Sherwood Lodge Independent Healthcare

Overall: Requires improvement read more about inspection ratings

29-31 Severn Road, Weston Super Mare, Somerset, BS23 1DW (01934) 631294

Provided and run by:
Garry and Jane Blake

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Background to this inspection

Updated 14 July 2023

Sherwood Lodge is an independent mental health hospital in Weston-Super-Mare that is dual registered as a nursing home, which provides community rehabilitative care and treatment of adults with mental health disorders, some of whom may be detained under the Mental Health Act 1983.

The service provides 24-hour residential care to both men and women and aims to provide a homely setting. The registration states the provider must only accommodate a maximum of 22 service users in receipt of the regulated activity of accommodation for persons requiring nursing or personal care, and those service users must be the only occupants of their rooms. At the time of the inspection there were 18 residents due to the majority of rooms now being single occupancy.

Sherwood Lodge has been registered with the Care Quality Commission since 1 October 2010 to carry out the following regulated activities:

  • Assessment of medical treatment for persons detained under the Mental Health Act 1983
  • Treatment of disease, disorder or injury
  • Accommodation for persons who require nursing or personal care.

There was a registered manager in post at the time of the inspection.

What people who use the service say

Most residents we spoke with said that the service was good, that they were content, and that the food was nice. Some residents told us they hated it at the service and wanted to leave.

Residents told us that staff were nice and kind, but some wished they would speak to them more often. One resident told us it was boring to live at the service.

Overall inspection

Requires improvement

Updated 14 July 2023

At the previous inspection in May 2022, Sherwood Lodge was rated inadequate overall and placed in special measures. This comprehensive inspection was conducted to check that the improvements the service had detailed in their action plan to the commission had been undertaken. The inspection was unannounced and covered all key lines of enquiry.

Our rating of this service ​improved​ from inadequate to ​requires improvement​ and the special measures were lifted because:

  • The environment had been improved since the previous inspection. The service had almost completed works on bedrooms, such as removing partition walls, and residents had been moved into single-sex bedroom corridors to ensure privacy and dignity.
  • Staff were now completing comprehensive, and individualised assessments of people’s needs and all residents had a completed and up to date personal emergency evacuation plan. Risk management plans were up to date and included appropriate details relating to people’s risk. Staff knew about resident’s known risks and how to act to prevent or reduce risks.
  • All staff we spoke to understood how to recognise and report potential abuse and the service worked with other relevant agencies to protect residents from abuse. All staff had completed safeguarding training. The service was now submitting relevant notifications to external organisations, including the local authority and the Care Quality Commission, in a timely manner. This was an improvement from the previous inspection.
  • Staff were reporting all incidents and managers investigated, identified learning and shared with the team. This was an improvement from the previous inspection.
  • All staff were now completing care records that were up to date and easily accessible to all members of staff. Residents were encouraged to be involved in their care planning. Residents had regular access from a wider multidisciplinary team and this was now documented within care records. Residents and their loved ones were invited to take part in reviews. Verbal and written interactions with residents were respectful, supportive and person centred. This was an improvement since the last inspection.

However:

  • Governance processes still required further improvement. Systems in place to assess, monitor and improve the quality and safety of the service were not always effective. There was a limited audit schedule, some audits were completed adhoc or hadn’t been regularly repeated, such as the weekly management of medicines audit did not include a check of all medical sundries and first aid supplies and a closed culture audit did not include all necessary questions.
  • Staff provided a limited range of care and treatment suitable for the residents in the service and care plans were not mental health recovery orientated and did not reflect personalised goals. Management had reviewed National Institute for Health Care and Excellence (NICE) guidance and identified which guidance was relevant to the service however this has not been addressed in a model of care for the service. The service provided activities, but they were not meaningful. Three out of the four relatives we spoke to said that the service wasn’t “very lively” and “everyone just sits all day in the lounge”.
  • At the time of inspection, staff did not have access to policies which may have aided the running of the service and the manager was unable to provide assurances that staff had appropriate employment checks in place, such as valid disclosure and barring service certificates. This was because essential documentation and confidential staff files had been removed from the service to the provider’s home address. However, we returned at a later date to review staff files and found employment checks in place
  • There were still several blanket restrictions in place but had no policy to ensure restrictions were proportionate, necessary, and least restrictive in line with the Mental Health Act Code of Practice. The blanket restrictions poster did not detail all restrictions in place and restrictions were not discussed as part of community meetings to ensure residents were aware of them. This included limited access to bedrooms, which some residents did not have their own keys for and could only access with staff support.
  • Not all staff had received regular supervision or completed mandatory training.
  • Some communal areas required further improvement and two bedrooms remained with a partition wall. There was still limited room and facilities to support therapeutic activities, for example a private area to meet with keyworker one to one. . Outside space had limited green space but had raised flower beds. Relatives we spoke with commented on the environment, stating it was run-down, grubby and required a freshen-up.