Sherwood Court

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'national lockdown - stay at home policy'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. Any authorised visitors were checked at the door of the home to make sure they were safe to enter. At inspection, the registered manager agreed to document these checks both as an aid to staff when receiving visitors and to ensure appropriate records were kept.

There was weekly testing of staff and every 28 days for people living in the home. Hand sanitiser and personal protective equipment (PPE) were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands, regular use of hand sanitisers and appropriate social distancing.

Where appropriate, ‘socially-distanced' visits had been taking place before the inspection. There was a visiting pod that had been created at the side of the home so that visitors did not have to enter the home itself. The facility incorporated appropriate protections for visitors and their loved ones. It was a high quality construction that could be used in all weather conditions. Visitors could register with the provider and use its web-site to arrange visits. This meant there was an absence of queuing and the gathering of people.

Infection control policy and people's risk assessments had been completed and revised during the pandemic. They were comprehensive, well documented and available to staff so that people were protected in the event of becoming unwell or in the event of a Covid 19 outbreak. The registered manager insisted people were tested before admission, consistent with local guidance. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by innovative use of social media and electronic tablets so people could contact their relatives and friends. Where required, staff supported people with this technology.

The home was clean and hygienic. Staff also had comprehensive knowledge of infection prevention, access to good practice guidance and had attended Covid 19 specialist training hosted by the provider. We noted this followed best practice and the latest guidance. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

If required, staff could receive Covid 19 related supervision and had access to appropriate support to manage their wellbeing. The registered manager had a good understanding and knowledge of the staff team. During inspection, we noted a caring approach to staff members' welfare at this challenging time.

The provider encouraged residents and staff appropriately around taking up the vaccines to Covid 19. This programme had been rolled out shortly before the inspection.

Further information is in the detailed findings below.

Sherwood court is a residential nursing home providing nursing and personal care for up to 68 older people and or people living with a dementia. At the time of the inspection 57 people were living at the service. The service was purpose built over two floors; split into two units. People had access to communal areas and bathrooms on both floors, all bedrooms were of single occupancy. The service was situated in a residential area of Preston, close to local amenities and public transport links.

People’s experience of using this service and what we found

Medicines were managed safely; staff had received the appropriate medicines training and competency checks. People told us they felt safe living at the service and investigations into allegations of abuse had been completed. Records confirmed the service shared lessons learned with the staff team. Staff had been recruited safely. We received mixed feedback about the staffing numbers in the service. The registered manager discussed their plans to introduce overlap shifts in the service. Staff had received training to support them in their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Consent to care and treatment had been recorded in people’s care files. People had access to relevant professionals to support their health needs where required.

People were supported with food and fluids. The registered manager took immediate action to amend a person’s nutritional record where an administration error was noted. The service had been developed to meet the needs of people. A large refurbishment was planned for early 2020.

People received good care; we observed staff offering timely and appropriate support to people. People told us they were supported to be independent and choices were offered to them.

Care files had been developed and some people we spoke with confirmed they had been involved in their development. A range of activities were available to people in the service. People’s individual and diverse needs were considered. Complaints were investigated and acted upon appropriately. Positive feedback about the service was seen.

We received positive feedback about the registered manager and the changes since she came to post. A range of audits were taking place and we saw senior management visited the service regularly. The service was open and transparent with the inspection and requests for information was provided promptly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 December 2018) where there was a breach of regulations in relation to recording of consent and the management of medicines. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

During the last inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regulations 18 staffing, 12 safe care and treatment for medicines management, risks and infection control, 15 premises and equipment, 10 dignity and respect and 17 good governance. We also made recommendations in relation to supervisions and appraisals, activities and recording.

Following our last inspection, we met with senior members of the management team including the nominated individual for the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found improvements had been made. However further improvements were required in relation to managing medicines and recording of consent in people’s care files. We also made recommendations in relation to individual risks assessments, mental capacity assessments and care planning.

Sherwood Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sherwood court is registered to provided accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 68 people in one purpose-built building over two floors. All bedrooms were of single occupancy and bathrooms and toilet facilities were available to people. There were communal lounges and dining facilities on both floors and people had access to outside space. The service was situated in a residential area of Preston close to public transport links and shops. There were 48 people on day one of the inspection and 49 people on day two of our inspection living in the service.

The service had a registered manager in post at the time of our inspection. 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 was run.

We saw evidence that servicing and checks of the environment and equipment were taking place which confirmed the home was safe and monitored. Fire risk assessments were seen along with essential fire checks. Individual risk assessments had been completed however not all care files had been updated to reflect people’s current risks.

Improvements had been noted in relation to the management of medicines however further improvements were still required. People received their medicines safely from staff.

Staff had completed relevant safeguarding training and there were polices and guidance available to guide them about how to deal with any allegations of abuse. Records we looked at included details of completed investigations and the actions taken as a result.

