Archived: Shevington Court Nursing Home

Shevington Court Nursing Home is a residential care home providing personal and nursing care to 30 people. The service can support up to 46 people. The home provides accommodation on the ground floor in one building.

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

Systems in place to monitor the quality of the service were not effective and failed to highlight or address concerns identified during this inspection. Improvements were needed to make the external environment safer.

The care planning and recording systems in place did not always ensure that up to date information was available in relation to people’s needs being met.

We have made a recommendation in relation to the deployment of staff.

People felt safe using the service and received their medicines on time. Safe recruitment practices were in place to help ensure that only suitable people were employed at the service.

People’s needs and wishes were assessed prior to moving into the service. People received care and support from appropriately trained staff. People were offered a nutritious and balanced diet and their healthcare needs were understood and met.

People were protected from abuse and the risk of abuse and staff understood their role in relation to this. People and their family members told us that the service was safe. Infection control practices were followed to minimise the risk of the spread of infection. Regular safety checks were carried out on the environment and equipment.

Staff knew people well and were knowledgeable about individual's needs and how they were to be met. People and their family members knew how to raise a concern or make a complaint about the service. People were treated with kindness by staff. Staff provided care and support that people were happy with.

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 (and update)

The last rating for this service was Requires Improvement (published 2 July 2018). At this inspection improvements had been made however, the provider was still in breach of regulations as further areas of improvement had been identified during this inspection. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Regulation 12 safe care and treatment and Regulation 17 good governance at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in March 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection we asked the registered provider to complete an action plan to show what they would do and by when. During this inspection we followed up on these areas and found that most of those concerns we had raised at the last inspection had been addressed, however other areas had not. This was specifically with regards to the implementation of effective and robust quality monitoring systems.

At this inspection we identified continued breaches of 12 and 17 and an additional breach of Regulation 10.

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.

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

The service is registered to accommodate up to 46 people in one adapted building. At the time of the inspection there were 42 people living at the service.

The service is located in St Helens and is situated over one level. It has access to a private car park at the front of the premises and there is a small garden to the rear.

The premises were not fully secure and action needed to be taken to make this safe. The lock on one fire escape was broken which meant the door did not close securely. The garden gate was also open and allowed access to a road via a busy car park. This posed a risk of people exiting the service without the required level of support. It also compromised the security of the premises if unauthorised individuals were to access the service.

Sensor alarms were not in place on two other fire escape exits, despite signs on both doors asking staff to ensure sensor alarms were turned ‘on’. Another of the fire doors had a sensor in place, however this was not turned on.

Five bedrooms had a strong odour and needed to be cleaned. We raised this with the registered manger and action was taken to clean these rooms thoroughly which made an improvement.

Action needed to be taken to make improvements to people’s bedrooms. In some bedrooms we found furniture which was broken, wall paper which was peeling from the wall and in one bedroom an electrical socket hanging loose from the wall. We also identified some rooms overlooking the car park which did not have blinds in place to protect people’s dignity.

Audits were in place however these had not been sufficient to identify and address those issues we had found during the inspection. We raised all our concerns with the registered manager and registered provider for them to address.

We have made a recommendation to the registered manager and registered provider around ensuring that processes were in place to promote equality and diversity within the service.

Meetings had been held with people and their relatives. This gave them the opportunity to ask questions about the service and keep abreast of developments. However, we identified that during one meeting information about our inspection in March 2017 had not been accurately communicated.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable adults and knew how to report any concerns they may have.

There were sufficient numbers of staff in post. We reviewed staffing rotas which showed consistent numbers of staff were put on shift. We also made observations on the time it took staff to respond to call bells and found this to be reasonable.

Recruitment processes were safe, however we identified that references were not always obtained from referees specified on application forms. It is best practice to obtain references from applicant’s most recent employer, or where this is not possible to outline an alternative option. We raised this to be addressed.

Staff had received the training they needed to carry out their role effectively. This helped ensure people received the care they needed.

