticeboards throughout the home and people were asked and encouraged to join in. Involvement was captured within personal activity records.

People and their relatives were involved in the running of the home, through attendance of resident and relative meetings and completion of questionnaires. The home encouraged feedback both through internal processes and also via an external care home review website.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly, monthly or quarterly basis, depending on the area being assessed and covered a range of topics including medication, accidents and incidents, infection control and training. Provider level audits had also been completed, to provide further oversight of all aspects of service provision.

This unannounced focussed inspection took place on Wednesday 19 July 2017. A full comprehensive inspection was last carried out at the home on 20 and 22 March 2017, when we rated the service as ‘requires improvement’ overall with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment in the management of medicines and good governance. The full comprehensive report from this inspection can be found on our website at www.cqc.org.uk/location/1-130725445.

During the last comprehensive inspection we identified the home had made significant progress since the previous comprehensive inspection in August 2015. As a result of identified progress between inspection and the fact positive action was taken between the first and second days of inspection to address concerns identified, including the production of a detailed action plan, we undertook this focussed inspection to re-look at the areas of medicines management and good governance, specifically medicines audits, to confirm the service now met legal requirements. This report only covers our findings in relation to these two areas, which fall under the ‘Safe’ and ‘Well-led’ key questions.

At the time of the 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 2008 and associated Regulations about how the service is run.

During this inspection we saw all issues with medicines management identified at the previous comprehensive inspection had been addressed. New systems and procedures had been in place for the last four months including a new process for monitoring and recording the ordering and receipt of medicines. This ensured medicines had been ordered in good time.

Daily monitoring of medicines fridges had been completed, utilising new recording sheets which prompted staff to reset the thermometer each time, to ensure subsequent recordings were accurate.

A new system was in place for monitoring the use of transdermal patches; which are medicated adhesive patches placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream, to ensure they had been applied to a different area of the body as per guidance and only one patch was in situ at any one time, to avoid the potential for overdosing.

Procedures and guidance was in place for managing the administration of medicines which are more effective if given before breakfast or on specific day. Where it had not been possible to administer the medicines before breakfast, staff had waited an hour after the person had eaten before administering.

The use of inhalers and blood glucose monitoring had been reviewed, with monitoring charts in place and guidance sought from the person’s general practitioner (GP), which was clearly detailed in the care files.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of medicines management. Audits were completed on a daily, weekly and monthly basis and covered a range of areas including completion of Medicine Administration Record (MAR) charts, stock level checks, topical medicines, ordering and receipt of medicines and record keeping. We saw action plans had been drawn up and implemented to address any identified issues, and our observations during the inspection showed issues had either been addressed in full or where in the process of being addressed, such as a medicine related reference book had been ordered but not yet received.

Shawcross Care Home is located in Ashton in Makerfield and provides residential and nursing care. The home is divided into two separate units, one for nursing care and one for people living with a diagnosis of dementia; which the home refer to as the EMI unit, each providing accommodation over two floors. The home provides single occupancy rooms with private toilet facilities and can accommodate up to 50 people. At the time of the inspection there were 43 people living at Shawcross Care Home.

A comprehensive inspection was last carried out at the home on 10 and 11 August 2015, when we rated the service as ‘requires improvement’ overall with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing and person centred care.

At this inspection we found the service had made improvements in regards to staffing and person centred care, however identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe care and treatment and the management of medicines and good governance. You can see what actions we told the provider to take at the back of this report.

At the time of the 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 2008 and associated Regulations about how the service is run.

We saw the home was clean and had appropriate infection control processes in place. Infection control audits were completed regularly and cleaning schedules were in place and up to date. Laundry was collected in different coloured bins to minimise the spread of infection. People told us they were happy with the cleanliness of the home and that their rooms were cleaned daily.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and were complementary about the level of care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Completion of the medication administration record (MAR) was done consistently and the home had effective systems in place for the administering of topical medicines. Staff authorised to administer medicines had completed the necessary training and had their competency assessed on a regular basis. However we identified issues with the management of stock levels and re-ordering of medicines, which meant people had missed doses of medicine until new supplies arrived. We also identified some issues with the recording of the medication fridge temperature and the monitoring of some medicines which people self-administered; such as inhalers or processes they completed themselves; such as blood glucose monitoring.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found the home was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. At the time of our inspection there had been 29 applications made to the local authority that were still awaiting assessment.

Staff confirmed that on-going training was provided and they received reminders when refresher training was required to keep their skills and knowledge up to date. Some staff commented on the majority of the training being provided via e-learning and how they would prefer more ‘face to face’ sessions, which they felt would better suit their learning style. We saw the home did provide practical sessions, many of which were sourced externally through the local authority. Completion of these sessions was monitored on a separate training matrix.

