Archived: Salisbury Residential Home

We found the following examples of good practice:

The service had built a pod into their lounge to look like a 1950s music booth with an entrance from the garden. Relatives entered the pod from the garden to visit the people who lived in the service, who they saw through a screen in the lounge. The pod was also used for entertainment with singers. There was a microphone system to aid hearing.

A person who used the service close relative died so the service organised for them to watch the funeral procession drive past and had a small wake in the dining room with photos of the person with the relative, to help them pay respects and remember.

The service had reorganised the bedroom arrangements so those people who walked with a purpose were downstairs for their safety and better observation and those people who were isolating due to being admitted or returned from hospital were upstairs, so their bedrooms could not be accessed easily by those that walked with a purpose.

A range of risk assessments had been completed for concerns raised due to the COVID-19, including changes which affected fire management, to ensure people who lived in the service were kept safe.

Staff who worked in the service had a reward day organised by the manager to say thank you for their hard work and sacrifices during this time. This was risk assessed and measures put in place to ensure it was COVID-19 safe.

Salisbury residential home is a residential care home, providing accommodation and personal care. The service accommodates up to 30 people in one adapted building. At the time of this inspection, there were 28 people living in the service, some of whom were living with dementia.

The service has four communal lounges, a dining area, and a garden which people can access.

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

People were cared for safely. Personal risks were assessed, and measures put in place to mitigate identified risks. Staff were recruited safely, and safeguarding processes helped to protect people from abuse. There were systems to ensure information about any changes in people's needs was shared promptly across the staff team.

People received their medicines safely, and in the way prescribed for them.

People were supported by staff who had completed relevant training to give them the skills and knowledge they needed to meet people's needs. People were supported to have sufficient amounts to eat and drink and were protected against the risk of poor nutrition. Staff supported people to maintain their health and well-being. 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.

Staff treated people in a kind and caring way. People and relatives valued the service and the support the staff provided. Staff treated people with respect and helped them to maintain their independence and dignity.

Care plans were detailed, person centred and reviewed regularly with people and their relatives, where appropriate. People, their representatives and staff were confident if they had a complaint they would be listened to and action taken to address the issue. People were able to take part in activities such as musical entertainment, head massage, and pamper sessions.

There was an open culture and ideas to develop and improve the service were welcomed. The provider had systems in place to monitor the quality of the service to ensure people received good care. People, relatives and staff were given the opportunity to feedback on their experience of the service.

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

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 18 January 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected this service in April 2018, where we found continued breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, governance, and person centred care. We also found new breaches of Regulations in relation to nutrition and hydration and staffing. The service was rated ‘inadequate’ overall and was placed in special measures.

Salisbury Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service accommodates up to 31 people in one adapted building. At the time of this inspection, there were 20 people living in the service, some of whom were living with dementia.

There was a registered manager in post. Since our last inspection in April 2018, the provider had registered as the 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. In August 2018, a new manager was appointed, and they have made an application to be the registered manager, at which point the provider will step down from this post.

This inspection in November 2018, found improvements had been made in relation to people’s safety and care delivery, and the service was no longer in breach of Regulations in relation to safe care and treatment, staffing, person centred care and governance. We did however find a repeated breach in relation to nutrition and hydration. The overall rating for this service is now ‘requires improvement’. The service has been removed from special measures.

People’s nutritional intake was now being monitored more accurately and we found new systems in place had supported this improvement. However, we found that food was not always served at appropriate temperatures, and the dining experience for people remained poor.

There were systems in place to monitor the quality and safety of the service provided. Some areas of improvement had not been identified through the auditing processes, however, the manager was in the process of updating audits to ensure they were robust.

Staff understood safeguarding procedures and knew how to report any concerns they had.

The provider calculated staffing levels via a dependency tool. Additional staff were brought in at busier periods. However, feedback we received from some people indicated that at times they had to wait for staff. This is therefore an area that will require constant review to ensure people receive care in a timely manner, and we have made a recommendation about this.

