Savernake View Care Home

Savernake View Care Home is a care home providing nursing and personal care for up to 64 people. The service provides support to older people, people under 65 years and people living with dementia. At the time of our inspection there were 48 people using the service.

People had their own rooms on two floors with en-suite bathrooms. There were various communal areas available to people around the home including a cinema, café, hair salon, lounges, dining rooms and a private dining area. There were well established gardens available from the ground floor.

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

Incident management had improved, and systems were more effective in assessing and reviewing incidents and accidents. Forms recorded action taken in response to help prevent reoccurrence. Risks to people's safety had been assessed and there was guidance available to staff to give guidance on support needed.

People who experienced distress had detailed guidance in place so staff would know how to support them. The provider had also given staff additional training on supporting people living with dementia. Staff were also provided training on safeguarding and had systems in place to raise any concerns.

Staff were recruited safely and there were enough staff available to meet people’s needs. Staff were seen to be wearing appropriate personal protective equipment (PPE) and there was plenty of stock available. Training on infection prevention and control good practice had been provided to staff, and we observed staff following guidance. The service was clean throughout and smelt fresh.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had visits from family and friends. We observed during our inspection people going out with their relatives and also having visits at the service. There was a café near the front entrance where visitors could help themselves to refreshments.

Medicines were managed safely, and staff had been trained and assessed prior to being able to administer medicines. Where people had medicines ‘as required’, there were protocols in place to give staff guidance on how to give the medicine. The provider had changed their pharmacist since the last inspection and told us they were already seeing improvements in the service provided.

The registered manager was visible at the service and kept systems under review. For example, staffing rotas were reviewed daily, incidents were kept under review until all actions were closed, regular quality monitoring checks were taking place and there were regular meetings with people and staff.

The provider had improved their oversight of the service and were confident quality safety checks were now effective in driving improvements.

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 11 October 2022) and there was 1 breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served the provider a Warning Notice for the breach of regulation. At this inspection we found improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had met a Warning Notice served following the previous inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Savernake View Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Savernake View Care Home is a care home providing nursing and personal care for up to 64 people. The service provides support to older people, people under 65 years and people living with dementia. At the time of our inspection there were 48 people using the service.

People had their own rooms on two floors with en-suite bathrooms. There were various communal areas available to people around the home including a cinema, café, hair salon, lounges, dining rooms and a private dining area. There were well established gardens available from the ground floor.

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

Systems in place to manage and respond to incidents were not robust. Staff were not consistently recording incidents on the correct forms which meant management were not aware of some safeguarding incidents or injuries. Whilst staff had sought medical advice in response to accidents and incidents, we found incidents had not been reported to the local authority or notified to CQC in all cases. In addition, we were not able to see action taken to prevent reoccurrence or monitoring for trends. The provider took immediate action to address this shortfall during our inspection.

Risks had been identified and assessed but risk management plans did not always provide staff with the guidance needed to support people safely. People who experienced distress reactions did not have guidance in place for staff to know how to respond to their distress consistently. Safeguarding incidents involving people were not added to handover sheets. This meant staff would not be aware of who was experiencing distress. This was a particular concern due to the high numbers of agency staff used.

Monitoring records in place to record actions taken in response to risks were not clear. We shared this with the registered manager during our inspection. They told us they would make sure agency staff followed the same recording processes as permanent staff.

Medicines were managed safely. An electronic medicines system was in use which helped to make sure people had their medicines as prescribed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was clean, and the property was kept in good repair. External contractors were used to service facilities and records were kept demonstrating safety. Staff wore personal protective equipment appropriately and there was plenty of stock available.

People could have visits from friends and families when they wished. During our inspection we observed visitors being welcomed all around the home. People told us they felt safe at the service and appreciated the staff and management. People could share their views in meetings which were held regularly.

Staff were recruited safely and there were sufficient numbers of staff deployed. At times there were staffing challenges due to short notice sickness, but the management tried to cover gaps with agency staff. In order to provide continuity agency staff were booked in advance which meant they booked the same staff to work at the service.

Since the last inspection there was a new registered manager. Feedback about their approach was positive. Staff told us they were approachable and supportive. People told us they knew who the registered manager was and felt able to share ideas or concerns with them.

Whilst quality monitoring systems in place had identified areas for improvement, they had not identified shortfalls found at this inspection. Medicines audits were taking place and being monitored by the provider. Infection prevention and control audits were completed regularly to monitor for cleanliness and good hygiene practice.

