Enter and view: Lady Sarah Cohen House (Second visit)

Healthwatch Barnet carried out an unannounced follow-up Enter and View visit to Lady Sarah Cohen House on 16 February 2017. The purpose of the visit was to review progress against recommendations made during a previous inspection in May 2016 and to gather feedback from residents, relatives and staff.

Overall, Healthwatch found that the manager and staff had taken the previous recommendations seriously and were working hard to improve the quality of care. The manager, who had since been appointed permanently, was using the earlier recommendations as part of her development plan for the home. 

The home had taken steps to strengthen staffing arrangements. Two additional nurses, an additional care manager and nine care assistants had been recruited, although some appointments replaced staff who had left. A dedicated member of staff had also been employed to support carers whose first language was not English, and student nurses were undertaking placements at the home. Management reported efforts to reduce reliance on agency staff and improve staff retention. 

Despite these improvements, some relatives continued to express concerns about staffing levels and the impact on residents. While one relative praised the excellent end-of-life care provided to their family member, others felt some residents with dementia were not receiving enough mental stimulation or timely assistance. One relative reported that a resident occasionally missed activities because staff were unable to support them at the required time, while another felt there were fewer volunteers and less support available at weekends. 

The report found that staff supervision arrangements had improved. Instead of receiving supervision every two months, staff were now receiving monthly one-to-one supervision linked to their annual appraisal process. 

Healthwatch also examined progress on care planning. The home had increased efforts to involve relatives, used a “resident of the day” approach to review care in detail and was exploring the introduction of electronic care plans. However, some relatives reported that they had not been contacted about reviewing care plans and were unclear about who their family member’s key worker was. The manager acknowledged that the care planning review process was not always well understood by relatives and required better explanation. 

Improvements had been made regarding the use of televisions in communal areas. Televisions were no longer routinely switched on during breakfast and music was played instead. During the visit, Healthwatch observed only one television in use, with a resident choosing to watch it. 

Concerns about GP services remained. The home had increased GP support through additional visiting doctors, but two of the three relatives spoken to during the visit continued to express dissatisfaction with the attitude and responsiveness of the GP service. 

Progress had also been made in supporting residents with hearing loss. The home had commissioned specialist support from the Jewish Deaf Association and provided hearing-related training for staff.

Hydration monitoring had improved following the previous inspection. New water jugs had been purchased to ensure residents had access to drinks, and the manager reviewed daily reports on residents who required fluid monitoring charts. Some relatives nevertheless continued to raise occasional concerns about access to drinks. 

The manager had worked to improve communication with relatives by adopting an open-door approach, moving her office to a more visible location on the ground floor and regularly interacting with residents and families. Notices promoting access to management had been displayed throughout the home. 

Other issues raised during the visit included concerns about laundry services and missing clothing, a temporary lift outage and suggestions that residents might benefit from visits by therapy animals. The home indicated that it planned to trial visits from a specially trained dog.

Overall, Healthwatch concluded that Lady Sarah Cohen House had made positive progress since the previous inspection and that many improvements had been implemented. However, some relatives continued to report concerns about whether all residents’ personal care, emotional wellbeing and activity needs were being consistently met.