Solway House

We found the following examples of good practice.

The staff team had ensured that only essential visitors were allowed into the service. People told us that they had contact with families by telephone or by using the home's I-pad. GP's and community nurses visited and followed all the relevant guidance.

The service had good supplies of personal protective equipment (PPE) and staff were suitably trained to use this. Staff ensured the house was clean and that anti-viral cleaning materials were in use.

People told us they felt safe and well supported by the staff team. Good attention was being paid to the physical and emotional well-being of people in the home.

Staff told us that the provider, registered manager and the deputy ensured their safety and well-being during the pandemic.

People’s experience of using this service

People told us they felt safe. Staff had received suitable training about protecting vulnerable adults. Good arrangements were in place to ensure that new members of staff had been suitably vetted and were the right kind of people to work with vulnerable adults. Accidents and incidents were responded to appropriately.

Staff were appropriately inducted, trained and developed to give the best support possible. Team members understood people's needs and had suitable training and experience in their roles. Staffing rosters were reviewed if people's needs changed. The service employed enough staff by day and night to meet people's needs.

People saw their GP and health specialists when necessary. Medicines were suitably managed with people having reviews of their medicines on a regular basis. Staff took the advice of nurses and consultants. The staff team had good working relationships with local GP surgeries. Nutritional planning was in place and special diets catered for appropriately. People told us they really enjoyed the food provided.

Solway House is a period property that has been modernised and adapted to meet the needs of the 18 people living there. The house was warm, clean and comfortable on the day we visited. The home had equipment in place to support care delivery.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us the staff were caring. We observed kind and patient support being provided. Staff supported people in a respectful way. They made sure confidentiality, privacy and dignity were maintained.

Risk assessments and care plans provided detailed guidance for staff in the home. People in the service or their relatives, as appropriate, had influenced the content. The registered manager ensured the plans reflected the person- centred care that was being delivered.

Staff could access specialists if people needed communication tools like sign language or braille.

People told us they enjoyed the activities, interests and hobbies on offer. The home was very much part of the local community with lots of visitors and involvement in local activities.

The service had a quality monitoring system and people were asked their views in a number of different ways. Quality assurance was used to support future planning.

The registered manager understood how to manage concerns or complaints appropriately. There had been no complaints in this service.

Records were well organised, easy to access and stored securely.

Rating at last inspection: Good (March 2017).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Solway House is an older property situated in a residential part of Maryport. The home is near to all the amenities of the town and has views of the harbour and the Solway. The home has been suitably adapted and extended to provide a home for up to 18 older adults and for people living with dementia or other mental health disorders. Accommodation is in single rooms and there are suitable shared areas. The home has a pleasant garden for residents use.

The registered manager for Solway House had retired in October 2016 and the provider had appointed a new manager who was beginning the process of registration. 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 provider was very much in evidence in the home and had been managing the service during this interim period. She was helped in this task by an assistant manager who knew the service and the people living there very well. The registered provider also had another assistant manager who was supporting the systems building in the home.

We last inspected in October 2015 when we rated the service as requires improvement. We had judged that the location was in breach of regulations related to safe care and treatment, safeguarding, good governance, staffing, fit and proper persons employed and person centred care. The provider had also not always informed us of incidents in the home. We received an action plan from the provider shortly after the report was published and we judged that suitable action was being taken. You can see what action we told the provider to take at the back of the full version of the previous report which can be found by going to http://www.cqc.org.uk/location/1-109788014.

At this inspection we judged that all of the breaches had been met. We saw that the registered provider had put in time and resources to deal with the previous issues.

The registered provider and her team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and could talk to us about how they would identify any issues and how they would report them appropriately. Risk assessments and risk management plans had been improved on and these now supported people well. Good arrangements were now in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. Any accidents or incidents had been reported to the Care Quality Commission (CQC) and suitable action taken to lessen the risk of further issues.

The home had increased the staffing levels after the last inspection and the provider and her management team were keeping rosters under review as people's dependency changed. Staff were suitably inducted, trained and developed to give the best support possible.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. The team made sure that strong medicines and any sedation were kept under review with the local GPs.

The provider and her team were aware of their responsibilities under the Mental Capacity Act 2005 if they judged that people were deprived of their liberty for their own safety. Most people in the home were able to leave the building when they wished and had flexible lifestyle choices. People told us that their consent was sought for any interaction, where possible.

People in the home were more than happy with the food provided. The provider had been cooking for some weeks and a new member of the team was being sought. People told us that despite the lack of a cook the provider and her team still gave them "good home cooking". The kitchen had good stocks of high quality food in place. When staff were concerned about nutrition they called on health professionals and put a nutritional plan in place.

