Salisbury House Residential Home

We found the following examples of good practice.

¿ The service followed safe visiting procedures. Visits were restricted to essential visitors only. However, there were safe measures in place to facilitate visits for people receiving end of life care where it had been assessed as being in the persons best interest due to their wellbeing.

¿ A purpose built Covid-19 secure cabin had been built on site for visitors and professionals to use.

¿ Shielding and social distancing rules were complied with. There were procedures in place that accommodated people should they develop COVID-19 or show symptoms.

¿ Safe procedures were in place for admitting new people to the home. People were only admitted to the home following evidence of a negative COVID-19 test.

¿ Sufficient supplies of personal protective equipment (PPE) were well placed and staff used and disposed of it correctly.

¿ Cleaning schedules were in place to ensure good infection control standards were maintained.

¿ People and staff had access to regular testing for Covid 19.

¿ Guidance on the use of PPE and current IPC procedures were clearly visible across the service.

¿ The registered manager and staff communicated regularly with family of people living in the home. They also had effective relationships with other professionals such as GP surgeries for the benefit of people living in the home.

¿ The registered manager supported staff with their well-being during the pandemic including those with additional health needs..

Further information is in the detailed findings below.

Salisbury House Residential Home is registered to provide personal care for up to 37 older people and at the time of our visit the service was providing support for 36 people some of whom were living with dementia. The accommodation is provided in single and double rooms over three floors. Access to the upper floors is by way of stairs or passenger lift.

At the last inspection on 15th January 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is Good.

People and relatives told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed them. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities.

People were encouraged to express their views and results of customer satisfaction surveys were positive. People and relatives felt listened to and any concerns or issues they raised had been addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team which we observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional.

Further information is in the detailed findings below:

The home required a registered manager. 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. There were two registered managers in post, they had been registered since 2011.

People who lived in the home told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff cared for the people they looked after and knew them well.

All medication records were completely legibly and properly signed for. All staff giving out medication had been trained in medication administration.

We reviewed six care plans and found these needed to be more informative and person centred. They also did not give appropriate guidance for staff to meet people’s needs. Regular reviews of care plans took place to monitor any changes but these did not reflect the changes to people’s needs and some care plans contained inappropriate language.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed. The provider told us that DoLS applications had been submitted to the Local Authority for some people

People and relatives we spoke with said they would know how to make a complaint, none of the people or their relatives we spoke with had any complaints.

People and staff told us that the home was well led and staff told us that they felt well supported in their roles. We saw that the registered managers were a visible presence in and about the home and it was obvious that they knew the people who lived in the home well and that the

staff were well supported to carry out their duties.

We saw that infection control standards in the home were monitored and managed appropriately. Audits were completed as necessary and maintenance records were up to date and legible.

We spoke with six people who used the service and with five staff. We looked at various documents and files, including three care plans and three staff files. We were able to speak with three visitors, who were all relatives of the people living at Salisbury House Residential Home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

We found that the provider had suitable monitoring in place to ensure that the premises were maintained to a good standard and providing the people who lived there a safe environment to live in.

We saw that regular reviews were taking place to check that people were receiving appropriate care and support.

We found that staff recruitment was robust to check that staff were suitable to work with vulnerable adults. Staff also received regular training to ensure they were equipped with appropriate skills and knowledge to do the work they were employed for.

People who lived in the home told us that they felt safe. One relative told us she had peace of mind that her mum was safe when leaving her mother at the home.

Is the service effective?

We saw from care records that other care professionals, for example doctors, opticians, district nurses and dietetic services were involved with the health and welfare of people living in the home.

We spoke with three relatives visiting the home on the day and they told us that they were more than satisfied with the care for their relative and involvement they had with planning their care.

Visitors told us that they could come at any time of the day and they were always made to feel welcome.

We spoke with staff who demonstrated a good knowledge of individuals' needs.

Is the service caring?

We observed staff and saw that they spoke with people with compassion and good humour. The atmosphere in the home was very relaxed and people were supported at their own pace.

We saw that people expressed their preferences in what to eat and drink, where they wished to sit and which activities they wished to be involved with.

Relatives told us that they felt that staff were caring.

Is the service responsive?

Relatives told us that they knew how to complain if the need arose but did not feel that this was necessary as any concerns they had raised had been dealt with straight away.

Two people living in the home told us that they were involved in meetings with the provider so they could give their opinion and make suggestions of any improvements needed. They confirmed that they felt their suggestions were acted on.

People living in the home told us that they had lots of activities to keep them occupied. We observed on the day of our visit a number of activities were being carried on, there was an organist playing and creating a sing-along in the lounge, and board games and a quiz in the dining area. We saw that all activities were well attended.

Is the service well-led?

Staff had a good understanding of the values expected by the provider and manager.

There were good auditing processes in place to ensure that people received appropriate care and that staff were supported and supervised.

Quality assurance systems have been established to continuously monitor and develop the quality within the service.

We saw people's needs were assessed and care planned. There was however a lack of adequate information about people's needs and risks in order to ensure people's welfare and safety needs were fully met.

We found the building provided a safe and suitable environment for people to live in. There were adequate maintenance arrangements in place to ensure repair/maintenance issues were picked up and resolved quickly.

We reviewed three staff records. We saw the necessary checks to ensure staff were suitable to work with vulnerable people was undertaken.

We reviewed the provider's quality monitoring systems. We found there were some systems in place but that they were not used effectively to identify and monitor the quality of service or the risks posed to people 's health, safety and welfare.

People's care records were not fully updated in relation to changes in people's needs or risks and on the day of our visit medication records and daily monitoring charts were not stored securely.

"The staff are lovely they are so kind and helpful.'

'Prior to mum moving into the home she came for lunch and then stayed for a few days to see how she liked it and how I would cope. It has worked out so well mum is settled and I am made to feel so welcome.'

Care records showed that care needs assessments, care plans and risk assessments were in place they were person centred and reflected the individual needs of the people who used the service. Relatives told us they felt their relatives were safe living at Salisbury House and that a good standard of care was provided.

The training records showed senior care workers and deputy managers had received medication administration training in the last twelve months. There was a medication policy and procedure in place to provide guidance and instructions for the staff to follow to maintain people's safety and wellbeing.

Records showed equipment such as hoists and specialist bathing equipment had been regularly serviced and where appropriate repaired or replaced. Care workers told us they felt they had good training opportunities they also said they had received training in how to promote safe working practices and meeting the needs of the people they supported.