We carried out an inspection of Shawcross Care Home on 10 and 11 October 2018. The first day of the inspection was unannounced.

Shawcross Care Home 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. The home is located in Ashton in Makerfield and provides residential and nursing care. The home is divided into two separate units, one for nursing care and one for people living with a diagnosis of dementia. The home can accommodate up to 50 people. At the time of the inspection there were 48 people living at Shawcross Care Home.

The home was last inspected on 19 July 2017, when a focussed inspection was carried out, which looked at the key questions of safe and well-led. This was because during the last comprehensive inspection carried out on the 20 and 22 March 2017, we identified two minor breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the management of medicines and good governance. We returned on the 19 July 2017, to check the progress the provider had made. During the focussed inspection, we found the provider had made the necessary improvements and was meeting all the regulations. As a result, we improved the ratings in the key questions safe and well-led, as well as the overall rating from requires improvement to good.

At this inspection we found the evidence continued to support the overall rating of good. However, we received mixed feedback about staffing levels and noted some discrepancy between the number of staff deployed each day and the amount the home indicated was required to meet peoples needs. As a result we had made a recommendation for the home to look at the allocation of staff on each unit, to ensure people’s needs are met both timely and safely.

At the time of the inspection the home had 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.

People and staff provided mixed feedback about the number of staff deployed to meet needs. The home used a system to work out the number of staff required to safely meet needs based on people’s dependency levels, these are sometimes called dependency tools. We noted staff numbers allocated on the nursing unit were less than had been recommended by the dependency tool. Observations during inspection also showed staff struggled at times to meet needs, including their own need for a break, due to the number of staff deployed..

People we spoke with told us they were happy living at Shawcross Care Home, and aside from some concerns with staffing levels, felt safe. Checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people.

Staff were knowledgeable about the different types of abuse, how to identify these and report any concerns. The home had appropriate safeguarding policies and reporting procedures in place, which had been followed consistently. Accidents and incidents had also been logged, with actions completed to minimise the risk of reoccurrence.

The home was clean, well maintained with appropriate infection control processes in place. Staff had access to and wore personal protective equipment (PPE) to prevent the spread of infection. Checks and servicing of equipment, such as for the gas, electricity, fire safety, passenger lift and hoists were up-to-date.

Medicines were stored, handled and administered safely and effectively. Staff responsible for administering medicines were trained and had their co

Shawcross Care Home is located in Ashton in Makerfield and provides residential and nursing care. The home is divided into two separate units, one for nursing care and one for people living with a diagnosis of dementia; which the home refer to as the EMI unit, each providing accommodation over two floors. The home provides single occupancy rooms with private toilet facilities and can accommodate up to 50 people.

This unannounced focussed inspection took place on Wednesday 19 July 2017. A full comprehensive inspection was last carried out at the home on 20 and 22 March 2017, when we rated the service as ‘requires improvement’ overall with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment in the management of medicines and good governance. The full comprehensive report from this inspection can be found on our website at www.cqc.org.uk/location/1-130725445.

During the last comprehensive inspection we identified the home had made significant progress since the previous comprehensive inspection in August 2015. As a result of identified progress between inspection and the fact positive action was taken between the first and second days of inspection to address concerns identified, including the production of a detailed action plan, we undertook this focussed inspection to re-look at the areas of medicines management and good governance, specifically medicines audits, to confirm the service now met legal requirements. This report only covers our findings in relation to these two areas, which fall under the ‘Safe’ and ‘Well-led’ key questions.

At the time of the inspection the home had 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.

During this inspection we saw all issues with medicines management identified at the previous comprehensive inspection had been addressed. New systems and procedures had been in place for the last four months including a new process for monitoring and recording the ordering and receipt of medicines. This ensured medicines had been ordered in good time.

Daily monitoring of medicines fridges had been completed, utilising new recording sheets which prompted staff to reset the thermometer each time, to ensure subsequent recordings were accurate.

A new system was in place for monitoring the use of transdermal patches; which are medicated adhesive patches placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream, to ensure they had been applied to a different area of the body as per guidance and only one patch was in situ at any one time, to avoid the potential for overdosing.

Procedures and guidance was in place for managing the administration of medicines which are more effective if given before breakfast or on specific day. Where it had not been possible to administer the medicines before breakfast, staff had waited an hour after the person had eaten before administering.

The use of inhalers and blood glucose monitoring had been reviewed, with monitoring charts in place and guidance sought from the person’s general practitioner (GP), which was clearly detailed in the care files.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of medicines management. Audits were completed on a daily, weekly and monthly basis and covered a range of areas including completion of Medicine Administration Record (MAR) charts, stock level checks, topical medicines, ordering and receipt of medicines and record keeping. We saw action plans had been drawn up and implemented to address any identified issues, and our observ

We carried out an unannounced inspection of Shawcross Care Home on 20 and 22 March 2017.

