Archived: The Saltings

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.

The service provider, also works as the manager. Registered providers 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 registered provider was not present throughout the inspection. The Saltings was last inspected on the 17 and 25 November 2015 where five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. During this inspection we found that the provider had made little improvement to the areas identified as a concern at the previous inspection. This included risk to people’s safety, safeguarding processes, the Mental Capacity Act, staff supervision and support, and leadership and management of the service.

There was a lack of oversight and leadership at the service. Feedback was obtained with the view of improving the service, but action was not taken or recorded to demonstrate the improvements that had been made.

The provider had not kept accurate or complete records to support staff to deliver safe care and treatment to people. There was little auditing within the service to assess how the care and treatment people received could continue to improve. The provider worked in a reactive way rather than having clearly established processes to ensure people had good outcomes.

People were not protected by robust recruitment procedures, the provider could not demonstrate how they ensured the staff they employed were suitable for their roles.

Fire drills had not been practiced so the provider could not be sure staff were able to assist people in an emergency situation. The provider had not developed any contingency plans should there be a disruption in the delivery of the service or if there was an emergency situation.

Accidents and incidents were recorded but the provider lacked good oversight of incident management. People's behavioural guidelines lacked enough information to guide staff to manage incidents well.

Some areas of medicine management needed further improvement to ensure people received their medicines when they required it. The medicine policy was out of date and did not contain current good guidance to inform staff of best practice.

The provider did not have a good understanding of the process they should follow to comply with the Mental Capacity Act. The provider was not working within the principles of the Act.

Staff had not benefitted from regular supervision or appraisals to discuss their roles and identify areas they needed further support or guidance in.

Care plans lacked enough person-specific detail which meant people may be at risk of receiving inappropriate support. Information relating to people’s health had not been kept updated which could impact on people if they were supported by staff who did not know them well. People were supported to access outside health professionals when they needed this.

There were suitable numbers of staff on shift to meet people's needs. Staff demonstrated a good

understanding of how to support people well.

Staff had received the necessary mandatory training to support people safely, meeting their needs. Additional training was obtained in specialised areas such as epilepsy, autism, and depression. A staff member told us training was an area which had recently improved.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

Staff demonstrated caring attitudes towards people and spoke to them in a dignified and respectful way. Staff communicated with people in a person centred and individual way to meet their own specific needs.

People were relaxed and happy in their home and at ease around staff. People were supported to attend activities and day trips outside of the service and were offered activities within the service.

People had access to an easy read complaints policy in their care files. Complaints were recorded and responded to as outlined in the complaints procedure.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.