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 2 August 2021). 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing and high use of agency staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Savernake View Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to governance systems,

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Savernake View Care Home is a nursing home in Marlborough providing care for up to 64 people, some of whom live with dementia. Accommodation is provided over two floors which are accessed by a lift and stairs. People have their own rooms and access to communal rooms such as lounges, dining rooms, cinema and activity rooms. On the ground floor people are able to access secure gardens. At the time of our inspection there were 53 people living at the service.

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

Prior to the inspection we received whistleblowing concerns about the management approach and people’s care and support. We continued to receive concerns during the inspection and shared all of them with the provider. We did not find evidence to substantiate all the concerns, but we did find some areas required improvements. We also received positive feedback about the service during the inspection from staff, relatives and professionals.

Whilst risks to people’s safety had been identified, action needed to mitigate risks by monitoring areas such as re-positioning had not always been recorded. Behaviour support plans to give staff guidance on how to support people when they were distressed were not detailed. Staff did not have the training they needed or the guidance to support people when they experienced distressed reactions.

Incidents and accidents had not always been recorded or reviewed to take action to prevent reoccurrence. In addition, actions required such as referring to other agencies or notifying CQC had not taken place in all cases.

People were supported by sufficient numbers of staff but at times there were unfilled gaps on the rotas due to short notice sickness. We have made a recommendation about staffing.

People and relatives told us they thought the service was safe. Staff had been trained on safeguarding but were not all able to demonstrate they understood their responsibilities around whistleblowing. The provider had posters up at the service with information about safeguarding and the whistleblowing policy was available to staff, but we have made a recommendation about this.

Medicines were managed safely; staff had been trained and had their competence to administer medicines checked. However, topical creams were not stored in the medicines room and had not all been dated when opened. The provider took action during our inspection to address this shortfall.

Staff were not always wearing appropriate personal protective equipment (PPE) when needed. The provider had given staff training on using PPE safely and had ample stocks of PPE available. People and staff were being tested regularly for COVID-19 as per the government guidelines.

Visitors to the service had to have a Lateral Flow Test which is a quick COVID-19 check providing results within 30 minutes. Staff screened all visitors checking temperatures and symptoms. Visitors were provided with PPE to wear during their visit.

The home was clean and smelt fresh. We observed windows were open to provide additional ventilation. Staff tried to encourage social distancing and seating had been arranged to promote this.

Quality monitoring systems were not robust and had not always identified shortfalls at the home. We had received whistleblowing concerns about the negative culture at the service and some staff told us the registered manager did seem to treat some staff more favourably. We also received positive feedback about the registered managers approach and management style. We have shared the concerns with the provider to review as part of their management oversight.

People felt listened to and were able to attend meetings. The provider sent out regular emails to relatives to keep them updated with changes to COVID-19 guidance. During the inspection the provider organised listening events for the staff which they told us they would continue to provide.

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

Rating at last inspection

The last rating for this service was good (published 30 August 2019).

Why we inspected

We received concerns in relation to people being locked in their rooms overnight by staff, unsafe staffing numbers, poor incident management and concerns about individual staff member’s approach. As a result, we undertook a focused inspection and visited the service at 23:00hrs to start reviewing the concerns. We reviewed the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance and failing to notify CQC of significant events at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Savernake View is a care home providing personal and nursing care to 42 people at the time of the inspection. The service can support up to 64 people.

The home was split across two floors, with four different units, for people with different residential and nursing care needs. People had access to the gardens and communal areas, including dining and living rooms, a cinema room, activities room, and hairdressing salon.

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

There was an electronic care planning and record keeping system. This ensured people’s personal information was stored in accordance with the General Data Protection Regulation (GDPR). It also meant it was possible to gain a clear overview of the care a person had received by filtering the records.

Medicines were managed and stored safely. We observed nursing staff using the electronic medicines management system. This system reduced the likelihood of errors occurring, as it maintained an ongoing stock count.

Guidance for the administration of ‘as required’ (PRN) medicines needed more information to ensure consistency. A nurse was assigned to work on these improvements by the second day of the inspection.

People and their relatives gave us consistently positive feedback about the home and the care they received.

There was a broad range of activities offered at the home. These included guest speakers and entertainers, as well as arts, crafts and fitness sessions.

There was good community engagement, with fundraising for charitable causes and involvement in local events.

People were supported by staff who had received enough training to meet people’s needs. Staff spoke positively about working at the home and were proud of the standard of care they provided.

There were a range of quality monitoring systems in place. These included surveys, meetings, and audits, where the registered manager maintained an overview of the service.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 26 June 2018)

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.

Savernake View 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.

Savernake view is registered to accommodate 64 people in one building across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At time of our inspection 38 people were living there.

There was 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.’

