Archived: Sheldon House Care Home

Sheldon House is a care home without nursing for up to 30 people. On the day of our inspection there were 25 people living at the service. It specialises in care for older people who are living with dementia or who experience other enduring mental illness.

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.

There was not 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. The provider was in the process of interviewing for a new manager who would register with the Commission.

At the last inspection on 27 June 2017, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

We received information of concern prior to our visit. This included care plans and risk assessments not being updated, incident forms not completed, poor leadership, care staff not being able to access information about people and GP’s not being contacted about people’s health concerns.

However, at this inspection we found these concerns unsubstantiated.

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views, so staff used other methods of communication, for example pictures. Others could tell us about the care and support they received. Due to people’s needs we spent time observing people with the staff supporting them.

People remained safe at Sheldon House. People who were able to told us they felt safe living there. One person said; “Yes I do (feel safe), I have never felt so relaxed as being here. I was alone before.” A relative said; “Yes, I do. I think it’s the best one she’s (their relative) been in, she’s been in lots of homes. She’s more like herself now.”

People received their medicines safely by staff that had received regular updated training. People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient number of staff to help keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive care from a staff team that had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company. One staff member said; “I love the atmosphere here and staff morale is good.”

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 wishes for their end of life were clearly documented. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with kindness and compassion by the staff who valued them. The staff, some who had worked at the service for a number of years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. People, relatives and staff said the providers were approachable.

People lived in a service which had been designed and adapted to meet their needs. The provider monitored the service to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service. The provider listened to feedback and reflected on how the service could be further improved. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

This unannounced comprehensive inspection took place on 27 June 2017. The last focused inspection took place on 26 October 2016. The service was meeting the requirements of the regulations at that time.

Sheldon House notified the Care Quality Commission that they would no longer be providing nursing care from the end of September 2016. Sheldon House now provides residential care and offers care and support for up to 34 predominantly older people. At the time of the inspection there were 26 people living at the service. Some of these people were living with dementia. The service uses a detached house over three floors and there is a passenger lift to assist people to the upper floors.

The service is required to have 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. The service had a registered manager in post.

The service had clear pictorial signage to meet the needs of people living with dementia. People’s bedroom doors had a picture on them of something that was important to them. This helped people to recognise their rooms and orientate themselves around the building. Sheldon house had recently purchased new furniture for the lounge areas. The service was well maintained and clean. There were no incontinence odours at the service. Renovation work and re-decoration was in process during this inspection visit. People’s bedrooms were well decorated and personalised to give them a familiar feel.

We reviewed the systems for the management and administration of medicines. The service had moved their medicines management on to an electronic system. Staff used laptops to record all medicine administration. People received their medicine as prescribed. Regular medicines audits were consistently identifying if any errors occurred. We found a few liquids and creams which had not been dated when opened. Most had been labelled with the date the item was opened and when it should be disposed of. However, some items were found that had recently expired and had not been disposed of. The registered manager assured us this had happened since the last monthly audit and staff would be reminded to monitor disposal dates of liquids and creams each time they used the items.

People were treated with kindness, compassion and respect. Staff showed affection for the people their cared for. People were relaxed and happy and moved around the service freely as they chose.

Staff were supported by a system of induction training, supervision and appraisals. Staff felt well supported by the registered manager who saw all staff regularly for a one to one meeting. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided, such as end of life care training. The training needs of all staff were well monitored by the registered manager and updates were provided in a timely manner. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. Any accidents and incidents were recorded and audited to help ensure the risk of re-occurrence was reduced.

People's rights were mostly protected because staff acted in accordance with the Mental Capacity Act 2005. Some consent forms were signed by the person themselves. Where a person was unable to do this, the consent was not always signed by a person with the legal power to sign on behalf of another, such as a lasting power of attorney for care and welfare. The registered manager assured us this would be addressed immediately. The service was planning to contact all families to find out who held such legal powers. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. 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 were provided with choices and their wishes were respected.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained accurate and up to date information. People appeared to be well cared for. Care planning was reviewed regularly and people’s changing needs recorded. However, there was no evidence that people, or if appropriate their families, were involved in their care plan reviews.

People had access to a programme of varied activities. An activity co-ordinator arranged regular events for people. These included singing, crafts and visits to the local area. A further member of staff was due to start in the coming weeks, to provide additional activities and one to one support for people who remained in their rooms.

The registered manager was supported by two heads of care, senior carers and a team of motivated and committed staff. Staff told us they were happy working at the service and worked well together. There was an efficient administration team who also supported the registered manager with the day to day running of the service.