There were group and individual activities which people could take part in. However, feedback from people indicated that this was not always meeting their individual and specialist needs. We have made a recommendation about this.

People were protected by the provider's recruitment procedures because checks were carried out on staff before they began work. However, we found some staff who had been employed for a longer period of time did not have robust checks in place.

Staff had an induction when they started work and had access to the training they needed to carry out their roles. The new manager had held supervision sessions with staff and had a schedule in place to ensure this was routinely undertaken.

There were safe systems of medicines administration and recording. Staff who administered medicines were trained and their competence observed before they were authorised to do so. However, when changes were made to medicines and new medicines were prescribed, the guidance sometimes had not been reviewed. However, medication was under review and relevant health professionals were involved.

We observed that staff were kind and caring when interacting with people. However, we did not see that their privacy was always respected. Some feedback from people indicated that the staff approach could vary.

People's care plans were personalised and reflected their individual needs. People and their relatives had opportunities to contribute to the development of their care plan, However, we did not always see that people had signed their care plans; the manager was reviewing this and ensuring people were involved as much as possible.

The provider had addressed previous environmental risks. Risk assessments in relation to people’s care had been completed and guidance provided to reduce the risk.

The service worked in partnership with other agencies. Where there had been identified concerns in people's health or wellbeing there were systems in place to contact health and social care professionals to make sure people received appropriate care and treatment. Professionals told us the manager and staff worked co-operatively with other agencies and adopted any guidance they recommended.

The provider had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted, however, staff were not aware of all people who had such restrictions in place. In some cases relatives had given consent but were not always legally entitled to give consent on people’s behalf.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received.

At our last inspection in August 2017, we found the provider to be in continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations in relation to person centred care, governance and safe care and treatment. Following the inspection, we took enforcement action and placed conditions on the registered provider's registration to submit monthly reports to us setting out how they would assess, monitor and take action to improve the quality and safety of the care and support provided to people living at Salisbury residential home. We also met with the provider to discuss what they would do to improve the key questions to at least good.

Salisbury Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Salisbury residential home accommodates 31 people in one adapted building. At the time of this inspection there were 27 people living in the service.

There was not 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. One of the partners in the provider partnership had applied to become the registered manager, but this had not yet been completed. There was an acting manager in post, who came to the service in November 2017 to support the service with on-going improvements.

At this inspection on 9 and 12 April 2018, we found continued breaches of regulation in relation to safe care and treatment, governance, and person centred care. We also found new breaches of regulations in relation to nutrition and hydration and staffing.

Risk assessments in relation to moving and handling were not always accurate, and did not contain relevant information to support staff to move people safely. Behavioural risks assessments were not sufficiently detailed to ensure staff had guidance on what action to take when people were distressed. There were no risk assessments in relation to choking or the use of bed rails. We found that some improvements had been made in relation to the monitoring of risk in relation to people’s weights, their risk of developing pressure ulcers, and monitoring of falls.

Quality monitoring systems and audits had failed to identify the shortfalls we found during this inspection. Whilst there were quality assurance mechanisms in place, these had proved ineffective at identifying areas for improvement, and not all aspects of the service were being effectively monitored. This placed people at risk of harm.

People's health and safety were at risk because the provider had failed to identify where safety was being compromised in relation to environmental risks. Alterations made to the passenger lift had not been risk assessed or checked by a competent person to ensure they were safe. There were exposed hot water pipes in people’s rooms and communal toilets within the service which posed a risk of burns if people were to touch or fall against them. We found two stand aid slings which were available for use, but were not safe to use due to wear and tear. The provider, acting manager and care staff did not always recognise risks in the environment, such as items which could cause potential harm.

The provider was using a dependency tool to identify the number of staff required according to people's needs. However, this had been ineffective in identifying the number of staff required to meet peoples social, emotional and physical needs. The provider had accepted a high number of new admissions in February 2018, which did not demonstrate a responsible approach to ensuring new admissions were carefully considered in line with on-going improvements the service was required to make.

