Archived: Saltshouse Haven Care Home

Updated 1 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is 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.

The inspection took place on 15 and 16 June 2017 and was unannounced. The inspection team consisted of two adult social care inspectors on both days. An expert by experience joined the inspection team on 15 June 2017. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The provider had not yet been asked to provide a Provider Information Report (PIR). The PIR 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, a PIR had been completed prior to the change in the provider’s legal name and the manager gave us a copy during the inspection. We checked our systems for any notifications that had been sent in, as these would tell us how the provider managed incidents and accidents that affected the welfare of people who used the service.

Prior to the inspection, we spoke with the local authority safeguarding, and contracts and commissioning team, about their views of the service. We also received information from health and social care professionals who visited the service.

During the inspection, we used the Short Observational Framework for Inspection (SOFI) on Bilton lodge. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also observed how staff interacted with people who used the service throughout both days and especially at mealtimes. We spoke with 18 people who used the service and 15 people who were visiting their relatives. We spoke with the manager, the head of care, unit managers on each of the three lodges, and the night care manager. We also spoke with eleven care workers, three of whom were seniors, the cook, the activity co-ordinator and maintenance personnel. We had discussions with two visiting health care professionals; a community nurse and a dentist.

We looked at specific care records relating to 11 people who used the service. We also looked at other important documentation relating to people who used the service. These included medication administration records (MARs) for 29 people and monitoring charts for food and fluid intake, weights, behaviour and pressure relief. 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 recruitment files for three new staff, training records, the staff rota, menus, minutes of meetings with staff and people who used the service, quality assurance audits and maintenance of equipment records. We completed a tour of the environment.

Updated 1 August 2017

The inspection took place on 15 and 16 June 2017 and was unannounced.

The provider had recently submitted an application to consolidate parts of the organisation under one legal name. This has been completed and subsequently means this is the first inspection of the service under this new legal identity. However, at the last inspection of this service in August and September 2016, we found breaches of regulations in multiple areas and took enforcement action to remove nursing from the provider's registration at this location. This meant that the three residential lodges remained open. The breaches of regulations included safeguarding people at risk of abuse, risk management, administration of medicines, nutrition and hydration, consent, staffing levels and training, infection prevention and control, not working effectively with care providers who share care and treatment, promoting dignity and respect, the planning and delivery of person-centred care and overall governance. The service was rated as Inadequate and placed in Special Measures.

We received an action plan from the provider about how improvements were to be made. At this current inspection, we looked at the previous breaches of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found significant improvements had been made in all areas, although there were two areas that required further improvement.

Saltshouse Haven Care Home is registered to provide care for up to 150 people who may have personal care needs or be living with dementia. The service has five separate lodges, Lelly, Coniston, Bilton, Preston and Meaux. Lelly and Coniston previously provided nursing care and are both currently closed. Bilton is specifically for people living with dementia and Preston and Meaux provide personal care to people. Each lodge has 30 single bedrooms, communal rooms, bathrooms and toilets, a small kitchenette and access to an enclosed garden. A separate lodge incorporates the laundry, the main kitchen and administration offices. The service is located on the outskirts of Hull and has good public transport access. At the time of the inspection, there were 12 people living on Bilton, 18 on Preston and 18 on Meaux.

The service is required to have 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 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. Since the last inspection, the service has had a change in manager. The new manager has been in post since December 2016 and has submitted an application to CQC to be registered; this had not been completed yet.

The overall management and governance of the service had improved although we found audits and evaluations of care plans had not identified specific issues that needed to be included. For example, people’s morning routines and previous pattern for rising and the action staff were to take if someone awoke very early.

We were unsure if staff had gained full and informed consent from people about their morning routines and this has been discussed in the Caring section of the report. When we inspected at 6am, three people who lived on Bilton lodge were washed and dressed and had been returned back to bed fully-clothed. We did not hear staff provide people with choices about this, for example, whether the person was reminded of the early time and did they want to have a cup of tea and return back to bed. This had potentially impacted on their dignity and choice. The practice of getting people washed and dressed and returned back to bed fully-clothed had been an issue at another service owned by the provider and they had taken this very seriously. They had informed managers to complete spot checks and reminded staff the potential this had for institutional abuse.

These two concerns breached regulations and you can see what action we have asked the provider to take at the back of this report. The manager told us they would continue to monitor this practice and have discussions with staff.

People had care plans to help guide staff in how to support them. Not all care plans had up to date information and some did not include people's preferences especially regarding the times of rising.

We found the service was safe. Staff knew how to protect people from the risk of harm and abuse and had completed risk assessments in order to minimise concerns. Equipment used in the service was maintained and any repairs were completed in a timely way. The service was clean and tidy.

People’s health and nutritional needs were met. Records indicated people had access to health care professionals and staff arranged for visits from GPs and district nurses when required. They also made referrals to specialist health care professionals such as speech and language therapists and dieticians when required. Health professionals spoken with said staff were good at contacting them quickly if they had concerns.

Menus provided people with choice and alternatives; drinks and snacks were served in between meals. People had special diets catered for and staff were knowledgeable about these. They completed additional monitoring charts when people had any nutritional concerns.

People who could talk with us told us staff were kind and caring and relatives were pleased with the care delivered to their family member. During the day we observed staff were attentive to people and knocked on doors before entering bedrooms.

Staff were recruited safely and full employment checks carried out before new staff started work. There were sufficient staff on duty to meet people’s needs during the day and at night. We saw staff had access to a range of training, supervision and support. Staff spoken with said both training and management support had improved since the last inspection. They felt confident supporting people and said they had the right skills to complete caring tasks. Staff also said that communication had improved and they felt able to express their views in meetings and on a day to day basis with the manager.

There was a range of activities for people to participate in; these included one to one sessions, group activities and trips to local facilities.

People told us they felt able to make a complaint in the knowledge that it would be addressed. They said the new manager was approachable and available when they wanted to speak with her. There was also a unit manager on each of the lodges who could manage day to day niggles and concerns.