• Care Home
  • Care home

Sherwood Lodge Independent Healthcare

Overall: Requires improvement read more about inspection ratings

29-31 Severn Road, Weston Super Mare, Somerset, BS23 1DW (01934) 631294

Provided and run by:
Garry and Jane Blake

All Inspections

27 April 2023

During an inspection looking at part of the service

At the previous inspection in May 2022, Sherwood Lodge was rated inadequate overall and placed in special measures. This comprehensive inspection was conducted to check that the improvements the service had detailed in their action plan to the commission had been undertaken. The inspection was unannounced and covered all key lines of enquiry.

Our rating of this service ​improved​ from inadequate to ​requires improvement​ and the special measures were lifted because:

  • The environment had been improved since the previous inspection. The service had almost completed works on bedrooms, such as removing partition walls, and residents had been moved into single-sex bedroom corridors to ensure privacy and dignity.
  • Staff were now completing comprehensive, and individualised assessments of people’s needs and all residents had a completed and up to date personal emergency evacuation plan. Risk management plans were up to date and included appropriate details relating to people’s risk. Staff knew about resident’s known risks and how to act to prevent or reduce risks.
  • All staff we spoke to understood how to recognise and report potential abuse and the service worked with other relevant agencies to protect residents from abuse. All staff had completed safeguarding training. The service was now submitting relevant notifications to external organisations, including the local authority and the Care Quality Commission, in a timely manner. This was an improvement from the previous inspection.
  • Staff were reporting all incidents and managers investigated, identified learning and shared with the team. This was an improvement from the previous inspection.
  • All staff were now completing care records that were up to date and easily accessible to all members of staff. Residents were encouraged to be involved in their care planning. Residents had regular access from a wider multidisciplinary team and this was now documented within care records. Residents and their loved ones were invited to take part in reviews. Verbal and written interactions with residents were respectful, supportive and person centred. This was an improvement since the last inspection.

However:

  • Governance processes still required further improvement. Systems in place to assess, monitor and improve the quality and safety of the service were not always effective. There was a limited audit schedule, some audits were completed adhoc or hadn’t been regularly repeated, such as the weekly management of medicines audit did not include a check of all medical sundries and first aid supplies and a closed culture audit did not include all necessary questions.
  • Staff provided a limited range of care and treatment suitable for the residents in the service and care plans were not mental health recovery orientated and did not reflect personalised goals. Management had reviewed National Institute for Health Care and Excellence (NICE) guidance and identified which guidance was relevant to the service however this has not been addressed in a model of care for the service. The service provided activities, but they were not meaningful. Three out of the four relatives we spoke to said that the service wasn’t “very lively” and “everyone just sits all day in the lounge”.
  • At the time of inspection, staff did not have access to policies which may have aided the running of the service and the manager was unable to provide assurances that staff had appropriate employment checks in place, such as valid disclosure and barring service certificates. This was because essential documentation and confidential staff files had been removed from the service to the provider’s home address. However, we returned at a later date to review staff files and found employment checks in place
  • There were still several blanket restrictions in place but had no policy to ensure restrictions were proportionate, necessary, and least restrictive in line with the Mental Health Act Code of Practice. The blanket restrictions poster did not detail all restrictions in place and restrictions were not discussed as part of community meetings to ensure residents were aware of them. This included limited access to bedrooms, which some residents did not have their own keys for and could only access with staff support.
  • Not all staff had received regular supervision or completed mandatory training.
  • Some communal areas required further improvement and two bedrooms remained with a partition wall. There was still limited room and facilities to support therapeutic activities, for example a private area to meet with keyworker one to one. . Outside space had limited green space but had raised flower beds. Relatives we spoke with commented on the environment, stating it was run-down, grubby and required a freshen-up.

24 May and 1 June 2022

During a routine inspection

Sherwood Lodge independent hospital provides community rehabilitation for adults with mental health disorders, some of whom may be detained under the Mental Health Act 1983.

During our inspection we raised a number of concerns with the provider and asked that they take action to make immediate improvements. For example, to the environment, equipment and the way risks were assessed for patients and how care was planned.