Solway House was an older property which people told us was a relaxed and homely place to live. There were nice touches around the home that made the environment comfortable for people living there. There had been on-going redecoration in the home and things like floor covering and furniture had been replaced as necessary. The provider had replaced windows in the house and was doing some work on fire safety and other areas to ensure the house remained a safe place to live and work in.

People who lived in the home and their relatives told us that the staff were extremely caring. We observed kind, patient and suitable care being provided. Staff knew people and their families very well. They made sure that confidentiality, privacy and dignity were maintained. People were encouraged to be as independent as possible. Staff had been trained in end of life care and we saw evidence to show that this kind of care had been done to good effect for many years.

Risk assessments and care plans had been developed and now provided detailed and relevant guidance for staff in the home. People in the service were aware of their care plans and were able to influence the content. The management team had ensured the plans reflected the person centred care that was being delivered.

We learned that the home had regular entertainers, activities and parties. Staff took people out locally and on trips within Cumbria. The team encouraged people to follow their hobbies and some people went out to art classes.

There had been no formal complaints received and people told us they felt able to complain and voice their opinions. The complaints procedure had recently been updated to good effect.

The management team checked on the quality of care and services on a regular basis. They had decided to create their own custom made system using guidance from a number of sources. We saw a list of quality assurance checks that were done which met with the aims and objectives of the service.

Recording was of a good standard with further improvements being planned. Records were easy to access and stored correctly. The provider had followed the relevant legislation about notifying CQC, the local authority and other bodies when there were accidents or other incidents in the service.

used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People were cared for in a clean and hygienic environment although further investment was required to refurbish parts of the home. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. They were also protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Is the service effective?

People were cared for effectively because the staff worked in conjunction with other providers to ensure people's needs were met.

Is the service caring?

People were cared for by warm and friendly staff who were knowledgeable about the people they cared for. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare

Is the service responsive?

Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who used the service and staff had been consulted with about changes and they had been listened to. The manager provided leadership and was aware of areas that required improvement.

'This is an excellent home. I have lived in the area all my life and all the girls (staff) are local. They keep me up to date with what is going on in the town. It is home from home here, a lovely family style situation.'

'I am pleased inspectors come to check we are well looked after. I can tell you this is a good home, excellent and we are very well catered for here.'

'It's lovely here, a real home from home. If I had to give marks out of ten I would give them 15.'

We saw that, and we were told by staff, that they were 'well supported' by the management team. They told us about the training they had completed and of the training planned. Staff told us that life at the home was like 'a big family.'

The staff told us that the manager and assistant manager were 'very approachable'. One person said, 'We can talk to them about anything and they listen and act on our comments.'

Another member of staff told us, 'We make sure that any concerns about residents are dealt with quickly. We are well supported.'

Following our last inspection of this service (March 2013), we had asked the manager to make improvements in some areas. We found that the manager had mostly carried out this work.

People had received assessments of their nutritional needs and those identified 'at risk' were closely monitored. If people's condition deteriorated, we found that the provider sought the help of health care professionals, without delay.

On the day of our visit we found the home to be clean, tidy and odour free. We did not receive any concerns about the cleanliness of the home from any of the people we spoke to.

We had asked the provider to make improvements to the way in which infection control and prevention was managed and monitored. We found that some improvements had been made. However, the provider's policies and procedures with regard to infection control and prevention were not up to date and did not refer to current good practice guidance. The home did not have effective systems in place to assess the risk of or to prevent the spread of infection.

We looked at the ways in which medicines were managed. Although some improvements had been made there were areas that needed attention. We found that some medicines were not stored appropriately and found items in the medication trolley that should not have been stored there at all. The provider needed to review their medication policies and procedures to make sure medicines were handled safely.

We spoke to some of the people that lived at Solway House. One of them told us 'It's not like your own home, but I am very comfortable here.' Another person said; 'if I have any problems I can tell the girls (care staff) or the manager. They listen to me and always sort things out for me.' People told us that 'the food is nice and there is always a choice' and 'I have my own room, which is very nice, I am very pleased with it'.

We spoke to a health care professional who was visiting the home at the time of our visit. They thought that Solway House was a 'good home, I have no issues or concerns about it. The staff know the residents very well and are very competent. They contact me when needed and always follow any instructions I leave for them with regard to people's care.'

We found that staff treated and spoke to people kindly and with respect. There was a happy and friendly atmosphere in the home and a good rapport between staff and the people that lived at the home.

We looked at a sample of care records. We found some evidence of care planning and risk assessment but the information recorded was not sufficiently detailed nor was it up to date to reflect people's current care and support needs.