Sharston House Nursing Home

Sharston House is a detached two storey Victorian property situated one mile from the centre of Knutsford. A large extension has been added to the existing premises to bring the total number of bedrooms to 48. The service had six beds called, 'Intermediate care' beds. They were operated with local commissioners to help people receive clinical support following a period of illness and admission in hospital. On the day of the inspection 48 people were living at the service. There is a car park at the front of the building. Assisted bathing facilities are provided on all floors. Staff are on duty twenty-four hours a day to provide nursing care and support for the people who live at the service.

We found the following examples of good practice.

The home had comprehensive policies and procedures to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and any visitors to use. Hand sanitiser was readily available throughout the service. Staff had received updated training on the use of PPE and we observed staff wearing it correctly during out inspection. Clear signage and information was in place throughout the home to remind staff of their responsibilities.

Contingency plans were in place in the event that the staffing was affected by COVID-19, including arrangements for block booking agency staff to maintain consistency of personnel.

Zoning was in place and the home was split into four distinct areas to minimise risk of spreading infection. Staff members assessed as vulnerable were not required to work in areas where residents who had tested positive for COVID-19 were living.

Separate entrances to the building were used by staff and visitors.

People’s experience of using this service: People who lived at Sharston House were happy about the service being delivered to them and liked living at the service. They shared lots of positive comments about their care, meals and menus provided and activities on offer. People were able to participate in a range of interactive and meaningful activities.

The registered manager and staff were very welcoming and caring about people who lived in Sharston House. There was a friendly and welcoming atmosphere at the service.

Safe care and treatment was consistently provided. People told us that they were happy at the service and they felt safe and secure. People's level of risk was regularly reviewed to keep people safe and comfortable. People’s medications were safely managed.

Staff were supported with training in relation to safeguarding and knew how to report any concerns.

People received support from consistent members of staff who were familiar with their support needs. Staff received training to help develop their skills and knowledge about the people they supported.

Staff understood and respected people's right to make their own decisions and supported people to make choices. People were involved in the decisions that needed to be made and consent was gained in line with the principles of the Mental Capacity Act, 2005.

People's privacy, dignity and independence was promoted. We received positive comments about the quality and range of social activities provided to everyone.

The service had an accessible complaints policy available to everyone. The manager used her reporting tools to reflect and learn from complaints and feedback. Several ways to gather feedback from people was provided by regular ‘resident and relative meetings’ and questionnaires to gather people’s views.

We recommend the service research local advocacy and mediation services to help them with any issues needing support to represent people living at the service.

Rating at last inspection: Good; (The last report was published in December 2017)

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

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

Sharston House Nursing home offers nursing and personal care and accommodation for older people. The service is currently registered for a maximum of 48 people. At the time of the inspection 42 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our previous inspection in March 2016 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014(the Regulations). These breaches related to recruitment processes, staffing levels, management of medicines, quality assurance and auditing systems, staff supervision and appraisal, treating people with dignity and respect, and meeting people's social needs.

At this inspection we found that significant improvements had been made and most of these matters had been addressed. There was only one breach of the Regulations which related to quality assurance and auditing systems. Audits of care plans and infection control audits had not identified that there was conflicting information in some care plans and that there was a shortage of hands free waste bins and damaged tiled surfaces in some toilets that would make them difficult to clean. You can see what action we told the registered provider to take at the back of the full version of the report.

The interior of the home was comfortable and homely, with people being encouraged to bring their own items and belongings to personalise their rooms.

The registered manager was very welcoming and evidently caring about people who lived in Sharston House. There was a friendly and welcoming atmosphere at the home and people told us that they were happy there and they felt safe and secure.

People were safeguarded from the risk of abuse. Staff knew how to recognise the signs of abuse and how to report concerns.

There were sufficient staff deployed to meet people's needs. Staff had received training, supervision and appraisals and staff meetings were held. Robust recruitment procedures were in place.

Staff sought and obtained people's consent before they provided care or treatment. Staff were aware of the additional requirements of the Mental Capacity Act should they be caring for a person who lacked capacity to make their own decisions.

People said that staff were very caring and kind.