Medicines management was not robust. Medicine audits were not regularly carried out. Risks had been clearly identified and assessed in people’s care plans. However, there was little guidance for staff on how to support people appropriately in order to minimise risk and keep people safe.

Cleaning schedules for the kitchen were not made available to the inspectors. Activities were not always planned or chosen to meet people’s specific interests. People’s private care records were not stored securely and were easily available to visiting members of the public.

The service was not providing staff with supervision in accordance with the schedule set out in their own policy. Staff training was not up to date.

The concerns found at this inspection had not been identified by the service. This meant there was not an effective system in place for regularly assessing and monitoring of the quality and safety of the service provided.

After this inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook this focused inspection on the 26 October 2016 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sheldon House on our website at www.cqc.org.uk

Sheldon House no longer provides nursing care for people. Some people with complex nursing needs have moved from Sheldon House to another service. People who continue to live at Sheldon House and have some nursing needs are now supported by visiting district nurses. The service now provides residential care for up to 34 older people, some of which are living with dementia. At the time of this focused inspection on 26 October 2016 there were 22 people living at the service.

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.

At this focused inspection we found improvements had been made to all the areas of concern found at the last inspection. Care plans had been put in to a new format which made it easier for staff to find the most current information. Care plans were reviewed regularly and took account of any changes that had occurred to people’s care and support needs. Risks had been identified, assessed and were monitored to ensure any changes were recorded. Risk assessments were regularly reviewed.

Care workers were motivated to provide a good standard of care and support to people living at Sheldon House. A new pictorial menu had been designed to support people with making meal choices. A new monitoring form had been designed to make the recording of people’s food and drink intake more efficient. Where it was necessary, people’s food and drink intake was monitored and recorded. People were weighed regularly. If it was identified that a person was losing weight, advice was sought, action was taken and recorded to address the concern. Some people required to be re-positioned regularly to help reduce the risk of pressure damage to their skin. We saw care staff were regularly recording when this care was provided. Pressure mattresses were regularly checked to ensure they were effectively set to corresponded to the person’s weight.

The district nurses visited daily to support people’s nursing needs and provide guidance for the care workers. The service was also working closely with dementia liaison nurses, social workers and GP’s in providing good care to people. We observed during this inspection visit that the staff and registered manager communicated regularly and effectively with external healthcare professionals.

The medicine administration records (MAR) were completed each time a person was given their prescribed medicines. There were no gaps in these records. All handwritten entries on to the MAR had been signed and witnessed by two staff to help reduce the risk of errors. Prescribed creams had all been dated upon opening. However, care staff were not always recording, on the medicine records for creams, when they applied such creams. Care staff were recording this in the daily record. This meant it was not easy to establish if creams had been applied. The registered manager assured us this would be discussed at a staff meeting to establish a clear process for this recording.

Care staff used safe and appropriate methods of assisting people to move and transfer from chairs and wheelchairs. There were increased activities provided at this inspection visit. Two activity co-ordinators worked hard to provide meaningful activities often on a one to one basis. There was a planned programme of relevant activities that people enjoyed. Some people were supported to take walks outside if they wished.

Staff were supported by induction, training, supervision and appraisals. Staff meetings had been held for all staff groups.

Cleaning schedules were regularly carried out each week with regular deep cleaning programmes being carried out monthly. The cooks were knowledgeable about people’s dietary requirements. Pureed meals were presented as separate food items on a plate, the colours of which were clearly recognisable which made it an attractive plate of food. People were provided with a pictorial menu to support them to make meal choices. People were positive about the food provided at the service.

Residents and family meetings were held to seek their views and experiences of the service provided. New furniture and floor coverings were planned for the service. The maintenance of the service was managed by the provider with an on-going programme of refurbishment.

At this focused inspection we found the registered provider had met the requirements of the regulations. However, we could not improve the rating for Safe, Effective, Responsive and Well led from Requires Improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This unannounced comprehensive inspection took place on 16 June 2016. The last inspection took place on 7 August 2015. The service was meeting the requirements of the regulations at that time. Prior to this inspection, we had been told by the service about a person who lived at Sheldon House who had experienced poor outcomes having spent some time in bed whilst unwell. This person had sustained pressure damage to their skin. The service had contacted the local safeguarding unit about this concern. We brought forward our planned inspection of this service as a result of this concern.

