Archived: Handsale Limited - Shakespeare Court Care Home Also known as Rosewood Court

People’s experience of using this service:

People told us they felt safe. Staff knew how to recognise and report concerns about people’s safety and welfare. Improvements had been made to the way staff were recruited, the required checks were done before new staff started work.

Risks to people’s health and welfare were identified and managed. Staff knew about people’s needs and care was delivered in line with people’s care plans. People’s medicines were managed safely.

There were enough staff to make sure people’s needs were met in a timely way. Staff received training and were supported in their roles. Staff were kind and compassionate and treated people with respect.

People were supported to eat and drink a varied diet which took account of their preferences and cultural and religious 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.

Improvements had been made to the way people were supported to spend their time and take part in social interaction and activity.

The home was clean and checks were done to make sure it was safe. There were plans in place to improve to make further improvements to the environment and to the gardens.

The systems for monitoring the quality and safety of the service had improved since our last inspection. The management team and staff were committed to the continuous improvement of the service. The provider now needs to demonstrate these improvements can be sustained and developed over time.

Rating at last inspection: Requires improvement. (Report published 24 October 2018.) Although the overall rating was ‘requires improvement’ the service was placed in Special Measures in October 2018. We do this when services have been rated as 'inadequate' in any key question over two consecutive comprehensive inspections. The 'inadequate' rating does not need to be in the same question. In the case of Shakespeare Court, it was the well led domain which was rated inadequate in October 2018 and March 2018. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe and effective care. Future inspections will be planned in line with our inspection programme. If we receive information of concern we may inspect sooner.

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

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

Shakespeare Court accommodates 80 people in one building. Within the building there are four units. Rowan and Aspen on the ground floor and Cedar and Willow on the first floor. Aspen and Rowan provide personal care with Rowan dedicated to care of people living with dementia. Willow and Cedar provide nursing care; Cedar is dedicated to the care of people living with dementia.

All parts of the home are accessible by means of passenger lifts and there is a small enclosed garden area.

The last inspection was carried out in November 2017; the report was published in March 2018. Following that inspection, the service was rated requires improvement overall and inadequate in well-led. The inadequate rating in the well-led domain was because this service has consistently failed to meet the fundamental standards, it has been rated requires improvement or inadequate since the first rating inspection in October 2014. The provider was in breach of four regulations relating to person centred care, consent to care and treatment, dignity and respect and good governance. Two of these, consent and good governance, were continued breaches from the previous inspection. Following the November 2017 inspection, we took enforcement action and issued a warning notice to the provider in relation to good governance.

During this inspection we found that although some improvements had been made the provider was in breach of five regulations. These related to safe care and treatment (Regulation 12), the employment of fit and proper persons (Regulation 19), person centred care (Regulation 9), dignity and respect (Regulation 10) and good governance (Regulation 17). Three of these breaches, person centred care, dignity and respect and good governance were continued breaches from the last inspection.

The overall rating for the service remains requires improvement. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.

The service had a registered manager. 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 told us they felt the service was safe. Staff had been trained to recognise and report abuse. However, some staff needed more support in recognising the impact of poor working practices on people’s wellbeing.

Risks to people’s safety and welfare were assessed and care plans were put in place to manage these risks. However, care was not always delivered in line with these plans which meant people were at risk of not always receiving safe care and treatment. In addition, we found the risk assessments and care plans were not always put in place promptly when people moved into the home.

People were at risk of receiving care and support from staff who were not suitable to work in a care setting. This was because robust recruitment procedures were not always followed.

There were enough staff deployed to keep people safe. Staff received training and support and told us they enjoyed working at the home.

People’s medicines were managed safely.

Overall the home was clean and there were good systems in place to prevent and control infection. However, there were unpleasant odours in some areas of the home. Some improvements had been made to the environment and the provider had plans for further improvements.

People’s needs were assessed before they moved into the home. People were supported to plan for their end of life care.

People had enough to eat and drink. People’s preferences and cultural and religious dietary needs were catered for. However, further improvements were needed to people’s meal time experiences.

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.

The service worked with other health and social care professionals to support people to meet their health care needs.

Most people said the staff were kind and we saw many examples of good interactions between staff and people who lived at the home. However, we also saw a lot of interactions were task based and staff missed opportunities to support and encourage people in a positive way.

We found the provider had acted to deal with complaints about the service.

The provider and management team were committed to improving people’s experiences. However, their systems for assessing, monitoring and improving the service were not being operated effectively.

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

Accommodation is provided in four separate units, each unit accommodates up to 20 people. Nursing care was provided on two units, Willow and Cedar with Cedar specialising in the care of people living with dementia. Residential care specialised in nursing care, Cedar and Rowan, are dedicated to the care of people living with dementia.

The last inspection was carried out in January 2017; the report was published in March 2017. At the last inspection we found the provider was in breach of three regulations. These related to staff training, (Regulation 18), the management of covert (hidden) medicines, (Regulation 11), and governance, (Regulation 17). The overall rating for the service was ‘requires improvement’. Following the last inspection we met with the provider and they provided an action plan detailed the actions they would take to improve the service.

During this inspection we found that while some improvements had been made the provider remained in breach of regulations.

There was a registered manager in place. 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.

We found people’s medicines were managed safely and improvements had been made to the way covert medicines were managed. However, we found the provider was still not working in line with the Mental Capacity Act. This was because they had not always ensured people’s representatives had the correct legal authority to make decisions about their care and treatment.

Most people told us they felt safe. Two people told us they sometimes felt unsafe because of actions by other people who lived there. Staff knew how to recognise and report concerns about people’s safety and welfare..

