We undertook this inspection of Shawe House Nursing Home on 20 and 22 June 2017 and was unannounced on the first day. The inspection team consisted of one adult social care inspector, a bank inspector and an expert by experience on the first day of the inspection. The inspection was unannounced which meant the provider did not know we were coming on the first day of the inspection.

Shawe House Nursing Home is located in Flixton, Manchester and provides nursing care for up to 33 people who live with dementia. Accommodation is provided on two floors. All bedrooms are single rooms and those on the first floor are accessible by a passenger lift. There is an enclosed garden area and parking for several cars at the front of the property.

At the time of our inspection there were 27 people living at Shawe House. The local authority had placed a temporary suspension on new admissions. It was envisaged that this suspension would be lifted once the home could demonstrate adequate improvements with regards to people's safety and the quality of care delivered.

The service had a registered manager in place. 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 last inspection in October 2016 we identified breaches of the regulations in relation to the safe care and treatment of people, person-centred care, consent, premises and equipment, staffing and the governance of the service. The home was placed in special measures as a result of the breaches identified at the last inspection and we served three warning notices.

At this inspection we found improvements had been made in all areas. We found the service was now working within the principles of the Mental Capacity Act (2005). Capacity assessments and best interest decisions were made where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. Staff offered people day to day choices about their care and sought their consent before providing support although we judged that the service needed to improve with regards to correctly recording people’s consent to aspects of their care.

People received their medicines as prescribed and the nurses had received relevant medicines administration training. Protocols for the use of ‘as required’ medicines were in place. The temperature of the medicines fridge had not been recorded for two days as this was reported as broken. A representative from the pharmacy came out to the home and addressed this on the first day of inspection. Staff were reminded to also record the temperature of the medicines room so that the effectiveness of medicines stored there was not reduced.

People we spoke with and their relatives were complimentary about Shawe House. Relatives told us they considered their family member to be safe, the staff knew people’s needs well and there were enough staff on duty to meet those needs.

There was less reliance on agency staff and staff appeared more confident and positive about their role. The registered manager had made new appointments that benefitted the home and was supported by a new deputy manager and a clinical lead.

Care plans and risk assessments were in place with guidance for staff in how people wanted to be supported and the tasks they were able to complete independently. These were written in a person centred way and had been regularly reviewed and updated when people’s needs changed.

Care plans were in place for the support people wanted as they came to the end of their lives and the home had been awarded The Six Steps to End Of Life Care accreditation certificate. Relatives were kept informed about the programme.

Appropriate referrals were made to the Speech and Language Tea

We inspected Shawe House on 12 and 14 October 2016 and the first day of the inspection was unannounced. Our last inspection took place on 14 July 2014. At that time we found the service met the standards with no breaches of legal requirements and received a rating of requires improvement.

Shawe House is a nursing home located in the Flixton area of Trafford. The home is registered to provide accommodation and nursing care for up to a maximum of 33 older people and accommodation is provided over two floors. Shawe House specialises in providing care and support to older people living with mid to late stage dementia. There were 33 people living at Shawe House on the day of our inspection.

The service 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate in any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We identified several potential safety hazards as we walked around the building, including the lift, which had been problematic prior to our inspection relatives we spoke with told us. The design and layout of the building with its narrow corridors was not ideal for people living with dementia. There was nothing made available to engage people who were able to mobilise around the building. There was no evidence of the implementation of good practice in modern dementia care and signage to aid navigation in the building was limited.

People living at Shawe House had high dependency needs. Over a third of the people living at Shawe House required two to one support with aspects of personal care and two people required one to one support during the day. The service relied heavily on agency staff who did not have access to the same training as permanent staff employed by Shawe House. There were insufficient numbers of suitably qualified, competent, skilled and experienced persons supporting people living in the home. Staff told us they received training in areas

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We carried out this unannounced inspection on 7 July 2014. The previous inspection was in April 2013. There were no breaches of legal requirements relating to the areas inspected on that occasion.

