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We are carrying out a review of quality at Salthouse Road. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Good

Updated 11 April 2017

199a – 203a Salthouse Road Lane is located in the east of the city of Hull and is registered to provide care and accommodation for up to a maximum of eight people with a learning disability. Accommodation is provided in three purpose built bungalows.

We undertook this unannounced inspection on 16 March 2017. At the time of our inspection there were 7 people living at the service.

At the last inspection on 5 February 2016, the overall rating for the service was ‘Requires Improvement’. This related to making improvements to medicines management, stopping the practice of wedging doors open and the safe storage of disposable gloves and aprons. Further action also needed to be taken to promote good infection control practices when washing clothing and other items. Some minor incidents between people had not been assessed and scored using the specific risk management tool provided by the local safeguarding team. Risk assessments were completed; but further detail was needed to be included for staff about recognising the signs of changing behaviours. When accidents or incidents had occurred in the service, records of actions taken to review and investigate these were not always in place.

At this inspection we found automatic closures had been fitted to doors so they were no longer wedged open. Disposable gloves were stored away from clients. Records were being maintained of all incidents and the action that had been taken following these and any referrals made to the local safeguarding team and the Care Quality Commission. Risk assessments had been updated and included information to guide staff on how to recognise potential triggers and changes in behaviour. Processes had been introduced to ensure accidents and incidents were analysed within the service by the manager, and further reviews of these were completed by the quality assurance manager and at senior management level.

There was no registered manager in post. The previous registered manager had recently left the service to take up another post within the organisation and a new manager had been appointed to the post in the last month. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their 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. When a service does not have a registered manager in place the rating in well led cannot be rated any more than ‘requires improvement’. A manager had been appointed but had not been through the registration process to become the registered manager. They had been at the service for two weeks at the time of our inspection.

We found improvements were required to ensure people’s specialist dietary records were completed in more detail to reflect what people had eaten and the texture and presentation of the food.

We found further action was required to ensure that the date was recorded when topical creams were opened. Individual ‘pro re nata’ (PRN when necessary) protocols for pain relief needed to be reviewed and include the dosage of the medicine that had been prescribed. These issues were addressed by the manager during the inspection.

Relatives and professionals praised the skills of the core staff team and shared their reservations about the reliance and use of agency staff and lack of continuity of managers in the service.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved.

The environment was found to be clean and tidy throughout. Areas of the service were beginning to look tired. This had been identified by

Inspection areas

Safe

Good

Updated 11 April 2017

The service was safe.

Medicines were safely administered as prescribed.

People who used the service were protected from the risk of abuse. Staff spoken with displayed a good understanding of the different types of abuse and were able to describe the action they would take if they observed any incident of abuse, or became aware of an abusive situation.

Safe recruitment processes were followed.

Effective

Good

Updated 11 April 2017

The service was effective.

People were supported by staff that undertook a range of training, relevant to people’s care needs. Staff received supervision, support and appraisal.

Staff understood the principles of the Mental Capacity Act 2005 (MCA), which meant they promoted people’s rights and followed least restrictive practice.

We saw people were supported to have a healthy and nutritious diet and to receive appropriate healthcare when required.

Caring

Good

Updated 11 April 2017

The service was caring.

We observed care was provided to people in a kind and caring way and their independence was promoted.

Staff provided people with information and explanations about the care they provided.

Responsive

Good

Updated 11 April 2017

The service was responsive.

Arrangements were in place to ensure people had the opportunity to engage in a variety of different activities both within the service and the wider community. People were enabled to maintain relationships with their friends and relatives.

People received person centred care. People had assessments of their needs and care support plans to guide staff in how to support them in line with their preferences and wishes.

There was a complaints procedure in place which was available in alternative formats.

Well-led

Requires improvement

Updated 11 April 2017

The service was not consistently well led.

There was no registered manager in post.

Relatives and professionals considered the turnover of managers at the service did not promote consistency and continuity.

There was structure to the organisation and levels of support and the registered provider was fully involved in overseeing the service.

There were systems in place to enable staff and other stakeholders to express their views. As the people who used the service were unable to be fully involved in completing questionnaires, the way their views and experiences of the service were captured could be further developed.