Staff received training relevant to their role, however, refresher training was overdue in some areas for several staff. Competency checks on staff performance were not being routinely carried out to ensure staff were applying their learning effectively; the acting manager told us they had begun this process with two staff members.

People's capacity to make decisions was assessed and Deprivation of Liberty Safeguards (DoLS) applications had been made where appropriate. However, some mental capacity assessments did not always reflect what the decision being made was, and why a test of capacity was needed.

People received their medicines safely, however, improvements were required in some areas to ensure documentation was accurate, and staff had up to date information about people’s medicines. There were areas of the service where external medicines were not secured. The service had not considered the risks around the potential for people accessing them and placing themselves at risk of accidental harm.

The provider needed to consider more fully how to maximise the suitability of the premises for the benefit of people living with dementia, and we have made a recommendation about this.

The provision of activity was improving, but was still not meeting individual and specialist needs. The activity co-ordinator had ideas on how to progress the current programme in place.

The service needed to develop their practice in supporting people in relation to their end of life care. Care plans made reference to people’s end of life wishes, but some contained only minimal information. The service did not follow best practice guidance to create care plans that set out people's wishes and needs in sufficient detail.

Food and fluid charts were not always completed fully or totalled to ensure people were receiving adequate nutrition and hydration. The dining experience was not conducive to an enjoyable mealtime and opportunity for social interactions, and we have made a recommendation about improving the dining experience for people.

Appropriate recruitment checks had been carried out on new staff, to ensure they were of good character and suitable to work with people in the service. This included obtaining references and ensuring DBS (disclosure and barring checks) were carried out.

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.

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.

Salisbury residential home provides accommodation and personal care to a maximum of 31 people. This includes older people, some who may be living with dementia. At the time of our inspection there were 26 people using the service.

We previously carried out a comprehensive inspection of this service on 6 June 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of regulation 18 of the Care Quality Commission (Registration) Regulation 2009, as they had failed to notify us of an incident resulting in serious harm to a person. Regulation 11, because formal mental capacity assessment and best interests decisions were not always carried out, and Regulation 9 because the service had not ensured that people received responsive care that met their needs. We also identified a breach of regulation 17, because the service had failed to implement effective systems to monitor and improve the quality of the service. We issued a warning notice in relation to Regulation 17. In November 2016 we returned to check if the service had met the requirements of the warning notice, and we found that improvements had been made and they were no longer in breach of Regulation 17.

At this inspection in August 2017, we found a continued breach of Regulation 9, and a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We took enforcement action to impose conditions on the providers registration. We asked the provider to identify the root causes of the shortfalls in the oversight and governance of the service and what action is being taken to mitigate these from reoccurring. This must include and consider risks associated with nutrition and any associated weight loss, falls, and pressure area care. This condition continues on a monthly basis, whereby the provider informs us of actions which have or are being taken to mitigate identified risks. We decided to impose these conditions on the providers registration because people may be exposed to the risk of harm.

The registered manager had left the service in June 2017. 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 was a manager in post who was still in their induction period, and they were planning to register with the CQC.

People's health, safety and well-being were at risk because the registered provider had failed to identify where safety was being compromised. Quality assurance and auditing mechanisms did not identify concerns we found during this inspection and had not been effective at driving and sustaining improvements. This constituted a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks associated with people's care and support were not always safely managed, monitored or reviewed in line with their assessed level of need. This constituted a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Whilst the registered provider had taken steps to improve the provision of activity, this was still not meeting the individual and specialist needs of people. Care plans were not always accurate or sufficiently detailed to reflect people’s needs and provide adequate guidance for staff. People's nutritional and hydration needs were not accurately documented or monitored to ensure their intake was sufficient. We could not be assured that relevant referrals to other professionals had been made promptly, or were being followed, as documentation was not available to demonstrate this. We also found that one person had not been referred for specialist input regarding their falls. This constituted a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received their oral medicines safely and in a timely manner. However, topical application, such as creams were not being documented as having been applied. This meant we could not be certain that people were receiving their topical medicines as prescribed.

