Salford House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Senior care staff and the management team understood the importance of learning from incidents, for example, where people had fallen or where lessons were learnt from this inspection around medicines administration. The registered manager said staff knew how to record and what to escalate to them for investigation. Processes ensured any learning was communicated to staff through staff meetings or at handovers, so staff continued to have the right information to support people. The registered manager showed us where an important message was shared with staff on to their personal devices. The provider could tell who had or had not read the message so it could be followed up to ensure learning was taken by all from important events.

People’s care plans were updated if needed following an accident/incident. The registered manager reviewed accidents and incidents at the home and regular analysis was made to see if there were any patterns or trends where actions could be taken. For most recorded incidents, there was limited harm or injury to people. Where additional measures were needed to manage falls, such as using equipment or alarms, this was considered and put in place where required. The provider told us they learnt lessons from inspections or audits undertaken at their other homes, whether positive or negative. They said it was important to share, especially from external professionals so they could continue to improve.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Pre-admission assessments were completed to ensure staff could meet people’s individual needs safely. This included staff assessing people’s suitability to live in the care home. Staff members spoken with had not yet had to do a handover to paramedics, however they were able to describe and show us what information they would send with the person. This was information relating to the medication the person was on, and for one person, this was seen to be accompanied by their catheter care plan. A staff member said they would make sure next of kin and any ‘as and when’ medicines was also communicated to any paramedics.

A healthcare professional told us staff were very good at making sure people were not admitted into hospital if they didn’t need it, preferring to keep people at home and making sure they had the right input and support. However, people were supported to attend hospital outpatient appointments by staff when needed. This helped to ensure people’s needs were known and any changes in the way their care was to be provided were identified.

The provider did concentrate on improving people’s lives however more work was needed to protect their rights for making decisions in people’s best interests. People did live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

The provider respected people’s rights when delivering care and treatment, however the documentation in relation to mental capacity assessments and best interest decisions needed to be improved. People’s capacity to make their own decisions had been considered. However, for the 4 people’s records we checked, how, what and why the decision had been reached was not always clear. Records did not show, how staff tried to support the person to understand what questions were asked. In some cases, we saw a decision had been made which was in the person’s best interests, but we also found inconsistent information about the persons capacity and understanding to make those decisions. Before we concluded our visit, the registered manager took action to improve their understanding and recording.

Without exception, people and relatives felt safe at the home, with each other and the staff. One person said, “It’s because there are that many people you can call on. If you were sad, they’d sit and talk to you and offer you a cup of tea.” Another person said about being safe, “Definitely yes, especially at night. I don’t need help but good to know it is there.” Staff knew what actions to take to keep people safe and they were confident to report any concerns to management or outside agencies. Staff understood what was meant by safeguarding and staff had no hesitation to report poor practice.

The provider did work well with people to understand and manage risks. Staff did provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff understood people's individual risks such as from falls, when eating and specific risks related to the way some people expressed themselves that could be linked to their cognitive impairment. One staff member said, “There are priority responses for [people] with these risks.” Another staff member told us, “What impresses me here is the hoisting, the equipment and that I have enough information to safely use the equipment, because staff show you how to use it.”

Staff were confident if they identified any further risks, senior staff would promptly take action to support people to mitigate their risks. One staff member said, “I would go to the senior in charge. I would definitely be listened to, for example if a person is having a bad day and can't walk properly, they would definitely get the GP.”

People’s care plans contained details of their risk and how staff needed to manage those risks. Staff’s knowledge of people’s individual risks was good. Most people’s risks were fully detailed within their care plans, for example catheter management requirements. Where people experienced falling in their rooms, floor mats and beds set to low positions helped minimise risk. However, some other plans would benefit from additional guidance for staff to reduce risks to people further, such as sexualised behaviours and how this was managed. From speaking with the staff they knew exactly what action to take to reduce risks to those people in their care.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People’s rooms were personalised for them. There was a number of bookcases in hallways, with an assortment of reading material. The entrance hallway was decorated for Autumn with decals on the doors, banners and bunting and an Autumn themed tree. This theme continued into the lounge and was commented positively on by people and relatives. The outside garden area was maintained so people could access and enjoy the outside space. One person told us about maintenance, saying, “This kid (maintenance person) is brilliant. He’s cleared up outside.”

