We carried out a review of the data available to us about Saltwood Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Saltwood Care Centre, you can give feedback on this service.
Saltwood Care Centre is a residential care home providing personal and nursing care for up to 68 people. The service provided support to people living with a range of health and care needs, including brain injuries, diabetes and people living with dementia. At the time of our inspection there were 60 people using the service. The service was arranged across four levels with lift access.
People’s experience of using this service and what we found
People told us they felt safe and were happy living in Saltwood Care Centre. One person said, “All the staff are very attentive; I have a button so I can call anytime. I have no concerns at all.” Another person said, “The staff are lovely. There is no ‘must’ in this care home, it is all down to you and what you want to do.” Relatives agreed their loved ones were safe and happy. One relative said, “Personally, I could not fault their care. On the whole I am very pleased with the service.” Another relative told us their loved one was safe because, “There are always staff around and at night there is a safety mat by the bed; if there’s an issue they always ring me.”
Most of the time there were enough staff deployed to meet peoples’ needs. People received safe care and treatment from staff who knew them. Medicines and infection control were both managed safely, and lessons were learned when things went wrong.
People were involved in decisions about their care and they received care which promoted their dignity, encouraged independence and was person centred. One person told us, “I have photos on the wall that they take down to clean and they always put them back in the same place. These memories are important to me.” Most relatives said they were involved in their relative’s care plans and were kept up to date with changes.
Effective quality assurance processes were in place to monitor the service and regular audits were undertaken. Staff had received appropriate training and supervision. A new manager had been appointed since our last inspection and staff told us they found them approachable and supportive with an open-door policy.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 5 February 2018).
Why we inspected
This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well led. This enabled us to look at the concerns raised and review the previous ratings. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good based on the findings of this inspection.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saltwood Care Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
Visiting arrangements followed government guidance. Visitors telephoned to arrange a time; they were asked to complete a COVID-19 test before entering the service.
Visitors could spend time with their loved one in their rooms and there was no time restriction. There were additional arrangements for visitors if there was a COVID-19 outbreak within the service. This included a separate room with direct access from the outside, so visitors did not come into the service.
Plans were in place to isolate people with COVID-19 to reduce the risk of transmission. There were enough supplies of personal protective equipment (PPE) throughout the service that staff could access quickly.
Staff had received training in infection control to keep people safe. Staff completed regular testing for COVID-19 in line with government guidance. The building was clean and odour-free.
Staff supported people to maintain relationships following guidance.
Saltwood Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Saltwood Care Centre accommodates 68 older people in one adapted building. There were 49 people using the service at the time of our inspection.
The registered manager had started work at the service in January 2017 and people and staff told us they were approachable and supportive. 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.
At the last inspection on 13 September 2016, we asked the provider to take action to make improvements to the way they manage infection control and medicines, and checked the quality of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well-led to at least Good. The provider had completed all the actions and the key questions, safe and well-led are now rated Good.
The provider and registered manager had oversight of the service. They had improved the checks and audits they completed. All areas of the service were checked regularly to make sure they met the standards the provider required. Any shortfalls were addressed and action was taken to make sure they did not occur again. The views of people, their relatives, staff and community professionals were asked for and acted on continually improve the service.
The way people’s medicines were managed had improved and was now safe. People received their medicines in the way they preferred and as their healthcare professional had prescribed.
The shortfalls in infection control identified at our last inspection had been addressed and regular infections control audits were completed to check the improvements were maintained. The building was well maintained and plans were in operation to continually maintain and improve the environment. The building and grounds were accessible to everyone.
Staff felt supported by the provider and registered manager, were motivated and felt appreciated. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be.
Staff were kind and caring to people and treated them with dignity and respect at all times. All the staff we spoke to told us they would be happy for their relatives to receive a service at Saltwood Care Centre. People told us staff gave them privacy. Everyone was encouraged and supported to be as independent as they wanted to be. The provider had begun to implement the Gold Standards Framework for end of life care and people received care in the way they preferred at the end of their life.
