Archived: Shawe House

Updated 15 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 and 22 June 2017 and was unannounced on the first day. The inspection team consisted of one adult social care inspector, a bank inspector and an expert by experience on the first day of the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience of services for older people. One adult social care inspector returned for the second day of the inspection.

We did not ask the provider to complete a Provider Information Return (PIR) on this occasion. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law.

We contacted the local authority commissioning team for feedback on the service. They shared with us recommendations that had been made by commissioning support officers following monitoring visits made during 2017 and actions taken by the home. We had received a report from the local Healthwatch board following an enter and view visit undertaken to the service in January 2017 that detailed their findings.

During the inspection we observed interactions between staff and people who used the service. As some people were not able to tell us about their experiences, we used the Short Observational Framework for Inspection (SOFI) during the lunch period in the lounge areas of the home. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with three people using the service, seven of their relatives and 15 staff including the registered manager, the deputy manager, a registered nurse, the activities co-ordinator, eight care workers and three ancillary staff. We observed the way people were supported in communal areas and looked at records relating to the service. These included six care records, four staff recruitment files, daily record notes, medication administration records (MAR), maintenance records, audits on health and safety, accidents and incidents, policies and procedures and quality assurance records.

Updated 15 August 2017

We undertook this inspection of Shawe House Nursing Home on 20 and 22 June 2017 and was unannounced on the first day. The inspection team consisted of one adult social care inspector, a bank inspector and an expert by experience on the first day of the inspection. The inspection was unannounced which meant the provider did not know we were coming on the first day of the inspection.

Shawe House Nursing Home is located in Flixton, Manchester and provides nursing care for up to 33 people who live with dementia. Accommodation is provided on two floors. All bedrooms are single rooms and those on the first floor are accessible by a passenger lift. There is an enclosed garden area and parking for several cars at the front of the property.

At the time of our inspection there were 27 people living at Shawe House. The local authority had placed a temporary suspension on new admissions. It was envisaged that this suspension would be lifted once the home could demonstrate adequate improvements with regards to people's safety and the quality of care delivered.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our last inspection in October 2016 we identified breaches of the regulations in relation to the safe care and treatment of people, person-centred care, consent, premises and equipment, staffing and the governance of the service. The home was placed in special measures as a result of the breaches identified at the last inspection and we served three warning notices.

At this inspection we found improvements had been made in all areas. We found the service was now working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support although we judged that the service needed to improve with regards to correctly recording people’s consent to aspects of their care.

People received their medicines as prescribed and the nurses had received relevant medicines administration training. Protocols for the use of ‘as required’ medicines were in place. The temperature of the medicines fridge had not been recorded for two days as this was reported as broken. A representative from the pharmacy came out to the home and addressed this on the first day of inspection. Staff were reminded to also record the temperature of the medicines room so that the effectiveness of medicines stored there was not reduced.

People we spoke with and their relatives were complimentary about Shawe House. Relatives told us they considered their family member to be safe, the staff knew people’s needs well and there were enough staff on duty to meet those needs.

There was less reliance on agency staff and staff appeared more confident and positive about their role. The registered manager had made new appointments that benefitted the home and was supported by a new deputy manager and a clinical lead.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed.

Care plans were in place for the support people wanted as they came to the end of their lives and the home had been awarded The Six Steps to End Of Life Care accreditation certificate. Relatives were kept informed about the programme.

Appropriate referrals were made to the Speech and Language Team (SALT) and dietician. Food and fluid monitoring charts were completed where required and kitchen staff were made aware of changes to people’s diets. We saw referrals to other health professionals were made when needed, for example an occupational therapist, tissue viability nurse or the dementia crisis team. This meant that people’s health needs were dealt with in a proactive and effective manner.

People we spoke with told us that the staff at Shawe House were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. Staff showed they had a good understanding of the needs of people who used the service and this was helped as care workers were now documenting in progress notes for those people they had assisted with personal care.

We saw care plans were reviewed monthly or following any changes in people’s needs. Staff documented when people refused aspects of personal care however it was not clear what actions, if any, staff took to encourage people to comply with care.

The React to Red - Safety Cross tool had last been completed in March 2017. If the tool is not used appropriately it is not obvious if any current pressure care regimes in place are working successfully. The registered manager said that this was an oversight and that use of the tool on a monthly basis would be reinstated but went on to explain that any concerns around pressure areas were identified and tracked with monthly wound management audits.

At the last inspection we had identified that people living at the home were not provided with information on advocacy services. At this inspection we saw that this had changed. The contact number for a local advocacy group was displayed on the noticeboard in the foyer.

A new activities officer was in post at the home. Regular activities included weekly entertainers and film afternoons. Information on care plans relating to life history was replicated in the activities files so that the activities co-ordinator was aware of past hobbies and could introduce activities that might be of interest to particular individuals. We were assured that people were offered appropriate activities but where participation in activities was limited staff tried to make them feel involved where possible. This meant the service to steps to ensure people were engaged in activities that were meaningful and helped with their wellbeing.

All areas of the home were seen to be clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care and the home had a business continuity plan in place to help address any unexpected emergencies.

A complaints procedure was in place. People we spoke with said the staff and registered manager dealt with any issues they raised verbally and a formal complaint we saw had been dealt with within acceptable timescales. It is good practice to include a record of the date the complaint was resolved as well as the date it was received so that the manager can audit that company policy response timescales have been met.

Audits and checks were completed on a range of areas, for example medicines, care plans, accidents and incidents, mattresses and aspects of the environment. We noted that some areas for improvement identified during an audit had not been acted upon in a timely manner, for example replacing a torn waterproof mattress cover.

The registered manager had introduced support mechanisms for staff such as a rolling rota, supervisions and staff meetings but return to work interviews following absences due to sickness were still not undertaken with staff. We will check at our next inspection to see if this support mechanism has been embedded into practice.

The home is no longer in special measures due to the improvements found during this inspection. The registered manager felt fully supported with the restructured management team and on-going assistance from the operations manager and recognised that the improvements to the service now needed to be fully developed and sustained.