Salthouse Road

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The overall rating for this key question is good. Risk assessments were completed for identified risks. There were enough staff in place who had been safely recruited. Appropriate actions were taken following accidents or incidents and the service acted in accordance with the MCA. However, we identified a breach of the legal regulations. During this assessment we found elements of risk had not been effectively managed. For example, items were accessible which could have presented a risk to people if ingested and staff didn’t always follow a person’s risk assessment. Care plans guiding staff in how to support people who were distressed were not consistently in place. Elements of infection prevention and control practice required improvement to ensure this was in line with best practice. People received their medicines safely however some records were not in place as required.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Policies and procedures were in place to guide staff practice. Accidents and incidents were reviewed to try and identify any potential themes or learning which could be used to improve the quality of the care provided. Team meetings were held and provided a further opportunity for learning.

Staff reported a positive learning culture at the service. When accidents or incidents happened these were discussed, and learning was shared. Appropriate actions were taken following accidents or incidents, including seeking the input of external professionals such as healthcare staff or social services. Staff and leaders were open and transparent during the assessment. The management team reflected about things that had gone wrong, with particular reference to the development of a ‘closed culture’. This term describes when there is a poor culture within a service, which can lead to harm for people who use the service. The management team were committed to the necessary improvements.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives and representatives all told us they felt people were safe. For example, a relative told us, “Yes. Definitely safe. I observed myself how careful the staff are, and they’d ring me if there was any issue.” People expressed confidence that issues would be addressed promptly.

The provider had not always informed CQC about allegations of abuse, in line with legal requirements. Further information about this can be found in the ‘governance and assurance’ quality statement. Systems and processes were in place to make sure people were protected from the risk of harm or abuse. The provider had an up-to-date safeguarding policy in line with current legislation. Safeguarding concerns were shared with the relevant agencies. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. Staff, including the managers, understood the principles of the MCA and capacity assessments and best interest decisions were completed where required. Mental capacity assessments and best interest decisions were made where required, involving people and relatives as appropriate. The provider had a detailed MCA policy and procedure in place.

People appeared to be relaxed and comfortable with staff, making jokes together and enjoying one another’s company. No concerns were raised with us that people felt unsafe.

Staff received training and felt confident in their knowledge of safeguarding. Staff had access to the safeguarding policy. They understood how to raise concerns and felt confident they would be listened to. A member of staff said, ‘I am confident that the management team would take appropriate actions, however if they didn’t take them I would take it further by reporting it to headquarters, CQC, safeguarding or even the police.”

Staff and leaders understood how to support people to minimise possible risks but hadn’t consistently practiced this. For example, not following guidance when supporting a person to eat. Staff confirmed risk assessments were in place and they could seek further guidance if needed. Staff undertook relevant training to ensure they could safely support people. This included training around understanding and supporting people with behaviours which may challenge the service. Staff were aware of the importance of not placing unnecessary restrictions on people’s lives and that legal authority should be sought for these.

The provider’s processes to monitor how risks were managed had not been effective in identifying and addressing some of the concerns we observed during our assessment. Care plans detailing how to support people if they were distressed were not consistently in place. This meant staff lacked clear guidance to ensure they were consistent and proactive in their support of people. This was fed back to the provider for them to address. Risk assessments were in place for identified risks, which were reviewed and updated when there was a change in the person’s needs. Staff were informed of any changes to risk assessments located on the electronic system. Policies and procedures were available to support staff in the event of an emergency within the service.

Risk assessments were in place for identified risks and described actions to take to mitigate those risks. However, staff didn’t consistently follow the guidance provided in risk assessments which exposed people to potential risks. For example, thickeners used to thicken fluids for people with swallowing problems were accessible and stored along with cleaning products which could have been ingested. Staff were observed supporting somebody with their food in a way which was not in line with recommendations and exposed them to unnecessary risk. People’s relatives and representatives told us they were kept informed of any changes and that onward referrals were made when required.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives and representatives gave positive feedback about the staff team and noted good working relationships with people who used the service. It was noted there had been a lot of new staff recently who people and families didn’t know as well. For example, a relative told us, “The ones (staff) I’ve interacted with are fantastic, but I don’t know the new staff.”

Recruitment processes were safe and ensured only suitable people were employed. Records demonstrated staffing levels were safe. We discussed with the provider the need to develop records to support that people had received their commissioned hours. Staff training was monitored to ensure they undertook the relevant training. Records showed staff had not consistently received regular supervisions and appraisals in line with the provider’s policy.

Staff told us they felt supported in their role. They undertook training the provider considered mandatory and training specific to people’s needs. Further training could be requested if the staff member felt this was needed. Staff noted staffing levels were safe. For example, a staff member stated, "The staffing levels in the home are appropriate and safe for the needs of the service and the people who require support." Some staff told us there had been occasions where people had not received their assessed hours of care, particularly if there had been last minute sickness amongst the staff team and additional staff could not be sourced.

We observed staffing levels were sufficient and in line with the support people required. People’s needs were met in a timely manner, and staff were able to spend time with people engaging in a variety of activities.

We observed some environmental issues in the service. This included, worn furniture, porous wood which could not be cleaned effectively and contaminated clothing which not been stored properly. Staff did not always follow best practice in relation to infection prevention and control, including clothing sleeve length not being below the elbow.

Staff were aware of their roles and responsibilities regarding the administration of medicines. Staff told us there was information available which enabled them to manage medicines safely and effectively. Staff received trained and had their competency assessed annually to ensure they could continue to safely administer medicines and to address any practice issues.

People’s relatives and representatives told us people received their medicines safely. We observed medicines were given in a person-centred and caring way. Where people preferred a different routine for their medicines this was supported. People were seen by their GP at least annually for a routine check-up in line with national guidance.

The service had safe systems for appropriate and safe handling of medicines. However, some documentation to assist in the administration of medicines was not in place. For example, guidance specific to each person on how to administer medicines to be taken as and when required was not always available. When a paraffin-based cream is absorbed into material it can make it flammable and this had not been risk assessed. Information was not always in place to clearly show where creams or ointments should be applied. People’s prescribed medicines were recorded on their medicines administration record. Medicine audits were completed regularly but had not highlighted the issues we found.