Shawcross Care Home is located in Ashton in Makerfield and provides residential and nursing care. The home is divided into two separate units, one for nursing care and one for people living with a diagnosis of dementia; which the home refer to as the EMI unit, each providing accommodation over two floors. The home provides single occupancy rooms with private toilet facilities and can accommodate up to 50 people. At the time of the inspection there were 43 people living at Shawcross Care Home.

A comprehensive inspection was last carried out at the home on 10 and 11 August 2015, when we rated the service as ‘requires improvement’ overall with two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing and person centred care.

At this inspection we found the service had made improvements in regards to staffing and person centred care, however identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe care and treatment and the management of medicines and good governance. You can see what actions we told the provider to take at the back of this report.

At the time of the inspection the home had 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 saw the home was clean and had appropriate infection control processes in place. Infection control audits were completed regularly and cleaning schedules were in place and up to date. Laundry was collected in different coloured bins to minimise the spread of infection. People told us they were happy with the cleanliness of the home and that their rooms were cleaned daily.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and were complementary about the level of care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Completion of the medication administration record (MAR) was done consistently and the home had effective systems in place for the administering of topical medicines. Staff authorised to administer medicines had completed the necessary training and had their competency assessed on a regular basis. However we identified issues with the management of stock levels and re-ordering of medicines, which meant people had missed doses of medicine until new supplies arrived. We also identified some issues with the recording of the medication fridge temperature and the monitoring of some medicines which people self-administered; such as inhalers or processes they completed themselves; such as blood glucose monitoring.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found the home was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. At the time of our inspection there had been 29 applications made to the local authority that were still awaiting assessment.

Staff confirmed that on-going training was provided and they recei

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at the location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

This is a summary of what we found.

Is the service safe?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies. One relative said: “We feel he’s safe here. Everything is fine.”

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse. One staff member said: “If anyone hurts anyone (I'm caring for) I would expect them to take it very seriously.”

Is the service effective?

People told us that they were happy with the care that had been delivered. A person who lived in the home said: “There’s always somebody to help.” Another person said: “I find it a very clean place, a nice place.”

Care records confirmed people’s preferences, interests and needs had been recorded and care and support had been provided in accordance with people’s wishes. One person said: “I’m quite satisfied.”

We heard that information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: “The staff are great, very caring.” One person using the service said: “The care staff are very nice, they have a joke with you. It helps to create a nice atmosphere.”

Is the service responsive?

People’s needs had been assessed before they were admitted to the home. People's needs were carefully described so that care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the senior carers and they briefed care staff at handovers and via the updated care plans.

One relative said “When he became ill they were here like a shot.” They also commented that the chiropodist had been called two weeks previously, a doctor called regularly as did an advanced nurse practitioner. They felt their relative was receiving good care from the team.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. One member of staff said: “He (the manager) supports you, asks how he can help.” People told us they had received customer satisfaction survey and that staff listened to their concerns. The manager met informally with families and was available whenever they visited. Staff told us they were clear about their roles and responsibilities and said : “There is always someone to ask.”

We spoke with five people when we visited Shawcross Care Home who were all happy with the service they received. We also spoke with two visiting relatives who stated that they were not aware of anything that needed to be changed about the home. We heard comments including "The staff are very pleasant. I am happy here"; "They (the staff) will do anything for you. They are a great help” and "I don’t think that anything needs to be changed."

At our last inspection in May 2013 we found that there was a system in place to monitor the quality of care. However, the system was not effective as actions were not always completed to address the issues and problems identified. At this inspection we found that improvements had been made and the service was now fully meeting this standard.

The people using the service who were able to tell us said that they were happy living in the home. We received comments such as "this place is a good place to live"; "this place is smashing" and " I am happy living here."

We saw staff being considerate and polite to the people they were caring for. There was a pleasant, relaxed and friendly atmosphere throughout the home. There was a lot of pleasant banter between residents, staff and visitors. Staffing levels had been increased since our last inspection and we observed that people no longer experienced unacceptable delays in receiving care.

We found that people received the care that they needed and that they were asked for their permission before care was given.

The people living at the home were cared for in a clean and hygienic environment. We found that there were appropriate procedures in place to prevent the spread of infection. The staff we spoke with were aware of the actions they could take to ensure the people using the service were protected from infection risks.

The service had appropriate procedures in place to recruit staff. These ensured that people who were unsuitable to work with vulnerable adults were not employed within the service.

We also looked at the home’s system for monitoring the quality of service that people received. People told us that they express their views of the service. However, we found that the system in place was not effective as the processes were not fully completed.

We visited Shawcross Care Home because we had received some information of concern. The concerns related to the care of the people with dementia at the home; staffing levels and the administration of medicines.

People told us that they were happy with the care they received at the home. We were told “I can’t fault this place”; “they look after us very well” and “if you ask for anything staff bring it and they try to help you as much as they can.” We found that there were delays in people’s care and support needs being met. This was due to a lack of staff rather that staff not planning the workload effectively.

We spoke with three sets of visitors and received mixed feedback about the home. One person told us that “visitors are treated like family.” Other visitors were concerned that staff were always busy and this had an impact on the timeliness of the care and support people received.