Staffing levels were adequate and had been regularly reviewed to ensure they were meeting the needs of people living in the service. Staff were trained in subjects relevant to the people they were caring for.

The registered provider and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Systems were in place to check if people were at risk of being deprived of their liberty. Systems were in operation to obtain consent from people and to comply with the MCA.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

People told us they had good relationships with staff who protected their privacy and dignity. We observed pleasant and patient interactions throughout our inspection. However, we received mixed feedback about the staff, with some people saying the staff approach could vary. Staff had a good knowledge about the people they supported.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

We undertook this focused inspection to check that the service had undertaken changes to meet the legal requirements of this regulation. This report only covers the findings in relation to the warning notice. You can read the report from our last comprehensive inspection in June 2016, by selecting the 'all reports' link for Salisbury Residential Home on our website at www.cqc.org.uk.

At this inspection carried out on 29 November 2016 we found that although further improvements were required, the service had met the requirements of the warning notice. We have not changed the overall rating for this service as a result of this inspection as it was only undertaken to follow up our enforcement action. The service and the domain of well-led, remains as requires improvement.

Salisbury Residential Home provides residential care for up to 31 people, some of whom may be living with dementia, a mental health condition or a physical disability. At the time of our inspection 27 people were living in the home. Accommodation is over two floors with a number of communal areas.

At the time of this inspection, the home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the inspection in June 2016, concerns were identified that demonstrated that the provider did not have effective systems in place to monitor the quality and safety of the service delivered. This had resulted in some people receiving a poor service.

At this inspection we saw that although some improvements were still required the service was no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which relates to governance. However, we have made a recommendation about the auditing of the quality of the service delivered.

The audits in place for monitoring the completion and accuracy of care plans and associated records were not fully effective and had not identified some issues in relation to this.

Whilst the service had assessed its adherence to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) further monitoring was required to ensure it was fully meeting its responsibilities.

Improvements had been made in meeting people’s social and leisure needs and an action plan was in place to further address these issues.

The service was auditing staffing levels and its ability to meet people’s needs in a timely and person centred manner. These were effective at identifying any issues and rectifying them.

Additional audits had been completed on the service and we saw that these were effective. They covered areas such as health and safety, accidents and incidents and medicines management.

The views of those that used the service, their relatives, staff and health professionals had been sought and information acted upon in order to develop the service.

Salisbury Residential Home provides accommodation and support to a maximum of 31 people. This includes older people some of whom may be living with dementia, people with physical disabilities, or people with mental health conditions. It does not provide nursing care. At the time of our inspection there were 25 people living in the home.

We last inspected this service on 30 June 2015 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of Regulation 17 as they had not identified some areas where actions for previously required improvements were still outstanding or had not been appropriately maintained. The provider was also in breach of the Regulation 11 because formal mental capacity assessments and best interests decisions were not always carried out and clearly recorded in people’s care plans and Regulation 12 because people’s medicines were not managed safely.

At this inspection in June 2016, we found continued breaches of Regulation 11 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

There was a manager in post who had been appointed in March 2016. At the time of our inspection, the manager had submitted an application to the Care Quality Commission (CQC) to become a registered manager. A registered manager is a person who has registered with the CQC 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.

Some improvement was still required regarding the safe management of people’s medicines. External medicines had not been stored securely and assessments regarding the administration of medicines were not reviewed. Staff were not always sufficiently trained and their competency was not always checked. This included the administration of medicines as some staff were not trained or assessed as competent to do so.

Staff had the knowledge to recognise, prevent, and report harm and knew how to raise concerns. They understood individual risks to people and how to manage these.

We received mixed feedback regarding whether staffing levels were sufficient enough to meet people’s needs. We have made a recommendation that the service review this.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements were still required in this area as not all staff demonstrated knowledge of the MCA and DoLS and the home was not working within its requirements.