People told us they had enough to do each day and enjoyed a wide range of activities. People had been asked about their spiritual needs and attended services at Saltwood Care Centre. Church volunteers also joined in with activities and events at the service and were part of the community of the home.
People were not discriminated against and received care tailored to them. Assessments of people’s needs and any risks had been completed. People had planned their care and treatment with staff and received support to meet their individual needs and preferences. Accidents and incidents had been analysed and action had been taken to stop them happening again. The registered manager worked in partnership with local authority safeguarding and commissioning teams, to support and develop the service. They asked for advice when needed and acted on this to improve people’s care.
Changes in people’s health were identified quickly and staff supported people to contact their health care professionals. People were offered a balanced diet, which met their needs and preferences. Staff helped people who needed support at mealtimes to have as much independence as they wanted. People told us they were able invite their friends and relatives to have meals and celebrations with them and which they enjoyed.
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. The registered manager knew when assessments of people’s capacity to make decisions were needed. Staff assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.
Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider. Complaints were investigated and responded to.
There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.
Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service. Records in respect of each person were accurate and complete and stored securely.
Services are required to prominently display their CQC performance rating. The provider had displayed the rating under their previous legal entity in the entrance hall of the service and on their website.
This service was last inspected on 30 June 2015 when we found the provider was not meeting the regulations in regard to the management of medicines, storage of equipment, management of complaints, maintaining peoples care records, analysing feedback from relatives, using an effective quality monitoring system, and ensuring there were enough suitably trained staff. We asked the provider to send us a plan of action for addressing these shortfalls which they did. This inspection looked at whether the action plans had been implemented fully and improvements maintained.
The service did not have a registered manager in place. The registered manager had just left prior to the inspection and an interim manager was providing support. A registered manager is a person who is 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.
At the previous inspection we had highlighted that the quality monitoring systems in place were not adequate to give assurance to the provider that the service was providing good quality care. Since then an improved range of quality monitoring had been implemented to inform the interim manager and provider about how well the service was performing, however the shortfalls identified at this inspection indicate that some of the audits were not being completed robustly to give an accurate assessment of some areas to enable the provider to make improvements.
There had been improvement in the management of medicines but there were shortfalls where the dating on opening of all boxed and bottled medicines had not been extended to non prescribed and ‘as required’ medicines. Records of administration of prescribed creams were transferring to an electronic system and during this period paper records were not well completed and there was a risk during this period the frequency of administration needed was not happening, similarly protocols for the administration of ‘as required’ medicines lacked sufficient detail.
The decorative state of the laundry area made it difficult to keep clean and there was a risk of compromising good infection control standards. Sluices were left unlocked when not in use, this posed a risk of people accessing chemicals used in the sluice but harmful to their health. In all other respects the premises were clean and well maintained.
Staff had received fire training and understood fire procedures and the evacuation of the building, they attended occasional fire drills and we have recommended the provider seek further advice in regard to some of these arrangements.
At inspection there was no one on an ‘end of life’ care pathway. We have recommended that the provider implement a recognised end of life care model which they agreed to do at inspection.
People told us they felt safe and liked the staff that supported them. Most relatives told us they had no concerns about the service with a few saying they had some niggles but these did not detract from the overall good standard of care and support provided to their relatives. They felt confident in the quality of care but thought some aspects of communication from staff could be improved upon.
Staff were able to demonstrate they could recognise, respond and report concerns about potential abuse. They treated people with kindness and respected their privacy.
Since the last inspection staffing levels had been reviewed and a dependency tool was used to assess numbers of staff needed, this was kept updated monthly or sooner if some needs changed significantly. The interim manager recognised there was a need to look also at how staff were deployed to make more effective use of all those already on duty and this is an area for improvement. Recruitment processes ensured only suitable staff were employed. Staff received induction and a range of training to give them the knowledge and skills they needed. Staff felt listened to and supported, with opportunities to talk about their work performance and development.
People ate a varied diet that took account of their personal food preferences. Their health and wellbeing was monitored by staff and appropriate referrals were made to health professionals and support given to attend appointments when needed. People were supported to maintain their independence for as long as possible and at a pace to suit them.
