The inspection took place on 26 June 2018. The inspection was unannounced.

Shaws Wood Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Shaws Wood Residential Care Home accommodates up to 39 people. Accommodation is arranged over two floors. There is a passenger lift for access between floors. There were 36 people living at the service at the time of our inspection. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility and some people received care in bed.

At our last comprehensive inspection on 21 October 2016 we rated the service good. However, we reported a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a focused inspection on 05 September 2017. At this inspection we found a continued breach of Regulation 12; Risks to people's safety in relation to fire had not always been appropriately assessed, mitigated or reviewed. We served registered persons a warning notice and told them to meet Regulation 12 by 31 October 2017. The provider submitted an action plan on 23 October 2017 to state they had met the Regulation.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service had a registered manager in post. 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 their relatives were given information about how to complain. The complaints information was not available for people in an accessible format. We made a recommendation about this. People and their relatives were actively involved in improving the service, they completed feedback surveys and had meetings.

Risks were appropriately assessed and mitigated to ensure people were safe. Medicines were managed safely. Records evidenced that people had received their medicines as prescribed.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. Accident and incident records were closely monitored, actions were taken in a timely manner to ensure lessons were learnt.

People were happy with their care and support. Staff had built up good relationships with people. Relatives confirmed that their family members were happy living at the service.

The service provided good quality care and support to people enabling them to live as fulfilled and meaningful lives as possible.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect. People’s privacy was respected. The service was homely, clean and tidy.

People were supported to maintain their relationships with people who mattered to them. Relatives were able to visit at any time.

There were enough staff deployed to meet people’s needs. The provider continued to operate a safe and robust recruitment and selection procedure to make sure staff were suitable and safe to work with people. Staff received training, support and supervision to enable them to carry out their roles safely.

Staff knew wha

This inspection took place on 05 September 2017 and was unannounced.

Shaws Wood Residential Care Home offers accommodation and long term care and support to up to 39 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. At the time of the inspection there were 38 people living at the service.

There was a registered manager employed at 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 the last comprehensive inspection, the service was rated Good overall and Requires Improvement in the 'Safe' domain.

We carried out an announced comprehensive inspection of this service on 19 and 21 October 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12 and Regulation 19 of the Health and Social Care Act Regulated Activities Regulations 2014, Safe care and treatment and Fit and proper persons employed. The provider sent us an action plan on 16 December 2016, this told us they had already taken action and were now meeting the regulation. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Shaws Wood Residential Care Home on our website at www.cqc.org.uk.

At this inspection we found that the service still required improvement in the ‘Safe’ domain. We received positive feedback about the home from people and a relative.

Topical medicines were not appropriately administered and recorded. Protocols were not in place for all as and when required medicines.

Risks to people’s safety in the event of a fire had not been appropriately assessed, mitigated and managed.

Risk assessments had been reviewed and updated when people’s care and health needs changed. Actions had been taken as a result of any accidents and incidents.

There were suitable numbers of staff deployed on shift to keep people safe. Effective recruitment procedures were in place to ensure that potential staff were of good character and had the skills and experience needed to carry out their roles before they were employed.

The home was clean and smelt fresh by the end of the day. Personal protective equipment was in place to protect people and staff from the dangers of cross infection.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.

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

The inspection was carried out on 19 and 21 October 2016. Our inspection was unannounced.

Shaws Wood Residential Care Home offers accommodation and long term care and support to up to 39 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 38 people living at the home on the day of our inspection.

The home had a registered manager. 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 on 04 December 2014 we found a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as good overall and requires improvement in well led. We asked the provider to take action to meet the regulations.

At this inspection, people gave positive feedback about the service. People felt safe and well cared for.

The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in employment history had not been explored to check staff suitability for their role.

Some areas of the home smelt strongly of stale urine. Effective cleaning methods were not in place to control infection.

People were at risk of unsafe care because there had been times at night when people had been unattended on the ground floor for short periods of time, whilst staff supported the staff upstairs during emergencies.

There was a call bell system in place which people could use if they required help and support. During the inspection we observed the call bell system ringing for long periods of time. There was an intermittent issue with the call bells where if a person pressed their call bell upstairs it was not sounding the alarm upstairs. We observed this to be the case and observed staff working downstairs ringing the staff upstairs to let them know that the call bell was sounding. We made a recommendation about this.

We checked the medicines records and found that there were gaps and inconsistencies in the medicines administration records (MAR) for people in relation to people’s topical creams. We made a recommendation about this.

Some staff had not had regular supervision with their line manager. Two staff had not had a formal supervision for 16 months and one had not had a formal supervision for 17 months. Staff who had worked longer than year had not received an appraisal. We made a recommendation about this.

People were given information about how to complain and how to make compliments. Complaints had not always been dealt with appropriately. We made a recommendation about this.

There were quality assurance systems in place. The registered manager carried out regular checks on the home. The audit systems had not identified the issues with staff recruitment records and topical medicines records. We made a recommendation about this.

People’s information was mostly treated confidentially, however one small office area upstairs did not have a door which meant that anyone could access the daily records held in there as well as information on the wall. We made a recommendation about this.

Staff had received training relevant to their roles. Staff were supported and encouraged to complete work related qualifications.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to exter

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.