As a result of the significant concerns identified during the inspection, we wrote to the provider to seek immediate assurances about the safety of those using the service. We advised them that if there was not significant improvement in the safety of care, we would take enforcement action to ensure they address the issues. The provider submitted an action plan describing what it would do to improve and sent us some information to show what actions had been taken. Although we were assured that patients weren’t at immediate risk of harm there is still much for the provider to do to ensure improvements continue and are embedded. We have also identified that the environment needs significant attention to ensure it can meet the needs of patients going forward. The environment is currently not fit for purpose.

As a result of our concerns we have rated the service as inadequate and placed it in special measures. We will continue to monitor the service closely.

Our rating of this service went down. We rated it as inadequate because:

  • The environment and equipment were not well maintained. There was broken furniture and other damaged items throughout the premises. The clinic equipment was overdue calibration and a service. Staff had not completed comprehensive assessments of patient needs to ensure the suitability of the environment and allocation of upstairs bedrooms.
  • The environment was not fit for purpose and it was difficult to see how staff, despite their best efforts, could provide contemporary community rehabilitative care in this environment. Many bedrooms were very small, some only a single bed length, with limited space to move around next to the bed and furniture. Bedrooms had partition walls in place to create single rooms. The partitions did not reach the ceiling to allow for natural light to enter the side of bedrooms without windows. However, this did not allow for the maintenance of privacy or dignity and patients without access to the windows could not control light or ventilation independently. There was limited room and facilities to support therapeutic activities. Outside space on site was limited to a courtyard that was generally used by those who smoked. There was limited green space and no separate space for those who did not smoke.
  • The service did not always comply with same sex accommodation guidance. Staff were unclear on how same sex accommodation was maintained and the bathroom facilities did not allow for suitable gender separation.
  • The service did not ensure that risk assessment and risk management processes kept people safe. Patients did not have contemporaneous and robust risk assessment and management plans. Most staff had limited involvement in the development of risk management plans and were not clear on the actions they should take to manage or reduce risk.
  • Staff imposed some restrictions on patients without a clear rationale. This included limited access to bedrooms, which some patients did not have keys for and could only access with the support of staff. The service had also imposed financial charges on a patient for damages caused when they were experiencing challenges with their mental health or behaviour without clear rationale and an agreed plan of care in place.
  • Staff and managers did not always recognise and report potential patient abuse, and patient safety incidents. Managers did not fully investigate incidents to identify learning and ensure patients were safeguarded against the risk of abuse.
  • Managers had not responded to a previous area for improvement highlighted during the last CQC inspection. Care records were difficult to navigate as documents were stored in different locations and files were over full. Staff did not have easy access to care records and were unable to locate the most up to date treatment and management plans. Daily handover records lacked detail and patient needs and risks were not clearly documented.
  • The service was registered to provide rehabilitation and recovery to patients, including those detained under the Mental Health Act but the model of care was not clear. The provider stated that they used the Recovery Star model, but this was not clear in care plans. Consequently, patients who should be supported to move on to a less restrictive environment were not receiving the support necessary for their rehabilitation.
  • Managers had not ensured that patients had easy access to multidisciplinary professionals including occupational therapists and clinical psychologists in line with a rehabilitation and recovery model of care.
  • Most staff were not involved in the review of care and treatment plans and these were not updated regularly. Patients and carers were not always involved in the development or review of care plans and in care decisions.
  • Working relationships with the GP surgery had broken down and managers tended to access out of hours service for physical health support rather than accessing support from their local surgery.
  • Managers did not implement effective governance processes, that aligned with a rehabilitative model of care, to ensure that performance, quality and risk were managed well.

However:

  • Families told us that staff supported, informed and involved them in their family member’s care and patients said they were happy at Sherwood Lodge.
  • Staff were generally committed to delivering kind and compassionate care, and it was clear that the majority genuinely cared about patients.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff felt supported by their peers and the leadership team.

