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Archived: Shawe Lodge Nursing Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 12 June 2018

The inspection took place on 28, 29 March and 04 April 2018. The first and third day of inspection was unannounced. We returned to the service on 1 May 2018 to carry out a welfare check on people living at the home and to check that urgent remedial works had been completed.

We previously inspected this service in December 2016 and found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve to at least good in the following areas: staffing and good governance. In March 2017 we issued a warning notice to the provider for the continued breach in good governance as we found no improvements had been since the previous inspection.

At this inspection we found new and continued breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to: safe care and treatment; meeting nutritional and hydration needs; premises and equipment; person centred care; dignity and respect and good governance.

Due to the serious failings found on this inspection we are taking urgent enforcement action. You can see what action we told the provider to take at the back of the full version of the report.

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.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Shawe Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate 41 people across three floors, one of which has separate adapted facilities. At the time of our inspection there were 33 people living at the home. The service promotes itself as one that specialises in providing care to people living with dementia or a mental health condition. Whilst the ground and first floor are mixed, the second floor of the home is a self-contained unit which provides a service for which for males with either dementia or a mental health condition and sometimes other complex behaviours.

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 service had a registered manager who had been in post since 2017 but had been registered with CQC since March 2018.

Due to the high number of incidents and falls at the home we included a Nurse SPA (Specialist Advisor) as part of the inspection team. Their main remit was to look at care planning documentation in relation to falls management and the involvement of other health professionals.

The environment had not been maintained and secured in a way that ensured the safety of people with dementia. We identified several maintenance issues present in the home, some that had been identified but not addressed. People were at risk of significant injury and or ill health as the building and facilities had not been maintained to the required standard.

Poor practices in the provision of care and support meant that people did not always receive safe care and treatment. People were at an increased risk of harm due to malfunctioning equipment.

Equipment was in a poor state of repair and there were poor practices in relation to infection control and hygiene due to issues with the environment. There were insufficient cleaning, continence care supplies and communal and personal toiletries provided meaning people were more exposed to the possible spread of infection.

We checked if medicines were administered, stored and disposed of appropriately and found that in the main they were. There were several occasions where night time medications had been recorded as being administered and taken, however the tablets remained in the blister pack. This had not been explored with staff and therefore there was no explanation as to why this would be. This meant that some people had not received their medication as prescribed.

Potential safeguarding incidents referred to the local authority had also been notified to the Care Quality Commission. We were assured that the registered manager was following safeguarding processes.

Personal emergency evacuation plans (PEEPs) outlined the level of support each person needed to be relocated to another area of the home in the event of an emergency.

Catering staff were not kept fully informed of people’s dietary needs and guidance from professionals such as the dietician therefore people receiving an inappropriate diet and at risk of their health deteriorating. In addition there was no monitoring of nutritional intake to ensure that people’s intake was appropriate and followed the recommended guidelines from health professionals, as the recording of meals and fluids provided and consumed was not sufficiently detailed or communicated to care staff.

Mealtimes were chaotic and disorganised and were not a good dining experience for people. We were not assured that people received adequate levels of nutrition due to the amount of food not eaten. A diet monitoring sheet was in use which reflected people’s food preferences and their dislikes but was not consulted by staff or known by the kitchen. One person disliked pasta and was served the pasta bake meal. Similarly, a person whose first language was not English enjoyed dishes from their country of origin. We saw no evidence that people’s preferences and cultural needs were met.

The service promotes itself as specialising in mental health and dementia care but there was nothing about this service that aligned itself to these specialisms. The building and environment were not dementia friendly and the rear garden area was not a safe area, especially for people with a diagnosis of dementia, a sensory impairment or poor mobility.

Staff received mandatory and other service specific training such as dignity training, physical intervention training and first aid, however the service could not evidence that all staff involved with the preparation of thickened fluids had been provided with the correct guidance and training. People were at greater risk of aspiration and choking as food and fluids were not being thickened in line with SALT guidance.

People living at the home lacked capacity to make specific decisions regarding their care and treatment so applications for DoLS authorisations were made were necessary. The registered manager took appropriate steps to ensure that people were deprived of their liberty only when necessary to keep them safe from harm.

Staff received supervision but we saw examples of when their concerns relating to the service had not been discussed or addressed. The home was not always following its own supervision process with regards to providing feedback from management to the employee.

People were supported to access other healthcare services however, instructions and advice from other health professionals were not always followed which placed people at risk of harm.

Interactions between staff and people were mainly warm and friendly but the care provided was not always respectful or dignified. Communal supplies of toiletries were used to bathe and shower some individuals. This is not person centred and is disrespectful to people receiving care.

