Salthouse Road

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

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service remained in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (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 did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice. Reviews of accidents and incidents lacked sufficient detail to effectively support learning and improvements within the service. The registered manager ensured immediate action was taken to keep people safe, and referrals made where necessary. Staff felt confident in what to do if there was an accident or incident, including contacting people's relatives or representatives.

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.

Information was shared with partner agencies, who they worked closely with to improve people's care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while

protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us people received safe care.

Staff received safeguarding and closed cultures training and were aware of the signs of abuse. Staff were confident if they raised safety issues these would be addressed. The registered manager had clear oversight of actions required and shared information appropriately to ensure people remained safe.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The registered manager had a process to monitor applications to deprive people of their liberty. The registered manager and staff team were aware of the significance of restrictions on people’s lives.

The provider did not always work well with people to understand and manage risks. Documentation was not always in place to ensure people were safe and enabled people to do the things that mattered to them.

Risk assessment information varied; some were detailed whilst others missed or lacked information to guide staff practice in areas such as moving and handling. Records were not consistently updated following a change in needs. This included a person who required thickened fluids to reduce the risk of aspiration. Staff knowledge regarding thickener was inconsistent.

Information to guide staff when supporting a person expressing their feelings or having an emotional reaction lacked sufficient detail to ensure a consistent approach. However, staff had completed training in this area and felt sufficiently skilled.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Bins which should be locked to protect people against potentially infected waste were unlocked on both days we visited the service. Cleaning products and thickener for fluids were also accessible on our first day, posing a risk to people who used the service. These points had been identified at our previous inspection.

Safety checks for the building and equipment were completed, and staff had taken part in fire drills. However, the records required development to evidence learning and actions required.

Communal areas were uninviting. However, people's bedrooms were comfortable and personalised according to their tastes and needs.

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. 

We observed staff were available to support people in line with their assessed needs. Staff told us they felt staffing levels were safe. They noted last minute sickness had an impact, but people remained safe. There was no monitoring of additional commissioned hours, used to provide one to one support, to ensure these were being used effectively.

We received some feedback about staff turnover, but overall staff still knew people well. For example, a relative told us, "Generally speaking, the service is really good. Staff who are here and know [person's name] are really good." Staff received supervision, and the registered manager was in the process of scheduling annual appraisals. Staff received training relevant to their role and the registered manager had oversight of the training completed. Not all staff had completed the mandatory training for supporting autistic people of people with a learning disability.

The provider operated safe recruitment processes. We discussed with the provider the need to ensure candidates had provided a full work history.

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 home and equipment were clean. Elements of the environment had some minor wear and tear which would have prevented effective cleaning. The maintenance team acted to address this during our assessment. Staff completed infection prevention control training and confirmed they had access to PPE.

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

Medicines records did not always support the safe administration of medication. For example, there was no guidance for staff administering medication covertly. Covert medication refers to medicines administered in food or drink without the person's knowledge or consent. We asked the registered manager to address this immediately. As and when needed medicines were administered to support people experiencing agitation or distress, however the effectiveness was not recorded. We discussed with the management the need for a consistent approach. The use of prescribed thickeners was not recorded, which had been highlighted at the previous inspection.

Medication administration records were completed and there were regular checks to ensure records were accurate. Staff completed medicines administration training and had their competency assessed. One staff member told us, "If I went to the registered manager and said I feel uncomfortable or need to be watched they would do that to help." Staff were knowledgeable about people's medicine regimes.