Shawe House is a nursing home registered to provide accommodation and nursing care for up to 33 older people. 30 people were living at the home on the day of our inspection. Shawe House specialises in providing care and support to older people living with mid to late stage dementia.

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

The registered manager was also managing another home and spending 50% of her time at Shawe House. Some relatives expressed concern that the manager was not as present as she had been before. Staff stated they were happy with the management arrangements, but we considered that the partial absence of the manager had affected the quality of life for people living in the home.

We saw that people who were mobile were able to move around the corridors freely but that the corridors were narrow and this posed a risk, which needed to be monitored. We found concerns relating to a blocked fire escape and a potential trip hazard on the slope leading to the garden.

There was musical entertainment provided on the afternoon of the day we were there, and there were regular entertainments, but there was scope for more activities designed specifically for people living with dementia.

Family members told us the staff worked very hard and provided a good quality of care. The staff we saw and spoke with were enthusiastic, and were gentle and kind towards the people they were helping. We saw that some people were given less attention from the staff than others.

From January 2013 to March 2014 Shawe House had failed to submit to the CQC notifications of deaths, which they are required to do under the regulations.

The registered manager was aware of the home’s responsibilities under the Mental Capacity Act 2005, the supporting code of practice and the Deprivation of Liberty Safeguards (DoLS). At the date of our visit there was one application in progress for authorisation under DoLS.  Such an authorisation is needed when people who lack the capacity to consent have their liberty restricted.

We looked around the home and saw that the residents were familiar with the manager and staff. The manager told us all the people who used the service had dementia.

We saw that some bedrooms were single rooms and some were shared bedrooms staff told us that there were 6 shared bedrooms. There were privacy screens evident in the shared bedrooms. Staff told us that 11 bedrooms had ensuite toilets and sinks. All the bedrooms were light bright and airy.

We saw that people who used the service were given options at meal times, we were shown a two week menu for people. The home provided soft or pureed diet if it was required. The manager told us that visitors to the home were offered food and drink at meal times if they were there.

We received complementary feedback from relatives. One person told us they cannot fault the place for care. The girls are so loving, nothing is too much trouble and X is fabulous. Another relative told us they were made “very welcome as a visitor and they made the right choice bringing their relative here”. One relative told us “staff are always respectful and courteous”.

We looked at evidence of previous safeguarding concerns raised within the home and saw that the correct procedures had been followed in each case. The manager showed us evidence that demonstrated that all safeguarding issues were taken very seriously and that every effort was made to learn lessons from incidents and improve processes where issues had been identified.

During the visit, we spoke the relatives of two people who use the service. They told us the staff kept them involved and discussed any changes to their relatives’ care with them on a regular basis.

The people we spoke with told us they were happy with the care their relatives received. They told us the staff were friendly, helpful and courteous and that their relatives were very well looked after. They also told us they had no concerns with their medication and that medicines were given on time.

The people we spoke with told us they felt there were enough staff around when they needed them. They told us the staff were very polite and helpful and treated their relatives with respect and dignity. They also told us that they had no concerns about the care received by their relatives and that they would speak to the Registered Manager if they had any concerns.

People who use the services at Shawe House all have a diagnosis of Dementia, which means people were not able to reliably give their verbal opinions on the service they received. Due to this our evidence was based on looking at people’s records, how people interacted with the staff, general observations throughout the visit and discussion with staff and visiting relatives.

We spoke to several visiting relatives to the home who were all positive about the care received by their relative. Some comments from relatives included:

“The privacy and dignity of ‘X’ is protected 100%.”

“I am very happy with the care here, I wouldn’t have ‘X’ anywhere else.”

“It feels like home from home here, everybody is very friendly.”

“Care needs are met to a very high standard, I am very happy with the care.”

“You couldn’t do better than Shawe House.”

“I am happy with everything here.”

“I have no concerns what so ever, I feel ‘x’ is very safe here.”

“The staff are exceptionally kind.”

“The staff appear well trained and are all regular.”

“The manager is always available if we need her and she is very supportive.”