This inspection was unannounced and took place on 11 and 12 July 2017.This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Sherford Manor Care Home specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. Because of the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 50 people living at the home.
Sherford Manor Care Home consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care. People were living with dementia which meant some people were unable to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff to help form our judgements. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at seven care plans and spoke to 14 people and three visitors. We also spoke to 15 members of staff. The new manager and a peripatetic manager were available throughout the inspection. The nominated individual and provider's regional manager were available on the second day of the inspection.
We carried out a comprehensive inspection of this service on 7 and 8 December 2016. Breaches of legal requirements were found as people were not protected from receiving unsafe care and treatment and were not protected from avoidable harm. People did not receive care and treatment which met their individual needs and preferences and the service failed to ensure people were provided with opportunities to make choices in their day to day lives. There were ineffective quality assurance systems in place to make sure any areas for improvement were identified and addressed.
After the comprehensive inspection, we used our enforcement powers and served three Warning Notices on the provider on 22 December 2016. These are formal notices which confirmed the provider had to meet the legal requirement in respect of safe care and treatment and person centred care by 30 January 2017. They had to meet the legal requirement in respect of effective quality assurance systems/good governance by 20 June 2017.
We undertook a focused inspection in February 2017 to check the provider had taken action to meet the legal requirements relating to the two warning notices we issued for safe care and treatment and person centred care. Although we found some improvements had been made the provider still failed to fully meet the requirement of the warning notice to become compliant by 30 January 2017. This meant the legal requirements had not been fully met; the provider had therefore not fully complied with our Warning Notices.
Following our last inspection in December 2016 we placed the service in special measures because the overall rating for the service was inadequate. Following the focused inspection in February we did not change the rating for the service because some parts of the warning notices were not met and because further time was needed to demonstrate the improvements made could be sustained.
At this inspection we found the issues in the three Warning Notices had been met; the provider has therefore fully complied with our Warning Notices.
There was no registered manager in post, however a new manager had been employed and was in the process of submitting their application to register with CQC. 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 new manager was supported by a peripatetic manager, the organisations regional operations manager and the nominated individual. A nominated individual is a requirement of our (The Care Quality Commission's) registration process where a provider is represented by an appropriate person nominated by the organisation to carry out this role on their behalf. The nominated individual is responsible for supervising the management of the regulated activity provided.
People told us they felt safe living in the home and with the care and support provided. Staff had all attended training in recognising abuse and they all felt they could talk with the management team if they had any concerns.
People were further protected from the risk of harm by the provider’s robust recruitment procedures. All prospective staff underwent checks to check their suitability to work with vulnerable people.
At the last inspection the people in the home were supported by a high number of agency staff. At this inspection we found a recruitment programme had been in place and there were sufficient staff to support the people in the home. The new manager explained that they had employed a new unit manager two registered nurses and care workers. They also had two activities co-ordinators two handy men and a new chef in the kitchen. When agency staff were used they managed to use the same staff maintaining continuity of care for people in the home.
All staff including ancillary and maintenance staff had received training in dementia awareness this meant people were supported by staff who understood their needs and could provide a homely inclusive atmosphere. Staff confirmed they had received training in areas relevant to their role and that the provision of training in the home had improved. One staff member said, “The training is really good now and we can ask for extra training and they listen.”
Two activities co-ordinators had been employed and were working with people to learn their life histories so staff had information to support meaningful conversations. One activities co-ordinator was creating meaningful memory boards with people to put outside their room. This meant it would be easier for them to recognise their room and provided staff with the information to strike up a conversation. We found people were engaged in activities meaningful to them and staff supported them in their chosen activity. For example one person was reading a book with a staff member whilst another person was helping the activity co-ordinator put together a memory board.
At our last inspection the home was in poor repair and people had been moved from the Rose Unit to an upper floor that was cramped and lacked space to walk freely. At this inspection we found improvements had been made and the Rose unit had been re-instated. The unit was bright airy and clean with people engaged in painting pictures to decorate the communal area. We saw other units in the home were all being refurbished and redecorated and the garden areas tidied. Visitors told us the general décor of the home had been improved and was more homely and welcoming.
Throughout the inspection we observed staff talk to people in a kind a caring way. They took time to sit and talk with people and help them engage in an activity of their choice. People on Redwood were supported to choose an activity and staff supported their choice to watch a film. People told us they felt respected and dignified interactions between staff and people were observed.
We found the mealtime experience for people had improved with people being supported to make an informed choice of the meal they wanted. A residents meeting had been held with the new chef and people had been supported to make suggestions about meals they would like. People said they would like traditional meals and more home-made snacks such as cakes. Consideration was being taken when preparing pureed meals and the pureed meal provided during the inspection appeared appetising.
We found care plans had been reviewed and re-written and they contained sufficient information for staff to meet the assessed needs of people living with dementia. Specific care plans for people with extra needs such as diabetes were very clear about the protocols in place to support that person safely.
At this inspection we saw the governance systems in place were being used to drive improvement. We saw audits were carried out by staff on the floor, then by the new manager and included weekly visits from the regional operations manager. An action plan was maintained and regular checks to assess and record progress against the action plan were in place. We saw improvements had been put into place following conversations with people living in the home, staff and relatives.
We discussed how the improvements and governance needed to be sustained over time and embedded in the day to day running of the home. Therefore we will continue to review the progress being made to ensure it is sustainable.