Staff were guided in the support they gave to people through the development of individualised plans of care and support that also included improved information about how health needs were to be supported such as Diabetes. Risks were appropriately assessed to ensure measures implemented kept people safe. People were encouraged by staff to make everyday decisions for themselves, but staff understood and worked to the principles of the Mental Capacity Act 2005 (MCA) where people could not do so.
The complaints process had been reviewed and people and relatives told us they found staff approachable and felt confident of raising concerns if they had them. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The interim manager understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.
People said their needs were attended to by staff when and if they required it. People were supported to maintain links with the important people in their lives and relatives told us they were always kept informed of important well being changes.
People and relatives were routinely asked to comment about the service and improvements had been implemented to ensure feedback was collated and analysed to inform service development, this information was still to be published for people and relatives to see and there were plans for this to be added to the quarterly newsletter.
We have made two recommendations:
We recommend that the provider seek guidance from an appropriate competent source as to the frequency of fire drills for day and night staff and make adjustments to current frequencies as required to ensure these meet the requirements of fire legislation Regulatory Reform (Fire Safety) Order 2005.
We recommend that the provider consult with a competent person regarding the implementation of the Gold Standards Framework for end of life care.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We undertook an unannounced inspection of this service on 30 June 2015 and 1 July 2015. A previous inspection in May 2014 found there was a lack of guidance to inform staff about peoples care and support needs. At that time we asked the provider to tell us what action they would take to address this. They sent us a plan of action on 24 June 2014. We looked at what improvements had been made and found these had not been fully implemented or completed.
Accommodation is provided over four floors, accessed by passenger lifts. Up to 68 people can be accommodated in total, with 55 beds for people with nursing care needs provided on the basement, ground and first floors. A further 13 rehabilitation beds are available on the second floor. At inspection there were 63 people in total receiving a service. The rehabilitation beds are provided for people discharged from hospital who require additional therapy support to help them regain skills and independence. For most people this support helps them to return to live in their own accommodation, where possible. This service is provided in partnership with the local health trust and local clinical commissioning group (CCG). The service is located in a residential location providing easy access to shops and public transport.
The service has a registered manager in post. A registered manager is a person who is 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.
A number of relatives spoke about the positive outcomes and impacts they had seen for their individual family member since they had moved to the service. They said they were satisfied with the care delivered and had no specific concerns. However, three also commented on the availability of staff at peak times.
Staff were guided by people’s individual care plans as to how they preferred to be supported, However, some risk information was not always completed properly, and the risk reduction measures implemented were not always recorded clearly to inform care staff. Guidance about some people’s specific physical or mental health conditions had not been developed so that staff knew how to support them safely.
The majority of people, staff and relatives thought staffing levels were enough. However about 30 per cent of relatives and people spoken with commented about staff availability particularly at peak times when they thought staff were often stretched to see to everyone. This was confirmed in discussions with staff. There was a correlation between peak times of the day and delays in staff responses to some call bells. This meant that a small number of people were left waiting longer for staff to respond to their call bells.
People were given their medicines in an appropriate way when they needed them, but improvements were needed in the way that medicines were recorded to ensure all aspects of medicine management was undertaken safely.
Staff said they felt supported and were provided with a rolling programme of training to update their skills on a regular basis and ensure they could support people appropriately. However, 13 out of 14 Registered General Nurses (RGN’s) were not shown as having completed first aid training an area for which they were responsible in the service. A mix of care staff and RGN’s were out of date with their moving and handling training and 14 care and RGN staff were not recorded as having had this training at all.
Although care staff demonstrated knowledge of people they supported, they had not been provided with training in respect of specific conditions some people in the service lived with such as diabetes, epilepsy, and behaviour that could be challenging. There was a risk that staff might not have the awareness and understanding of the impact of some people’s conditions if these were not managed or supported appropriately.
