Archived: Saxlingham Hall Nursing Home

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.

This inspection took place on 8 November 2016 and was unannounced.

A registered manager was in post at the time of our inspection. 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.

Staff had been recruited safely and had been well trained. There were enough staff on duty with the skills and knowledge to provide people with the care and support they needed. Staff received regular supervision sessions and felt supported in their roles. The turnover of staff was very low and many of the staff had worked at the service for a number of years.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

Staff were very well trained; some staff had received additional training in order that they carried out extra roles such as in the provision of activities. Staff were eager to learn and use their skills within the home to ensure that people were receiving exceptionally good personalised care.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People had plentiful choices of the food and drink they ate. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The registered manager and team worked effectively and in partnership with healthcare professionals and was pro-active in referring people for assessment or treatment whenever it was required.

There was a friendly and welcoming atmosphere within the home; Visitors were made warmly welcome and encouraged. People were supported to maintain contact with family and friends, in some cases using additional technology such as email and video links.

Care plans detailed people’s specific support requirements. People and their relatives were involved in the reviews of their care according to their individual preferences.

Staff involved and treated people with compassion, kindness, dignity and respect. The high standard of care enhanced people's quality of life and wellbeing. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted. This provided them with a sense of purpose and wellbeing.

There was a strong culture within the home of treating people with respect and of high quality care The views of people and their relatives about the quality of care provided at the service were regularly sought and acted on. Information was given to people about how to raise any concerns they may have and where concerns were raised these were dealt with speedily and in depth. Relatives said they felt welcomed at the service and would highly recommend it to other people.

The home was extremely responsive to people’s needs. Staff potential to deliver additional tasks such as activities was recognised and promoted. Activities were planned by staff who worked closely with people to establish their individual and unique preferences. People were supported to take part in activities of their choosing, based on their specific requests.

The home was exceptionally well led. There were very effective quality monitoring processes in place which covered all areas of the home and care delivered to people. Staff retention was very good; staff enjoyed their jobs and the care they delivered to people. Staff were extremely positive about the way the home was managed and were happy in their work. There was a clear management structure in place; staff understood their roles and responsibilities. The home was organised and well run and the culture was open and transparent.

The registered manager was very approachable and took action promptly if changes were needed.

Staff were encouraged to raise ideas and suggestions and demonstrated the core values of the home during the inspection. A considerable number of audits of people’s care and the systems in place to support the delivery of care were in place. The audits enabled the registered manager to make continuous improvements where necessary to ensure the continued high standards of care.

We found that people were happy with the care they received and were asked for their consent before the staff performed a task.

People liked the food and told us they had a choice of food and drink. The service monitored people for the risks of malnutrition and dehydration and took action when people were identified as being at risk.

The service was clean and free from offensive odours.

People told us that the staff were caring. The staff also told us that they were happy working for the service. We saw that the required checks had been completed before staff started working for the service to ensure that they were of good character.

People told us that they did not have any complaints and that they would be confident to talk to the staff if they were unhappy about anything.

We saw that staff interacted with people who used the service in a respectful, caring and professional manner. Staff were attentive to the needs of people and responded to requests for assistance promptly.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.