Archived: Shawe Lodge Nursing Home

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 pr

Shawe Lodge Nursing Home is located in Urmston, Manchester and provides nursing care for up to 41 people who live with dementia. Accommodation is provided on three floors. All bedrooms are single rooms and are accessible by a passenger lift. There is a designated unit on the second floor, which supports male residents only with complex needs. Communal rooms are available on the ground and second floors. There is an enclosed garden area and parking for several cars.

At the time of our inspection there were 41 people living at Shawe Lodge. This had steadily increased since our last inspection and the home was now at full capacity. A nurse form the Care Commissioning Group we spoke with said the home supports people with complex needs, some of whom have moved from other services who were not able to meet their needs.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was supported by a clinical lead.

At our last inspection in November 2015 we identified breaches of the regulations in relation to the administration and recording of medicines, accurate monitoring records of the care and support provided, consent, monitoring and mitigating environmental risks and not having an effective audit system.

At this inspection we found improvements had been made in some areas such as medicines management and consent. However we identified continuing breaches in monitoring records and the lack of robust audit systems in place to monitor and improve the service. New breaches were identified for staff training and regular checks on the fire alarm system were not being completed. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have also made a recommendation about using best practice guidance to plan the environment suitable for people living with dementia and that all sluice, cleaning room and store cupboards are kept locked.

People we spoke with, and their relatives, were complimentary about Shawe Lodge. They said they felt safe, the staff knew their needs well and there were enough staff on duty to meet their needs. Staff were positive about their role.

Staff knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the registered manager or clinical lead would act on any concerns raised.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed. Care plans were in place for the support people wanted as they came to the end of their lives.

People we spoke with told us that the staff at Shawe Lodge were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service.

Staff had received training, however this needed refreshing. Supervisions took place in response to an issue and were not planned throughout the year to support the staff team. Staff meetings were held for the ground floor staff team. A new unit manager had been appointed for the second floor and had started to engage the staff team to gain their ideas and input for the unit.

People received their medicines as prescribed and the nurses had received relevant medicines administration training. Guidelines for the use of ‘as required’ medicines were not always in place. Care staff added thickeners to food and drinks to reduce the risk of choking; however trained nurses signed the medicine administration charts.

Care plans and risk assessments were in place to help ensure people’s health and nutritional needs were met. Monitoring records for food and fluid intake, personal care were inconsistent and not always completed in a timely manner. The layout of the lounge areas on the ground and second floors and the number of people using these spaces, especially at meal times, meant staff had to sometimes stand up when supporting people with their food because there was not enough dining facilities, especially on the second floor. This may be intimidating to someone living with dementia and shows a lack of dignity and respect. Records we reviewed showed that staff contacted relevant health professionals to help ensure people received the care and treatment they required.

We found the service was working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support.

All required checks with the disclosure and barring service (DBS) were made when recruiting staff and two references were obtained. However the gaps in one person’s employment history had not been explored and accounted for.

An activities officer was in post at the home. Regular activities included an entertainer and a pub night. One to one games and crafts were undertaken with people. Memory boxes were being made to assist people to be able to identify their own rooms.

All areas of the home were seen to be clean. Procedures were in place to prevent and control the spread of infection. Improvements had been made in the management of clinical waste. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

Tests of the fire safety system had not been completed as planned since the service’s handyman had left three months before the inspection. Maintenance of the home had also lapsed during this period. A new handyman had started work at the home the week of our inspection.

A complaints procedure was in place. People we spoke with said the staff and registered manager dealt with any issues they raised verbally without needing to use the formal complaints process. This was confirmed by the staff and registered manager.

Audits were completed by the registered manager. However these were not consistently completed and were in response to issues identified by external audits and checks rather than being proactive and being used to drive improvements within the service. The registered manager said they were planning to have a set timetable for completing audits.