Staff responded appropriately to residents and we heard staff strike up natural conversations with residents. One person’s first language was not English and although one care worker was able to communicate with them in a language they could understand, we saw no other format of communication used to make information more accessible to the person. Staff dealt with episodes of challenging behaviour well, using good use of space and distraction techniques to diffuse situations and maintain safety.

People and their relatives were involved in the planning and review of care. The service gathered information and had processes in place to try and ensure the care delivered was person centred, but this did not always happen. People were not given the opportunity to shower / bathe on a regular basis and no action was taken by staff if people refused on a regular basis. Two bathrooms were out of order and not everyone could access the bathing facilities that were working in the home. In one bedroom the hand basin taps had been broken for 12 months which meant that the person had not had access to running water for daily personal care in their own room

Care files were well structured and contained both clinical information and personal information about the individual. We saw staff respond to people needs during the inspection but this was sometimes hampered due to the lack of equipment and poor facilities.

A singer provided entertainment on one day of inspection but there was little in the way of games and activities to help keep people engaged and, stimulated. People were at risk of social isolation The activities room was kept locked at all times because the activities co coordinator said the room was unsafe for people to access independently . Activity co-ordinators were limited in their role as there were often not enough staff to offer support with activities and on occasions we saw the activity co-ordinators assist with aspects of care.

A log was in place to record complaints and we saw all had been appropriately responded to. Relatives we spoke with were comfortable in making a complaint.

Required repairs identified in earlier audits were still outstanding at the time of our inspection. There was no evidence of action having been taken by the registered manager or the provider to rectify these and other identified faults. These posed a significant risk to the health and safety of people residing at the service

Staff were not being updated by the management team about any concerns they had and good governance in relation to supervisions was not being followed.

There were problems associated with the delivery of food, in particular meat and dairy products, due to non- payment of invoices. Both the butcher and the dairy have ceased supplying foods to the home. The senior management team at provider level had not taken the necessary steps to ensure deliveries of vital food orders to the home remained uninterrupted. In addition to the disruption in the supply of meat and dairy products, food stock was regularly taken from the kitchen’s stores by staff and daily planned menus could not be prepared. This meant that service users were at risk of malnutrition by not receiving an appropriate nutritious and balanced diet.

Governance systems and processes were not established or operated effectively to ensure compliance with the regulations. This meant care was not being delivered safely or in line with people’s needs. Governance systems at location and provider level were not effective to ensure that the service meets the requirements of the Health and Social Care Act and accompanying regulations.

Inspection areas

Safe

Inadequate

Updated 12 June 2018

The service was not safe

The environment had not been maintained and secured in a way that ensured the safety of people with dementia.

Poor practices in the provision of care and support meant that people did not always receive safe care and treatment.

Equipment was in a poor state of repair and there were poor practices in relation to infection control and hygiene, including insufficient cleaning and continence care supplies.

Effective

Inadequate

Updated 12 June 2018

The service was not always effective

The service was not effective

Catering staff were not kept fully informed of people’s dietary requirements and therefore people were receiving an inappropriate diet which put their health and safety at risk.

Mealtimes were not a good dining experience for people. We were not assured that people received adequate levels of nutrition due to the amount of food not eaten.

People were supported to access other healthcare services. Instructions and advice from other health professionals were not always followed which meant people were at risk of harm.

Caring

Inadequate

Updated 12 June 2018

The service was not caring.

Interactions between staff and people were mainly warm and friendly but the care provided was not always respectful or dignified.

Communal supplies of toiletries were used to bathe and shower some individuals. Staff regularly took supplies of food from the kitchen stores which meant that planned menus could not be provided. This is not person centred and is disrespectful to people receiving care.

Staff responded appropriately to residents and we heard some staff strike up natural conversations with residents.

Responsive

Requires improvement

Updated 12 June 2018

The service was not always responsive

The service gathered information and had processes in place to try and ensure the care delivered was person centred, but this did not always happen.

We saw staff respond to people needs during the inspection but this was sometimes hampered due to the lack of equipment and poor facilities.

Care files were well structured and contained both clinical information and personal information about the individual.

There were very limited activities for people which were not designed towards the service users and people had no access to an outside are because the garden was not a safe area.

Well-led

Inadequate

Updated 12 June 2018

The service was not well led

The service had no effective governance systems in place

Good governance in relation to supervisions was not being followed. Staff did not always receive the feedback they required.

The environment and facilities was not fit for purpose and not maintained appropriately. Repairs identified in earlier audits were still outstanding at the time of our inspection. There was no evidence of action having been taken by the registered manager or the provider to rectify these and other identified faults. The service had taken no action in response to concerns raised by its staff.

There were problems associated with the delivery of food, in particular meat and dairy products, due to non- payment of invoices. There were issues in relation to infection control and hygiene due to the lack of availability of appropriate equipment and cleaning products.

Management at provider level had not taken the necessary steps to ensure deliveries of vital supplies remained uninterrupted.