During our last comprehensive inspection in August 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely and people did not always have access to on-going healthcare that was responsive to their needs. In addition, care plans were not always person centred and did not provide enough detailed guidance for staff on how to meet people's needs and consent to care was not always sought in line with the Mental Capacity Act (2005). We also found that records kept in respect of people using the service, were not always accurately recorded or complete. Internal audits identified shortfalls, but sufficient action was not taken to address these.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found the provider had met two of the Regulations but two still remained in breach.

Care plans were not consistently person centred and recordings in daily records were not always professional. We found care plans did not contain guidance for staff on managing behaviours which could be challenging to others. Care plans were not reflective of people’s needs and staff did not always follow the most up to date guidance.

People received care from staff who had the right skills and knowledge. Staff had received training in areas such as manual handling, safeguarding, dementia and mental capacity.

Medicines were managed safely, following the service’s introduction of an electronic medicines management system. However, we found shortfalls with the management of people’s topical creams.

The service had improved their relationship with the GP surgery and people now had better access to the GP. Staff told us communication between the home and the GP had improved.

People told us they felt safe living at Savernake View. Staff had a good understanding of protecting people from avoidable harm and said they were confident that any concerns raised would be acted on.

Improvements had been made to gaining people’s consent to care and treatment, and where needed, associated mental capacity assessments had been completed. Where people lacked mental capacity to consent, the registered manager had made applications for Deprivation of Liberty Safeguards.

People told us they liked the food on offer and if they did not like what was on the menu, they would be offered an alternative. There were plenty of drinks and snacks available.

People spoke highly about the care they received. They said staff treated them with kindness and compassion.

Staff felt supported by the management team. There were quality assurance systems in place to monitor the quality of the service people received. People and/or their relatives had opportunities to provide feedback about their care.

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 22 and 23 August 2017 and was unannounced. This was the service’s first rated inspection since being registered with the CQC in August 2016.

The service had 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.

Medicines were not managed safely. We found gaps in the medicines administration records (MAR). Medicines had not been signed as administered and there was nothing documented to indicate that staff had either escalated this for investigation or had undertaken a stock check to ascertain whether they had been administered.

People did not always have access to on-going healthcare that was responsive to their needs. Although people were registered with a local GP practice, the GP did not regularly visit and there was nothing documented to indicate that people’s heath had been regularly reviewed. Staff said that accessing the GP for advice was not easy and that communication was by fax only. This meant there were often delays in seeking GP support.

Care plans were not always person centred and did not provide enough detailed guidance for staff on how to meet people’s needs. Care plans contained risk assessments for areas such as falls, moving and handling, skin integrity and malnutrition. These had been regularly reviewed; however, when risks had been identified the care plans did not always provide staff with enough guidance on how to reduce the risks.

When people had accidents, incidents or near misses these were recorded and monitored to look for developing trends. However, we found that people were not always supported to stay safe.

A significant number of people, relatives, visitors and staff expressed concerns about lack of staff, the use of agency carers/nurses and the impact that this had on the quality of care.

The service did not follow the requirements set out in the Mental Capacity Act 2005 when people lacked the ability to give consent to their care and treatment.

Language used in some of the care plans we looked at was unprofessional and did not demonstrate that staff were respectful of people.

Internal audits had identified shortfalls and action had been taken. However, we found that the action taken was not sufficient to resolve the shortfalls, for example, the safe management of medicines. Records kept in respect of people using the service, were not always accurately recorded or complete.

People told us they felt safe living at Savernake View. Comments included “A nice place to live - a gentle environment to live in. Everyone nice and friendly.”, “I like it here no hassle from anybody.”

People told us that they mostly liked the staff and felt they worked hard to provide a good level of care. Most staff were described as kind, considerate, caring and approachable.

Staff had the knowledge and confidence to identify safeguarding concerns and act on them to protect people. They had access to information and guidance about safeguarding to help them identify abuse and respond appropriately if it occurred.

The service followed safe recruitment practices. Records showed that checks had been made with the Disclosure and Barring Service [criminal records check] to make sure people were suitable to work with vulnerable adults.

People’s preferences including their dislikes and any allergies were recorded and visible in the kitchen. We saw the chef also catered for people from different cultural backgrounds, for example would occasionally prepare polish cuisine for a person from Polish background.

Care plans had been reviewed regularly, although it did not appear as though the issues we noted had been identified during the reviews. We saw that people’s relatives were invited to attend regular reviews and saw that this had happened and that their feedback was asked for.

People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest other activities they would like to complete. People told us they enjoyed the activities on offer.

People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Regular residents’ and relatives’ meetings were held.

Staff generally spoke highly of the registered manager. Speaking with relatives and people, they told us they knew who the manager was and felt the service was well managed. The registered manager was supportive and approachable.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.