Salis Care C.I.C.

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to people receiving person-centred care, the implementation of best practice guidance and the management oversight of how the Mental Capacity Act 2005 was being met.

This service scored 50 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

They provider had not always completed a comprehensive assessment of people’s needs prior to their support starting. This had led to staff not always being able to meet people’s needs and people not being able to make choices regarding who they shared their home with. The manager and director of care told us they had recognised changes were required and had enhanced the assessment guidance. They shared their revised assessment process which was designed to gather more detailed information and ensure people had the opportunity to meet each other prior to them receiving support at the setting. However, as this approach had not been used at the time of our assessment we were not able to determine how effective this would be in practice.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People did not benefit from best practice guidance being embedded into the way staff worked. The lack of understanding regarding what Right Support, Right Care, Right Culture meant people’s rights were not always considered. Whilst people were supported to make choices and go out, the lack of understanding around people’s communication and distressed behaviour meant opportunities to develop and maintain interests had been missed. The manager told us prior to their commencing their role there had been a lack of understanding in relation to the support people required when anxious or distressed. This had led to restrictions being placed on people’s choices and routines. The manager and staff told us new ways of working and the removal of restrictions had led to people being more involved in their support and plans were in place to develop this further. Whilst these changes were positive for people receiving support, they were not always planned to ensure the structure and guidance needed was effective. In other areas we found the changes in the way staff supported people had led to positive outcome for people such as going out more and making informed choices regarding how they spent their time.

The provider did not always work well across teams and services to support people. The management team held regular meetings with staff. Minutes of these meetings showed they were mainly instructional with the manager passing on information rather than working together with staff and people. Few staff comments were recorded and there was little opportunity for staff to engage in dialogue The manager acknowledged this was case as due to having recently taken over they needed to communicate changes being made. They told us they spent a lot of time at the setting and listened to the views of staff and people through discussion and observation. However, they were not able to demonstrate how feedback was consistently gathered and responded to.

A handover was completed between staff when coming on duty and leaving. We observed details of how people had been, how they had spent their time, and any concerns were discussed. This enabled a smooth transition for people when the staff supporting them changed.

The provider did not always support people to manage their health and wellbeing, and staff did not always support people to live healthier lives. We received mixed responses from relatives in relation to people being supported to live healthier lives. One relative told us, “The routine for [relative] was very established but has been lost. Now [they] are not active [they] have put on so much weight. It’s affecting how they walk.” A second relative told they felt their relative received good support to remain active and healthy. Staff told us they encouraged everyone to go for walks and to be more active, but some people declined. Although records evidenced people were encouraged to be active, this was not always effectively planned and communicated. For others, records showed they were supported to take part in a variety of active interests which supported them to remain healthy.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent.

There was a lack of consistency in how people’s desired outcomes were identified, monitored and improved. Some relatives we spoke to felt that although staff were now trying to make improvements, the lack of skilled staff supporting their relatives initially, had meant previous skills and achievements had been lost. One relative told us, “The staff are trying now but it’s so hard to get back to where [relative] was.”

Systems to record people’s wishes and how their aspirations were identified had not been effectively implemented for all those receiving support. For some people this meant their support plans and goals had not changed for long periods and their quality of life had not been holistically reviewed. The management team told us they were reviewing people’s support on an individual basis and looking to remove barriers by working alongside health and social care professionals. We observed this was having a positive impact with some people going out more often and others having more independence at home. However, changes were not always being made in a planned way and no goals or aspirations were recorded or reviewed with people to ensure their achievements were recognised.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider failed to ensure the principles of the Mental Capacity Act 2005 (MCA) were implemented and that staff were aware of their responsibilities in line with this. Although the majority of staff had completed training in relation to the MCA, they were unable to demonstrate they understood how this impacted on the way people were supported.

Capacity assessments had not been completed for people in relation to individual decisions such as people receiving one to one or two to one support, locked doors or restrictions on them leaving their home without support. Whilst some people had previously had capacity assessments completed, these lacked detail and the providers system stated these were no longer in date. No best interest decisions were recorded, and consideration was not always given to less restrictive measures. For example, we saw one person had an audio monitor in place which meant when they were in their bedroom staff and others were able continually hear them. Staff told us this was in place to monitor the persons health condition. However, there was no evidence to show that less restrictive measures had been explored which may have protected their dignity.

The manager told us they were aware processes were not being followed in relation to the MCA. However, they informed us a number of restrictions had been removed since they had been in post to ensure people had greater freedom in their home. This included removing locks from kitchen cupboards where people’s food was stored as this was causing people to be anxious. The manager told us they also considered this to be overly restrictive as all those people receiving support had a minimum of one-to-one support which meant staff were always available to support them in the kitchen. Staff told us they felt this change had made a big difference to people and incidents of distressed behaviour around the kitchen had reduced.