08 May 2018

During a routine inspection

We rated Sherwood Lodge Independent Healthcare as good because:

  • Significant improvements had been made since our inspection in 2015. This included taking action to address the issues we had raised in the previous report.
  • The provider had carried out extensive refurbishments to ensure the environment was safer for the patients.
  • Staff managed risk well. All staff knew the patients and shared risk issues with each other on a day to day basis.
  • Male and female sleeping areas were now segregated in accordance with guidance on same gender accommodation.
  • The provider ensured they carried out their statutory duties of informing the Care Quality Commission of when a safeguarding concern was raised.
  • The service had updated policies and procedures related to the Mental Health Act (1983) Code of Practice. Staff monitored use of section 17 leave on an ongoing basis.
  • Staff were caring, respectful and supportive, and we received positive feedback from patients, carers and stakeholders.
  • There were governance processes in place to ensure more robust oversight of the service.
  • The service was well-led. The clinical manager was visible and ensured the needs of the patients were a high priority at all times.

However:

  • Some care plans did not contain risk information and some risk assessments were not regularly updated.
  • Some clinical records, particularly belonging to those subject to detention under the Mental Health Act (1983), were full and difficult to navigate.
  • Staff did not always inform patients of their right to an independent mental health advocate.

4 and 5 November 2015

During a routine inspection

We rated Sherwood Lodge Independent Mental Healthcare as requires improvement because:

  • fixtures and fittings were in need of attention. Floors in some areas were slippery following cleaning during our visit and staff had recorded a high level of slips and trips through incident reporting
  • staff documented and monitored risks poorly. This was particularly for patients detained under the Mental Health Act 1983 where a higher level of monitoring and risk management would be expected. There was no systematic means of recording risk or mental state when patients took or returned from daily Section 17 leave as the home had an open door policy
  • male and female sleeping areas were not segregated in accordance with Department of Health guidance on same sex accommodation. Although a bathroom separated the genders they were in very close proximity on the upper floor.
  • The provider were not providing statutory notifications of abuse or allegations of abuse to the Care Quality Commission
  • There was very little acknowledgement of the potential for dignity to be compromised. Some windows facing an outside smoking area had open curtains. This displayed room contents and personal belongings
  • the service had not updated all its policies and procedures in line with the revised Code of Practice related to the Mental Health Act 1983 so compliance with the Act was poor, including patients being allowed leave without daily risks or mental state being documented
  • there was no formal governance framework or system to make sure staff learned lessons following investigation of incidents of harm or risk of harm.
  • the risk register was very limited. It did not address operational or environmental risks.

However,

  • we observed staff engaging in warm, caring and kind interactions with patients and staff appeared to be genuinely concerned for the welfare of their patients
  • staff showed very good understanding and knowledge of the patients including individual risks
  • We were told there was a good relationship with the community and management plans were in place with the police
  • patients were able to raise issues and were involved in house meetings. Feedback from patients and carers was generally positive
  • there was access to the acute mental health ward if patients experienced deterioration in mental state
  • there were efforts made to provide a homely environment and atmosphere. Patients could access quiet areas in the home away from communal areas to relax if they wished
  • we saw a full activity programme timetable. During our inspection we saw patients joining in with activities such as foot spas and artwork. Staff we spoke with were enthusiastic about their activity programme
  • staff morale appeared good. Staff told us they enjoyed their work and were able to contribute to the service.

5 August 2014

During an inspection in response to concerns

We looked at the files for five people who use the service. In four of the five we saw the new paperwork titled “about me” had been completed. This was easy to follow and gave a good account of the background and current needs of the person which they had signed to show agreement.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Care plans were person centred and included information about all areas of the person's life including their health, personal and social care needs.

We spoke with all staff on duty during our visit and found a good level of knowledge about safeguarding and the ability to apply this knowledge to the people in their care. We observed staff intervening in a positive and respectful manner when people became agitated with each other. The language used by staff was kind and respectful.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

30 January 2014

During a routine inspection

Patients' health care needs had been monitored and responded to appropriately. Information about patients' health needs and contact with health care professionals had been recorded. We were informed that the service received “good support” from healthcare professionals and there were no problems obtaining their input for patients when required.

