The inspection took place on the 04 September 2017 and was unannounced. Sherrell House provides accommodation and nursing care to up to 92 people. People living in the service may have care needs associated with dementia. There were 79 people living at the service on the day of our inspection.

We carried out an announced comprehensive inspection of this service on 28 and 29 November 2016. We reported that the registered provider was in breach of the Health and Social Care Act 2008 registration and regulated activities regulations.

Regulation 18 Registration Regulations 2009 Notifications of other incidents

Regulation 11 HSCA RA Regulations 2014 Need for consent

Regulation 12 HSCA RA Regulations 2014 Safe care and treatment

Regulation 17 HSCA RA Regulations 2014 Good governance

Regulation 18 HSCA RA Regulations 2014 Staffing

We took enforcement action and served a Warning Notice against one of the more serious breaches that we found in respect of Regulation 13, section (1) (2), of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We gave the provider until 17 March 2017 to ensure they complied with the Warning Notice. We judged the service as "requires improvement" following the inspection of November 2016. You can read the report from our last inspection, by selecting the 'all reports' link for 'Sherrell House' on our website at www.cqc.org.uk.

We asked the registered provider to make improvements and they sent us a plan with the actions they intended to take. At this inspection, we found the service had made significant improvements and that all the breaches of regulation found in our visit in November 2016 had now been met.

A registered manager was not 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. The registered manager left the service in August 2017. A new manager had been appointed and was due to start in September 2017. A member of the provider’s senior management team was managing the service on an interim basis.

People felt safe living at Sherrell House. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed.

Robust recruitment procedures had been followed to reduce the risks of employing staff unsuitable for their role. There were sufficient numbers of staff deployed to meet people's needs.

Staff received comprehensive training to enable them to meet people's care and support requirements. We asked staff members about training and supervision. They all confirmed that they now received regular training and supervision throughout the year.

People were given support to take their medicines as prescribed. Daily checks were carried out by unit managers to ensure medicines were managed safely.

Nutritional needs were met and people were supported to access healthcare services if they needed them. People's health needs were closely monitored and any changes to their needs were immediately reflected in their care plans and the care that they received.

Accidents and incidents were recorded, analysed and trends identified. The provider had worked hard to significantly reduce the amount of falls occurring at the service.

We found staff understood the importance of gaining consent from people and when needed people's capacity had been assessed. When people were unable to make decisions these had been considered and made in people's best interests. Deprivation of liberty safeguard (DoLS) applications had been submitted by the service in order to ensure that people were not being detained without authorisation.

Care was delivered to people in a personalised way and information was shared with staff to ensure that they were aware of peop

This inspection was undertaken on 28 and 29 November 2016 and was unannounced.

Sherrell House provides accommodation and nursing care to up to 92 people. People living in the service may have care needs associated with dementia. There were 79 people living at the service on the day of our inspection.

A registered manager was not 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. The registered manager left the service in March 2016. A new manager had been appointed but has not yet made application to the commission as required.

People were not protected from the risk of harm. Risk management plans for individual people

did not support people's safety. Staff and management had not acted to protect people and safeguarding matters were not reported. People’s medicines were not safely managed and they were not protected from the risk of harm to their wellbeing.

Up to date guidance about protecting people's rights had not been followed so as to support decisions made on people’s behalf and to comply with legislation. Staff were not provided with suitable training and support to enable them to meet people's needs effectively. Staff performance was not suitably monitored and appraised to ensure good practice was in place.

There was a lack of clear management oversight and leadership in the service that had impacted on the quality and safety of the care people received. The provider’s quality assurance processes were not sufficiently robust or effective as they had not identified the failings in the service at an earlier stage to enable corrective action to be promptly taken. The provider had failed to notify the Commission of events as required.

Improvements were needed to recording aspects of the care and treatment people received, such as their food and fluids intake or application of their prescribed creams as well as to guidance for staff on how to support some areas of people's care. People’s opportunities to participate in social activities and meaningful engagement also needed to improve.

People were supported by sufficient numbers of staff to meet people's needs effectively and staff were safely recruited. Arrangements were in place to support people to gain access to health professionals and services. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences.

People living and working in the service had the opportunity to say how they felt about the home and influence the service it provided.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 16 April 2015.

Sherrell House is registered to provide accommodation for 92 older people who require personal or nursing care. People may also have needs associated with dementia. There were 67 people living at the service on the day of our inspection.

A registered manager was in post in 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.

Staff had attended training on safeguarding people. They were knowledgeable about identifying abuse and how to report it. Recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the home.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People felt their dignity and privacy was respected and they all spoke in a complimentary way about the kind and caring approach of the staff. Visitors felt welcome and people were supported to maintain relationships and participate in social activities and outings.

Staff were well trained and used their training effectively to support people. Staff understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

Care plans were regularly reviewed and showed that the person, or where appropriate their relatives, had been involved. They included people’s preferences and individual needs so that staff had clear information on how to give people the care that they needed. People told us that they received the care they needed.

The service was well led, people knew the manager and found them to be approachable and available in the home. People living and working in the service had opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response. The provider and registered manager had robust systems in place to check on the quality and safety of the service provided, to put actions plans in place where needed, and to check that these were completed.

We completed a responsive inspection of this service after receiving information of concern.

