Archived: Sailaway Residential Care Home

Sailaway is a residential care home that provides personal care for up to 18 people aged 65 and over. At the time of inspection 10 people were living at the service, including people living with dementia and people with a learning disability.

People’s experience of using this service:

The registered provider is the person who is usually in day to day charge of the service. They were not present at the inspection on the 24 May 2019 and had been absent from Sailaway since 17 May 2019. The person left in charge during the provider’s absence is referred to in this report as ‘the manager’. This person was not registered with the Care Quality Commission and was not legally responsible for how the service is run or for the quality and safety of care provided.

During periods of their absence from the care home, the registered provider did not leave a suitably qualified and competent person in charge. The manager left in charge did not demonstrate an understanding of the knowledge and skills required to manage a care home. The manager did not demonstrate competencies in the overall management of the service and was not fit and competent to be in charge due to their personal conduct and failure to improve the service.

Aspects of leadership and governance of the service were not effective in identifying some significant service shortfalls, such as failing to ensure staff were appropriately trained and skilled to undertake aspects of their role.

The provider was not always delivering the appropriate level of support that people were assessed as requiring to meet their needs and keep themselves and others safe.

Incidents were not always responded to, recorded or addressed appropriately.

Records were not always kept about persons employed or the management of the regulated activity.

The registered provider had not ensured that there were always suitably trained and competent staff on duty to administer medicines.

The provider had not ensured a process to implement or sustain the improvements that they told us that they were going to make. There was a lack of improvement to the service people received.

Rating at last inspection:

The last inspection the service was rated as Inadequate. (published 16 May 2019)

Enforcement;

At the last inspection on 20 and 26 February 2019 and 10 April 2019, report published 19 May 2019, the service met the characteristics of inadequate in three key questions, Safe, Effective and Well-Led and requires improvement in two key questions; Caring and Responsive. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded. We are taking enforcement action and will report on this when it is completed.

Follow up:

The overall rating for this service remains ‘Inadequate’. This means that it remains in ‘special measures’. We will keep the service under review and, if we do not propose to cancel the registration we will re-inspect within 6 months to check for significant improvements.

The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question overall, we will act 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 overall, we will act to prevent the provider from operating tis service. This will lead to cancelling the providers registration or to vary the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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

Sailaway is a residential care home that provides personal care for up to 18 people aged 65 and over. At the time of inspection 16 people were living at the service including those with Parkinson’s disease, diabetes and people living with dementia.

People’s experience of using this service:

¿The registered provider is the person who is usually in day to day charge of the service. They had been absent from Sailaway for a period of more than 28 days during November and December 2018. On the 20 February we were told by the manager that the provider had been absent since the 10 February and was not due to return until the end of April.

The person left in charge during the manager’s absence is referred to in this report as ‘the manager’. This person was not registered with the Care Quality Commission and was not legally responsible for how the service is run or for the quality and safety of care provided.

The manager did not demonstrate an understanding of the knowledge and skills required to manage a care home. We observed that they did not have the skills and competencies to meet people’s assessed needs and keep them safe. The manager had visited the service up to three times a week. When they were not in the service there was no clear leadership or responsible person in charge.

¿People were not always protected from abuse and improper treatment. Systems and processes to protect people from abuse were not operating effectively. The manager and provider had not always reported incidents to the local authority safeguarding team. Staff did not know how to report a safeguarding incident or concern. This placed people at significant risk of harm as allegations and injuries were not being responded to appropriately.

¿Incidents were not always recorded or addressed appropriately, risk assessments were not robust and did not always cover relevant risks.

¿New staff had not always been recruited safely. Processes were not in place to ensure people were suitable for the job they were applying for or that new staff were of good character.

¿The rota did not always ensure that there were medicines trained staff on duty. This meant that some people did not always have access to “As required” medicines for pain relief and other prescribed medicines.

¿Advice and recommendations of external healthcare professionals were not always followed.

¿People did not always receive person centred care that met their needs and preferences. There was a risk that new or agency staff would not know how to meet people’s needs safely or in accordance with their personal wishes and preferences as care records were not always up to date.

¿Risks were not always clearly assessed for people. The action staff may need to take to safeguard people from harm or to provide person centred care was not always detailed in their care records.

¿People did not have any meaningful stimulation and occupation. People told us that there was little to do and they spent most days in the lounge with the television on. They did not get an opportunity to go out unless it was with a relative or friend.

¿Aspects of leadership and governance of the service were not effective in identifying some significant service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people.

¿Some parts of the premises were not secure, clean or properly maintained.

¿The provider could not evidence that there was an accessible complaints process and whether complaints were investigated. People were unsure of how to raise a complaint.

¿Information about the service was not always in an accessible format for people to understand.

¿There was limited information for staff on people’s communications needs in accordance with the Accessible Information Standards (AIS).

¿People told us that the food was very good and they had enough to eat and drink.

Rating at last inspection:

Good. (The last inspection report was published on 19 April 2017)

Why we inspected:

The inspection took place on the 20 and 26 February 2019 and was unannounced. The inspection was brought forward because of concerns raised to CQC from the local authority. We had been told that there was a long-term absence of the registered owner and lack of effective management oversight by the person left in charge. Staff lacked knowledge and skills to support end of life care and there were not always sufficient numbers of staff on duty.