Staff confirmed they received supervision with their line manager, which along with the completion of staff meetings, meant they were supported in their roles. We did note that the frequency of supervisions varied between staff members, with some completing twice as many as others.

Observations of meal times showed these to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people and encouraged them throughout the meal. We saw nutritional assessments were in place and special dietary needs catered for. People told us they received enough to eat and drink and were offered a good choice of meal options, with alternatives available. Food and fluid charts were completed; however we noted inconsistencies in recordings between 17.00 and 22.00 on all the charts we viewed. When this was raised with the registered manager, we saw they had already identified the issue and had taken steps to address this with the staff team.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the quality of the staff and the standard of care received.

We looked at six care files which contained accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and the care that they received was person centred.

The home employed two activity coordinators, who planned and oversaw the activities completed within the home. People we spoke with said they were satisfied with what was on offer, and we observed a range of different activities being completed over both days of the inspection. The home actively documented activities and displayed photographs of the different events that had taken place within the activity room and photo albums.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care. We saw evidence of action plans being implemented to address any issues found, however none of the issues we had found with medicines management had been identified via the auditing process.

Questionnaires were circulated regularly to capture the views of people using the service, their relatives and any visiting professionals, with feedback displayed and accessible for everyone to read.

This is a summary of what we found.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One relative said: 'We feel he's safe here. Everything is fine.'

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse. One staff member said: 'If anyone hurts anyone (I'm caring for) I would expect them to take it very seriously.'

Is the service effective?

People told us that they were happy with the care that had been delivered. A person who lived in the home said: 'There's always somebody to help.' Another person said: 'I find it a very clean place, a nice place.'

Care records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. One person said: 'I'm quite satisfied.'

We heard that information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: 'The staff are great, very caring.' One person using the service said: 'The care staff are very nice, they have a joke with you. It helps to create a nice atmosphere.'

Is the service responsive?

People's needs had been assessed before they were admitted to the home. People's needs were carefully described so that care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the senior carers and they briefed care staff at handovers and via the updated care plans.

One relative said 'When he became ill they were here like a shot.' They also commented that the chiropodist had been called two weeks previously, a doctor called regularly as did an advanced nurse practitioner. They felt their relative was receiving good care from the team.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. One member of staff said: 'He (the manager) supports you, asks how he can help.' People told us they had received customer satisfaction survey and that staff listened to their concerns. The manager met informally with families and was available whenever they visited. Staff told us they were clear about their roles and responsibilities and said : 'There is always someone to ask.'

At our last inspection in May 2013 we found that there was a system in place to monitor the quality of care. However, the system was not effective as actions were not always completed to address the issues and problems identified. At this inspection we found that improvements had been made and the service was now fully meeting this standard.

We saw staff being considerate and polite to the people they were caring for. There was a pleasant, relaxed and friendly atmosphere throughout the home. There was a lot of pleasant banter between residents, staff and visitors. Staffing levels had been increased since our last inspection and we observed that people no longer experienced unacceptable delays in receiving care.

We found that people received the care that they needed and that they were asked for their permission before care was given.

The people living at the home were cared for in a clean and hygienic environment. We found that there were appropriate procedures in place to prevent the spread of infection. The staff we spoke with were aware of the actions they could take to ensure the people using the service were protected from infection risks.

The service had appropriate procedures in place to recruit staff. These ensured that people who were unsuitable to work with vulnerable adults were not employed within the service.

We also looked at the home's system for monitoring the quality of service that people received. People told us that they express their views of the service. However, we found that the system in place was not effective as the processes were not fully completed.

People told us that they were happy with the care they received at the home. We were told 'I can't fault this place'; 'they look after us very well' and 'if you ask for anything staff bring it and they try to help you as much as they can.' We found that there were delays in people's care and support needs being met. This was due to a lack of staff rather that staff not planning the workload effectively.

We spoke with three sets of visitors and received mixed feedback about the home. One person told us that 'visitors are treated like family.' Other visitors were concerned that staff were always busy and this had an impact on the timeliness of the care and support people received.

People told us that they had no problems or issues in relation to medicines. There was a system in place to ensure that medicines were stored and administered safely. There were some minor errors with medicines that the manager was aware of and was monitoring to ensure that these were not repeated.

We spoke with six staff members and we found that they were working hard and interacted well with people and relatives. We found that most staff had completed a range of training and there were several new staff who still needed to completed some training.