A range of quality audits were undertaken to provide assurance about service quality. The registered manager also undertook spot checks of the service and met with the provider on a weekly basis to make a report about the service. Shortfalls highlighted by this inspection indicate that the current auditing systems in place have not been implemented robustly and their effectiveness needs further review. People were asked to give their views about the service but no clear system was in place for their comments to be analysed and acted upon.
Staff records showed that they received supervisions infrequently but felt well supported and informed, and able to comment and raise issues about the service with their supervisors or the registered manager.
Staff said they received an induction to ensure they understood their role and responsibilities. They received training in essential skills to help support people on a day to day basis and their competency was assessed through observations and the completion of workbooks. There was a good framework for the recruitment of new staff, and important checks on suitability of new staff were undertaken.
We found the service was well maintained, showed signs of investment and development and ongoing improvement. Appropriate checks and servicing were undertaken to maintain the safety of the building and equipment used.
The registered manager had an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. They understood in what circumstances a person may need to be referred, and when there was a need for best interest meetings to take place. We found the service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and that people’s rights were respected and upheld.
Staff said they felt listened to, able to express their views, and found the registered manager and the deputy and other senior staff approachable. Staff understood how to protect people from the risk of abuse and the action they needed to take to alert managers or other stakeholders if necessary, if they suspected abuse. This was to ensure people were safe. There were low levels of incidents and accidents. These were managed appropriately by staff who sought the appropriate action or intervention as needed to keep people safe.
People were provided with a healthy choice of foods and people found these enjoyable and to their taste. They were consulted about the menus and able to influence changes within them. People and staff told us that people were supported to access routine and specialist healthcare appointments to maintain their health and wellbeing. People were provided with a programme of activities and staff were observed and heard encouraging people to participate, or provided with one to one support in their bedrooms.
We viewed all areas of the premises during the inspection, and spoke with people who lived there and some of their relatives. The majority of people told us that they liked living in the service and were satisfied with the support they received. Some told us that although they felt their own specific care needs were met they did sometimes have to wait for support and felt that more staff were needed at certain times.
We contacted a range of Health and Social Care professionals who have contact with the service for their views. They commented positively on the quality of care and support provided and felt the service to be well run. However, this inspection highlighted some shortfalls in the following areas that could compromise the safety of people in the service.
The majority of staff and relatives said they thought there was an open, friendly and supportive culture within the home. They spoke positively about the leadership and approachability of the registered manager. Staff felt confident of raising issues with her and understood their responsibility for reporting concerns when they saw or found them.
We have made one recommendation:
We recommend that sluices are kept locked when staff are not present to safeguard people from harm.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.
The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Below is a summary of what we found.
Is the service safe?
This service was not completely safe because of a lack of guidance for staff. Each person had a care plan detailing their care needs; however records showed that although risks had been identified, there was a lack of guidance for staff to follow to reduce the risks and implement strategies to make sure people were as safe as possible. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
We found that the environment of the service was safe, clean and hygienic. Equipment was well maintained and the service was going through a renovation programme to ensure that the environment continued to meet people's needs safely.
People were given their medicines when they needed them and in a safe way. All medicines were stored safely and according to the services policies and procedures.
The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.
People's care needs and the qualifications, skills and experience of the staff were taken into account when making decisions about staffing numbers required to the meet the needs of people who used the service.
Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.
Is the service well-led?
On the whole the service was well-led.
Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team.
Systems were in place to ask people who used the service, relatives and staff for their views about the service.
Audits of the medication and care plans and other systems used at the service had been completed to assess the quality of the care being provided. However, the service had not fully identified the shortfalls in the care plans found at the inspection. Therefore we have asked the provider to note that the system in place to audit the care plans was not fully effective to make sure people were receiving the care they needed.
The service worked well with other agencies and services to make sure people received their care in a joined up way.
Is the service effective?
On the whole the service was effective. People told us they were satisfied with the service they received. We saw that staff were attentive to people using the service and responded promptly when needed.
People's health and care needs were assessed with them and /or their representatives, however when people were at risk of not eating and drinking enough there was no monitoring of their fluid and dietary intake. Some of the care plans had not been reviewed regularly. Care plans were therefore not able to support staff to consistently meet people's needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
Is the service caring?