We visited the service again on the 10 April 2019. This was announced to assess the improvements the provider had made since our visit on the 20 and 26 February 2019.

Enforcement:

This service met the characteristics of Inadequate in three key questions, safe, effective, and well led, and Requires improvement in two key questions; caring and responsive. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded We are taking enforcement action and will report on this when it is completed.

Follow up:

The overall rating for this service is ‘Inadequate’. This means that it has been placed into ‘special measures’ by CQC. We will keep the service under review and, if we do not propose to cancel the registration we will re-inspect within 6 months to check for significant improvements.

The purpose of special measures is to:

¿Ensure that providers found to be providing inadequate care significantly improve.

¿Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question overall, we will act 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 overall, we will act to prevent the provider from operating tis service. This will lead to cancelling the providers registration or to vary the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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

The home was managed by the provider who is in day to day charge and worked alongside staff in order to provide care to people. The provider is a registered person and 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.

At our last inspection to the service in November 2015 we found one breach of regulations. The provider had not ensured there were systems and processes to adequately protect people from abuse and improper treatment. Concerns were also identified with regard to medicines received into the home when people were on short stay or respite care. We asked the provider to take action and the provider sent us an action plan In February 2016 which told us what action they would be taking. At this inspection we found that improvements had been made and the regulations were now met. As a result of improvements made, the service’s overall rating had improved to “good.”

People told us they felt safe. Relatives told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.

There was a system in place to ensure that medicines were managed safely. All staff authorised to administer medicines had received training and the competency of staff administering medicines was checked on a regular basis.

Risks to people’s safety were assessed and reviewed. Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely.

People were involved as much as possible in planning their care. Each person had a plan of care which provided staff with the information they needed to support people and meet their needs. Care plans contained information which was relevant to each individual and enabled staff to provide effective support to people.

Staff received regular training and there were opportunities for them to study for additional qualifications. Staff were supported by the management through supervision and appraisal. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider and staff understood when an application should be made and how to submit one and was meeting the requirements of DoLS. The provider and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. People spoke positively of the food and the choice they were offered. We were told, “The food is good, there is always a choice”. Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. People were supported by a range of health professionals and appropriate referrals were made for guidance or additional support.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiled and laughed with people and offered support. There was a good rapport between people and staff.

The provider and staff were flexible and responsive to people's individual preferences. People were encouraged to maintain their independence and to participate in activities that interested them.

The provider had a clear complaints procedure and a copy was given to people when they moved into the home and their relatives; there was also a copy of the complaints procedure on the notice board in the home.

The provider had a policy and procedure for quality assurance. They operated an open door policy for both staff and people using the service and their relatives. Weekly and monthly checks were carried out to help monitor the quality of the service provided. There were regular staff and residents’ meetings and feedback was sought on the quality of the service provided through quality assurance questionnaires. The provider welcomed feedback on any aspect of the service. The staff team said communication between all staff at the home was good.

We looked at the processes, procedures and records held by the service relating to the use and management of medicines. We observed that medicines were stored securely.

We reviewed the administration records and supporting information. These records were complete, and included supporting information to ensure that staff would administer the medicines in a consistent manner.

The provider had a system in place to monitor how medicines were used in the home and to check that it was safe.

We observed the administration of medicines at lunchtime. One person that we spoke with told us that they were happy with the way that they received their medicine. They told us, 'I get what I need when I need it'. We spoke with two members of staff and the manager. One member of staff told us, 'The staff are regular and we all know the people'.

We noted that the provider had taken some action to address the compliance action we set at our inspection in April 2013 concerning the recording and safe administration of medication. We found that the majority of medication was administered safely. However, medications with variable doses or that were prescribed on a 'when required' basis were not appropriately recorded. We also found that some medication was not stored appropriately. Further action was required to ensure that people were protected from unsafe or inappropriate care.

We spoke with four people. They told us that it was a good home and that they felt supported. One said, 'There's not much I could say against the place'.

We spoke with two relatives. One told us, 'I think it's great actually, it really is'. The other said, 'I think it's very well run; they look after people well'.

We spoke with three members of staff and the manager. One member of staff told us, 'I really like this job'. The manager said, 'I've got really good staff, we work like a family'. We observed that staff had a good relationship with people and knew them well.

We noted that the provider had taken action to meet the compliance action we set at our inspection in October 2012 concerning the storage of medication. We found, however, that some other aspects of the management of medicines required action to ensure that people were protected from unsafe or inappropriate care.

They told us about the care and support they had received and confirmed they were satisfied. One person told us, 'As places go, I would give it eight out of ten!' Another person told us, 'The staff are very nice, very friendly, I feel I am very lucky here.' A relative said, 'Sailaway is warm, friendly and caring. It's got soul; it's not sterile. It's not posh but it's homely. The residents always come first.'

People we spoke with told us they felt safe. They confirmed that they found care staff were competent and skilled when providing for their needs. They also confirmed that the provider often spoke to them to ensure they were satisfied with the service provided. We were informed they found the provider was approachable and their views about the service had been taken into account.