This inspection took place on 30 June 2015 and was unannounced
Salisbury Residential Home provides accommodation and care for a maximum of 31 older people, many of whom are living with dementia. At the time of our inspection there were 26 people living in the home.
The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.
The service was rated Inadequate following our last inspection. We met with the provider and the manager, who acknowledged the amount of work that needed to be done, in order to improve the service provided for people living in the home. During this inspection we saw that significant improvements had been made to the running of the home and mostly positive comments were received from people living in the home, relatives and staff.
Our previous inspection of November 2014 identified concerns that people’s medicines were not managed safely. During this inspection we acknowledged that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.
People were still not fully protected against the risks associated with unsafe medicines management because some records were inaccurate and some had not been completed. In addition, some people’s PRN information was not sufficiently detailed and some prescribed ‘external use’ medicines were not stored securely.
Our previous inspection of November 2014 identified concerns that staff, the manager and the provider did not have a good understanding of the Mental Capacity Act (2005) or the Deprivation of Liberty Safeguards. Therefore, there was a risk that people who lacked capacity to make their own decisions did not consistently have their rights protected. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.
Some staff had completed training in MCA and DoLS and some were booked to do it. Appropriate Deprivation of Liberty Safeguard (DoLS) applications had been made for some people, who lacked capacity, although formal mental capacity assessments and ‘best interest’ decisions were not always clearly recorded in people’s care plans and capacity assessments or best interests decisions were not in place for people receiving crushed or covert medicines. However, staff consistently respected people’s choices and obtained consent from people before doing anything.
Our previous inspection of November 2014 identified concerns that the provider had not taken proper steps to protect people from the risks of receiving inappropriate or unsafe care as they had not always assessed the risks to peoples safety, carried out an assessment of people’s needs or planned and delivered care to ensure people’s welfare and safety. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.
People’s care plans had been updated and guidance for staff was much improved. Detailed assessments of risks for people had been completed and staff had a good understanding of how to support people appropriately to minimise the risks.
Issues and concerns regarding infection prevention and control were identified during our previous inspection in November 2014 and an audit was carried out by an NHS infection control nurse in February 2015. During this inspection we saw that a number of improvements had been made, with a cleaner environment overall and equipment that was clean, hygienic and fit for purpose. Procedures had also been improved to reduce to possibilities of infection and cross contamination.
Following a visit from the local authority’s Fire Officer in May 2015, some areas for improvement and action were identified. During this inspection we saw that some of the required works had already been completed and a quote had been obtained for an upgrade to the current fire detection system.
Our previous inspection of November 2014 identified concerns that there were not always enough staff to meet people’s needs or to keep them safe. During this inspection we saw that improvements had been made to the consistency of staffing levels and concluded that this was no longer a breach. Staff were deployed appropriately and there were sufficient staff to meet people’s needs and ensure their safety most of the time.
Our previous inspection of November 2014 identified concerns that some staff members training was out of date and some had not received appropriate training to enable them to provide people with safe and effective care. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.
Staff were appropriately trained for the roles they carried out. Although some updates were still required, further relevant training was already planned. Supervisions, observations, handover meetings and staff meetings also helped enhance staff’s knowledge and skills to be able to support people safely and effectively.
Our previous inspection of November 2014 identified concerns that people were not always supported to eat their meals where it was required. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.
Staff supported people who needed assistance to eat and drink, according to their individual needs. People were also given sufficient amounts and choices of food and drink and were encouraged to be as independent as possible with regard to eating and drinking. A number of people were having their mealtimes monitored in order to ensure they were eating and drinking sufficient amounts and any concerns were referred to the dietician and, where necessary, the speech and language team, in a timely way.
Our previous inspection of November 2014 identified concerns that staff did not always treat people with consideration or respect. People did not always have choice and there was little evidence to show that people were involved in making decisions about their care. During this inspection we saw that improvements had been made and concluded that this was no longer a breach.
People’s choices were considered and respected and staff took time to listen to people and provide reassurance, particularly when their mood was low. Staff respected people as individuals. People were also involved as much as possible in planning their own care.
Our previous inspection of November 2014 identified concerns that assessments of people’s needs had not been carried out appropriately and care records did not contain enough information within them to enable staff to understand what care people required. During this inspection we saw that improvements had been made and concluded that this was no longer a breach.
People’s needs had been assessed and were regularly reviewed. Care plans described people’s individual circumstances and provided clear guidance for staff to know how to support people effectively and in line with their wants and needs.
People were also able to access other healthcare professionals and services as and when needed and referrals for specialist input, such as the falls team or dietician were made in a timely fashion.
Our previous inspection of November 2014 identified concerns that some people’s care records contained inaccurate information and some records had not been completed as required by the provider. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.
Care plans and records relating to people’s daily care had been completed appropriately and were up to date. However, formal mental capacity assessments and ‘best interests’ decisions were not always clearly recorded in people’s care plans and some of the records relating to the administration of medicines were inaccurate or incomplete.
Our previous inspection of November 2014 identified concerns that people who used services and others were not protected against the risks associated with unsafe or inappropriate care due to ineffective systems to monitor the quality of the service provided. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.
The manager, one of the providers and senior care staff were regularly monitoring the quality of the service provided by way of audits, check lists and observations. However, these audits were not always effective as some did not identify gaps or inconsistencies in care provision and record keeping.
The level of staff training had improved and was ongoing. Senior staff and management constantly carried out observations and any poor care practice was picked up quickly and dealt with promptly by the care coordinator or manager.
A quality assurance survey had recently been carried out, with questionnaires being given to people using the service, their relatives and staff and all the results were mostly positive
The management team were approachable and supportive and people were able to make a complaint if they needed and any concerns raised were listened to and responded to appropriately.
Staff morale had improved and was good and improvements had been made to how the home was run and organised overall.
We found that the provider was in breach of three regulations. You can see the action we have told the provider to take at the back of the full version of the report.