Health and safety and environmental checks on water quality, water temperature equipment, the environment and maintenance issues were completed. The maintenance person told us staff reported any issues to them, and they fixed them, or, worked with other professions where needed to ensure repairs were undertaken. When rooms became free, the provider took the opportunity to redecorate or refresh those rooms ready for the next person. People could access the communal areas and corridors which were not blocked or restricted and there was a lift that people could use to access other floors. Some communal bathrooms had been retiled and updated. Regular checks included fire safety and general safety. However, we found some checks had not identified where window restrictors and/or their fixings needed to be updated and some fire doors shut too quickly. We also found food stock cupboards in communal areas were unlocked, which could have an adverse impact for people at risk of choking, on modified diets or who were diabetic. The registered manager took action to resolve these issues before we concluded this inspection.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives raised no concerns about staffing levels. Where people needed assistance, they received this with minimal delay. The registered manager told us they assessed the staffing levels needed to meet the needs of all the people who used the service. Staff raised no concerns to us around staffing levels and in some cases said, the registered manager and deputy manager would help them to ease any pressures. The provider undertook appropriate recruitment checks before staff stated working at the service to ensure the suitability of staff before they commenced employment. These included obtaining references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions.

Staff were positive about the training they received which was relevant and necessary for their role. One staff member said they had benefited from an induction which included shadowing experienced staff. This was confirmed by a senior care staff member.

We had a conversation with the provider regarding limited levels of staffing at night, given people’s needs and support to get people out of the home in an emergency. The provider told us they had recently spoken with the registered manager, and this would be reviewed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider assessed and managed the risk of infection.

Salford House presented as clean and well maintained. Communal bathrooms had paper towels, soap dispensers and signage to inform and remind people and visitors about good hygiene practice. Foot operated bins helped reduce contact points to limit risk of cross infection.

People’s bedrooms were cleaned regularly and housekeeping staff told us they used different mops for different floor types to minimise risk of cross contamination. Housekeeping staff said most of the week there were 2 of them which helped them to maintain good standards of cleanliness. At weekends, there was 1 housekeeper, but we were told people’s rooms and communal areas were prioritised. Staff with responsibilities for managing infection control process had a good understanding of how to reduce the likelihood of infection. Staff told us they had received specific training in how to do this. One staff member said, “[Registered manager] is sharp on us doing the training.” Staff confirmed there were sufficient resources to keep the home clean. Staff were observed wearing appropriate personal protective equipment (PPE) around the home. Stocks of PPE were available throughout the home for staff and visitors. Refurbishment of the home was ongoing and improvements to some décor would help maintain an environment that supported safe infection control.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We found improvements were required in the way some people’s medicines were administered and recorded. For those people, we found people had not come to harm, but we could not be confident those people received their medicines safely and as prescribed. For example, we found some pain patch medicines were not applied correctly to the skin. When a medicated pain patch is not applied as directed, it may not deliver the right dose of medication, potentially leading to a loss of pain relief or, in some cases, an overdose. Staff who administered these medicines were aware they had to rotate where the patch medicines were applied on the person’s body. Yet, we found staff did not do this in line with manufacturers guidelines. A rotational patch body map chart was completed, which showed pain patch medicines were applied to the same skin site before they should be. We also found some topical creams did not record the date of opening which could cause problems as some creams should not be used 3 months from being opened. We told the registered manager and provider about these issues during our visit. They showed us evidence they had issued all staff with a reminder of the importance of rotating certain medicines and using opened dates for creams and to add this check onto their audits.

Medicines were stored safely, with staff recording daily temperatures that were within safe range. Where some medicines required stricter controls, we found they were checked and signed when administered to ensure people had received the right doses. Where people had medicines given on an as and when basis, protocols and guidance informed staff of the information they required to administer those medicines safely.

Processes to make sure people received their medicines were completed, such as regular audits and to limit medicine errors at the earliest opportunity. Staff told us they completed daily stock count checks to ensure medicines were given when needed.