Archived: Salcasa

Salcasa is a residential care home providing care and support to people with a learning disability and/or autistic people. The service can support up to five people. At the time of the inspection there were five people living in the home. Salcasa is a single storey building with a large garden and an attached annexe.

People’s experience of using this service and what we found

Quality monitoring systems and governance in the service was not effective. There was a lack of clear guidance for staff on how systems should be used. Support plans were not always accurate or up to date. There was a lack of recorded information relating to risks that affected people. This had reduced the ability of the management team to assess and monitor risks. Where such information had been recorded no formal audits or oversight was in place to help monitor and assess potential risks. The electronic care record system was not being consistently used as it did not always work or did not meet the needs of the service. This meant staff were duplicating information and there was a risk information could get missed due to two systems operating.

Not all risks relating to people and the environment had been assessed or responded to robustly. However, the impact from this was minimal due to the support provided by the stable, consistent and knowledgeable staff team. Principles of healthy eating and support around this were not embedded in the service. The management team confirmed this was an area they were continuing to work on and had recently introduced some new measures around this. Some historic safeguarding incidents relating to 2019 had not been reported to CQC or the local authority. We were confident from speaking with the registered manager that this was a historic concern and similar incidents would be reported if they had occurred more recently. Recruitment checks were in place which included assurances of good character, however gaps in employment history had not always been fully explored.

People were supported by staff who knew them well and had a good understanding of their individual needs and risks, including how to monitor and mitigate them. Medicines were managed safely, and people received their medicines as prescribed. There was enough staff to meet people’s needs. People were protected from the risk of infection and were living in a clean sanitary environment. Incidents that occurred in the service were reviewed and staff were supported to learn from these.

There was a person-centred ethos in the service and people were supported to achieve good outcomes. People were supported by a positive cohesive staff team who worked well together. Relatives were happy with the support provided and the communication from the service regarding this.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Systems were in place to help support people to be involved in their care and support. The care delivered met people’s individual needs. During our conversations with staff and the management team they demonstrated a person centred and inclusive ethos.

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 good (published 19 February 2019).

Why we inspected

This was a focused inspection to check on a specific concern we had about the provider’s governance systems and oversight of the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the well-led and safe sections of this report.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Salcasa on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance 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 for 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.

Salcasa is a care home for five people with a learning disability. The accommodation is a single storey building with a large garden. At the time of the inspection five people were living at the service.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

People received care and support from a stable staff team who knew them extremely well. Care was delivered in a person-centred way based on people’s preferences.

Staff encouraged people to be as independent as possible. Risks that people were exposed to were assessed and measures were put in place to minimise them. People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way.

Staff provided consistent care and support to people. People were involved in their care and support and staff respected their privacy and dignity. Staff had a good understanding of people’s needs, preferences, histories and routines. People received appropriate support to maintain their health and to achieve good health outcomes. People had opportunities to take part in a wide range of activities which met their individual choice and preferences. This enabled people to achieve positive outcomes and a good quality of life.

The registered manager was experienced and passionate about providing people with support to enable them to develop. Staff felt listened to and valued and they felt involved in the development of the service. Relatives praised the management of the service and the impact that living in the service had on the people accommodated.

Rating at last inspection: Good (report published 13 April 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection

Follow up: We will continue to monitor all intelligence received about this service to ensure that the next planned inspection is scheduled accordingly.

Salcasa is a service that provides accommodation for up to five people. It offers residential care for adults with learning disabilities and mental health conditions. On the day of our inspection five people were living in the service. This inspection took place on 3 March 2016 and was unannounced.

The service had a registered manager (‘the manager’) in post. 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.

People living in the service were safe and benefited from the support of sufficient numbers of staff, who were well trained, supported and felt valued in their work.

Staff and the management team understood their responsibilities in safeguarding people from harm. When appropriate they contacted the local authority to report concerns. The home knew how to support people’s needs without restricting their freedoms.

Appropriate recruitment procedures were followed and pre-employment checks were carried out to ensure staff were suitable to work with people receiving care and support. There was a robust induction programme for new staff.

Medicines were managed and administered safely in the home and people received their medicines as the prescriber had intended.

Staff were skilled and motivated to support and care for people. Staff also knew people and their needs well. All staff received appropriate training and were supported well by the manager.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager told us that some people living in the home did not have capacity to make certain decisions for themselves. The manager had appropriately made DoLS referrals to the local authority because they were restricting some people’s freedoms in order to keep them safe.

People had enough to eat and drink and the staff who prepared food provided good quality food and catered for individual preferences. People also had access to the community on a daily basis and often had meals out.

People had regular access to healthcare professionals and were supported to attend appointments. Staff managed people’s health appointments and made appropriate health and social care referrals.

All staff at the service were caring and supportive and treated people as individuals. The care provided was sensitive and person centred and people’s privacy, dignity and wishes were consistently respected. Friends and relatives were welcome to visit as and when they wished and people were supported to be as independent as possible.

People were happy living in Salcasa and their interests were encouraged and supported by staff. There was a positive atmosphere in the service and people were supported to have regular access to the community if they wanted to. People were also involved in planning their care.

There was an open and positive culture at Salcasa. People using the service and their relatives were given opportunities to raise issues about the quality of the care provided. Relatives knew how to make a complaint if needed.

The service was being well run and people’s needs were being met appropriately. The manager was approachable and communication between the manager and staff was frequent and effective.

There were a number of systems in place to ensure the quality of the service was regularly monitored and maintained. The provider carried out regular audits to identify areas that needed improvement and an action plan was put in place for the manager to complete.

Our observations during this inspection showed the staff on duty interacting in a jovial and friendly manner and speaking respectfully with people. We also noted that any personal care requirements were carried out privately and in a dignified manner.

One person we spoke with told us that they felt safe living in the home and had no problems with how they were supported by staff. Other people we observed appeared comfortable and relaxed in the presence of the staff on duty.

One person we spoke with said, of the staff: 'They're all good here, they look after us really well. The staff take me to different places when I need them to.'

This person also said: 'I haven't got any complaints, I'm really happy here with everything.' They replied, 'Yes' when we asked if they were happy talking to the staff or the manager if they did have any concerns and added: 'I talk to all of them, they're all good.'