We carried out a review of the data available to us about The Shrubbery Rest Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Shrubbery Rest Home, you can give feedback on this service.
The Shrubbery Rest Home is a care home providing support with personal care needs to 21 people at the time of this inspection. The home can accommodate a maximum of 26 older people. Accommodation is provided in an adapted building.
People’s experience of using this service and what we found
Systems to assess, monitor and mitigate risks to people’s safety and well-being had improved. People were protected by the provider’s staff recruitment procedures. Staff received the support and training they needed to meet people’s needs. Staff were deployed in sufficient numbers to meet people’s needs. People received their medicines when they needed them from staff who were trained and competent to carry out the task. Infection, prevention, control procedures had improved and helped to protect people from the risk of infection.
Systems to monitor and improve the quality and safety of the service provided had improved and were now effective in identifying and addressing shortfalls. People, their relatives and staff were provided with opportunities to express a view about the service provided. People’s care records had been reviewed and now contained important information for staff to enable them to provide care and support which met people’s needs and preferences. The provider worked in partnership with others to achieve good outcomes for people. These included health and social care professionals and stakeholders.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update). The last rating for this service was requires improvement (published 22 July 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and good governance.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. However, significant improvements were found at this inspection, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led in their entirety.
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 coronavirus and other infection outbreaks effectively.
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; safe and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Shrubbery Rest Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Shrubbery Rest Home is a care home providing personal care to up to 26 people. At the time of the inspection there were 21 people living there, although three people were in hospital on the day of our visit so 18 people were in the building. The home supported older people, some of the people were living with dementia or other mental health support needs. People may also have had sensory and/or physical disabilities.
People’s experience of using this service and what we found
Risks to people’s health and wellbeing were not always assessed and planned for so we could not be sure people were always kept safe. Lessons had not always been learned when things went wrong. It was not always clear what action had been taken to reduce ongoing risk to people. People were not always protected from the risk of cross infection and the provider was not always following government guidance. Medicines were not always managed safely; some people had missed doses of medicines and we could not be sure they were always stored appropriately. Staff were not always effectively deployed as communal areas were often unattended and multiple incidents were unwitnessed.
Quality assurance systems were not fully effective at identifying areas for improvement as many concerns identified on inspection were not always known to the provider. Medicines audits had not been effective at identifying concerns and ensuring improvements were made. Reviews of people’s care plans were not always accurate or effectively reviewed.
Whilst the provider and registered manager had an action plan to improve the service, some concerns had not been recognised so this plan this had failed to fully address the concerns we found, until we provided feedback. Once they were made aware of our concerns, they were proactive in making necessary improvements.
Staff were recruited safely and risk assessments were in place until references had been received from previous employers. Staff understood their safeguarding responsibilities and referrals were made to the local safeguarding authority.
People and staff were complimentary of the registered manager and provider. They felt they were approachable and felt supported. The registered manager was aware of their duty of candour.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
At the last inspection we inspected the key questions of safe and well-led and the last rating for this service was good (published 19 January 2021). The service has deteriorated to requires improvement overall.
Why we inspected
We had received some anonymous concerns from people telling us they were members of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led.
The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were also used in calculating the overall rating at this inspection.
The overall rating for the service has deteriorated to requires improvement overall. This is based on the findings at this inspection.
Enforcement
We have identified a number of breaches of regulation in relation to the safe care and treatment of people, ineffective quality assurance systems and the deployment of staff.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Shrubbery rest home provides accommodation with personal care for up to 26 people. People who
use the service had physical health and/or mental health needs, such as dementia. At the time of the inspection, 19 people used the service.
People’s experience of using this service and what we found
‘As required’ PRN protocols were in place to highlight when people needed medication to help with their pain management. The provider intended to make improvements to evidence more clearly stocks of ‘as required’ medicines and how staff recorded the administration of these
Care files contained information for staff to ensure people’s risk were managed in a safe way. Care files contained risk assessments for the use of equipment in the home and for people’s health conditions.
People’s personal emergency evacuation plans clearly documented the support they would require should they need to be evacuated from their home.
Daily handovers were completed to record any outstanding concerns related to people’s safety and the environment, ensuring staff remained up to date with all important information.
People told us they felt safe in the home.
The acting manager completed a number of monthly quality audits to assist with the governance of the service and drive improvements where shortfalls had been identified. However, they did not always identify issues with the medication count.
People’s care files evidenced where the provider had been in contact with relevant health care professionals to support people’s needs.
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 17 January 2019). You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Shrubbery Rest Home on our website at www.cqc.org.uk.
Why we inspected
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 coronavirus and other infection outbreaks effectively.
We received concerns in relation to people's care and how the service was promoting people's
safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
The ratings from the previous comprehensive inspection for those key questions not looked at on this
occasion were used in calculating the overall rating at this inspection. The overall rating for the service has
not changed. We did not inspect effective, caring and responsive due to us wanting to limit ourselves and spend the least amount of time in the home as possible.
