Saivi House

About the service

Saivi House is a residential care home providing personal care for up to 5 people who have a learning disability. At the time of the inspection, there were 4 people living at Saivi House which is in 1 adapted building. The provider, Saivan Care Services Ltd, operates 3 local care homes. Staff work across all 3 homes.

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

Right Support

Recruitment practices were not consistently safe as some required checks had not been completed before staff worked at the service.

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 supported this practice.

Staff supported people to take their prescribed medicines and to access healthcare services.

People could choose how they wanted to spend their time, whether they wanted to be with other people or in their own space and what and when they ate. Staff provided support and guidance where people needed this with arranging their chosen activities and appointments and with personal care and food preparation.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

The staff team had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs.

Right Care

There was a relaxed atmosphere in the home where staff were respectful and supportive in their interactions with people. Where people required support with personal care this was provided in a discreet way that promoted people’s dignity and privacy. People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

People were relaxed and confident in approaching staff for support.

Right Culture

Staff demonstrated a positive person-centred attitude to their work and promoted people’s rights and autonomy. They also were proactive in ensuring people had equal access to local services.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity. Staff told us they enjoyed working at the service and we saw they had formed good relationships with people they supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service good. The report was published on 12 September 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This inspection was a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made a recommendation. We recommended the provider improve their recruitment practice in line with best practice.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home had responded to peoples’ choices and individual needs during the pandemic to help them carry out activities outside the home safely. For example, ensuring lateral flow testing each day before they leave the home.

When the provider admitted people to the home, they recognised and responded to peoples’ individual needs whilst following the current guidelines. People were tested before being admitted then a period of isolation in their room before a further test at the end of the isolation period. Staff carried out regular welfare and mental health checks throughout the isolation period.

The staff were aware of who to contact should they have an outbreak of Covid 19 and the protocols to follow.

The provider was following the current government national guidance regarding home visiting. People had their named visitors and essential care giver. Information on the home procedures and the use of personal protective equipment (PPE) was available.

The home had set up a testing station in a building attached to the main home. Visitors were tested in this area before being able to undertake a visit. Visits took part in residents rooms and were escorted to the rooms to reduce contact with other residents and staff.

The home had alternative methods to support social contact for visitors who were not named. For example, video calling.

The home had sufficient supplied of PPE. There were PPE stations throughout the premises. Staff had received training in infection prevention and control and how to don and doff PPE.

The provider had a system in place to ensure staff had the necessary vaccinations and had completed the necessary Covid 19 testing prior to working at the home.

All residents had received at least two doses of the Covid 19 vaccination.

The layout of the service and communal areas supported social distancing. The premises looked clean and hygienic throughout. There were cleaning stations in place and adequate ventilation.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

At the last inspection on 4 November 2015 the home was overall rated Good.

At this inspection we found the home remained Good.

People in the home had complex needs and some people were unable to provide us with verbal feedback. On the day of our inspection, we spoke with two people. Following the inspection we spoke with one relative and one social care professional to obtain their feedback about the service. They told us they were confident people were safe in the presence of care workers and in the home.

During the inspection we observed people were treated with kindness and compassion. It was evident that positive caring relationships had developed between people who lived in the home and staff.

People who used the service spoke positively about staff and the care provided at the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm. Staff were knowledgeable about people's individual care needs and were aware of the triggers and warning signs which indicated when people were upset and how to support people appropriately.

There were enough staff to meet people's individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that staff did not appear to be rushed and were able to complete their tasks. People who used the service told us that staff always had time to speak with them. The registered manager explained that there was flexibility in respect of staffing and staffing levels were regularly reviewed depending on people's needs and occupancy levels.

There were arrangements for the recording of medicines received into the home and for their storage, administration and disposal. However, we found that medicines were not always stored at the appropriate temperature and we made a recommendation in respect of this.

We found the premises were clean and tidy. There was a record of essential inspections and maintenance carried out. The service had an Infection control policy and measures were in place for infection control.