People told us they enjoyed the food that was available. Snacks and drinks were provided to people throughout the day which helped people maintain a healthy weight and stay well hydrated.

Where required, people were supported to access support from health and social care professionals, which helped ensure people’s health and wellbeing was maintained.

We observed examples that showed positive relationships had developed between people and staff. We overheard laughter and conversation and people told us they enjoyed the “banter” they had with staff. People’s care records also contained information about their likes, dislikes and life histories which helped staff get to know the people they were supporting.

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’s care records contained important and up-to-date information about their care needs. These outlined to staff what level of support needed to be provided. Daily monitoring records were kept up-to-date by staff which outlined the support that have been given.

Shevington Court provides accommodation to older people or people living with a physical disability who require nursing or personal care. The service is registered to accommodate up to 46 people and at the time of the inspection there were 40 people living at the service.

The service had been without a registered manager since November 2016; however a new manager had been appointed and was in the process of registering with the CQC. 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 the inspection we identified breaches of 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Bed rail risk assessments did not always consider the relevant information to determine whether these were safe and appropriate. In one example a person had fallen out of bed whilst climbing over their bed rails. The bed rail risk assessment had not been updated following this incident to determine whether they were still suitable. The falls risk assessment had been updated, however did not provide detail around the person having tried to climb over the bed rails. This meant that staff did not always have access to up-to-date information, and appropriate action had not been taken to keep people safe.

Risk assessments relating to the use of portable heaters had not been completed and therefore people could be at risk of harm. Following the inspection visit the manager completed these, and sent us a copy.

We identified that mental capacity assessments had not always been completed as required. In one example we asked that a person be referred to the local authority for review to ensure they were receiving the correct level of support. We have made a recommendation to the registered provider around carrying out their role and responsibilities in relation to the Mental Capacity Act 2005 (MCA).

Parts of the environment needed making safe when we first arrived at the service. After we raised these issues, action was taken to rectify the issues identified and these issues did not reoccur for the remainder of the inspection visit. Records showed that regular checks of the environment were being carried out, however it was evident from the issues we identified that these were not always effective.

Audit systems were effective at monitoring some areas of the service but not others. For example parts of the environment needed making safe when we first arrived at the service. Whilst checks on the environment were being carried out, it was evident from the issues we identified that these were not always effective. Audit systems had also failed to identify issues relating to mental capacity assessments, and lessons had not always been learned from accidents and incidents.

Staff had received training in safeguarding vulnerable adults and knew how to report their concerns both inside and outside the organisation. Recruitment processes were robust which helped to ensure that those people employed were of suitable character to work with vulnerable adults. This helped protect people from the risk of abuse.

Infection control procedures were being followed by staff. During personal care interventions staff wore personal protective equipment (PPE) such as disposable aprons and gloves. This protected people from the risk of infection, and helped maintain their health and wellbeing.

People told us that they enjoyed the food and that they got enough to eat and drink. Staff were aware of people’s dietary needs which ensured that people received a diet that was appropriate for them, for example low sugar, or soft food options.

People were supported to access support from health care professionals where required to maintain their health and wellbeing. Where people became ill, they were referred to their GP or paramedics for support.

People’s privacy and confidentiality was protected by staff. Staff ensured that doors remained closed whilst supporting people with personal care tasks. Personal information was stored in secure cabinets and staff ensured that these were put away after use.

Positive relationships had developed between people and staff, and people were familiar with the management team and knew how to make a complaint, or raise any concerns they may have. The registered provider maintained a record of complaints that had been received, which showed these had been responded to in a timely manner.

The majority of care records contained up-to-date information relating to people’s needs. These were personalised and contained information around their life histories and personal preferences. This provided information to staff on how to support people, and gave them an insight into the people they were supporting. This helped facilitate positive relationships between people and staff.

Meetings were held with staff, people using the service and their family members. This helped ensure they remained up-to-date with developments within the service, and were able to contribute to decisions being made.