Sheldon House is a care home which offers care and support for up to 34 predominantly older people. At the time of the inspection there were 29 people living at the service. Some of these people were living with dementia. The service is situated in a detached house over three floors, with a passenger lift to assist people to reach the upper floors.

The service did not have 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. The acting manager told us they were considering applying to become the registered manager but an application had not been made at the time of this inspection.

At this inspection we found two people had lost weight. Staff were recording people's intake and output and the records showed this had reduced recently. Assessments were being carried out of people's skin condition. Pressure mattresses were being used to provide support and protection against skin damage. However, some mattresses were incorrectly set and the settings were not being monitored regularly.

We checked the medicine administration records (MAR) we found that some people had not received their medicines as prescribed. There were gaps in the MAR where prescribed medicines had been omitted. For example, on the 1 and 2 June 2016 doses of a prescribed medicine were not given with no reason given on the MAR. No reasons were recorded for these omissions. We found handwritten entries on to the MAR, following advice from healthcare professionals. These entries were not always signed and witnessed to help reduce the risk of errors.

Guidance for staff on the ‘shelf life’ of creams and liquids once opened was displayed in the nurses room. It clearly stated opened creams and liquids should be used within three months. However, we found prescribed creams and liquids were not always dated upon opening. This meant staff would not know when the item had become unsafe to continue to use. We found creams that had gone beyond their safe to use by date in peoples rooms. Medicine audits were not being regularly carried out. The nursing staff were not following their own guidance.

Risks had been clearly identified and assessed in people’s care plans. However, there was little guidance for staff on how to support people appropriately in order to minimise risk and keep people safe.

We saw staff repeatedly assisting people to stand by lifting them under their arms. We saw handling belts being used to physically lift people to a standing position. This is not in accordance with best practice guidance.

We found a dirty black mop in use in the kitchen. We were told such equipment was changed weekly. This mop had not been changed for a long time. Cleaning schedules were not made available to the inspectors. The acting manager told us they were aware of some of the concerns we identified but effective action had not been taken to address them. This meant there was a potential infection risk in the kitchen.

Care plans held a large amount of information, some of which was historical. This meant staff could not easily find the most accurate and up to date information. Care planning was not always reviewed in a timely manner to take account of people’s changing needs. Where appropriate, relatives were included in any care plan reviews.

Files containing peoples' confidential information were found in a corridor on a table outside a person’s room and on a table in the main lounge area. This meant people’s private care records were not stored securely and were easily available to visiting members of the public.

There was no clear process of auditing the medicines administration process, the pressure relieving mattress settings, and the monitoring charts being completed by staff. The concerns found at this inspection had not been identified by the service. This meant there was not an effective system in place for regularly assessing and monitoring of the quality and safety of the service provided.

The service had experienced a shortage of nurses and care staff. Agency staff had been used extensively over recent months. Two new nurses were due to join the service in the near future. The service had identified the minimum numbers of staff required to meet people’s needs and the rota showed there were mostly sufficient staff on duty.

Activities were provided. Activities were not always planned or chosen to meet people’s specific interests. Staff had created "busy bags" designed to hold specific items of interest and enjoyment for individuals. These items could be used to prompt conversations and activity. However, staff told us these bags were rarely used.

Staff were supported by a system of induction training, supervision and appraisals. However, the service was not providing staff with supervision in accordance with the schedule set out in their own policy. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. However, these records were not always regularly monitored by nursing staff.

The service was well maintained. The owners carried out regular repairs and maintenance work to the premises. The boiler, electrics, gas appliances and water supply had been tested to ensure they were safe to use. There were records that showed manual handling equipment had been serviced. Fire alarms and evacuation procedures were checked by staff, the fire authority and external contractors, to ensure they worked. There was a record of regular fire drills.

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

The care plans had been reviewed and updated. We saw the emotional and physical needs of the people who lived at Sheldon House Nursing Home were clearly documented.

People had access to a range of services including hairdresser, chiropodist and GP'S.

Medication was dispensed and administered in a safe manner. The home had an adequate system for the storage and ordering of medication.

Work had been carried out to replace some of the windows and carpets in the property. We saw that redecoration had been completed in areas.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

People's privacy and dignity were respected and maintained.

Staff had gained information regarding the life history, likes and dislikes of the people that lived at Sheldon nursing home.

Care plans did not inform or direct staff to provide care that reflected the people's individual physical needs.

The home had an effective system in place to ensure people who lived in the home were protected against abuse.

The system used to provide people's medication was not working safely.

The premises had not been well maintained and in some areas of the home it was cold.

Staff were supported and trained to provide care.