Archived: Saltshouse Haven Care Home

Updated 22 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was in response to concerns and was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11and 26 August and 8 and 9 September 2016 and was unannounced. On the 11 August 2016, the inspection team consisted of two adult social care inspectors. On the 26 August 2016, the inspection team consisted of two adult social care inspectors and a registered general nurse from Continuing Health Care commissioned by Hull Clinical Commissioning Group. On the 8 September 2016, the inspection team consisted of two adult social care inspectors and a representative from the local authority commissioning team. On the 9 September 2016, the inspection team consisted of two adult social care inspectors.

The registered provider had not yet been asked to complete a Provider Information Return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. However, we checked our systems for any notifications that had been sent in as these would tell us how the registered provider managed incidents and accidents that affected the welfare of people who used the service.

Prior to the inspection we spoke with local authority safeguarding, and contracts and commissioning team about their views of the service. We also spoke with members of the continuing health care team and a health professional who was a safeguarding lead and had raised concerns with us about the service.

During the inspection we observed how staff interacted with people who used the service throughout the days and at mealtimes. We used the Short Observational Framework for Inspection (SOFI) on Bilton, Preston and Meaux lodges. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with eight people who used the service and 17 people who were visiting their relatives. We spoke with a range of staff which included the regional director, the registered manager, a unit manager, a nurse, two senior care workers, 12 care workers and two hostesses (who served meals to people on Coniston lodge). During the inspection, we also spoke with two visiting health professionals and two members of an ambulance crew who were collecting a person for a routine hospital visit.

We looked at 20 care files which belonged to people who used the service to check how their needs were assessed, any risks identified and to see how care was planned and recorded as delivered. We also looked at other important documentation relating to people who used the service. This included medication administration records (MARs) for all people who used the service and some monitoring charts for food, fluid, weights, pressure relief and changing behaviour. We looked at how the service used the Mental Capacity Act 2005 to ensure that when people were assessed as lacking capacity to make their own decisions, best interest meetings were held in order to make important decisions on their behalf.

We looked at a selection of documentation relating to the management and running of the service. These included four staff recruitment files, probationary forms, training records, the staff rota, minutes of meetings with staff, quality assurance audits, surveys, complaints management, compliments received and maintenance of equipment records.

Updated 22 December 2016

Saltshouse Haven is registered to provide care for 150 people, some of whom may have nursing needs or who may be living with dementia. The service is located on the outskirts of Hull and has good public transport access. The service is divided into five separate lodges, Sutton (closed at present), Coniston, for people with nursing care needs, and Bilton, Preston and Meaux for people with residential care needs. Each lodge has a separate entrance, their own communal rooms, bedrooms and an external garden. Administration is carried out from the main building and laundry and catering are delivered from another building within the site. Each lodge has a ‘unit manager’.

The service had a registered manager in post as required by a condition of their registration. 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 2008 and associated Regulations about how the service is run.

Saltshouse Haven had a full comprehensive inspection in September 2015 and concerns were found regarding how people received person-centred care, dignity and respect, safe care and treatment, managing complaints, good governance, staffing and obtaining consent. We issued warning notices for staffing and consent and requirement notices for the other concerns. The service was rated as Inadequate and placed into special measures, which meant we were to follow up with another inspection within six months. A full comprehensive inspection to follow up the requirement notices and warning notices was completed in February 2016 and we found significant improvements had been made. The service was removed from special measures and rated as Requires Improvement. Although compliant with the requirement notices and warning notices at the February 2016 inspection, we wanted to make sure the improvements were sustained and we planned to return and inspect the service again within 12 months.

Findings specific to Coniston lodge:

Due to concerns raised by health professionals we inspected Coniston lodge 11 and 26 August 2016. As a result of findings, we decided to take urgent action and liaised with the local authority and Hull Clinical Commissioning Group to ensure the people who lived on Coniston lodge were found alternative placements at other services for their nursing care. The registered provider’s representative was informed of the decision. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. Due to the level of risk and concerns found during the inspection, the registered provider agreed to a voluntary suspension on further admissions to Saltshouse Haven.

The concerns found on Coniston lodge resulted in us finding the registered provider in breach of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches included, management of the service, providing person-centred care, the need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’; this is the second time the service has been in ‘special measures’ in a 12 month period and the registered provider must take action to improve and sustain the improvements. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We found inadequate staffing levels had impacted on the quality of care people received on Coniston lodge. People who used the service had sustained injuries due to a number of poor moving and handing incidents, staff had to be prompted to take action regarding one person’s health care needs, some people’s nutritional needs were not met and seating arrangements when people ate their meals was not always appropriate or safe.

There was a lack of robust risk management, staff had not always following guidance from health professionals and there was the use of improper physical interventions for one person.

Some people had not received their medicines as prescribed due to stock control issues, errors in administration and non-application of creams. Some people had poor hand and nail care and personal hygiene.

We found general concerns in documentation such as care planning and recording, advice from health professionals not transferred to care plans, risk assessments identified issues but lacked some control measures and care plans were not always updated following incidents. There was a lack of follow-through in recording of some issues so it was difficult to see if the care had been provided and the issue addressed. There were gaps in some people’s monitoring charts and wound care records, and re-dressing times were not always followed.

There were concerns with the management of infection prevention and control as some areas and equipment required cleaning.

We found specific staff lacked understanding about the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, obtaining consent and carrying out care and support in people’s best interests. Documentation that showed best interest decision-making had not been completed appropriately.

Findings for the service as a whole:

There was a policy and procedure to guide staff in how to manage complaints and a record was held of investigations and outcomes. Improvement was required regarding a more customer focus approach and accuracy of the complaint letters sent out to people who had raised concerns.

There was insufficient induction, supervision and support to staff in lower management positions. There were shortfalls in how the service was managed overall and how care staff were overseen and supported when carrying out their roles. Some care staff had received formal supervision but others had not received any for some months. Staff had received a range of training but we were concerned some areas had not been fully understood.

We found audits had taken place regarding Saltshouse Haven as a whole, which highlighted specific issues, but there lacked analysis to ensure lessons were learned and incidents did not reoccur.

Findings specific to Bilton, Preston and Meaux lodges:

We decided to complete further inspection visits to Saltshouse Haven on 8 and 9 September 2016 to assess the care people received on the other three remaining lodges, Bilton, Preston and Meaux. On the days of the inspection there were 17 people who used the service on Bilton lodge, 18 on Preston lodge and 25 on Meaux lodge. During these two inspection days, the service was overseen by a regional director for the registered provider, BUPA. There were also other senior managers on site supporting staff with reviewing care plans and risk assessments.

We found there were sufficient staff on duty on each of the residential lodges as some members of staff had moved across to them when people moved from Coniston lodge to alternative placements. However, staff told us prior to the changes, there were days when there was insufficient staff on duty and this had impacted on the care and monitoring they were able to provide. The regional director told us they would complete a staffing review to ensure sufficient staff were on duty in line with people’s care needs.

We found employment checks were carried out prior to new staff starting work in the service. The recruitment process helped to ensure only suitable staff worked with vulnerable people. In one staff file we found gaps in their employment history had not been explored and documented.

There were policies and procedures to guide staff in how to safeguard people from the risk of harm and abuse. Staff had received safeguarding training and were able to describe the different types of abuse and how to report any issues of concern.

We saw people who used the service had assessments and care plans. The assessments did not always comment on the impact on people of their health needs and disabilities. Care plans did not always detail guidance for staff regarding the support people required to meet their assessed needs.

The care files included information about visits from professionals which helped to ensure people’s health and social care needs were