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Inspection carried out on 17 February 2017

During a routine inspection

This was an unannounced inspection that took place on 17 February 2017 and we returned on 21 February 2017 to give feedback and look at some of the documents we had not seen on the first day of inspection.

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

Inspection carried out on 12 October 2015

During a routine inspection

The inspection took place on 12 October 2015 and was unannounced.

Solway House is situated in a residential area of Maryport, close to the town centre with views over the sea and harbour. It is registered to provide accommodation and personal care for up to 18 people, some of whom may have dementia. The home is an older style property adapted for use as a care home. Accommodation is provided over two floors, in single bedrooms but the home does have one double room.

There is a registered manager at this 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.

We spoke to five of the people that lived at Solway House and one of their visitors. Everyone we spoke to told us that they were “very happy” or “very satisfied” living at this home. People told us that the staff were “very good” and looked after them “very well”.

Everyone we spoke to told us that they had never seen anything at the home to cause them concern. They also said that should they have any concerns, complaints or issues, they knew who to speak to about them. People told us they were confident they would be listened to and that actions would be taken by the staff and management.

The home was clean and free from any unpleasant odours. The provider showed us some of the environmental improvements that had been made at the home and told us about the plans for further improvements for Solway House.

We observed staff supporting people who used this service. The staff were kind, polite and acted very discreetly when helping people with their personal care needs. The people who lived at Solway House appeared well groomed and cared for. The staff were very attentive to people’s needs without compromising independence. The atmosphere at Solway House was warm and friendly. Visitors were made welcome and people could meet their visitors in private if they wished.

At the time of our visit to Solway House, there were a sufficient number of staff available to support people with their needs. However, we found that there were times when there were not enough staff on duty.

We found that there were a considerable number of unwitnessed falls at the home which had resulted in people being injured. We found that risk assessments lacked information and had not been reviewed and updated following any incidents. These actions would have helped identify and reduce the risks of the accident happening again.

The sample of staff recruitment records we looked at showed that the provider had not followed safe recruitment practices. There were gaps in the pre-employment checks and the manager told us they were not aware of the requirements of this regulation.

We observed some poor practices used by staff during our visit. These included poor moving and handling techniques and infection control practices. We were told that the person carrying out risk assessments did not have the skills and knowledge to carry these out effectively. We spoke to the manager about these matters during our inspection.

The records showed that staff had received some training about the Mental Capacity Act 2005 but we found that there was a lack of understanding. We noted that the principles of the Mental Capacity Act 2005 Code of Practice had not been followed when assessing people’s ability to make a particular decision or when placing restrictions on their liberty.

Although staff were able to tell us about the care and support needs of people living at Solway House the care plan records contained little information and guidance in relation to people’s needs. Some were out of date and this placed people at risk of receiving inconsistent and unsafe care.

The provider had system in place to help monitor the standard and quality of the service but this was not effective. There were gaps in staff personnel records and people’s personal care records were out of date. Accidents and incidents had not been routinely reviewed and evaluated to help identify and reduce potential risks to people who lived and worked at this service.

We checked the information we held about Solway House and compared this with the events and incidents we found recorded at the home. We found that some of the incidents should have been reported to us (CQC) but the provider had not done so. The registered manager told us that they were not familiar with the requirements of this regulation.

We looked at the way in which people were supported with their medicines. We found that medicines were generally well managed and people received their medicines as their doctor intended. The use of when required medicines could be improved to help ensure these types of medicine are used and monitored safely.

The people we spoke to during our visit to the home told us that the food and the cook at the home were very good. We observed the serving of the lunchtime meal and spoke with the cook. People were able to make choices about what they ate. People told us that they had been supported by staff to help manage their weight. However, this type of support was inconsistently provided and where food and fluid intake needed to be monitored, records were poorly maintained.

People who used this service were able to speak directly to the manager and provider of this service on a daily basis. However, there were no formal processes in place for people to comment on their experiences and of how the service was run.

We have recommended that the service seeks guidance about assessing and managing the nutritional needs of people who use this service.

We have recommended that the service seeks advice and guidance about supporting people to express their views about the quality of services they experience.

We have recommended

that the service considers current guidance on the management of some medicines.

We found breaches of the following regulations:

Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because care and support had not been personalised to meet people’s individual, changing needs.

Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider had not taken adequate action to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm.

Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014. People who used this service were not protected from improper treatment.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that the provider did not have systems in place to ensure the quality of the service and compliance with the law.

Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. People who used this service were exposed to the risk of harm because staff did not have up to date skills and knowledge to work safely.

Regulation 19 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The staff recruitment process was not robust and the provider could not be certain that only fit and proper people were employed to work at the home.

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

We also found breaches of Regulation18 of the Care Quality Commission (Registration) Regulations 2009. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

Inspection carried out on 12 August 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We

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.

Inspection carried out on 20 February 2014

During a routine inspection

We spoke to a third of the people who used this service. All of them were very complimentary about Solway House and the care they received. Some of the comments we received from people living at Solway House included the following:

“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.

Inspection carried out on 7 March 2013

During a routine inspection

Two visitors that we spoke to told us that their relative had received “excellent care”, they added that their relative was cared for in bed and “does not have bedsores, they are very well looked after.”

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.

Inspection carried out on 7 December 2011

During a routine inspection

We were able to speak to residents and relatives and all the comments were extremely positive. They included.

"I love living here and the staff are so kind".

"I love all the girls, they are like my own family".

"We get lovely meals with lots of home cooking".

"Living here is like being at home and it is always lovely and warm especially in the winter".

During our visit we observed the provision of care and found it to be professional, warm and appropriate.