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Inspection carried out on 31 July 2018

During a routine inspection

Salt Hill Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Salt Hill Care Centre can accommodate up to 53 people (including couples) and provides nursing care, personal care and respite care to older and younger adults living with dementia, physical disabilities, learning disabilities and mental disorders. At the time of our visit there were 49 people using the service.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a registered manager in post.

When we completed our previous inspection on 4 and 5 May 2017, we found concerns relating to end of life care. At the time this area was included under the key question of ‘Caring’. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this area is included under the key question of ‘Responsive’. Therefore, for this inspection, we have inspected this key question and also the previous key question of ‘Caring’ to make sure all areas are inspected to validate the ratings.

At our previous inspection, the provider was rated ‘Requires improvement’ in all key questions of ‘Safe’, ‘Effective’, ‘Caring’, ‘Responsive’ and ‘Well-led’. We found a number of breaches in the Health and Social Care Act 2008 (Regulations) 2014. We asked the provider to send us an action plan to show what improvements would be made, by 23 July 2017. The provider submitted the action plan by the specified date.

We found the service had made the required improvements and are now rated 'Good' in all key questions.

People and relatives gave positive comments about the caring nature of staff. Comments included, “(Staff) very friendly, tolerant, forgiving and always around to help”, “They (staff) are always quite cheerful.”

People told us staff made sure those close to them felt like they mattered. Staff had a good understanding of people’s care and support needs. Staff ensured people’s privacy and dignity was respected and they were supported to be independent. Information about people was kept secure.

People said they felt safe from abuse. Comments included, “I feel quite safe” and “It’s as safe as houses. I would speak to (name of staff) if I felt unsafe.”

People were protected from harassment, discrimination and breaches of dignity and respect. Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and there were sufficient staff to care for people. Risks to people’s safety were assessed and medicines were administered safely.

People were cared for by staff who were appropriately inducted and trained. People’s nutritional needs were met. They were supported to live healthier lives and had access to healthcare services.

We have made a recommendation in relation to the provision of snacks. This was because people and relatives told us there was not a wide variety of snacks on offer. This was confirmed by our observations.

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 showed the service acted in accordance with the Mental Capacity Act (2005).

End of life wishes and preferences were captured with people and their relative’s involvement. The service was responsive to peoples’ care needs and social well-being. All compl

Inspection carried out on 4 May 2017

During a routine inspection

Salt Hill Care Centre is a care home with nursing registered to provide the regulated activity of accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for older people. It provides care and support to people living with dementia and learning and physical disabilities. At the time of our visit there were 53 people living in the home.

The most recent comprehensive inspection of the service was on 4 and 5 February 2016. The inspection resulted in an overall rating of ‘good’, with a ‘requires improvement’ in the key question is the service well-led. We found a breach in Regulation 18 CQC (Registration) Regulations 2009 (Notification of other incidents). A requirement notice was issued and we requested an action plan to be submitted by the provider on 13 April 2016. The provider failed to submit an action plan by the required date.

People and their relatives said the service was safe. Comments from people included, “Oh yes, quite safe” and “Yes, I’m safe here.” This was supported by relatives whose comments included, “Yes, she’s (family member) safe and well looked after, I can guarantee that she’ll be safe here.”

We found various work practices that placed people at risk of receiving unsafe care. This ranged from staff not having relevant training; people’s dependency levels not being regularly assessed to ensure appropriate staffing levels are in place; unsafe handling and administration of medicines to concerns about health and safety of the premises.

People and their relatives gave mixed feedback concerning how skilled and competent staff were. Comments included, “Seem alright. My laundry gets done; I just leave it on the bed” and “No. There needs to be more staff and better trained staff. I see them go to a resident in a chair and pull her up by her hands. I know they should put their arms under her arm and lift her.”

We found staff did not receive appropriate induction and training. The service did not always act in accordance with the Mental Capacity Act 2005. This legislation was put in place to protect people who are not able to make specific decisions. The service ensured people had access to a range of health care professionals to in order to maintain good health.

People felt the service was caring. Comments included, “The caring could not be better, the girls do their utmost to look after them all. They always offer me something to eat or drink, they’re very hospitable. I can come any time and I can make a cup of tea” and “They (Staff) look after her (family member) really well, her hair is always brushed, she never smells, she gets showered.”

We observed some good care practices. For instance staff were cheerful; attentive and encouraged people to eat. However, on other occasions we observed care was impersonal. We found people’s choices about end of life care was not reviewed regularly or discussed with appropriate others, to determine whether changes were needed.

Pre-admission assessments undertaken to establish peoples’ care needs were not designed to capture all the relevant information. We have recommended the service consider relevant nationally recognised evidenced –based guidance on the completion of assessments. People did not always receive care that was responsive to their specific needs. This was evident when reviewing the care of people who were diabetic; at risk of developing pressure ulcers and who were socially active.