During our inspection, we spoke with nine of the 80 people who used the service. We also spoke with four visitors and five staff. We looked at six people's care records, staff rotas and information on areas of staff training. We also looked at records and the provider’s policy about safeguarding vulnerable people from abuse.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

People were cared for in a clean environment. People told us they felt safe living in the service. A visiting relative said, “I know [person] is safe here and feel happy to leave [person].” Another person said, “Staff show [person] kindness. If we had any concerns, we could speak to the staff and the manager."

We looked at the care records. Each person had a plan of care and associated risk assessments in place.

Staff were trained in recognising the signs of abuse and how to report this. The provider had their policy and procedure for protecting vulnerable adults from abuse on display so that people could access this information if needed.

Staff had also been trained in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

Care plans had recently been reviewed so as to have up to date information for staff on how to meet people’s needs. We also saw that people had been supported to access healthcare professionals such as the GP, community dietician and chiropodist.

People were supported to access activities that interest them.

Is the service caring?

People’s needs were met and their diversity and specific needs taken into account when providing their care. People told us they were happy with their care. One person said, "The staff are nice, they talk to me nicely, I feel safe with them."

Is the service responsive?

We spoke with people who used the service and visiting relatives about the care and support provided at the service. All of the people we spoke with told us overall that they were satisfied with the care they received. One person and their relative said, “The food is lovely and the staff are absolutely perfect. I am very happy with how they look after [person]. I have peace of mind.” Another person told us that staff gave them the care they needed and helped them to reposition themselves regularly.

People were not always supported well when they had their meals. Some people required additional support to eat their meals and staff had not responded effectively to meet these people’s needs in a timely manner.

Is the service well-led?

Where incidents occurred, these were recorded and fully investigated in line with the provider’s policy. Actions were taken as required to ensure that events did not re-occur.

People told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to. One person said, "The staff are nice, they talk to me nicely, I feel safe with them."

At our inspection in July 2013 we found that effective arrangements were not in place to gain and review consent from people who lived at Sherrell House. When we inspected the service in November 2013, the provider was able to demonstrate that they had taken steps to address the identified shortfalls. We found evidence that up to date appropriate assessments of people's mental capacity had been completed.

During our visit to Sherrell House on 12 July 2013 it was clear staff had a good relationship and communicated well with people living in the home. Where people were unable to provide a verbal response or tell us about their experiences we saw that staff interacted positively with them, supported them respectfully and explained what they were doing to give reassurance to them.

Even though the majority of staff had been trained in the Mental Capacity Act, we saw no evidence that up to date appropriate assessments of the mental capacity of the people had been carried out.

People could spend time how they wished, with some choosing to sit in their own rooms, or in one of the lounges, which were situated on each floor. There was a varied, daily programme of activities.

People told us they enjoyed the food at Sherrell House. One person said, "The food is nice. If I don’t want what’s on the menu, I often don’t fancy a full meal, they’ll do me a sandwich or some soup instead.”

We saw there was a complaints policy and procedure in place and on display in the reception. The procedure was clear and informed people how to complain and when they could expect their complaint to be dealt with.

People who were able to express their views verbally said they had been asked about their preferences and interests and felt that these had been respected when they moved into the home. They also told us that they felt their privacy and dignity were respected at the home. People told us that they had been able to bring some of their own things to make their rooms more homely and personal. They also told us that the home was kept clean and that it always smelt nice.

People told us they received care and support that met their needs. One person said, "I wasn't sure what to expect and wasn't keen to come. The staff are great, really great and the care is actually fine. There are plenty of activities, the activity coordinator is wonderful; she really is. We have a choice of drinks and meals, where to go, what to do and what time to go to bed and get up. People here listen to me."

People who were able to verbally express their views confirmed they felt safe at the home and that staff treated them with respect. One person said, “I definitely feel safe and confident here, the staff do treat us well and are ever so nice.”

People we spoke with told us that staff were available when they needed them and that staff responded within a reasonable time if they used their callbell. People told us that staff were, “nice”, “helpful” and “approachable.” One person said, “The staff are very good, they work really hard and do a good job.”

Some people were unable to provide a verbal response or tell us verbally about their experiences as a result of their limited verbal communication or poor cognitive ability. We spent time observing and noted their non verbal clues. These indicated that people were relaxed and comfortable and found their experience at the home to be positive.

People using the service who were able to express views verbally told us that they were generally satisfied with the care they received at the home. They told us they felt safe and spoke positively about the staff who supported them. Relatives and visitors spoken with did not always share this view about care provided or staffing levels. Some people felt that the person’s care was not well managed or that there were regularly not enough staff on duty to meet people’s needs and keep people safe. One relative of a person using the service told us that they were concerned about the level of training in dementia care provided to staff.

Those people we spoke with who were living at Sherrell House also had different views about whether there were enough staff available to meet their care needs and preferences. Some people said that staff responded to a call for assistance within reasonable times and they could get up when they wanted. Other people told us of different experiences. They told us that the time they waited for staff to assist them varied. One person told us they were woken up very early in the morning and had never been asked if this was their preference, another person felt they could not have a bath instead of a shower as there were not enough staff for this.

One person with whom we spoke during our inspection told us of concerns with the consistency of management at the service. They said that in just over one year there have been six different managers. They also added that they are "not very impressed with the new manager, they remain in the office with the door shut and I have never seen them out on the floor around the home." Dissatisfaction was also raised about the turnover and changes of staff and the level of use of agency staff as this did not provide familiar faces to people using the service and promote consistency and continuity of care.