Sheerwater House 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.

Sheerwater House is registered to provide accommodation for up to 20 older people who require residential or nursing care. At the time of our inspection there were 16 people living at the home.

The inspection took place on 29 August 2018 and was unannounced.

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 last inspection of Sheerwater House was undertaken in March 2017 and the service was rated as ‘Requires Improvement’. We found at this inspection despite receiving an action plan from the provider telling us how they would address these shortfalls, the service had not improved.

Risks to people were not always effectively monitored or managed. Emergency plans were not always accurate or updated and medicine records were not always managed in line with best practice. People were not always protected from infection at the service. Accidents and incidents were recorded and reported but there was no overview or analysis of the data by the registered provider. This meant that opportunities to identify patterns or trends were missed. The premises were not completely adapted to meet the needs of people living with dementia.

There were not enough staff to safely and effectively care for people which affected the quality of care they received. Staff were not able to spend time with people as they were focused on their tasks.

Peoples’ independence was not always maintained as they did not have frequent access to baths and showers. Staff did not always respect people’s privacy and dignity. People did not have access to sufficient meaningful activities throughout the week and care plans were not person centred or detailed to include peoples’ preferences. Complaints were not recorded and the process for complaining was not clearly displayed or communicated.

The registered provider had not implemented strategies for person-centred care or enabled continuous development or learning at the service. Quality assurance and audits had not been effective or robust in identifying issues or improving the service. People were not always effectively engaged by the service although there were meetings, surveys and a social media page.

People had enough to eat and drink and received support from staff where a need had been identified. People's individual dietary requirements where met. The Mental Capacity Act (MCA) was adhered to and staff always asked for people’s consent.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police. Staff induction and ongoing training was tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support. Staff recruitment procedures were safe to ensure staff were suitable to support people in the service. End of life care was provided sensitively and in line with people's needs and preferences to ensure people had a pain free and dignified death.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them.

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 regis

This inspection took place on 7 March 2017 and was unannounced.

At the last inspection in June and July 2015 we found a breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to medicines and activities records not being maintained. We found at this inspection this Regulation continued to be breached but for different reasons. We also identified some new concerns.

Sheerwater House is a care home providing residential care for up to 20 older people, some of whom are living with dementia. At the time of our inspection there were 18 people living at the service.

There was 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 told us that they felt safe. However, people were not always protected from the risk of infection and people were not receiving support with oral health care.

People felt there were in-sufficient staff to meet people’s needs. There was a shortage of cleaning staff resulting in care staff having to do cleaning and laundry tasks.

People's rights were not always protected because the staff did not act in accordance with the Mental Capacity Act 2005. The home had CCTV in place in the communal areas and had a closed Facebook page for relatives to access. No-one had consented to the use of these.

People were not living in an environment that was always appropriately maintained. Some areas were not clean and odour free.

Peoples care was not always planned and plans lacked the detail required for staff to know what care to provide to people.

There were mixed views on the activities available to people. Some people did not think there was enough for them to do.

The provider did not have effective systems in place to monitor the quality of the service. Some quality assurance systems were in place but these did not identify that people were not being protected against the risk of harm, that not all care was planned, that care plans lacked detail, or that people did not have mental capacity assessments in place for the use of CCTV and social media.

The registered manager had not notified CQC about a significant event. This involved someone making threats to the management and the home. When people had accidents, incidents or near misses these were recorded, but not monitored to look for developing trends

People’s medicines were managed and administered safely, and people received their medicines on time.

Staff had a good understanding of how to protect people from abuse and knew how to report safeguarding concerns. The provider followed safe recruitment practices.

Care records contained up to date risk assessments to guide staff in how to keep people safe.

The risk of fire had been assessed and plans were in place to minimise these risks. Regular fire drills were being completed and all staff had received fire training. Personal Emergency Evacuation Plans (PEEPs) were in place for every person.