Medicines were stored and administered safely. Staff giving medicines to people had received appropriate training and supervision to support them to do this. Monthly audits of the medicines were carried out.

People knew how to raise a complaint and their views were listened to and responded to in a timely manner, with positive outcomes.

Feedback provided by people was listened to and positive changes to the service were made as a result.

People were able to participate in a range of interactive and stimulating activities.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of food and drink.

The service was previously inspected in November 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Sharston House Nursing Home provides personal care and accommodation for up to 48 people with nursing, residential and respite needs, and also offers dementia, convalescence and palliative care.

Sharston House Nursing Home is a detached two storey Victorian property situated one mile from the centre of Knutsford. The home has recently benefited from an extension to bring the total number of bedrooms to 48.

Forty-four people were being accommodated at Sharston House Nursing Home 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 is run.

The home was going through a period of change following initiatives put in place by the new provider who took ownership of the home late in 2015. At the time of the inspection there was no manager at Sharston House Nursing Home. We were informed by the operations manager that a new manager had recently been appointed and would commence their role on the 14 March 2016. After the inspection the regional director confirmed the new manager had started her role at the home.

The management of the home was being overseen by two operations managers. Both operations managers and the regional director were present during our inspection and engaged positively in the inspection process. The management team were observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors.

During this inspection visit we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to recruitment processes, staffing levels, management of medicines, quality assurance and auditing systems, staff supervision and appraisal, treating people with dignity and respect, and meeting people’s social needs. You can see what action we told the registered provider to take at the back of the full version of the report.

Medicines were ordered, stored, administered and disposed of safely. However we found the registered provider did not record homely remedies. Without any records in place for homely remedies this was open to error and misuse.

Although people told us that staff were caring and kind to them, we saw that staff did not always deliver care to people well.

People’s needs were assessed before they came to live in the home; however we found some assessments were not regularly updated. Care plans were based on the needs identified within the assessment. Some of these had not been reviewed regularly which meant that some of the care plans did not reflect the current needs of people. The care planning system used was in the process of being replaced to reflect a more personalised approach to care needs.

People’s social needs were not being met. People told us they were bored and activities did not occur regularly.

The provider did not have an effective recruitment and selection procedure in place and did not carry out all the required checks when they employed staff.

Staff were provided with induction and regular on-going training. However we found gaps in supervisions and appraisals for staff.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of service users were not in place and auditing systems were not robust. Record keeping was not always accurate and up to date, in relation to the treatment provided to people living at the home

Staffing levels were not structured to meet the needs of the people who used the service. A dependency tool to assess the required staffing levels to meet people’s needs was due to be implemented. People and staff told us at times there were not enough staff on duty to meet their needs.

The registered provider had policies in place to safeguard people from abuse. Staff were aware of the whistleblowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

Records showed that people had access to GPs, chiropodists and other health care professionals (subject to individual need).

We found that the home was properly maintained to ensure people’s safety was not compromised.

We looked at the arrangements in place to protect people from harm and abuse. We found that the staff knew what they would do if they had some concerns.

Our observations, documentation we reviewed and the people we spoke to assured us that the people who lived in the home were experiencing care and support that met their needs.

We looked at the procedures for recruitment of new staff and we saw that all the appropriate checks had been made to ensure that staff were suitable to work at the home.

We looked at the home's systems for ensuring that they provided a quality service. We found that these were very good and that the systems relating to monitoring the care provided were completed on a monthly basis.

A person visiting the home told us they had a lot of information regarding the home when making their choice and said they were 'very happy with the way things were'. They said the staff were always in touch regarding the care of the person they were visiting and said they 'couldn't fault the care'. Another person visiting the home told us that everything was fine and their relative received 'good care' and they were always consulted about their relatives care and treatment and everyone working in the home was pleasant and were always ready to listen.

Another person said 'I've no complaints at all, the staff are lovely'. They also said 'I know all the staff's names and they know mine'. Another person told us that they could always choose where they like to eat their meals, they told us "I sometimes like my lunch in my room or sometimes in the dining area'. One person said 'it's always hard moving house but the staff here have made it easier for me'. Another person we spoke to said they were happy and the staff were 'very nice'.