People’s preferences and needs around meals were accommodated and people were assisted with eating and drinking when unable to do this for themselves. People were supported to receive the health care they needed. People at risk of not eating and drinking were identified; however where some people required their food and fluids to be monitored this was not always done.

People were supported by kind and caring staff, who ensured people felt involved and able to make decisions regarding their care. However some practices did not always promote people’s dignity.

People and their relatives were involved in the planning and reviewing of their care. People and their relatives felt able to raise concerns. Concerns were listened to, responded to appropriately and action taken to resolve them.

People did not always receive responsive care that met their needs. There was a lack of daily planned activities for people living in the home and there was not always enough stimulation and activities for people.

The provider had not identified some areas where actions for previously required improvements were still outstanding or had not been appropriately maintained. Improvements were still required regarding the service’s quality monitoring systems and some records continued to be incomplete and inaccurate.

People and staff were listened to and involved in decisions regarding the service, there was an open and inclusive culture within the home. Staff were valued and supported by the manager and provider.

As part of this inspection we spoke with the manager of the service, and looked at the records relating to investigations into recent safeguarding issues.

Below is a summary of what we found. The summary describes what we observed and the records we looked at.

Is the service safe?

Our inspection concentrated on how the service protected people from abuse or the risk of abuse. We found that they had learned from recent incidents and amended their policies and practice to ensure that people's safety was paramount.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and under review. Relevant staff had been trained to understand when an application might be necessary and how to submit one. This meant that people's rights were protected and they were not subject to unnecessary restrictions .

We found that quality assurance procedures were in place which, amongst other things, considered the safety of people who used the service.

Individual risk assessments were in place within people's care plans. These ensured any risks were identified and minimised and sufficient staff were in place to ensure people were safe.

The purpose of this inspection was to check that people who used the service were provided with safe and effective care that met their needs. We spoke with the manager and staff members who told us about the improvements made in the service to meet people's needs.

We conducted this inspection to establish the following about The Salisbury Residential Home: Was the service safe? Was it effective? Was it caring? Was it responsive and was it well-led?

Below is a summary of what we found. This summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, people's relatives and from reviewing records.

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

Is the service safe?

Most of the people we spoke with who lived at The Salisbury told us that they felt safe and secure and that staff treated them with respect and dignity. Some people we could not communicate with but we did observe and note how they were treated, how they were provided with assistance and what efforts were made to keep them safe.

People we were able to speak with told us that they knew who to speak to if they didn't feel safe or were unhappy about something. They indicated that staff took great care to ensure that they felt safe and secure. The relative of one person we spoke with told us "It was a sudden respite admission. We were so unprepared and just not sure what to do or what to expect. Of course we checked out the Care Quality Commission reports on the website, but that was only a part of the decision for us. It was how helpful and careful the manager was during the admission process that swung it. We haven't looked back and now they [the relative] have decided to stay permanently."

We inspected the staff rotas and found that there was sufficient staff on duty to meet people's needs, and to keep them safe, throughout the day and night.

There was a system of identifying and rectifying equipment and building faults and the home employed a maintenance technician. Health and Safety records were up to date as were maintenance records for servicing equipment. This meant that people were not exposed to unnecessary risk.

We saw that the home was clean and well maintained.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

All aspects of people's care had undergone a rigorous review since January 2014 to measure and ensure quality, safety and people's satisfaction.

The Salisbury demonstrated that it took great care to ensure the care and wellbeing of the people who used the service. This was shown in individual care plans, continuing risk assessments, daily records and communication records. Where it had been possible we saw evidence of people being involved in decisions about their care and that their needs and wishes were known.

There was a system of recording and managing incidents and complaints. We saw evidence of how the home responded to issues, or requests, which resulted in the home increasing its levels of effectiveness and satisfaction.