People were supported by staff who had received training to carry out their roles. Staff received induction, regular mandatory training and other training required to meet the specific needs of people and were regularly supervised and appraised.

The staff met people's dietary needs and preferences. People were offered choice and meals were nutritious and well presented. Staff members provided support to people who required it.

People’s health care needs were monitored and any changes in their health or well-being prompted a referral to their GP or other health care professionals.

People and their relatives told us that staff were caring, respected their dignity and promoted their independence.

People were in

We visited this service as we had received some concerning information regarding medicine management. The inspector gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? On this inspection we looked at the arrangements in place for the management of medicines.

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

Is the service safe? We found that people's medicines were not handled safely.

You can see our judgements on the front page of this report.

We visited the home to make sure the provider had actioned the shortfall we found during our inspection on17 January 2014.

We spoke to the provider and registered manager and looked at two care plan folders. On this occasion it was not necessary to speak with people who used the service.

We found the provider had ensured that records held related to people who used the service were up to date and fully completed.

This was a follow up inspection to check that the provider had made improvements in the areas of records keeping. We had also received a concern about the cleanliness of the home, so in addition we checked for cleanliness and infection control procedures.

During this inspection we spoke with three people who lived at the home and two people who were visiting. We spoke to five members of staff which included the manager.

We found that the provider had put new recording systems in place and had made improvements to their record keeping. However, we noted that there was still work to do.

We looked around the home and found it to be clean and tidy. People told us that they had no concerns about cleanliness. One person told us “The cleanliness is fine.” We saw that the provider had systems in place to monitor the cleanliness of the home.

We carried out this inspection on 2nd October 2013 to see if improvements had been made following our last inspection in June 2013. During this visit we spoke to a senior member of staff and reviewed the care records of six people who used the service. We spoke to the manager by telephone following the visit.

During our visit we saw that the provider had taken a number of steps to improve the record keeping at the service. We noted that staff files were now complete and up to date. However, we noted that there was still some information left to be completed on resident’s files.

During our discussions, we were told that there had been another change to the management of the home. A new deputy manager had started in April 2013 to support the manager who was there at the time. However, both the manager and deputy manager had now left and a new manager had taken up post. We were told that this had impacted on the provider’s ability to make all of the improvements required by the time of our inspection on 2nd October.

During our inspection we spoke with three members of staff as well as the new acting manager.

We spoke to three people who used the service who told us that they liked living at Sheerwater House. We spoke to a relative who was visiting who told us “The staff are fantastic”.

The manager had been in post since March and had reviewed each person’s care needs. We saw that staff treated people kindly and attended to people’s needs promptly. We noted that throughout the day people were smiling and seemed happy and relaxed.

We saw that the home was clean, tidy and well organised. One person told us “It’s well kept. They clean every day”.

We saw that most staff training was up to date and most staff had received supervisions. Staff told us that the new manager had made improvements and that they “Felt better equipped to carry out their duties”.

We saw that the provider had systems in place to monitor the quality of the service and there was a complaints log to record any complaints received.

We saw that the provider had made several improvements in record keeping, however not all records were up to date.

The service had 19 residents at the time of our inspection. The atmosphere in the home was friendly and relaxed.

We spoke to six people who used the service, and two relatives. Each person we spoke with was happy with the care and treatment they received. Comments were positive and included “The staff are quite good”, “It’s like my home”; “If we want anything we have it”.

Throughout the day we saw that staff interacted with people well and spoke to them with kindness and respect.

People told us that they could make choices about what they did and where they spent their time. However, people were not always given choice. For example there was no menu choice and people were not informed of the meal that would be served in advance. However comments about the food were mainly positive.

People who used the service and their relatives told us they felt safe at the home and they knew what to do and who to speak to if they wanted to raise a concern. People told us “staff are kind”, “I’m well looked after” and “I like it here”.

Staff were not up to date with training and there were no training records available.

People told us they were happy at the home and they would talk to the manager if they wanted to raise a complaint.