We observed staff treated people with dignity and respect and interacted well with people. We found that staff understood how to support people with making daily living choices. However, we noted that people or their representatives had not been involved in decision making and giving their consent for care and treatment

Relatives we spoke with were happy with the care provided to their loved ones. They said, "There is family atmosphere here" and, "All the staff are very good". People who lived in the home told us they were happy with the way they were cared for.

We found that people’s needs were not always assessed appropriately in order to promote continuity of care. This included a lack of proper information on how to reduce risks such as those associated with falls.

People enjoyed their meals and were supported if needed, by staff in a discreet manner. However, there was a lack of choice available and nutritional assessments did not always meet people's needs.

People were protected from abuse because staff had been trained and understood how to recognise different types of abuse.

The recruitment procedures at the service were sufficiently robust to ensure the safety and wellbeing of people living there and staff received appropriate induction and training.

Not all of the records for monitoring and recording the care given were accurately maintained. This meant that there was a lack of proper information available about how care was assessed and given.

During our last inspection visit on 11 June 2012 we found the provider was not meeting a number of standards. The provider sent us an action plan following our visit to tell us what they were going to do to achieve compliance. During this visit we found that improvements had been made in all the standards where we had previously found areas of non compliance.

There were 33 people living at Shaws Wood at the time of our visit. We used a number of different methods to help us understand the experiences of people using the service. Many of the people using the service had cognitive impairment due to dementia which meant they were not always able to tell us about their experiences. We observed how people interacted with staff and the management of the service. We saw the atmosphere in the home was calm and relaxed.

People we spoke with told us they were satisfied with the service they received. Their comments included, “They look after us well, there are no problems here.” “Staff are very helpful, they help me with things I can’t manage myself.” “I like it here, staff are very kind.” “I have no complaints.”

There were 32 people living at Shaws Wood at the time of our visit. We used a number of different methods to help us understand the experiences of people using the service. Many of the people using the service had cognitive impairment due to dementia which meant they were not always able to tell us about their experiences. We observed how people interacted with staff and the management of the service. We saw the atmosphere in the home was calm and relaxed.

Most of the people we spoke with told us they were very happy in the home. Their comments included, “They look after us very well”, “Staff are very caring and cheerful with it” and “I’ve never had a problem here”. Some people told us staff were very busy and did not have much time to spend with them.

The inspection was carried out by three Inspectors over three days. During this time we viewed all areas of the home; talked with people living in the home, visitors to the home and talked with the deputy manager as well as other staff.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the grounds of the home were unsightly and overgrown. We found that many window frames of the home were rotten and required replacing.

The home had not been decorated in a suitable way to meet the needs of people who lived in the home who had a visual impairment. Some doors to bedrooms had a picture or name on the outside which helped the person identify their room, other rooms had no name or picture which made it difficult for people to find their room.

We found most areas of the home were clean. However, we found shower rooms which posed a risk to people who used them.

Some people did not have access to call bells to summon help when they needed it.

People's needs were assessed and care and treatment was not always planned and delivered in line with their individual care plan. We found that the home did not have suitable arrangements in place to deal with foreseeable emergencies. We found that the home did not have suitable plans in place to manage fire safety.

Records showed that the provider had not taken people's care needs into account when making decisions about the number of staff the home required daily.

Records were not kept up to date. We found repositioning charts, food and fluid charts that had not been completed accurately. Medicines were not correctly accounted for.

The home did not have up to date information for staff on how to keep people safe which meant that staff didn’t know what to do if they had concerns.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning for foreseeable emergencies, fire safety and maintaining the home.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was no evidence of people being involved in assessments of their needs and planning their care particularly people who lacked capacity to give consent.

We saw that a bed rail had been put in place for one person; the relatives of the person had not been consulted about it and had not been involved in decision making.

We found that some care plans lacked information and clarity for staff about how to support people who used the service.

Some people were not getting food supplements and fluid in the way that their needs in these areas had been assessed which meant the home was not meeting their nutritional needs.

Some staff had not received suitable supervision, training and support.

We have asked the provider to make improvements and meet the requirements of the law in relation to involving people in planning their care and consent to care and treatment.

Is the service caring?

Staff supported people to take part in planned activities. We saw that staff offered encouragement to people to join activities and that they spoke with people in a kind and caring manner.

One staff member told us they did not get time to spend with people. We found that several people spent all or most of the day in their bedroom and were at risk of becoming lonely or isolated.

People we spoke with who used the service said they “Think it’s all wonderful”; “Carers are all lovely” and “I’m happy living here”.

Staff told us that they did not feel valued and said that communication was poor.

Is the service responsive?

People's views were not always listened to and taken into account in the ongoing management and monitoring of the home's progress. The provider did not seek the views of people actively involved with people who lived in the home.

Staff views were not listened to by the provider; staff did not receive regular supervision or have meetings.

We have asked the provider to make improvements and meet the requirements of the law in relation to involving people in planning their care.

Is the service well-led?

The provider did not have effective systems to identify, assess and manage risks to people's health, safety and welfare.

Staff had not had enough information from the provider to carry out their roles safely. One staff member told us communication, “Was horrendous”.

We found that a range of audits had been undertaken by the service. These included monthly medication checks, falls audits and monthly health and safety checks. The audits had not picked up that controlled drugs had not been recorded correctly and had not picked up that there were significant fire safety issues in the home.

We have asked the provider to tell us what improvements that will make in relation to improving the auditing arrangements, staff training and gaining feedback from people who use the service, relatives and staff.