People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. Peoples were given care and support by staff in a way that suited them best.
People we spoke with said they felt that sometimes they had to wait a while for staff to get to them but they said that when they arrived they did not rush them and did things at their pace. They said that staff were polite and spoke to them kindly.
One person said, 'It's very good here. The nurses are ace, I could not wish for more.'
Is the service responsive?
The service was responsive.
People's medicines were reviewed regularly by their doctor. When people experienced pain their needs were responded to and they were given the prescribed medication they needed to help alleviate their pain.
People and their relatives knew how to make a complaint if they were unhappy. They told us if they had any concerns they would speak to the registered manager or the deputy. They were confident that their complaint would be taken seriously and acted on. We looked at some of the complaints that had been received by the service and how they had been dealt with and found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.
Another person said 'I am very happy here, it is a lovely place to be. I am well looked after, I have no complaints.'
We spoke with six people who used the service, two relatives and a visitor to the home. People we spoke with who used the service told us that they were happy with the care and support they received. One person told us "It's wonderful here, very good" and another person commented 'they look after us very well'.
We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible to people who used the service.
We spoke with people who told us there were enough staff on duty and that they had a good understanding of people's needs. We found that staff had regular supervision and that they undertook training to keep their skills and knowledge up to date.
The home had a range of checks and audits in place to monitor the quality and safety of the service provided.
We found that the home kept accurate records and stored them safely and appropriately, to ensure people's details and information was protected.
People told us they could make decisions about their day to day care and support. They said their privacy and dignity was respected.
Generally people were satisfied with the care they received. Comments included, 'Everyone has been really kind, and it's OK'. 'I'm happy in this place they really care'. 'I am very happy here, yes I like it here' and 'I wouldn't want to be anywhere else'. People could not remember their care plans, but relatives told us they had been involved in planning their family member's care and support. We found that although people had expressed their preferences in relation to personal care these preferences were not always met.
People told us they felt safe living at Saltwood Care Centre and spoke highly of the staff. People said they felt the staff had the right skills and experience to meet their care and support needs. One person said, 'Everyone is really friendly and the staff are absolutely lovely'.
People did not have any complaints, but felt confident any brought to the attention of the service would be resolved. One person said, 'I'm quite happy here, I've got no complaints at all, in my opinion they are very good'.
People told us that they were generally happy with their care, but there was a mixed response when we asked people if they are happy with how often they were helped to have a bath or shower. Most people said they had a bath or shower once a week and some people said they would like to have more choice about this. One person said 'the staff encourage me to have a shower as it is quicker for them, but I'd really prefer a bath.' Another person said that 'I have a shower about twice and week and that suits me fine'.
Everyone said that they could choose how they wished to spend their time, including whether they wanted to join in the social activities in the conservatory each day. Most people said they enjoyed the activities, but some people said they preferred to remain in their rooms to watch TV or read. However, most people that use the service told us that they did not get to go out into their local community very often and that they would like to do this more. Two people commented 'It would be nice to get out for a walk and some fresh air' and ' We don't get to go out of the home much, I'm lucky as my family and friends come and take me out, but I don't think everyone has that.'
People told us that the staff were quick to respond if they felt unwell or were worried about their health and that they could see a doctor when they needed to. Most people said that the staff came quickly when they called with the buzzer and everyone told us that they felt there were enough staff on duty, although some said that it would always be nice to have more. People told us that they liked the staff and felt confident that they knew what their needs were. Comments about the staff included 'They are very pleasant and they help you with whatever you need', 'very nice' and 'they're all pretty good'.
People that use the service told us that they felt safe living in the home. They said that the staff were pleasant and treated them kindly. They knew who to talk to if they had any concerns or wanted to make a complaint.
People told us that they were satisfied with the standards of cleanliness in the home. One person said 'There are cleaners here everyday, they start first thing and Hoover, dust and clean my sink. My bed is changed every day.'