People and their relatives gave a mixed response in regards how complaints were handled. Comments included, “I don’t have anything to complain about. It’s okay here”, and “There’s a resident who swears a lot, using really unpleasant words and I didn’t want my wife exposed to it. I told the (Registered) manager but he didn’t do anything about it so I said not to bring my wife into the lounge anymore. I don’t see why any of us should have to put up with it. I would prefer for her to

Inspection carried out on 4 February 2016

During a routine inspection

Salt Hill Care Centre is a care home with nursing registered to provide the regulated activity of accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for older people. It provides care and support to people living with dementia and learning and physical disabilities. At the time of our visit there were 53 people living in the home.

The most recent comprehensive inspection of the service was on 1 May 2014 The service was meeting the requirements of the regulations at that time.

People and their relatives were happy with the quality of the care provided and felt staff were friendly, kind and took good care of them. We observed people were looked after in a caring environment and saw staff were attentive to people’s needs, being gentle and compassionate when people became distressed.

People’s safety was maintained and protected. Staff were knowledgeable about how to keep people safe and had undertaken the relevant training. Risks assessments were put in place and risk management plans clearly recorded what actions must be taken by staff to reduce those risks. A review of medicines records showed medicines were administered in line with the service’s medicines policy. The service carried out safe recruitment practices which ensured people were cared for by staff that were of good character. We observed there was sufficient staff to provide care and support to people; this was supported by our review of staff rosters.

People and their relatives felt staff were efficient at their jobs and were adequately skilled to provide care, treatment and support. Staff were appropriately inducted, trained, supervised and appraised. They spoke positively about management ensuring they acquired the relevant skills to carry out their job roles.

Where people lacked the mental capacity to give consent the service ensured it acted in line with the Mental Capacity Act (2005). Staff demonstrated a good understanding of the act and knew the correct procedures to follow to ensure people who lacked capacity were still involved in the decision making process. During our visit we observed the service complied with the Deprivation of Liberty Safeguards (DoLS) by ensuring they applied for authorisation from the supervisory body before placing any restrictions on people who lived in the home.

People were effectively supported at meal times. They spoke positively about the meal choices available and expressed satisfaction with the food on offer. Where people were at risk of malnutrition appropriate professional assistance was sought. The service promoted the health and wellbeing of people by ensuring they had access to health professional. For instance regular GP visits. A health professional gave positive feedback about the clinical knowledge of a staff member and care that was given to people.

People felt the care delivered was specific to their individual needs. Staff demonstrated a good understanding of not only people’s care needs but what they liked and disliked. Care records evidenced what was important to people. People social needs were met. We observed an activity taking place during our visit and saw good interaction by staff and people were actively engaged. Relatives thought the service responded promptly to their requests. People and their relatives knew how to raise concerns and the complaints log evidenced all complaints received were responded to appropriately.

People, their relatives and staff felt the service was well managed. This was because management was effective, supportive and visible in the service. The provider sought feedback from staff, people who received care and their relatives. This covered all aspects of service delivery.

We found robust quality assurance systems in place to improve the quality and safety of people who used the service. The service ensured the quality systems in place were reviewed for their effectiveness.

Inspection carried out on 1 May 2014

During a routine inspection

The inspection was carried out by one inspector who gathered evidence to help answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the DoLS. The deputy manager informed us they had requested six standard DoLS applications from the local authority for individuals they anticipated they may have to use restraint for in event they wanted to leave the home. This demonstrated people were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the DoLS.

We saw completed induction programme schedules undertaken by the staff members and completed interview questionnaires which confirmed their fitness to do the job. Training records reviewed indicated what courses the staff members had undertaken, also what relevant qualifications they had achieved in order for them to be able to perform their duties. For example, safeguarding adults, mental capacity act 2005 (MCA) and DoLS, basic fire safety, moving and handling, infection control, first aid and emergency treatment. This demonstrated people could be confident they would be safe and their health and welfare would be met by staff members who were appropriately qualified and physically and mentally able to do the job.

Is the service effective?

We spoke with two people who told us how staff obtained consent from them when providing care. One person commented, �Staff always asks for my permission.� This was supported by the staff we spoke with. One staff told us; �In many cases, I obtain consent verbally.� Another staff member said, �I would ask them and get their preference of what they want and explain what needs to be done.� We reviewed their training records and saw they had undertaken relevant training. This meant before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We looked at the home's Selection and Recruitment of Staff Policy dated September 2010. This documents detailed how the home would ensure vacant positions were filled by the most suitably and qualified and experienced applicant by the effective selection, screening and recruitment processes. The policy stated that subsequent job offers would depend on satisfactory clearance. For example, a minimum of two references, one of whom must be the applicant�s current or most recent employer; a check on any apparent gaps in employment history; verification of personal identity and check on the validity of professional, educational qualifications. This demonstrated the service had effective recruitment and selection procedures in place to ensure the health.

Is it caring?