We saw evidence that care plans and risk assessments were reviewed on a monthly basis or as and when required. Reviews with people using the service and their family members were also noted to take place. This told us that the home took reasonable steps to work with families to deliver care in a way which was both satisfactory and re-assuring.

Is the service caring?

The Salisbury operated an 'open door' policy to people living at the service, their families and staff. This meant that staff and management could be approached at any time to listen to and act on any concerns or suggestions.

We noted that people were supported respectfully and courteously. We also noted that people were regularly spoken with in a polite manner by staff. Smiles and words of comfort were offered and interactions seen to be understood by the person spoken with.

Care and support provided was individual and informative.

We noted that other healthcare professionals worked with the home to ensure continuity of care where necessary.

Was it responsive?

We saw that the home responded to people on an individual basis. People's likes/dislikes were acted on and we saw every effort made to put the interests and wellbeing of the individual first.

One person we spoke with said 'It's lovely here, they are so kind and cannot do enough for me.' We saw staff responding to people's needs and questions in a proficient manner. We noted that whilst staff were busy during the inspection that they still took time out to re-assure people, interact with them and engage with them.

Food could be eaten in private or in the dining room. We noted that hot and cold drinks were made available throughout the day.

We noted that comments and thoughts were shared in daily records and shared across the management and care teams as part of regular reviews.

Was it well-led?

The Salisbury was undergoing a thorough review of its quality assurance system. A recently appointed manager had introduced, for example, new ways of monitoring food intake, hydration, personal care and how the provider worked with other healthcare providers. Other recent efforts to ensure a well led service included the introduction of a monthly newsletter for residents and relatives. A suggestion box had been placed in the main entrance. A recent survey of services provided had taken place and the provider was considering results at the time of the inspection.

Learning from incidents/complaints was recorded and shared with residents, staff and relevant interested parties. Any shortfalls in service provision were put right such as a recent change in catering supplier.

We found that people's personal care records, and other records kept in the home, were accurate, safe and filed appropriately and securely.

The purpose of this inspection was to check that people who used the service were provided with safe and effective care that met their needs. We spoke with the manager and a staff member who told us about the improvements made in the service to meet people's needs.

We looked at the care records of two people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. People's nutritional needs were met.

We spoke with three people who used the service who told us they were happy with the service they were provided with. One person said about the care and support they were provided with, "It is pretty good, well I should not say pretty good, it is good." Another person said, "We don't complain about it."

During this inspection we found that concerns regarding abuse were made to the appropriate professionals who were responsible for investigating safeguarding issues. The provider had notified us of incidents, as required by Regulation 18.

We found that people were provided with a clean and hygienic environment to live in. The shortfalls identified in our last inspection had been addressed, this included replacing soiled mattresses.

Our last inspection found that there were sufficient staff numbers to meet the needs of the people who used the service. However, prior to this inspection we had received information from an anonymous source, which told us that the staffing levels during the night had been reduced. Therefore, we checked the staffing levels at night met the needs of the people who used the service and the arrangements in place to monitor the staffing levels. We found that there were sufficient staff numbers to meet people's needs.

We found that people were not cared for in a clean and hygienic environment.

We found that people were cared for by staff who were trained and supported to meet their needs.

We looked at the care records of six people who used the service and found that people's needs and how these needs were met were documented.

We spoke with six of the 29 people who used the service. They told us that they were satisfied with the service they were provided with and that the staff treated them with respect and kindness. One person said, "I'm very happy with how I am treated. They (staff) are all very good." Another person said, "I get what I need." During our inspection we saw that the staff interacted with people in a caring, respectful and professional manner.

We found that the provider's complaints procedure explained how people could raise concerns if they were not satisfied with the service. There were systems in place for people to share their views about the service.

People told us that the staff treated them with respect and listened and acted on what they said. One person said, 'They are very kind.' Another person said, 'The staff are excellent.'

People told us that they were provided with enough to eat and drink. One person said, 'There are always two choices but you can change your mind and they will get something else for you.'