Staff demonstrated that they had the knowledge and skills they needed to perform their roles. Staff spoke positively about the training they had received and we saw evidence that staff had completed training which included safeguarding, medicine administration, health and safety, basic life support aid and moving and handling. We noted that staff had received some supervision sessions. However, we noted that these had not taken place consistently since our previous inspection and raised this with management. The registered manager explained that they had recently employed a care supervisor who would be responsible for ensuring these were carried out consistently.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly and were updated when people's needs changed.

The registered manager explained to us that they encouraged people to be independent as much as possible but provided support where necessary.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005).

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The registered manager informed us that one person who lived in the home was subject to DoLS and we saw that relevant documentation was in place.

People spoke positively about the food arrangements in the home. People's weights were recorded regularly. This enabled the service to monitor people's nutrition so that staff were alerted to any significant changes that could indicate a health concern related to nutrition.

People spoke positively about the atmosphere in the home and we observed that the home had a homely atmosphere. Bedrooms had been personalised with people's belongings to assist people to feel at home.

Each person had their own activities timetable which was devised based on their interests. Activities included attending the local leisure centre, going shopping and movie nights.

We found the home had a management structure in place with a team of care workers, care support worker and the registered manager. The home had an open and transparent culture. Staff told us they were encouraged to have their say and were supported to improve their practice. Staff told us that the morale within the home was good and that staff worked well with one another. They spoke positively about working at the home. They told us management was approachable and there was an open and transparent culture within the home and they did not hesitate about bringing any concerns to management. Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred monthly and were documented.

There was a quality assurance policy which provided detailed information on the systems in place for the provider to obtain feedback about the care provided at the home. The home undertook a range of checks and audits of the quality of the service and took action to improve the service as a result. These audits included health and safety, infection control, medication, fire safety and care documentation.

We found that the provider had a system in place to protect people who used the service from abuse, and incidents were recorded and monitored so that appropriate action could be taken to protect people from harm. People who used the service told us they felt safe at Saivi House. One person said, "The staff look after us very well, and the police come sometimes to make sure we are safe."

We found that the registered manager had implemented a system to collect and respond to feedback about the service, and had undertaken a series of spot checks to ensure people received a good quality service that met their needs.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

We found the service did not always respond appropriately when supporting people who sometimes exhibit challenging behaviours which left people at risk of harm.

Is the service effective?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded, and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

We found there were arrangements in place to deal with foreseeable emergencies.

Is the service caring?

We observed staff treating people respectfully, with kindness, patience and gave encouragement when supporting them. People were also offered choices about the way their care was delivered. We found people were encouraged to be as independent as possible.

We saw that individual care plans were person centred. Care plans were updated each day with each person's daily activities and information about their mood and behaviour.

We found people did not always receive care and support that reflected their individual needs.

Is the service responsive?

We found people's needs had been assessed before they moved into the home and a care plan developed to help support their individual needs.

We found that people's care plans were not always reviewed and updated quickly in response to a change in their care and support needs.

Is the service well-led?

We found that people living at Saivi House were regularly consulted about their care and treatment; however, it was unclear whether or not their concerns were always listened to or any appropriate action taken. We found the provider took account of comments and concerns from staff; however, it was unclear if action points identified at staff meetings were always acted upon. We saw the provider had some systems in place to assess and monitor the quality of their service.

We found that the provider had taken action following our last inspection. Checks we carried out on medicines provided evidence that medicines could now be accounted for, improvements had been made to medicines records, and protocols were now in place to provide staff with sufficient instructions to administer medicines safely. Therefore medicines were now being managed safely for the protection of people who use the service.

We found that staff and the management team knew people as individuals, and responded to people's care and support needs. Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We also found that the service liaised well with healthcare professionals to help meet people's individual needs.

People told us they were happy with the maintenance and cleanliness of the care home. We found that people were protected from the risk of infection. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

However, we found that people were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the recording and safe administration of medicines were not in place. In particular, the service could not account for some stock shortfalls with many as-needed medicines, and there were no up-to-date individual protocols in place for supporting people with as-needed medicines.