In most cases risks to people’s safety and wellbeing were identified and managed. Incidents were reviewed and ways to improve the service were identified. However, we found this learning was not always put into practice.

There were enough staff deployed. However, the home was finding it difficult to recruit nurses and needed to use a lot of agency staff. This sometimes meant there was reduced leadership on the nursing units. This also had a negative impact on the effectiveness of the management team. Improvements had been made to staff training. Staff told us they felt supported to carry out their duties.

The home was clean and safe. Some areas were in need of refurbishment and this was being addressed. There had been some adaptations to the building to support people living with dementia.

People had enough to eat and drink and there was a varied menu. Feedback about the food was mixed. We found people were not always supported to make informed choices about what they wanted to eat. We found more needed to be done to improve people’s meal time experiences.

Staff knew about people’s physical care needs but did not always know much about people’s life stories and this information was not always recorded. This is important to delivering person centred care.

Most people were satisfied their needs were met. However, we found inconsistencies in people’s care records which created a risk people would not always receive appropriate care.

People were supported to meet their healthcare needs and had access to the full range of NHS services.

Most people told us staff were caring and treated then with kindness. We saw staff interacting with people in a positive way which helped people to feel better. However, we also saw a lot of interactions were task based and did not enhance people’s wellbeing. There was a programme of activities however we found for some people there was not enough stimulation or interaction.

We found the provider had taken action to deal with complaints about the service.

There were systems in place to assess, monitor and improve the quality and safety of the services provided. However, these were not robust enough and needed further development. The provider was committed to improving people’s experiences and had engaged a consultant to support the home’s management team in achieving this.

We identified four breaches of regulations, these related to person centred care, (Regulation 9), dignity and respect, (Regulation 10), consent to care and treatment (Regulation 11) and governance, (Regulation 17). Two of these breaches, (Regulations 11 and 17), are continued breaches from the previous inspection.

You can see what action we told the provider to take at the back of the full version of the report. 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.

We inspected the service on 24 January 2017and it was unannounced. On the day of the inspection 58 people were living at the home.

The person previously registered as manager was due to leave the service two days after our inspection. They had cancelled their registration with the Care Quality Commission. This person is referred to in the report as the outgoing manager. A person registered as manager at another of the providers’ services had started work at Shakespeare Court and was due to take over management responsibility. This meant there was not a registered manager for the service at the time of our inspection. 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 and relatives we spoke with told us the service delivered good quality care and they did not raise any significant concerns with us. People said they felt safe and trusted the staff. They said staff were kind and care and support provided was appropriate and met their individual needs. People told us they did not have to wait for staff attention. People said they were treated with dignity and respect and their privacy was respected. This was confirmed by our observations.

Staff understood how to identify and act on any safeguarding concerns. Systems were followed to report safeguarding concerns appropriately. Risks to people’s health and safety were assessed. Care plans included any necessary risk assessments based both on actual and perceived risk.

Overall, we concluded medicines were safely managed although some improvements were needed. People received their medicines as prescribed and medicines were stored securely.

Overall, we found there were sufficient staff to meet people’s needs although we have recommended the provider ensures this is kept under continuous review. Safe recruitment procedures were in place. Staff training was not up to date and the induction programme was of a poor standard.

The premises was safely managed. There were pleasant communal areas for people to spend time and the required maintenance and checks took place to make sure the building was safe. The service was clean and tidy.

People told us the food was good and that they had sufficient choice. We found mealtimes to be a pleasant experience and people were provided with diets that met their religious and cultural needs. Nutritional needs were assessed but monitoring of nutritional intake and people’s weight was not always sufficient.

The service had failed to take action in relation to a recommendation we made during our previous inspection and therefore was not always acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s needs were assessed and clear and person centred plans of care put in place. People and their relatives told us they were involved in care planning. Staff we spoke with had a good understanding of the people they were caring for.

A programme of activities was in place, provided by an activities co-ordinator. However this was insufficient to meet the needs of all of the people living at the home.

A system was in place to record, investigate and respond to any complaints. People had responded positively about the manner in which their complaints had been managed. People were listened to and their opinions used to make positive changes to the service.

Systems to assess, monitor and improve the service were not sufficiently robust. Some audits were carried out, but action was not always taken to address issues identified.

We found three breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

The people who used the service told us they were looked after very well and felt safe with the care and treatment provided. Their comments included: "It is very nice here", 'I like it here', 'They are all lovely' and 'I love living here'.

We spent time observing the four lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people.

The interactions we saw between staff and people who used the service and visitors were respectful. We saw some people engaged in activities with members of staff such as watching TV, enjoying beverages and snacks and reading a memory book.

In one of the areas where we carried out an observation we saw staff spent a lot of time standing in the corridors. They talked with people who were walking up and down the corridor but they did not have much interaction with the people who were in the lounge area. We saw that for the most part staff only interacted with people in the lounge area when there was a specific care task to be carried out.

We saw that staff did not always explain to people what they were doing, for example, when helping someone to transfer with the aid of a hoist. We saw that staff did not always talk to people when supporting them to eat and did not always explain to people what they were being offered to eat and/or drink.

We looked at some people's care records and found that the records did not always include accurate information about their care needs.

There were policies and procedures in place to make sure vulnerable people were protected from the risk of abuse.

We found there were systems in place to make sure staffing levels were reviewed and took account of the needs of the people who used the service. The staff we spoke with did not raise any concerns about the numbers of staff on duty.

There was a complaints procedure and the records showed people's complaints were taken seriously and addressed.