The Shrubbery

The Shrubbery is a residential care home providing personal care and accommodation to up to 45 people. The service provides support to older people living with dementia, mental health needs and/or physical disabilities. At the time of our inspection there were 36 people using the service.

People’s experience of using this service and what we found

Systems and processes to ensure effective oversight of the service required improvement. Audits had not always been effective in identifying risk factors and putting mitigating strategies into place.

Risks to people were not always recorded fully or mitigated. We found concerns with the recording of mitigating strategies being completed, and missing information within care plans and risk assessments.

Medicine management required improvement. Records were not always completed to identify why an ‘as required’ medicine had been administered. Prescribed thickener had not been recorded to evidence the correct amount was used to reduce the risk of choking.

Staff felt supported within their roles and felt confident to discuss any concerns they may have with the management team.

Feedback was sought from people, relatives and staff to identify where improvements were needed. Staff and people were also offered regular meetings to share information and discuss any concerns they had.

People were supported by staff who were safely recruited, had received an induction and were supported within their roles. People told us staff were caring.

People were protected against infections such as COVID-19. Staff followed government guidance on testing and wearing appropriate personal protective equipment (PPE). The home appeared clean and there were no malodours. Cleaning schedules were in place to evidence when cleaning was completed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 January 2019).

Why we inspected

We received concerns in relation record keeping, safeguarding and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Shrubbery on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicine records, risk strategies and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in post. 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 registered manager was fully aware of their legal responsibilities and was committed to providing excellent leadership and support to staff.

People living at The Shrubbery felt safe and received care from staff that had been employed following safe recruitment procedures. The provider ensured that lessons were learned when things went wrong to reduce the likelihood of re-occurrence. People received their medicines on time and as prescribed.

People received support from staff that had the skills and knowledge to meet their needs and were supported to eat and drink enough to maintain their health and wellbeing. People were actively involved in decisions about their care and support needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were happy with the care they received and felt valued by staff and the management team. People’s independence was promoted and their privacy and dignity protected. Visitors were welcomed and told us The Shrubbery was like a family.

People received personalised care that took into account their individual needs, likes, dislikes and preferences. A wide range of activities were available to meet people’s needs. People had personalised their bedrooms with their own belongings and the environment had been adapted to meet the needs of people with dementia.

Quality assurance systems ensured the provider was alerted at the earliest opportunity to any issues that needed resolving. We found there to be an open and inclusive culture within The Shrubbery. The registered manager had an open-door policy and sought feedback from people, their relatives and staff to identify improvements. The provider had committed to making structural changes to the Shrubbery to further enhance the indoor and outdoor space available for people living at the home.

Further information is in the detailed findings below.

We carried out our unannounced comprehensive inspection on 5 July 2016. Prior to this inspection we had received concerns in relation to the care people were receiving and the management of the service. We therefore needed to ensure that people's care was being delivered in line with the fundamental standards.

There was a registered manager in post. 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 felt safe. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient numbers of staff available to meet people's care and support needs

Effective recruitment processes were in place and followed by the service.

Medicines were stored, handled and administered safely within the service.

Staff members all had induction training when joining the service, as well as regular ongoing training.

Staff were well supported by the manager and had regular one to one time.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were able to choose the food and drink they had and staff were able to support people with this.

People were supported to access health appointments when necessary.

The staff supported people in a caring manner. They knew the people they were supporting well.

Where possible, people were involved in their own care planning and were able to contribute to the way in which they were supported.

People's privacy and dignity was maintained at all times.

People were supported to take part in a range of activities and social interests.

The service had a complaints procedure in place and people knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action needed to be taken.