Archived: The Saltings

Updated 14 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 and 11 August 2017 and was unannounced. Two inspectors carried out the inspection.

Before our last inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not ask the provider to complete another PIR prior to this inspection. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at any safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We met with all three of the people who lived at The Saltings. Not everyone was able to verbally share with us their experiences of life in the service. We therefore spent time observing their support. We looked at the environment including the bathrooms and people’s bedrooms. We spoke with staff and the registered provider/manager.

We ‘pathway tracked’ all three people living at the service. This is when we looked at people’s care documentation in depth, obtained their views on how they found living at the service where possible and made observations of the support they were given. This allowed us to capture information about a sample of people receiving care.

During the inspection we reviewed other records. These included three staff training and supervision records, three staff recruitment records, medicines records, risk assessments, accidents and incident records, quality audits and policies and procedures.

Updated 14 September 2017

This inspection took place on 10 and 11 August 2017 and was unannounced.

The Saltings is registered to provide accommodation and personal care for a maximum of three people. There were three people using the service during our inspection; who were living with a range of health and support needs. These included autism, learning disability, epilepsy and other complex conditions.

The Saltings is a detached house situated in Littlestone, Kent. People had their own bedrooms and there was a shared lounge with comfortable seating and TV. A dining area had been set up in the lounge and meals and drinks were prepared in the kitchen.

The service was managed day to day by the provider, who is registered with the CQC. 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.

The Saltings was last inspected in February 2017. At that inspection the service was found to require improvement overall with the well-led domain rated as inadequate. We served a Warning Notice on the provider for a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also issued requirement actions for breaches of six further Regulations.

At this inspection the requirements of the Warning Notice had not been met and we found other breaches of Regulation. There had been a lack of robust leadership and oversight to ensure people’s safety and the quality of the service. Leadership was lacking and the provider/manager demonstrated that they had neither taken ownership of the issues raised during our last inspection; nor of their own policies.

We identified a number of risks which had not been recognised or addressed by the provider/manager or staff. These included recruitment processes, which remained inadequate in ensuring that suitable staff were employed to work with people. The premises were unsafe for people in some areas but neither the provider/manager nor staff had picked up on the risks and remedied them.

Medicines were not always managed safely and there were no (as needed) medicines PRN protocol in place despite this being raised in our last report. The medicines policy had been updated but was not specific to the service.

Fire drills had not been recorded, but the provider/manager told us they had happened. Accidents and incidents did not always document events accurately and preventative actions had not been properly considered to keep people safe from harm. The provider’s safeguarding process had not been consistently followed leaving people exposed to a risk of harm.

The provider/manager and staff lacked knowledge and understanding about the Mental Capacity Act 2005; and were not always acting within its principles to observe people’s rights and choices. Deprivation of Liberty Safeguards had not been sought for people who needed constant staff supervision if they left the service.

There were shortfalls in people’s health action plans and a lack of records to evidence health checks, including of people’s weight. People for whom a fortified diet had been recommended did not receive meals with any extra calorific value than other people on ‘normal’ diets.

Behaviours were not assessed, monitored or managed appropriately to ensure people and others were kept safe. Staff training was inadequate and exposed people to risk because staff worked alone without the necessary knowledge to support some people’s conditions.

Care plans were not consistently person-centred and had not always been updated to show current information. Activities required further input for one person, to ensure they received sufficient social stimulation.

Records about complaints did not include information about investigations or outcomes. Auditing processes had been largely ineffective in highlighting areas of the service that were unsafe or required action to improve quality.

Personal emergency evacuation plans had been improved since our last inspection and the provider/manager now had a business continuity plan in place. Safety checks had been carried out on gas and electrical supplies. The service was clean and fresh, but no deep-cleans had been scheduled.

The provider/manager and staff were kind and caring towards people. We observed only gentle and considerate interactions and people appeared comfortable and relaxed with staff. There were enough staff deployed to meet people’s needs.

We found a number of breaches and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.