Salt Hill Care Centre

Updated 20 September 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, 1 pharmacist inspector, 1 specialist advisor and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Salt Hill Care Centre is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, they were not working in this capacity and had not submitted their application to de-register. The provider had recruited a new manager who had applied to become the registered manager.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 5 July 2023 and ended on 22 July 2023. We visited the service on 5 July 2023. An inspector conducted staff telephone interviews on 12 July and 22 July 2023.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. Feedback of concerns about the service was received from local authorities and was included in the planning of this inspection.

During the inspection

We spoke with 8 people, 2 care workers, 2 senior carers, registered manager, operations manager, 2 directors and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked in detail at 10 care plans, 11 medicine administration records, 5 staff recruitment files and the service's staff training matrix. We looked at a variety of records relating to the management of the service, this also included the service's policies and procedures.

Updated 20 September 2023

About the service

Salt Hill Care Centre can accommodate up to 53 people (including couples) and provides nursing care, personal care and respite care to older and younger adults living with dementia, physical disabilities, learning disabilities and mental health support. At the time of our visit there were 29 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

There was not a high incidence of falls in the service. However, risk assessment processes required further improvement.to protect people from avoidable harm.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not always seek or consider partnership working with all specialist health and social care professionals and external agencies. Further work was needed to provide effective care and support to autistic people, people with learning difficulties, people living with dementia and people who were semi-independent.

People and relatives said their family members were safe from abuse and protected from the risk of infection. Staff records confirmed they had received training and they were appropriately inducted and supervised. There were enough staff deployed to provide care and support to people. People’s nutrition and hydration needs were met.

Right Care:

The provider did not always refer to nationally recognised guidance when developing care plans for autistic people, people with a learning disability, people living with dementia and people who were semi-independent.

The provider did not work in line with the Accessible Information Standard, to meet the communication needs of autistic people and, people with a learning disability and people whose first language was not English.

People and relatives described staff as caring, compassionate, thoughtful, and patient.

Care plans were now more person-centred as they provided detailed information about people’s life stories and preferences for care. Improvements were made to make it a dementia friendly environment.

Right Culture:

Further improvements were required in relation to the provider’s quality assurance systems, around the auditing of administration of medicines, care planning, assessing and managing risks, communication, and obtaining people’s consent.

The provider did not always operate effective systems and processes to make sure they assessed and monitored the service against all regulations.

The provider had introduced new quality assurance systems but it was too early for us to determine how effective they were. The management team were working hard to develop a positive and improvement driven culture.

Rating at last inspection and update

The last rating for this service was inadequate (published 11 October 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been in Special Measures since 10 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part due to concerns received by local authorities about ineffective management and to follow up concerns found at our last inspection of the service. A decision was made for us to inspect and examine those risks.

We found no evidence people were at risk of harm from these concerns. However, we found further improvements were needed in relation to management of medicines, assessing and managing risks, effective care planning, meeting people’s communication needs, need for consent and good governance.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.