About the service: Sherwood Lodge is a residential care home that provides personal care to up to 49 older people. At the time of the inspection 27 people were living at the service. The service is purpose built over two floors. All bedrooms were of single occupancy and a number of bedrooms had ensuite facilities. People had access to communal areas. These included a lounge, dining room, conservatory and outside secure space.

People’s experience of using this service: Improvements were noted in the way the service managed risks. Staffing levels had increased and the monitoring of people’s assessed needs was completed to ensure the staffing levels were suitable. Staff training had improved consistently for all staff members. Improvements in the management of medicines was noted. Safeguarding was being managed safely.

Consent had been obtained and recorded. Relevant deprivation of liberty applications had been submitted. Capacity assessments and best interests decisions were now being completed appropriately. People had access to relevant professionals to support their health and assessed needs.

People and relatives told us they received good care. This was confirmed by professionals we spoke with. Staff spoke with people kindly and treated people with dignity and respect, maintaining their diverse needs and rights.

Improvements in the development and completion of people’s care files was noted. These confirmed people or their representative had been consulted in them. A range of activities were being provided and technology was being used in care planning, assessing and monitoring of the service. Systems were in place to investigate and act on complaints or concerns.

Positive feedback was received about the management team and the changes since they came to post. Staff, resident and relative meetings were taking place. Audits and monitoring of the service was being undertaken.

Rating at last inspection: Inadequate. The inspection report was published on 6 November 2018.

Why we inspected: This was a scheduled inspection based upon the previous ratings and to follow up the special measures in place since the last inspection.

Follow up: The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive any concerning information.

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

We previously undertook a comprehensive inspection on 20 and 25 April 2018 because of concerning information we had received from the Local Authority in relation to the safe care and treatment of some people who lived at the service. These included, staffing levels, personal care, lack of monitoring, incidents and accidents as well as the leadership and management of the home.

Due to unforeseen circumstances we were unable to produce a report of our findings. Therefore, we undertook this unannounced comprehensive inspection on 18 and 22 June 2018. This meant the home did not know we were going to inspect. This inspection took account of the risks identified during the April inspection. We last inspected the home and provided a rating on 6 and 9 March 2015 where it was rated as good overall.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding people from abuse, safe care and treatment, meeting people’s nutrition and hydration needs, medicines management, staffing, management of risks, accidents and incidents, person centred care, infection prevention and control, Mental Capacity Act and Deprivation of Liberty Safeguards, records and good governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to dignity and respect and consent. You can see what action we have taken at the bottom of the full version of this report. We made recommendations in relation to checks, audits and monitoring takes place on the environment an equipment actions are taken to rectify any findings to ensure it is safe for people to live, visitors to access and staff to work in.

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

Sherwood lodge is registered to provide accommodation and personal care for up to 49 older people in one purpose built building over two floors. People who used the service had access to lounge and dining facilities as well as a conservatory and secure outside gardens to the rear. All bedrooms were of single occupancy a number of which had ensuite facilities. At the time of our inspection 36 people were in receipt of care at the home.

The service did not have a registered manager in post at the time of our inspection. A new general manager had been recruited to the home and was in the process of her registered managers application with the CQC. This process has been completed since 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.

Whilst some areas of the home were clean and tidy we noted a number of people’s bedding was dirty. The general manager told us they had introduced a daily walk around to check all areas of the home. We saw staff wearing appropriate personal protective equipment during personal care and household duties.

Accidents and incidents were not consistently recorded; we saw gaps in their completion. Not all people who used the service told us they felt safe. Where risks were evident or had changed, we noted not all people’s risks assessments were updated to reflect their current needs.

Whilst there was evidence of the procedure followed for staff recruitment we noted risks assessments had not been completed

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to look at the overall quality of the service.

This was an unannounced inspection carried out on 08 July 2014. The previous inspection was carried out on 23 May 2013, when there were no concerns identified and we found the service was meeting all standards looked at.