People told us the staff members who supported them knew them well. One person said, �They (staff) know what I like to eat and make sure I get it. They speak to me in a respectful way and listen to what I have to say.� We spoke to three staff members who confidently explained the care needs of the people they supported. One staff member when referring to a person they supported told us, �X is not fully mobile and requires assistance with eating and drinking, they can become physically aggressive. It is important that staff explain what they would be doing before providing care to them." We reviewed the care plan of the person and saw it supported what the staff member had told us. This meant people could be confident that staff members knew the care needs of the people they supported.

Is it responsive?

We looked at the relative communication records. This noted discussions staff had with the individual's family members and what action had been taken to address their changing behaviour. We saw the family members expressed gratitude with the care that had been provided and agreed with the home that more help would need to be sought from the person�s social worker and GP. This meant care plans was regularly reviewed and changed to meet the changing needs of people who used the service.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. For example, the deputy manager told us. �We had a resident who was always falling. We noticed this occurred at night time so management decided that an alarm mat which would alert staff members every time the person got out of their bed. This enabled staff to assist them and we found falls had stopped.� This helped to ensure the likelihood of further accidental injury was reduced.

Is it well-led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We reviewed the residents� survey dated December 2013 and saw that the majority of the forms were completed by people�s relatives who responded positively on all the questions asked. For example, relative rated the quality of care received, how they were involved in the running of the home and the choice of meal as excellent. On one of the questionnaires a relative commented, �X has been at Salt Hill Care Centre for a year now and seems very happy and settled. The staff team are friendly and are always happy to answer any questions we may have.� One person we spoke with told us, �There are no improvements necessary.� We saw comments boxes was situated on all floors in the home. This showed the service regularly sought the views of people and those who acted on their behalf.

We asked for and received a summary of complaints people had made and the provider�s response. The complaints log recorded dates complaints were received, what they concerned and what actions were taken. This showed people�s complaints were fully investigated and resolved, where possible, to their satisfaction.

Inspection carried out on 1 May 2013

During an inspection in response to concerns

People told us they were supported by staff and had named carers whom they could talk to about their care needs. We found people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People said they were offered a choice of food and drinks. We found people were provided with choices of food and drink that took into account their individual preferences and needs, including their cultural and religious requirements.

There were mixed responses to whether people thought there were enough staff to provide care to them. One visitor we spoke with told us: �I feel there is always enough staff.� Another person said: �No, definitely not! Half the ones I had when I came here have gone.� We found there were enough qualified, skilled and experienced staff to meet people�s needs.

People told us staff looked after them well. One person said: �They really look after me.� We found all staff received a comprehensive induction that took account of recognised standards within the sector and was relevant to their workplace and their role.

We saw surveys asked people various questions about aspects of care received. We found the service sought feedback from people who use the service or others acting on their behalf.

We found the provider had reported all incidents that affected the health and safety and welfare of people who used the service to the Care Quality Commission.

Inspection carried out on 28 June 2012

During an inspection in response to concerns

We used the Short Observational Framework for Inspection (SOFI) as part of this inspection visit. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. It involves spending time observing how people�s care is delivered and the interactions between staff and people using the service. It provides a valuable way of assessing people�s overall well being.

We spent time in one of the lounges observing the afternoon routine. We observed that the seating arrangement in the lounge did not promote a homely environment. The television and radio were both on at the same time. Not all the people may have appreciated the music on the radio as it was not age appropriate. However, people did not complain.

We observed staff offering people lots of drinks to keep them hydrated as it was a hot day. We observed staff interacting with people in a game of skittles. A number of people declined to participate and staff accepted their wishes. We observed staff speaking to people in a respectful manner and providing encouragement.

We observed a carer washing a person�s feet in the lounge area in the presence of other people. This meant that their privacy and dignity were not upheld. We observed a staff member was able to communicate effectively with a person and their relative whose first language was not English. This demonstrated that the service employed staff who had the skills and aptitude to provide care for people from ethnic minority.

A person who used the service was able to tell us about their experience. They said that their needs were being met at the service. They said �the food is good.�

We spoke to four relatives of people who used the service. They told us they were happy with the care that their family members were receiving. They said that staff made them aware if there were changes to their family members� care. They all said the care was improving. One person said �sometimes staff are not always around in the lounge.�

Relatives of people who used the service told us that they would speak to the manager if they had any concerns. One person said that �they regularly attended residents and relatives meetings and had found them useful�.

During a routine inspection

People told us they were involved and consulted about their care. Staff discussed care and support options with them. They said staff respected their privacy and dignity and they were able to choose what clothes they wished to wear, what time to rise and retire, what time to have their meals and what activities they wished to participate in.

People said they have a care plan and their opinions were sought when it was written.

They told us they were registered with a general practitioner (GP) and their medical needs were looked after appropriately. They said the staff supported them with their medicines.

People said they felt safe living in the home. It was new and the furniture and fittings were modern. They said they knew whom to speak to if they were worried.

People told us staff were trained appropriately to meet their needs.