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. Capacity assessments and best interests decisions were recorded in most people’s care files. Where gaps were seen the registered manager gave us assurances that they would update these. Staff were observed asking people’s permission before undertaking any care or activity. However, we saw little evidence of formal consent being recorded in the care files we looked at.

People had access to a varied menu which included choices on offer to them. we received consistently good feedback that the food offered to people was of good quality and reflected their needs, likes and choices.

We saw people had access to activities. Records we looked at confirmed activities were being provided to people. People were treated with dignity and respect and their rights were protected. People were very positive about the care they received from the staff team. Information relating to advocacy services was available to support people with decisions.

Care plans had been developed that provided staff with up to date guidance about how to meet people’s needs. However, one care file we noted needed completing to reflect their current needs. The registered manager took immediate action to resolve this.

We received positive feedback about the registered manager and the improvements since she came to post. Relevant meetings were taking place which provided information about the home and enabled people’s views to be discussed.

Appropriate audits and monitoring was taking place that demonstrated the home was monitored and safe for people to live in. Records we looked at confirmed complaints were dealt with appropriately. Policies and guidance was available about how to raise a complaint.

The previous inspection took place on 22 June 2015, during which no breaches to the Regulations were identified, and the service was rated as good. This inspection took place on 22 and 25 August 2017. The first day of the inspection was unannounced. The second day was announced.

There was no registered manager in place. 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 previous registered manager had left the service in May 2017. Since then, a regional management team had been at the home, and an acting manager had been in position. However, on 18 August this regional management team had been replaced, and a new management team had been appointed to oversee the home. “’

Our observations and discussions found that people using the service did not always have enough staff available or suitably deployed to meet their assessed needs. Staff were found to very busy, and they felt that they could not always offer people the person centred care that they wanted to. Relatives had concerns that the staffing levels or deployment of staff was unsatisfactory. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our observations and discussions found that the measures in place relating to the safe handling of medicines, the prevention of risks and the prevention of the spread of infection and cleanliness within the home were not satisfactory. Some areas of the home was found to be unclean, risks around people's behaviour had not been properly assessed and measures put in place to reduce these risks had not been properly addressed. A registered nurse was seen to make a "minor" mistake whilst administering medicines, and as a result the inspector had to intervene to ensure correct procedures were followed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

One of the units within the home was specifically used as a dementia care unit, and we found that the environment and adaptations were unsatisfactory as they did not met the expectations of the current best practice and guidelines relating to dementia friendly environments. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We noted that on occasions, staff interactions with people living with dementia was minimal, and on one occasion, very undignified. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People using the service must be treated with respect and dignity at all times.

Our evidence gathering and observations found that there had been a lack of management oversight within the home overall in the last six months. This had led to some people being exposed to potentially avoidable risks, and that good governance issues such as effective infection control measures, risk assessment, record keeping, staff deployment and morale, audit and monitoring systems had not been routinely been addressed. As a result, the systems and processes that enabled the service provider identify and assess risks to the health and welfare people who use the service were not satisfactory. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff did not always receive support through effective supervision and appraisal. We recommended that this be given priority so that individual staff members could use the process to develop both personal and service led goals and objectives.

For some people living with dementia, their access to activities during the day was limited, and we recommended, that improvements were made to ensure that people's social and intellectual needs were met.

We reviewed recruitment practices and found that all staff had the required pre-employment checks including DBS and references. All files we looked at had the required information under schedule three of the Health and Social Care Act 2014.

Relatives we spoke with were happy with how their loved ones medicines were managed. We saw that controlled drugs were managed in line with the best practice guidelines and medicines were counted and checked as required.

Staff we spoke with told us they received a variety of training via different methods of learning such as classroom based, e-learning and by completing work booklets. We saw evidence within staff files of training certificates and reviewed the homes training matrix. However, we recommended that the service revisit the national guidance on catheter care, and considered how they could provide appropriate training to nurses in relation to catheter care, and other healthcare issues if needed, in order to ensure people's needs were effectively met.

The home was working within the principles of the Mental Capacity Act 2005. They had carried out appropriate assessment of people's capacity to determine if they could make specific decisions. Assessments were based on specifics and where necessary specific best interest decisions were made and recorded. People we spoke with told us they knew how to raise issues or make complaints. They also told us they fell confident that any issues raised would be listened to and addressed.

You can see what action we told the provider to take at the back of the full version of the report.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

We found family members were happy with the care of their relations

We saw the home was clean and hygienic with no odours. People who used the service and family members commented on the standards of cleanliness. One family member told us, “I was impressed how spotlessly clean it is. The staff are constantly busy cleaning and I was surprised how good it was and there was no smell of urine”.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

We found family members were happy with the care of their relations

We saw that there were no rules imposed on people.