Archived: Saltways - Care Home with Nursing Physical Disabilities

Updated 26 July 2018

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 planned to check 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 was prompted in part by a notification of an incident which reflected concerning information about the management of risk of Percutaneous endoscopic gastrostomy (PEG) feeding. We looked at some of these concerns during this inspection.In addition, we knew the police were investigating some of these concerns at the time of this inspection. We continue work with other agencies, such as the local authority, clinical commissioning group and the police following this inspection. This was because we wanted to ensure the provider had acted to mitigate risks to people’s safety and welfare.

This inspection took place on 9, 15 and 30 May 2018 and was unannounced.

The inspection team consisted of two inspectors and a specialist advisor who was a registered nurse, [they attended the inspection on 9 May 2018].

As part of the inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us by law. We also spoke with the local authority and the Clinical Commissioning Group [CCG] about information they held about the provider.

Prior to our inspection the provider had completed a Provider Information Return [PIR]. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to formulate our inspection plan.

We spoke with eight people who lived at the home and five relatives. We met and spoke with five members of care staff, a senior care member of staff, two registered nurses, an agency nurse and the physiotherapist. We also spoke with a member of the kitchen staff, the operations director and quality director, the service improvement managers, the deputy manager, the covering manager, and the nominated individual. We did this to gain people's views about the care and to check that standards of care were being met.

We looked at the care records for six people. We checked that the care they received matched the information in their records. We also looked at records relating to the management of the service. This included audits carried out, staff rosters, training records and actions plan that were in place. We also looked at staff files so we were able to review the provider's recruitment process.

Updated 26 July 2018

This inspection took place on 09, 15 and 30 May 2018 and was unannounced. The previous inspection was undertaken in January 2017 and at that time the provider achieved a rating of ‘Requires Improvement.’

Saltways Care Home with Nursing and Physical Disabilities is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Saltways Care Home with Nursing and Physical Disabilities is registered to provide accommodation and nursing care for a maximum of 24 people. There were 17 people living at the home on the day of the inspection.

There was a registered 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. The registered manager was not present at the time of our inspection.

Risks to people's health and wellbeing were not always identified, and risk management plans were not always in place to instruct staff on how they should manage risks to people consistently and safely.

People were not fully protected from harm and abuse. Accidents and incidents had taken place and had not been reported to the appropriate authorities. Potential safeguarding concerns had not been recognised and acted on appropriately. Systems were not in place to collect this information and learn lessons.

There were not always sufficient trained staff, on duty to care for people safely, and to meet their needs. We found there was no current analysis and overview of accidents, incidents, and safeguarding concerns at the home to assess whether any trends or patterns were identified and future risk could be mitigated.

People were supported to maintain a healthy diet and staff were aware of people's dietary needs and preferences. However, where people received their food supplements via a Percutaneous Endoscopic Gastrostomy [PEG] feed the provider had not ensured all nursing staff had received training and had their competencies checked.

People were not routinely involved in the planning and development of their care. People were not supported to access a wide variety of activities during the day, and did not always have their wishes respected if they did not want to participate in some of the activities. End of life care planning had not been considered and so did not focus on people's preferences and wishes.

Relatives were confident that if they raised a complaint, it would be dealt with appropriately.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. However, existing quality assurance procedures did not always identify where improvements were required. Quality monitoring procedures needed improvement to ensure these were undertaken regularly, to monitor service provision.

There was a lack of oversight of the service by the provider and the registered manager. There was a distinct lack of audits in place that would provide the registered manager with a view of what was happening at the service. The audits that were in place were ineffective, inconsistently completed and did not highlight the areas of concern that came to light during the inspection. The provider had not informed CQC of important events that occurred at the service, in line with current legislation.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. 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 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 six breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.