People consulted expressed satisfaction with standards of cleanliness. They were overall happy with the physical environment of the home, though one person said the toilet roll in a communal toilet was hard to reach. Several people told us that staff were available when needed, though sometimes they had to wait if they were busy.

Three people who were able to give a good account of their experience of life at the home were unaware that they had care plans. They could not recall seeing these records or being involved in the care planning process.

People said staff were friendly, helpful and respected their dignity. Some could recall being involved in planning their care. Others could not recollect being involved in this process. They were confident staff would respond to any request for changes in the way their needs were met and to their personal care routines.

People expressed satisfaction with arrangements for meeting their heath needs. They saw their general practitioner, district nurses and other professionals, when necessary. They told us staff were supportive and responsive to their needs and felt they must be appropriately trained. People said there was a choice of meals though satisfaction with catering standards was mixed. They told us the home was always clean and hygienic and found it comfortable and suitably equipped. People were aware of how to make a complaint and felt safe. They said they would talk to their carers, staff or the registered manager if they had a complaint or concern. They felt confident action would be taken to resolve any problems.

People said the registered manager was approachable and the providers took an interest in their wellbeing. They appreciated the homely, stimulating “family” style atmosphere. One person said the home’s atmosphere was the reason why their relative had chosen this home, on their behalf, over others. They felt this had been the right choice. They told us the providers had been very accommodating to the extent they added an en-suite toilet to their bedroom, at no additional charge, before they moved in. They offered to do this, recognising the importance of this facility to their self esteem and wellbeing. They told us that from time to time the home’s management sought their views about the home. They felt their views and suggestions had been listened to and were valued.

This inspection took place on the 30 June and 1 July 2015 and was unannounced.

Sheerwater House is owned by Sheerwater Healthcare Limited. It is a privately owned care home providing accommodation for up to 20 older people. At the time of our inspection there were 16 people living at the service, 15 of whom are living with dementia. Nine people used specialist equipment to mobilise. The accommodation is over three floors that are accessible by stairs and a passenger lift.

At the time of our visit a registered manager was 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.

Staff had not ensured people were living in an environment that was always well maintained.

The provider and manager carried out a number of checks to make sure people received good quality of care. They undertook audits  to ensure people were receiving care that met their assessed needs.

However, we found not all records had been appropriately completed. For example, there were gaps in the medicine administration records and the daily notes were not accurate and up to date.

The previous inspection of the service found staff to breaching the regulations in regard to the management of medicines. During this visit we found staff had made improvements with the management of medicines.

Staff were aware of their responsibilities to protect adults at risk from harm or abuse and were able to tell us what they would do in such an event. People’s care would not be interrupted in the event of an emergency and people needed to be evacuated from the home as staff had guidance to follow.

Appropriate checks were made on staff before they commenced working at the home. This ensured that people were cared for by appropriately vetted staff.

Where there were restrictions in place, staff had followed legal requirements to make sure this was done in the person’s best interests. Staff had a clear understanding of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

Staff were provided with training specific to the needs of people who were living at the service. This allowed them to carry out their role in an effective way. It was evident staff had a clear understanding of the individual needs of people.

There were enough skilled and qualified staff deployed at the service to meet the assessed needs of people.

People were involved in choosing the food they ate and choices of meals were provided. An alternative option was available if people did not like what was on offer.

People were supported to keep healthy and had access to health care services. Professional involvement was sought by staff when appropriate. Relatives told us staff referred people to health care professionals in a timely way.

Staff supported people in an individual way. They planned activities individually with people so they did the activities they preferred to do. People and their relatives were involved in developing and reviewing of their care plans.

The provider encouraged people and relatives to feedback their views and suggestions about how to improve the service. Complaints were recorded and used to means to improve the service.

Staff felt supported by the manager and had regular team meetings where they discussed events at the service and how it was run.

We identified breaches in 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 the report.