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Saltmarsh House Residential Care Home Requires improvement


Inspection carried out on 1 August 2019

During a routine inspection

About the service

Saltmarsh House Residential Care Home is a small residential care home that can provide accommodation and personal care to up to 12 people aged 65 and over in one adapted building. At the time of the inspection eight people were living at the home. People living at the home had a range of needs including some people living with dementia. People had their own bedrooms and some rooms offered an en-suit facility. People could access a range of communal spaces including a lounge, conservatory, dining room and the front and back garden area’s offered patio seating. The provider was registered as an individual (sole trader) with direct responsibility for the carrying on of the regulated activity at the location. As a consequence they did not need to have a registered manager.

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

People’s medicines were not always managed safely, and staff did not always follow best practice guidance. People’s risk management plans did not always provide accurate, person-centred information for staff to follow. The home was visibly clean and tidy, however we found infection control measures were not always robust to prevent the potential spread of infection. There were clear safeguarding procedures in place to protect people from the risk of harm. People and their relatives told us they received safe care.

Systems in place to review the quality of care and ensure records were complete and accurate were not always effective. Audits completed by the provider did not identify the issues highlighted in this inspection report. There was a clear management structure in place, and people and relatives we spoke with told us they had good relationships with the provider and staff.

Most 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 mostly supported this practice. However, systems in place did not always ensure consistently good outcomes for people were achieved when their needs changed. People spoke positively of the meals on offer and had access to appropriate levels of support from staff that knew them well.

People and their relatives told us they received kind and compassionate care. People told us staff treated them with dignity and respect and encouraged people to maintain their independence where possible.

People’s likes, and dislikes were reflected in their care plans and we saw care was delivered in line with people’s preferences. People had opportunities to engage in activities in the home on a regular basis.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was good (published 4 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.


We have identified breaches of regulation on this inspection. This related to safe care and treatment, as we found people’s medicines were not always managed safely or in line with best practice guidance. We found the provider did not operate effective systems or processes to ensure all people’s records were clear, contemporaneous and accurate. The systems and processes operated to assess, monitor and improve the quality and safety of the service people received were not effective.

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

Follow up

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

Inspection carried out on 13 December 2016

During a routine inspection

The inspection took place on 13 December 2016. It was unannounced. At our previous inspection in August 2014 we found breaches of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider had failed to make the necessary pre-employment checks and records of mental capacity assessments did not show that legal requirements had been met. At this inspection we found improvements had been made, and the provider was now meeting the requirements of the regulations.

Saltmarsh House Residential Care Home is registered to accommodate up to 12 people. It provides personal care services for older people who may be living with dementia. At the time of our inspection people were accommodated in private rooms on three floors of an adapted private home. Shared facilities included a lounge, dining room, conservatory, and an enclosed garden.

The provider was registered as an individual (sole trader) with direct responsibility for the carrying on of the regulated activity at the location. As a "registered person" they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. As a consequence they did not need to have a registered manager.

The provider had put arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment practices were in place to make sure only workers suitable to work in a care setting were employed. There were arrangements in place to store medicines safely and securely, and to administer them safely and in accordance with people’s preferences.

Staff received training, supervision and appraisal to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People had a choice of home-cooked menus. People were supported to access external healthcare services, such as GPs.

Staff had developed caring relationships with people they supported. People were able to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Staff delivered care and support which were based on assessments and plans which took into account people’s needs and preferences. Staff supported people to take part in leisure activities where they wanted to. People were aware of the provider’s complaints procedure, but there had been no complaints made.

The home had a welcoming, homely atmosphere. The registered provider managed the service efficiently and monitored the quality of service provided. The provider responded to feedback to improve the service people received.

Inspection carried out on 5 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. The provider and registered manager are the same person.

There was a registered manager in post that was responsible for the day to day running of the 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 and associated Regulations about how the service is run.

