Shedfield Lodge

Shedfield Lodge 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.

We found the following examples of good practice.

• People were supported to keep in touch with families and visits were planned and well organised to reduce risk and avoid the potential spread of infection.

• Information was easily accessible on arrival, or before visits, to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control.

• Alternative forms of maintaining social contact were used for friends and relatives. For example, keeping in touch using video calls or visiting in the communal garden. People had access to a telephone and staff were available to support if required.

• All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home, alongside having their temperatures taken. Visitors had no contact with other residents and had minimal contact with care home staff.

• Facilities were in place to wash hands for 20 seconds, or to use hand sanitiser, on entering and leaving the home.

• A screen was provided in the entrance porch of the home showing visitors how to wash their hands properly.

• There was prominent signage and instructions to explain what people should do to ensure safety.

• Admissions from hospital or interim care facilities, and new residents admitted from the community, were isolated for 14 days within their own room.

• People were assessed regularly for the development of a high temperature (37.8°C or above), a cough, as well as for other signs such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting.

• All staff in high risk groups such as Black, Asian and minority ethnic (BAME) had been risk assessed, and adjustments had been made.

• All members of staff worked in only one care setting, this included part-time and agency staff.

• Staff were trained and knew how to immediately instigate full infection control measures to care for people with symptoms to avoid the virus spreading to other people and staff members.

• Arrangements were in place so staff could appropriately socially distance during breaks, handovers and meetings.

• Staff had received training from an Infection Prevention and Control (IPC) specialist.

• A testing scheme for all staff and residents had been implemented, known as ‘whole home testing’. The provider had tests for regular 'whole home testing' as well as tests for any suspected or symptomatic residents or staff.

• Staff wore a fluid repellent surgical mask, gloves and apron when delivering personal care to all people. Use of personal protective equipment (PPE) was in accordance with current government guidelines COVID-19 PPE. We observed staff to be wearing PPE as per guidelines. Disposal of used PPE prevented cross-contamination as it followed local protocols, in particular single use items and how PPE is disposed of safely.

• Communal areas such as outdoor spaces and garden areas were used creatively to help with IPC. The provider had identified a specific outside paved area at the front of the premises to support people to have visits safely with their relatives whilst enabling their rear gardens to be utilised as a safe outside space for people to access independently and safely.

• The provider had encouraged people and visitors to provide feedback about their well-being and how they have felt during the pandemic, including anything they had found difficult or any suggestions they had for improving practices.

• Effective cleaning schedules were in place in all areas of the service.

•The provider ensured that current guidance was shared in a timely way with the service. When the guidance was updated the risk, parameters were reviewed, and changes made. This reduced any potential risk of infection.

• Contingency plans were in place to manage ongoing or future outbreaks or other events effectively. The provider collected data and regular reports from the service. This information was analysed and used to inform future incident management and support learning.

• All staff feedback was positive about the training and support they had undertaken. They commented the registered manager and the provider were supportive.

Further information is in the detailed findings below.

We last inspected the service in March 2015 and rated the service as good. This inspection found that the service remained good.

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.

Shedfield Lodge is registered to provide accommodation and support for up to 34 older people who may also be living with dementia. The home has permanent residents but also provides respite care. This home is not registered to provide nursing care. On the day of our visit 28 people were living at the home. The home is located in a rural area two miles from the town of Wickham, Hampshire. The home has a large living room, conservatory, dining area and kitchen. People's private rooms are on both the ground and first floors. There is a stair lift and passenger lift to the first floor. The home has a garden and a patio area that people are actively encouraged to use.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles.

The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People and where appropriate their relatives were involved in their care planning, Staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Is the service safe?

The service was safe because each person had a support plan which identified their individual needs before they came into the home, an assessment of possible risks to the person and a description of the person’s needs for support and treatment.

People living at Shedfield Lodge had a Personal Emergency Evacuation Plan (PEEP) in place. This gave clear and concise instruction on the level of assistance needed to evacuate people from the home in the event of a fire.

People were safe because staff received safeguarding training during their induction and it was updated regularly. We saw training included the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff we spoke with were able to identify different types of abuse and knew the correct procedures to follow if they had any concerns.

There were effective systems in place to make sure the premises provided a safe environment. We looked at the fire log book and saw inspections of the fire safety system were taking place to the required timescales.