Follow up
We will aim to re-inspect this service within the published time scale for services rated good. We will continue to monitor the service through the information we receive.
There is 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.
Risks to people had been considered and risk assessments were in place when needed. After incidents occurred within the home, these were reviewed to ensure they were up to date and relevant. There were enough staff available for people and they did not have to wait for support. The provider had a system in place to ensure adequate staffing levels within the home. Medicines were managed in a safe way to ensure people were protected from the risks associated with these.
People were supported by suitably recruited staff and were happy with the care they received. Staff received training and an induction that helped them to support people. There were safeguarding procedures in place to ensure people were protected from potential harm and these were followed when needed. We found 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 treated in a kind and caring way and were happy with the support they received from staff. They were involved with reviewing their care. People were encouraged to be independent and make choices how to spend their day. People’s privacy and dignity was also upheld.
People enjoyed the food and were offered a choice. People were supported to access health professionals when needed and the home worked jointly with these professionals. People had the opportunity to participate in activities they enjoyed.
The home was decorated in peoples preferred way and the environment was clean and free from infection. There was signage around the home to help prompt people living with dementia and information was available for people in their preferred format. People’s cultural and religious needs had been considered.
There were systems in place to monitor the quality of the home and when needed, action was taken to drive improvements. The provider sought the opinions of people and relatives and used this information to make changes. A registered manager was in post and they understood their responsibilities around registration with us and notified us of significant events that had occurred within the home. They were also displaying their rating in line with our requirements. There was a system in place when things went wrong in the home so that lessons could be learnt.
The service had 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.
When we completed our previous inspection on 31 January 2017 we found concerns relating to how risks to people were managed. The information staff required to transfer people safely was not always available and when people had behaviours that may challenge staff did not always know how to support them in a consistent way. We also found further improvements were needed to ensure people were protected from potential harm or abuse. When needed mental capacity assessments had been completed however decisions had not always been made in people’s best interests. The provider had not always notified us about significant events that had occurred in the home. The quality audits that had been introduced had not always been completed and therefore we could not be sure they were effective. The provider was rated as requires improvement overall. At this inspection we found improvements had been made however further improvements were needed. This is the second consecutive time the service has been rated Requires Improvement.
We could not be assured there were always enough staff to offer support to people. Our views were also shared by other professionals we spoke with. There were long periods when people in communal areas were unsupported and interactions from staff were task focused.
The provider had not always considered people’s cultural needs and the pre assessment the provider completed did not always cover people’s diverse needs. Where people were living with dementia we could not be sure how they had been supported to make choices, as information was often in written form.
Risks to people were managed in a safe way and staff had the information available. Staff knew how to recognise and report potential abuse and the provider had safeguarding procedures in place, when needed we saw these had been followed. Staff knew people well and people were happy with the care they received. Medicines were managed to ensure people were protected from the risks associated to them.
Infection control procedures were in place and implemented by staff and the provider when needed. Staff received an induction and training that helped them offer support to people. When people lacked capacity to make decisions for themselves we saw capacity assessments were in place and decisions made in people’s best interests. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People told us they enjoyed the food and were offered a choice. People and relatives said they were involved with reviewing their care and when needed people had access to health professionals. People’s privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day and remain independent. Some people were offered the opportunity to participate in activities and pastimes they enjoyed.
Staff felt listened to and were able to raise concerns. The provider used feedback from people and relatives to bring about changes. Quality monitoring checks were completed to make improvements to the service. The registered manager understood their responsibility around registration with us and we had received notifications when significant events had occurred within the home. The provider was displaying their previous rating in line with our requirements.
The service was registered to provide accommodation for up to 26 people. At the time of our inspection, 23 people were using the service.
There was not a registered manager in post. A new manager had very recently been appointed who had commenced the CQC registered managers application process. 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 were not always protected from potential abuse as concerns were not investigated or reported appropriately. Risks to people were not always managed in a safe way. When incidents occurred sometimes no action was taken to ensure these were reviewed and avoid any reoccurrence. When people had behaviours that may challenge staff offered an inconsistent approach. Staff did not always have information about moving and handling to ensure people were supported in a safe way. When needed mental capacity assessments had been completed however decision had not always been made in people’s best interests.
The provider was not always notifying us about significant events that had occurred in the home. The quality audits that had been introduced had not all been completed and therefore we could not be sure they were effective.
People were supported in a caring way by staff they liked. Staff had received an induction and training to help them offer support to people. There were enough staff available to offer support. People were encouraged to make choices about their day and remain independent.
People enjoyed the food and were offered a choice. They had the opportunity to participate in activities they enjoyed. Medicines were managed in a safe way to ensure people were protected from the risks associated to them. When needed people had access to health professionals.
Staff felt listened to and supported by the new manager. People knew how to complain and complaints had been responded to in line with the provider’s procedures. Staff knew people well and they felt involved with planning their care.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.