Sherwood Lodge provides care and support for a maximum of 49 older people. At the time of our visit there were 44 people who lived at the home. Sherwood Lodge is a purpose built home situated in the Fulwood area of Preston. It offers mainly single room accommodation but can offer shared accommodation if required. It is set in 2.5 acres of landscaped grounds shared with Sherwood Court, a large adjacent nursing home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Safeguards were in place for people who may have been unable to make decisions about their care and support.

We looked at how medicines were prepared and administered.  We saw medication given to one person was not observed as being taken. We also found that people’s medication records did not always accurately match the quantity of stock left. 

The registered manager assessed staffing levels to ensure there was enough staff to meet the needs of people who lived at the home. We observed staff made time for people whenever required and took time to explain things to people so they didn’t feel rushed. We saw there was a range of individual and group activities taking place. However people who lived at the home told us there was not always enough staff on duty, which meant sometimes they had to wait to be supported.

We found people were involved in decisions about their care and were supported to make choices as part of their daily life. Most people had a detailed care plan which covered their support needs and personal wishes. We saw plans had been reviewed and updated at regular intervals. This meant staff had up to date information about people’s needs and wishes. Records showed there was a personalised approach to people’s care and they were treated as individuals.  However people who had recently been admitted to the home did not have a care plan in place.

Staff spoken with were positive about their work and confirmed they were supported by the registered manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs.

The management team used a variety of methods to assess and monitor the quality of the service. These included annual satisfaction surveys, ‘residents meetings’ and care reviews. Overall satisfaction with the service was seen to be extremely positive.  However systems to monitor the health, safety and well-being of people who lived at the home, had not been effective in identifying areas where improvement was required. This included administration of medicines, care planning for new admissions and ensuring adequate staffing levels to consistently meet people’s needs.

We visited Sherwood Lodge as part of our planned schedule of inspections and to follow up on areas on non compliance identified at our last inspection in January 2013. We looked at outcomes 2, 4, 9, 13, 16 and 21. We noted improvements in outcomes 2, 4 and 21 where non compliance was identified in January 2013. We have judged the service compliant against the outcomes we assessed.

People we spoke to living at Sherwood Lodge told us they were happy with the way the service was managed and the way they were supported.

We observed that interactions between people living at the home and staff were positive. People told us they enjoyed living at Sherwood Lodge and that staff respected their routines and lifestyles.

People living at Sherwood Lodge told us the importance of maintaining their independence was essential to them and that there were sufficient staff available to support them.

People told us they were able to choose their own routines and lifestyles and consent to care and treatment. They said that staff supported them to maintain their independence and were quick to respond to their requests for assistance.

We saw that people’s health care needs were supported by staff who they commented were ‘caring’, ‘polite’, ‘make a fuss of you’ and ‘great listeners’.

Staff told us they were well trained and supported. We saw they were respectful of the needs of people living at the home.

People we spoke to living at Sherwood Court told us they were happy with the way the service was run, and the way they were supported. We were able to speak to people and observe their care as well as interactions between them and staff. People told us they enjoyed living at Sherwood Court and that staff respected their routines and lifestyle. One person told us, “I have lived here …. years. No complaints about the care and the food is excellent. There’s lots to do and the staff tell me I keep them on their toes. They are only joking but It’s nice to know your are appreciated”.

People living at Sherwood Court told us the importance of maintaining their independence was essential to them. They told us they were able to choose their own routines and lifestyles and these decisions were respected by staff. They said that staff supported them to maintain their independence but were quick to respond to their requests for assistance. One person told us, “I am usually asked what I want. I’m alright as they (staff) care for me very well. If I need help I ask them when I am ready. If they are busy then I can wait, I don’t mind”.

We saw that people’s health care needs were supported by staff who they commented were ‘friendly’, lovely girls’, ‘care with a smile’ and ‘great at cheering me up when I am fed up’. Staff told us they were well trained and supported. We saw they were respectful of the needs of people living at the home.

During our visit to this location we spoke with a good percentage of residents, relatives, staff and external professionals. We received positive feedback from everyone and we were told that a good quality of service is provided at Sherwood Lodge.

