Background to this inspection
Updated
16 October 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector, one specialist nurse and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Saxlingham Hall 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We reviewed all the information we held about the service, including the previous inspection report and notifications of incidents the service is required to tell us about. We used all of this information to plan our inspection.
During the inspection
We spoke with ten people who used the service and three relatives about their experience of using the service. We also spoke with the chef, two nurses (including the clinical lead), two care staff a member of the maintenance staff, the registered manager and a director who was previously the registered manager of the service.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us easily.
We reviewed a range of records. These included eight people’s care records and five medicines records. We also reviewed rotas, two staff training and recruitment records and other documents relating to the safety and quality of the service.
After the inspection
We sought clarification on some issues from the service and viewed some written feedback from a hospital professional, which had been sent to the service. We consulted the CQC Medicines team for advice about the storage of medicines at low temperature. We also contacted nursing colleagues from the local clinical commissioning group for their expert opinion on aspects of nurse training at the service.
Updated
16 October 2019
About the service
Saxlingham Hall is a residential care home and was providing personal and nursing care to 34 people at the time of the inspection. The service can support up to 36 people.
Saxlingham Hall accommodates people in a large period manor house in a rural village. There are communal dining and recreation areas, as well as extensive grounds.
People’s experience of using this service and what we found
People who used the service, and their relatives, were very happy with the care and support provided and spoke highly of the staff. One person commented, “The care I get is very good. I am here for respite care and so far all my needs are met. The nursing staff are very good and I can’t fault them. The staff are very polite and try hard to make you feel at home.”
We identified concerns with the way medicines were managed. Stocktaking procedures were not robust. It was not possible to be sure that people had received the correct amount of their medicines. Audits of medicines did not identify the issues we found which meant that the provider did not have good oversight of this aspect of the service.
Risks were mostly well assessed and managed. However, some environmental risks had not been identified and action taken to protect people from harm. The newly registered manager did not have sufficient oversight of these aspects of health and safety. Audits, although plentiful, were not always acted upon and effective in driving improvements.
The staff team worked collaboratively and well; staff felt supported. Stakeholder views were regularly sought and acted upon.
Staff were recruited safely and were clear about their safeguarding responsibilities. Staffing levels reflected the provider’s own assessed safe number. However, several people commented that there was sometimes a wait for staff to respond to call bells.
Staff were trained to carry out their roles and received a good induction when they were first employed. Access to health and nursing care was good and feedback from healthcare professionals was positive.
Staff showed an understanding of consent issues. People were supported to have maximum choice and control of their lives. Staff mostly supported them in the least restrictive way possible and in their best interests, however review of the use of a lap belt in armchairs was needed to make sure people were not being unlawfully restrained. We have made a recommendation about this.
The environment was suitable for people, although the communal lounge was quite small. People enjoyed the beautiful gardens and the views from their rooms.
Staff were kind and caring towards the people who used the service and their relatives. Staff promoted people’s independence and upheld their dignity. There were good relationships between staff and those they were caring for and feedback about staff was universally positive.
The service enabled people to follow their own hobbies and interests. Activities were varied, appropriate and inclusive. End of life care was good and we observed prompt responses to people's changing needs. Complaints were managed in accordance with the provider’s policy and action taken promptly.
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 outstanding (published 14 January 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach of regulation in relation to the management of medicines 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.