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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
Sherrington House Nursing Home provides accommodation and nursing care for up to 39 people accommodated over three floors. This includes care of people with learning disabilities or physical health needs. On the day of the inspection 34 people were living in the home.
Comprehensive Inspection 9 July 2014
A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’
The experiences of people who lived at the home were positive overall. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. People remarked that the food was particularly good.
However, we found systems and processes to keep people safe required improvement. The home did not have suitable quantities of staff with the required skills and experience. Vacant posts needed to be recruited to, to ensure consistent staffing numbers were maintained. This meant people may experience inconsistent levels of care and support. We found that there was a high turnover of staff and people reported to us that new staff did not always have the skills and experiences to care for them safely. This is a breach of Regulation 22, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Recruitment processes required improvement to ensure all the required background checks on new staff members were consistently applied. For example, staff who had recently been employed at the home did always have references from their last employer. The lack of robust recruitment procedures risked that people were being cared for by unsuitable staff. This is a breach of Regulation 21, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Medicines were not managed safely, as we found examples where people had not received their medication which could have resulted in unnecessary discomfort. This is a breach of Regulation 13, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
The home met people’s nutritional needs and people reported that they had a good choice of food. Links with healthcare professionals was good and they all stated that the home followed their advice and delivered appropriate care.
The management of care records required improvement. We found there were two formats of care records in use at the home and the information contained in them was not consistent. This meant people may be put at risk, as staff may not have the most up-to-date information on people’s care. This is a breach of Regulation 9, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
People and staff spoke positively about the new manager at the home and told us they listened and acted on comments and concerns.
Quality assurance processes required improvement; the issues we found had not been identified by the provider’s own monitoring and audit processes. This is a breach of Regulation 10, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found two notifications which should have been submitted to the Care Quality Commission (CQC) had not been. This is a breach of Regulation 18 Health and Social Care Act 2008 (Registration Regulations) 2010. We spoke with the manager about this and warned them we would take further action if future notifiable incidents were not reported to CQC.
Focused inspection 20 January 2015
Following the previous inspection , the registered manager had left. A new manager had been recruited and was in the process of applying for the registered managers post.
After our inspection of 9 July 2014 the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. We undertook this unannounced focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to; care and welfare of people who use services, management of medicines, requirements relating to workers, staffing and assessing and monitoring the quality of service provision.
We found the provider had made some improvements in relation to the management of medicines. Protocols had been introduced to assist staff in the administration of “as required” medicines. However, although the recording of medicines had improved we still found some gaps in medication records, and some medicine stock levels did not concur with amounts recorded on documentation. This meant there was a lack of accountability for some medicines.
We found some improvements had been made to staff skill and knowledge and more consistency to staffing levels during the daytime. However we had concerns that staffing levels were not always maintained during the night and documentation was unable to provide evidence that night-time staffing levels were consistently maintained.
We found the service was meeting people’s care needs and people told us they were well cared for. Care records were being transferred to a computerised system and the process was nearly complete. However, we found there were some shortfalls in the care records which created a risk of people receiving care that was unsafe or inappropriate.
Although the manager had plans to implement a robust quality assurance system we found audits in areas such as medication, staffing levels/dependency, infection control, care quality and care records were not yet taking place which meant risks in these areas were not always being routinely identified and rectified.
We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we asked the provider to take at the end of the report