Archived: Saltways - Care Home with Nursing Physical Disabilities

Saltways Care Home with Nursing and Physical Disabilities is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Saltways Care Home with Nursing and Physical Disabilities is registered to provide accommodation and nursing care for a maximum of 24 people. There were 17 people living at the home on the day of the inspection.

There was a registered manager in post. 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. The registered manager was not present at the time of our inspection.

Risks to people's health and wellbeing were not always identified, and risk management plans were not always in place to instruct staff on how they should manage risks to people consistently and safely.

People were not fully protected from harm and abuse. Accidents and incidents had taken place and had not been reported to the appropriate authorities. Potential safeguarding concerns had not been recognised and acted on appropriately. Systems were not in place to collect this information and learn lessons.

There were not always sufficient trained staff, on duty to care for people safely, and to meet their needs. We found there was no current analysis and overview of accidents, incidents, and safeguarding concerns at the home to assess whether any trends or patterns were identified and future risk could be mitigated.

People were supported to maintain a healthy diet and staff were aware of people's dietary needs and preferences. However, where people received their food supplements via a Percutaneous Endoscopic Gastrostomy [PEG] feed the provider had not ensured all nursing staff had received training and had their competencies checked.

People were not routinely involved in the planning and development of their care. People were not supported to access a wide variety of activities during the day, and did not always have their wishes respected if they did not want to participate in some of the activities. End of life care planning had not been considered and so did not focus on people's preferences and wishes.

Relatives were confident that if they raised a complaint, it would be dealt with appropriately.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. However, existing quality assurance procedures did not always identify where improvements were required. Quality monitoring procedures needed improvement to ensure these were undertaken regularly, to monitor service provision.

There was a lack of oversight of the service by the provider and the registered manager. There was a distinct lack of audits in place that would provide the registered manager with a view of what was happening at the service. The audits that were in place were ineffective, inconsistently completed and did not highlight the areas of concern that came to light during the inspection. The provider had not informed CQC of important events that occurred at the service, in line with current legislation.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as

inadequate for any of the five key questions it will no longer be in special measures.

We found six breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home is registered to provide accommodation and nursing care for a maximum of 24 people. There were 20 people living at the home on the day of the inspection. At the last inspection on 24 June 2015 the service was rated as good.

Since the last inspection the registered manager left the service and a new manager had been appointed but had not yet registered with CQC. 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.

People told us they felt safe and staff were available to support them when they needed care. People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. People were supported by staff to have their medicines when they needed them.

The principles of the MCA had not been consistently applied. Staff had limited knowledge of the MCA and how this impacted on the care provided to people. Systems for reviewing DoLS applications had not identified actions required. The failure to recognise and action the conditions of a DoLS authorisation meant that the person was deprived of their liberty when this was not lawful.

Staff understood people’s individual care needs and had received training so they would be able to care for people living in the home. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s needs were met. People told us they enjoyed meals times and were positive about the choice of food they received.

People were comfortable around staff providing care and relatives told us people had developed good relationships with staff. Relatives said people’s privacy and dignity was maintained and we made observations that supported this.

People said staff knew them and the care they needed, however, people gave mixed responses about whether they were involved in planning their care. Care plans we viewed did not show us how people were involved in reviewing their care. People told us they could raise any issues should the need arise and action would be taken.

People told us they would like more activities. Staff and relatives told us that activities could be improved to support people’s interests. The provider had taken steps to address this and had employed a new driver and activities coordinator.

Records of accidents and incidents were maintained but systems did not show how they were monitored to identify trends within the home to reduce the likelihood of events happening again and ensure required actions were taken.

The management team had systems in place to check the quality of the service provided, however these had not always been consistently completed to identify any improvements required.

People, relatives and staff said that the service had been through a period of change. They acknowledged recent improvements had been made but said further improvements were needed. People, relatives and staff spoke positively of the new management team and of the team work of the staff team.

Recent changes had been positive but more time will be needed to embed the changes and ensure improvements are sustained and that changes made result in consistent improvement in the care and support given to people.

You can see what actions we told the provider to take at the back of the full version of this report.

We looked at care plans for four of the people who lived there. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

We found that staff had knowledge of safeguarding and would take the appropriate action to safeguard people form abuse. One member of staff said: 'If I saw any abuse I would report it straight away'.

People who lived there had support to make choices about their care and treatment and their wishes were respected.

We saw that staff helped and supported people. We spoke with one relative of a person who lived there. They told us that they were: "Really happy, it's a brilliant place". We saw that people received care that met their individual needs.

We found that there were regular audits and quality checks. We also saw that the provider sought feedback from the people who lived there and their families and carers. This ensured that the provider was able to monitor the quality of its service delivery.

The three relatives of people who used the service gave us positive feedback about the standard of care and support that staff provided. One person said that, "The care generally is very good". Another person said that people living there were, 'Treated with respect, the staff always try their best".

People's complaints and concerns were fully investigated and resolved where possible. One person said that any concerns were, 'Sorted straight away'.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "Excellent training, lots of training to go on". Another said that, "Supervision is very good, I feel supported in my job'. This meant that staff had the support and knowledge to meet the care and welfare needs of the people living there.

Medicines were prescribed and given appropriately to the people who used the service.