Patients were protected against the risks of receiving unsafe or inappropriate care. We read three care plans. These contained assessments of need and provided staff with information about the care and support patients required.

The staff we spoke with were knowledgeable about the procedures to follow should a patient go missing or, in the case of detained patients, fail to return to Sherwood Lodge within agreed timescales. We were shown the records for a detained patient who had gone absent without leave. Records demonstrated that staff had responded promptly and had informed appropriate authorities, which included the police.

We were informed that staff turnover was low and agency staff were only used “where absolutely necessary.” This meant that patients were supported by staff who knew them well. We spoke with three members of staff. None expressed any concerns about staffing levels or about their ability to meet patients’ needs. Comments included “I think staffing levels are good here. It’s never a problem” and “I’ve never experienced any problems and we get to take patients out a lot.”

Systems were in place to ensure that staff received appropriate levels of support. Staff were very positive about the support they received and they confirmed that they received regular supervision sessions.

Sherwood Lodge had been converted from two large Victorian houses many years ago. The design and layout of the home would not be appropriate for patients with limited mobility. Access to upstairs bedrooms was via stairs and the service did not have a lift.

Sherwood Lodge provided accommodation for up to 24 patients. Two years ago partition walls were built in four double rooms to provide patients with more privacy. This resulted in three bedrooms not having the provision of a window. These bedrooms only received natural light because the wall partitions were not to ceiling height. We found that these bedrooms provided limited space for patients. Patients did not raise any concerns with us about their accommodation and the provider informed us that patients had been involved in the decision to convert double bedrooms to single rooms. Patients had also been able to choose the decor for their rooms.

Patients were provided with opportunities to express a view about life at Sherwood Lodge. Patients attended regular meetings where they could discuss a range of topics. Patients had been able to discuss activities, social events and meal options.

8 February 2013

During a routine inspection

Patients told us that they were involved in discussions about their care and support. We saw that patients had access to information about how they could access independent advocates. Patients were told of their rights of appeal under the Mental Health Act.

We found that staff had supportive, respectful and professional relationships with patients. Patients we spoke with confirmed that their right to privacy and independence were respected.

There were comprehensive assessments of patient's mental health needs. There were limited assessments which identified the patients health and social care needs and reflected a person centred approach. The provider had made sure that staff had accurate details about organisations they could get in touch with if they had concerns about the service.

We found that the provider had appropriate arrangements in place for management of medicines. There were accurate administering records. Patients rights were protected which made sure that their treatment was appropriate and safe.

Patients told us they felt able to make a complaint if they wished. There was a lack of information available to patients about how to make a complaint.

Staff we spoke with told us they were well supported. We found that managers and nurses were approachable so that staff felt able to ask for advice and support when they needed it.

23 November 2011

During a routine inspection

Patients told us how well supported they were with their mental health needs by the staff team and the manager. We were told 'It is lovely here the manager is a very nice person'. 'It's nice here they look after me'. 'I don't want to be here but its much better then the place I came from' and 'Sherwood Lodge is a happy family environment'.

Patients were treated with respect and were supported in their recovery from long term mental health problems. We met some patients at Sherwood Lodge who were being cared for under a section of the Mental Health Act. This meant the Mental Health Act was being used to gain legal permission to give patients compulsory assessment or treatment. We found patients under a section were properly supported and they had their legal rights maintained.

Patients were involved in planning the care and support they needed. The care plan records explained what support patients needed clearly and were informative. There were risk assessments records about patients which clearly showed actions to be done to keep them safe as well as to protect other people. Patients under a section were helped to understand their treatment regime, as well as the reasons why it had been decided they must stay there for their safety and /or the safety of others.

Patients were cared for by staff who had a good understanding of complex mental health needs. This meant patients received care from staff who understood the support and treatment they needed.

There were systems in place to review and learn from all critical incidents and occurrences that may have impacted on patients' wellbeing. Patients were involved in monitoring and reviewing the quality of treatment and the service they received.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.