The inspection took place on 04 December 2014 and it was unannounced, which meant that the provider did not know that we were coming.
Shaws Wood Residential Care Home offers accommodation and long term care and support to up to 36 older people. Some people were living with dementia, some had mobility difficulties, sensory impairments and some received their care in bed. Accommodation is arranged over two floors. There is a passenger lift for access between floors. There were 30 people living at the home on the day of our inspection.
The registered manager left the home in July 2014. The head of operations and strategic development as the provider’s representative explained that the new manager was in the process of making their application to become 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.
We last inspected Shaws Wood Residential Care Home on 01 May 2014 where we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took enforcement action against the provider. We asked the provider to take action to make improvements in the consent to care and welfare, care and welfare of people who use services, meeting nutritional needs, safeguarding people who use the service from abuse, management of medicines, safety and security of premises, supporting workers, assessing and monitoring the quality of service provision and records.
During our inspection on 04 December 2014, we checked to see whether improvements have been made to meet the relevant requirements. We found that significant improvements had been made. Not all of these had been embedded into the practices within the home, there were further improvements to make and we identified one area where there was a further breach.
Staff had received training relevant to their roles. A new system was in place to make sure staff were supervised, but this had not yet been embedded but staff felt they received good support.
A thorough audit of the home had not been carried out. The mock inspection toolkit within the provider’s quality assurance tools had not been used. Therefore there was no record to demonstrate that the quality of care, records, environment, health and safety had been monitored and reviewed. Suitable arrangements were not in place to ensure quality assurance systems are effective, and used to drive continuous improvement. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Staff knew and understood had to protect people from abuse and harm and keep them as safe as possible. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.
People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity. Guidance about any action staff needed to take to make sure people were protected from harm was included in the risk assessments. Each person had a personal emergency evacuation plans (PEEPs) in place. Each PEEP provided information to staff about the level of assistance people would need in the event of an emergency at the home and provided guidance on how to safely evacuate the home.
The home had undergone a number of repairs and alterations. For example, corridors had been decorated and they were colour coded, the skirting boards were painted with contrasting paint to assist people with visual impairments. A new sensory garden had been developed; this area had been planted up with flowers, herbs and strawberry plants. The garden was secure and well kept.
People told us that they did not have to wait for their care needs to be met. For example, call bells were answered promptly. One person said, “I have my own carer at night, she comes quickly when I press this”.
There were enough staff on duty to meet people’s needs. Staffing numbers had been regularly monitored and amended to meet people’s assessed and changing needs.
Medicines were stored, administered and disposed of safely.
Staff had undertaken training relevant to their roles and said that they received good levels of hands on support from the management team. Some people had sensory impairments; however we noticed that staff had not received sensory training. This meant that staff may not have had training and guidance to enable them to provide care and support to people who had sensory loss.
We recommend that training is provided to ensure that staff have the knowledge and understanding to meet people’s sensory needs.
There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005and Deprivation of Liberty Safeguards (DoLS).
People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for. The chef had a good understanding of how to fortify foods with extra calories for people at risk of malnutrition. Menus were available as large text and pictures which helped people understand these and make choices.
People received medical assistance from healthcare professionals when they needed it. A district nurse told us that the staff had been responsive and approachable; they had listened to advice and had been proactive in referring people to special teams such as the Community Mental Health Team.
People were able to find their way around the home independently. Bathrooms, shower rooms and toilets had symbols on the doors to help people identify where they were.
People told us they found the staff caring, and that said they like living at Shaws Wood. One person told us that it was the “Next best thing to home”. Relatives gave us positive feedback, which included “Staff are kind and respectful” to their family member. Staff were kind, caring and patient in their approach and had a good rapport with people. Staff supported people in a calm and relaxed manner.
People had been involved in planning their own care. All the records we viewed had consent to care and treatment forms that had been signed by the person or their relative. Relatives told us that they were involved with reviewing their family members care on a monthly basis.
Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect, for example staff made sure that doors were closed when personal care was given.
People and their relatives and visitors had access to a number of shared areas which meant that they could spend private time together. People’s information was treated confidentially. Personal records were stored securely.
The home worked with a local hospice to ensure that people who were at the end of their life were supported to receive appropriate medicines and support. This included support to discuss their funeral wishes.
People told us that the home was responsive and when they asked for something this was provided.
Care plans included information on; personal care needs medicines, leisure activities, nutritional needs, as well as people's preferences in regards to their care. Some people’s risk assessments lacked detail.
People were engaged with activities when they wanted to be. The activities plan for the home showed that activities took place every day of the week. This included two activities per week led by outside organisations including a local church. Two people mentioned the church services, with one saying, “It’s very important. The one that comes is the church I used to go to, and they visit me”. Another said, “It’s like I go to church”.
The complaints policy was displayed on the wall of the home. The policy was dated September 2014 and detailed the arrangements for raising complaints, responding to complaints and the expected timescales for a response.
A ‘Family and friends survey’ had been completed in September 2014 with generally positive results which were displayed for people to see. Relatives told us that they were kept well informed by the home and they were able to attend regular relatives meetings.
People told us they were happy with the changes the provider had made to the home. People said, “What we suggest, they do” and “I love the new colours; I’m really pleased with it all”.
Staff were well supported by the management team. They told us that communication had improved and staff meetings had taken place. Staff were confident that the management team and provider would deal with any concerns relating to bad practice or safeguarding issues appropriately. The provider and management team were visible throughout the home. Staff told us that they felt confident to contact the management team during evenings and weekends and were confident that they would gain support.
The registered manager left Shaws Wood in July 2014. A new manager was appointed. The new manager was on planned leave when we visited the home. The manager had started their application to CQC to become a registered manager, but this had not been completed.
The Provider had acted on advice given by Kent Fire and Rescue Service (KFRS) in May 2014. They had worked hard to achieve compliance. KFRS revisited the home on 20 October 2014 and advised them that they now met The Regulatory Reform (Fire Safety) Order 2005.
You can see what action we told the provider to take at the back of the full version of this report.