People were safe because the provider had arrangements in place that ensured equipment was checked, serviced and if necessary repaired or replaced.

The provider ensured appropriate checks were undertaken before staff started work. We looked at the recruitment records of four care workers. We found photographic identification present on each care worker file. Disclosure and Baring Service (DBS) checks were undertaken on new staff. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted the provider was working with the local authority to ensure proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

The service was effective because care plans were reviewed monthly by the registered manager or their deputy. Family members confirmed that they were kept informed of any changes in their relatives’ health.

The equipment and aids that helped promote people’s independence and welfare included mobile hoists; slings: stand-aids/rotundas: walking frames: walking sticks; wheelchairs: specialised seats: raised toilet seats: and specialist cutlery. We also looked at records and documents that showed the provider had arrangements in place for regular servicing of lifting equipment. For example, lifting hoists, lifting hoist slings and standing transfer aids.

Is the service caring?

The service was caring. During our visit we looked at four care plans. We talked with people and one visiting relative who told us they were involved in planning their relatives care and support. The relative told us: “We talk about how mum likes things and they do their best to accommodate”.

Care records showed healthcare professionals were involved when people needed them.

Is the service responsive?

The service was responsive. We spoke with one visiting health care professional who said: “I have been visiting the home for the past two years. I have no undue concerns about the care people receive. There is a very low incident of falls within the home and very few skin related issues. The staff are very proactive in identifying concerns and calling us for advice”

In each person’s room there was a ‘Remember I’m me’ care chart. This gave staff an overview of things that were important to people using the service.

Is the service well led?

The service was well led. In two care plans we reviewed we saw people had attended the local eye hospital recently for tests in relation to macular degeneration. The hospital discharge notes included an electronic print to demonstrate to staff how that person’s vision was impaired [blurred]. The registered manager told us: “We included this in the care plan so that staff could see and have an understanding of how visual impairment can affect people” One member of staff said: “Knowing how people’s vision can be affected helps us to understand their needs and give the best care we can”.

The provider ensured staff received regular training and development. We saw recent staff training certificates that included: food hygiene and safeguarding vulnerable adults. The manager showed us the training schedule which recorded the training care workers had undertaken and when refresher training was due.

During our inspection on 13 February 2013 we judged that people were not protected from the risk of infection. We arrived at Shedfield Lodge at 9am on the day of this inspection. We toured the premises and found that all of the areas of the home to be in a clean condition. The actions taken by the provider to improve the service and meet this regulation following our inspection in February 2013 had been met.

During our inspection on 13 February 2013 we judged that the provider did not operate an effective system to regularly assess and monitor the quality of service and to identify and manage the risks to the health, welfare and safety of people. A new computer based system for monitoring compliance and quality assurance has recently been installed by the provider. The manager was in the process of receiving training for this and told us: 'Going forward this will ensure that we address areas that we need to improve on".

We found the provider to be in the process of reviewing all care plans and had employed an independent consultant to support the process. The quality improvement officer for Hampshire County Council was also providing support to the home. We looked at three care plans that had been reviewed. They were detailed and contained a range of information relating to the individual and how the home would manage their care.This meant that people's personal records including medical records were accurate and fit for purpose.

People we spoke with said they were happy living at Shedfield Lodge and that their needs were met. One person said "I am happy here and staff care about me."

Systems to monitor the cleaning of the home had been introduced by the provider and a new bathroom installed. However, some areas of the home were not clean and Infection control practices needed improvement to meet national guidance.

The provider had introduced some systems since the last inspection to monitor the quality of care and service provision .However,some improvements were required to ensure the systems were effective .

For this inspection we reviewed four essential standards where we had previously identified areas of improvement or non-compliance. We also looked at other standards relating to quality and safety of care.

Staff treated people with dignity and respect. People were given time to express their needs and were listened to by staff. Before people received care they were asked for their consent and the provider acted in accordance with their wishes.

People's needs were assessed and care was planned and delivered in line with their individual care plan.

We found that some areas of the home were not clean. Infection control practices did not comply with the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance.

Staff told us they felt supported, and had access to training, advice and opportunities for shared learning.

There was not an effective system to monitor the quality of the service to ensure improvements were identified and implemented. This meant that people were not always protected from risks.

Care records viewed required further work to ensure they were accurate and detailed how decision making was reached.