Comments from those we spoke with included:

"The staff are really good. They will do anything for us";

"The best thing about living here is the staff. They are very respectful and treat me well. They are marvelous";

"The food is excellent. I cannot fault it at all";

"I wouldn't have mum anywhere else and that says it all".

We inspected Sherwood Lodge on 06 and 09 March 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. Sherwood Lodge provided 24 hour personal care for 49 older people. Sherwood Lodge offered mainly single room accommodation but could offer shared accommodation if required. The home offered both short term and long term care. It was set in landscaped grounds shared with Sherwood Court, a large nursing home. The home was easily accessible by road and rail with frequent bus services. The service provider was registered to provide accommodation and personal care for 42 older people. The majority of the bedrooms had en suite facilities.

On 05 March 2015, we received information from the Local Authority Safeguarding Team that stated a whistle blower had raised concerns about the operation of the home to a visiting District Nurse. The alleged concerns included inadequate staffing levels; that people living at the home were potentially subject to rough handling from a staff member; and that people were made to get up very early against their will. On 06 March 2015, these allegations were investigated under the Local Authorities safeguarding procedures by a social worker and the police. The investigation is on-going.

The staff rota showed that there were enough competent staff on duty who had the right mix of skills to ensure that practice was safe. However, the information within the rota was not always clear. We recommend that the service consider current guidance and best practice in relation to document management and recording.

Staff at the home explained that as people living at the home now used various pieces of equipment such as walking aids and wheelchairs, this meant that the corridors and communal areas of the building sometimes got crowded with equipment. We recommend that the service provider consult national guidance and best practice relating to storage of equipment in care facilities.

Information contained within the care files showed that staff had considered some people’s preferences and choices regarding end of life care. These had been recorded in most cases, and we saw that the person themselves had been involved in the discussions, and planning arrangements. We recommend that the service consider current guidance and best practice on end of life care.

People who used the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Decisions relating to people’s care were taken in consultation with people who used the service, their next of kin and other healthcare professionals. This ensured their rights were protected.

Staffing levels were determined according to people’s individual needs, and there were enough staff available at the service. We saw information within the rota to show that extra staff were provided where people’s needs changed and when they required extra support. Staff received training that was relevant when supporting the needs of people living at the home. Staff were supported through good links with local community healthcare professionals. This ensured people who used the service received effective care and support relating to their healthcare and social care needs.

There was a relaxed atmosphere at the home. People told us they enjoy living there and their relatives told us that staff was supportive and approachable. People were able to take part in activities that they enjoy and receive support from the staff if required.

Staff members took into consideration the Mental Capacity Act (2005) for people who lacked capacity to make decisions. People’s mental capacity was assessed and there was information available in the service for the staff that helped them support a person with fluctuating capacity. We observed consistent approaches from staff; with staff explaining to people before they undertook a care process, other staff gave the person information about the care and support they were in receipt of.

Where people who used the service lacked capacity to understand or make certain decisions relating to their care and treatment, where appropriate, best interest meetings were held which involved family members, independent mental capacity advocates, and social workers.

We looked at the systems relating to medicines management and saw that the records relating to medicines were accurate and up to date. People were supported to receive the correct medicines at the right time. Staff working at the home had received appropriate training in medication administration.

The service and staff respected and involved people in the care they received. Care plans showed the person’s choices and personal preferences. The care planning process had involved the person or their relative when they were written, and their views were reflected in the plans. People told us they had input into the menus or activities at the home and we saw information within the menu and the care files to show that that the choice of meals was varied.

Staff were provided with support, induction, supervision, appraisal and training. The service had a system to manage and report accidents and incidents. When action plans were needed to monitor people's safety these were produced. The service had a quality assurance system and, where appropriate, governance systems in place.

There was a registered manager in place 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. We last inspected this service on 08 July 2014 and the home was required to make improvements in relation the administration of medicines, care planning for new admissions and ensuring adequate staffing levels were in place to consistently meet people’s assessed needs. We included the information and findings of the last inspection when planning and undertaking this inspection.