Archived: Shawe House

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.

Shawe House is a nursing home located in the Flixton area of Trafford. The home is registered to provide accommodation and nursing care for up to a maximum of 33 older people and accommodation is provided over two floors. Shawe House specialises in providing care and support to older people living with mid to late stage dementia. There were 33 people living at Shawe House on the day of our inspection.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 in 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.

We identified several potential safety hazards as we walked around the building, including the lift, which had been problematic prior to our inspection relatives we spoke with told us. The design and layout of the building with its narrow corridors was not ideal for people living with dementia. There was nothing made available to engage people who were able to mobilise around the building. There was no evidence of the implementation of good practice in modern dementia care and signage to aid navigation in the building was limited.

People living at Shawe House had high dependency needs. Over a third of the people living at Shawe House required two to one support with aspects of personal care and two people required one to one support during the day. The service relied heavily on agency staff who did not have access to the same training as permanent staff employed by Shawe House. There were insufficient numbers of suitably qualified, competent, skilled and experienced persons supporting people living in the home. Staff told us they received training in areas including moving and handling, safeguarding, fire safety, health and safety, food hygiene and infection control. The training matrix was not clear with regards to the training staff were expected to do according to their roles and the frequency of this training. There were gaps in moving and handling training.

Best interest decisions were not recorded for people using the service who were known to lack mental capacity. People and their relatives (when appropriate) had not been involved in planning and reviewing their care plans.

Proper audits and checks on the quality and safety of the service were not in place. We saw examples of poor and inaccurate record-keeping during our inspection. Observation records had been completed on one individual but we were not assured that these checks had been done. Water temperature checks had been completed in advance for the weekend following the inspection and rotas did not always accurately reflect who was on duty.

People and their relatives told us that the staff were caring. On the days of our visits, people looked well cared for. Most staff spoke respectfully to people who used the service although we did see incidences where care workers were dismissive and disrespectful to people.

Staff did not have regular supervision or an annual appraisal with line managers. There were regular meetings with residents and relatives which were minuted. Relatives raised any issues they had with the service at these forums.

People liked the food that was offered at the home and we saw that meals were homemade from good quality ingredients. The service had a document in place that detailed people’s dietary requirements but this was not visible in the kitchen. The registered manager assured us that this document would be made available to agency cooks covering the service at the weekend and would be updated to reflect any changes in people’s diets.

Relatives told us they felt people were generally safe at the home. Staff could explain the different forms of abuse people may be vulnerable to and said they would report any concerns to one of the managers. None of the people or their relatives said they had ever made a complaint but any informal concerns raised had been addressed by the service.

We saw that Deprivation of Liberty Safeguards applications had been made for the people that needed them. We saw people had access to a range of healthcare services, including GPs, district nurses and chiropodists which meant that people’s holistic health care needs were being met.

Staff demonstrated they knew people’s personal histories, their preferences, likes and dislikes, although we noted that care workers did not access care plans. The service was involved in the Six Steps to Success in End of Life programme, aimed to enhance end of life care through supporting staff to develop their roles around end of life care and had informed relatives about this.

There was an activities coordinator who was relatively new in this post. We saw evidence of some activities that were person centred, as the co-ordinator spent one to one time with individuals. They had ideas about future activities to promote the wellbeing of people who lived in the home.

There were no restrictions on visitors to the home and some relatives were more involved then others in their family member’s care. A core group of relatives were actively involved in the home and attended regular relative meetings to air their views about the service.

We saw that some bedrooms were single rooms and some were shared bedrooms staff told us that there were 6 shared bedrooms. There were privacy screens evident in the shared bedrooms. Staff told us that 11 bedrooms had ensuite toilets and sinks. All the bedrooms were light bright and airy.

We saw that people who used the service were given options at meal times, we were shown a two week menu for people. The home provided soft or pureed diet if it was required. The manager told us that visitors to the home were offered food and drink at meal times if they were there.

We received complementary feedback from relatives. One person told us they cannot fault the place for care. The girls are so loving, nothing is too much trouble and X is fabulous. Another relative told us they were made 'very welcome as a visitor and they made the right choice bringing their relative here'. One relative told us 'staff are always respectful and courteous'.

We looked at evidence of previous safeguarding concerns raised within the home and saw that the correct procedures had been followed in each case. The manager showed us evidence that demonstrated that all safeguarding issues were taken very seriously and that every effort was made to learn lessons from incidents and improve processes where issues had been identified.

The people we spoke with told us they were happy with the care their relatives received. They told us the staff were friendly, helpful and courteous and that their relatives were very well looked after. They also told us they had no concerns with their medication and that medicines were given on time.

The people we spoke with told us they felt there were enough staff around when they needed them. They told us the staff were very polite and helpful and treated their relatives with respect and dignity. They also told us that they had no concerns about the care received by their relatives and that they would speak to the Registered Manager if they had any concerns.