People told us that they had no problems or issues in relation to medicines. There was a system in place to ensure that medicines were stored and administered safely. There were some minor errors with medicines that the manager was aware of and was monitoring to ensure that these were not repeated.

We spoke with six staff members and we found that they were working hard and interacted well with people and relatives. We found that most staff had completed a range of training and there were several new staff who still needed to completed some training.

People told us that they were happy with the care that they received at Shawcross Care Home. We were told “They are looking after me well” and “I am happy here.”

People were also complimentary about the staff at. We were told “Staff are very good” and “The staff are good. They are good people.”

We asked people about the choices that they were given by staff at this care home. We received many positive comments about this. We heard “I am given choices about my clothes and what to eat”, “I am given choices about everything” and “I can stay in my room if I want to.”

People we talked to said that they were content with the service provided at Shawcross.

Comments included:

"We’re happy with everything here."

And

"Staff seem very pleasant."

This unannounced inspection took place on 10 and 11 August 2015. We last inspected Shawcross Care Home on 15 July 2014, at which time the home was found to be meeting all standards we reviewed.

Shawcross Care Home is in Ashton in Makerfield, Wigan. It provides residential and nursing care. This care home provides single occupancy rooms with en-suite facilities for up to 50 people. The service provides support to people living with dementia as well as people who have mainly physical care needs.

At the time of our inspection there was an acting manager who was in the process of registering with Care Quality Commission (CQC) to become the registered manager for the service. 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.

At this inspection we found two breaches of the regulations. These were in relation to staffing and person centred care. You can see what action we told the provider to take at the back of the full version of this report.

Staff told us they did not think there were always sufficient numbers of staff on shift to meet people’s needs in a timely way. There were mixed views on staffing from people using the service Some told us there were not enough staff and this would mean they would have to wait for support at times. At one point in the inspection we saw staff were in a handover and call bells were not responded to in a timely way. We saw a tool was used to calculate staffing levels, however this had not been updated after a new person had moved in.

People living at Shawcross told us they felt safe. Staff we spoke with were aware of safeguarding procedures and had received training in safeguarding of vulnerable adults. We looked at recruitment records and saw that checks had been carried out to help ensure staff were of suitable character to work with vulnerable people. However, the service could not demonstrate it had considered any potential risks in relation to a disclosure of a conviction by a staff member. Steps were underway during the inspection to ensure this was looked into.

The service carried out risk assessments in relation to health and care needs and measures were identified to reduce risk wherever possible. We saw one person’s falls risk assessment had not been updated following a suspected fall, although appropriate actions such as a GP referral and completion of an accident form had been carried out.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The service had made DoLS applications as it had identified a requirement. However, an application had not been made for one person where it had been required. This was completed during the inspection.

Staff received regular supervision and had received training in areas such as safeguarding, fire safety, infection control and DoLS. Staff were able to explain how they would seek consent before providing care or support and we observed staff asking permission before giving medicines. However we saw two instances of poor practice where staff did not communicate or seek consent before providing support at meal times.

Part of the home specialised in providing support to people living with dementia. This part of the home was split over two floors. We saw that one floor had lots of adaptations to make it more dementia friendly, whilst the other had only minimal adaptations. Staff received training in dementia, including a number of staff who had received additional training in ‘resident experience’. This training aimed to simulate what it was like for someone living with dementia who was receiving care at the home in order to build empathy.

People told us they had enough to eat and drink. We saw information was available to help ensure any special dietary requirements were catered for. There was evidence in people’s care plans that referrals were made and advice sought from other health professionals as required.

We observed staff interacting with people in positive, respectful and friendly ways. People told us the staff were kind and caring. Staff were able to describe how they would support people to retain independence, although we observed one instance of a person being provided with support to eat where their care plan indicated this was not necessary. There was evidence of involvement of people and their families in the development and review of care plans.

We looked at pre-admission assessments and saw the assessment for one person was limited in detail. There was a lack of information in relation to this person’s preferences and support requirements. Staff told us they felt their opinions in relation to pre-admission assessments were not considered.

The service sought feedback from people using the service through surveys and resident and relatives meetings. We saw that a ‘you said, we did’ document had been produced, which clearly displayed actions that had been taken in response to any concerns or suggestions received.

A range of audits and checks were undertaken by the manager to monitor the quality and safety of the service. These had not picked up an issue in relation to a risk assessment that required updating. The acting manager told us this could have been due to a member of staff leaving, but also that new format care plans, which were in the process of being introduced would provide prompts to ensure regular review.

Staff told us they liked working at the home and some had worked there for a number of years. They told us there had been a high turnover of managers, which was felt to be due to a negative culture putting pressure on the managers from the staff team. The acting manager told us they felt the culture was improving in the home and that there had been a number of changes to the staff team recently.

People and staff told us they felt able to approach the manager with any concerns. However, three staff we spoke with felt action in relation to concerns raised, such as in relation to staffing and admissions, had not always been listened to or acted upon.