Saltmarsh House Residential Care Home provides care and accommodation for up to 12 older people. Four of these people were living with dementia. At the time of the inspection there were 12 people living at the home.

Staff knew people’s needs and received training in subjects relevant to providing care including nationally recognised care qualifications. People told us their care needs were met and they were consulted about their care needs. Two people said the home was like a “family” to them. Staff were observed to treat people with dignity. The lunch time was convivial where staff and people ate together. People and their relatives told us the staff treated people well.

The registered manager had attended a training course on the Mental Capacity Act 2005. Individual’s care records showed the guidance contained in the Mental Capacity Act 2005 Code of Practice was not being followed regarding the assessment of those who were unable to consent to their care, and, where decisions were made on behalf of those people. We found the service needed to make improvements in this area.

Staff were aware of the procedures for safeguarding people at risk from possible abuse and for reporting any safeguarding concerns. People told us they felt safe at the home. The local authority safeguarding team told us the registered manager and staff worked with them regarding any safeguarding investigations.

Accidents and incidents in the home were monitored and reviewed. Amendments were made to care plans to reduce the likelihood of any reoccurrence of injuries or accidents to people.

The home had sufficient staff to meet people’s needs although the registered manager was reviewing this in light of discussions with staff.

Checks were made on the suitability of newly appointed staff to work with vulnerable people. For one staff member adequate checks and references had not been made prior to the staff member starting work. We found the service needed to make improvements in this area.

The views of people and staff about the standard of the service were sought by survey questionnaires so that any improvements could be identified. People, and relatives of those who lived at the home, told us they felt able to raise any issues and were consulted about care issues. Staff told us they were included in discussions with the registered manager and deputy manager about policies and how the home ran.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 21 February 2014

During an inspection looking at part of the service

Following an inspection of Saltmarsh Residential Care Home, in November 2013, the service was identified as not being compliant with one of the essential standards. This standard related to care and welfare of people who used services . This concern was judged to have had a minor impact on people who used the service.

The provider wrote to us telling us that they were compliant with this standard on 23 January 2014.

At this inspection we spoke with a person who used the service, the registered manager, deputy manager and two members of staff.

Care and treatment was planned and delivered in a way that was intended to ensure people�s safety and welfare. Accidents/incidents were recorded, risk assessments carried out and care plans updated to reflect the care needs of people who used the service.

Inspection carried out on 15 November 2013

During a routine inspection

People's choices and consent to care and support were observed to be respected at all times during our visit. We observed staff supporting people with day to day activities, and the interaction was observed to be sincere, respectful and responsive to individual support needs.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected. A family member told us "the care here is excellent, they accommodate her needs and look after her very well".

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas singing with staff and interacting with each other. During our inspection we observed people spending time in their bedrooms listening to music and talking to family members. We also saw one person spending time in the workshop completing woodwork projects.

Incident forms were not completed following every fall at the service and there were discrepancies between the accident file and falls register. There was not any evidence of risk assessments being reviewed following a fall or accident within the service. The lack of updates meant that people using the service were not protected from harm and the risks were not reduced.

Inspection carried out on 22 February 2013

During a routine inspection

People told us what it was like to live at Saltmarsh House Residential Care Home and described how they were treated by members of staff and their involvement in making choices about their care. People told us they felt that their personal care was carried out in a manner that promoted their privacy and dignity.

People told us that there are many activities to participate in. They were given opportunities to take part if they chose to. They told us that the staff always asked how they were and staff discussed with them how they were going to do to assist them. We spoke with two relatives who told us they were happy with the care provided.

Inspection carried out on 27 January 2012

During a routine inspection

We spoke with people who told us that they found the home comfortable. They liked the food and told us that the members of staff were �nice� and �helpful.� We spoke with one person who said: �Since my first day here, the people here have been just wonderful.� We spoke with one person who told us the home was cleaned every day and that his room was �clean and tidy.�

Reports under our old system of regulation (including those from before CQC was created)