All inspections: Saffron House - Care Quality Commission

This inspection visit took place on 4 April 2017 and was unannounced.

Saffron House provides residential care for older people, some of whom were living with dementia when we visited. It is registered to accommodate up to 48 people. There were 37 people using the service on the day of our inspection visit.

At our last inspection carried out on 23 June 2016 we found that the provider had not met the regulations relating to safeguarding people from abuse, staffing and good governance. They had also failed to notify us of significant events that had occurred at the service. They wrote to us to tell us how they intended to make the required improvements. At this inspection we found that the provider had made the required improvements.

The service had a registered manager. 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.

People were safe and their relatives confirmed this. Staff understood their responsibilities to keep people safe from avoidable harm. The provider had followed safe recruitment practices.

Risk associated with activities of people’s care had been assessed and measures were in place to prevent avoidable harm. The environment and equipment was checked and maintained in order to keep people safe.

There was a suitable number of staff when we visited. The provider checked that staffing numbers remained sufficient.

People received their medicines as prescribed by their doctor. People were supported to maintain their health and had access to health professionals.

People were supported by staff who had received training and support to meet their needs. Staff felt supported and their competency in their role was checked.

People enjoyed their meals and were supported to have enough to eat and drink. Where people had dietary requirements, these were met and staff understood how to provide these.

People were supported in line with the requirements of the Mental Capacity Act. People’s mental capacity to consent to their care had been assessed where there was a reasonable belief that they may not be able to make a specific decision.

Staff at all levels treated people with kindness and compassion. Dignity and respect for people was promoted. People felt valued and that they were listened to.

People’s care needs had been assessed and were reviewed to make sure that they continued to meet their needs.

People’s independence was promoted and people were encouraged to make choices. They had access to activities so that they could remain active and follow their interests.

The registered manager had sought feedback from people and their relatives about the service that they received. We saw that they had taken action based on this feedback. The provider’s complaints procedure had been followed when a concern had been raised and people felt able to make a complaint if they needed to.

Staff felt supported. They were clear on their role and the expectations of them.

People and their relatives felt the service was well led. Systems were in place to monitor the quality of the service being provided and to drive improvement.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.

We inspected this service on 23 and 27 June 2016. The first day of the inspection was unannounced.

Saffron house is a 48 bedded residential home for older people, some of whom have dementia. On the day of our inspection there were 39 people using the service.

The service had a registered manager. 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 were left in communal areas for long periods of time without the support they required. There were not enough staff to keep people safe and to meet their needs. People were at increased risk of falls or harm from other people who used the service due to behaviour that may challenge others.

People were not sufficiently protected from the risk of harm or abuse. We saw that staff had not recognised when people’s behaviour towards others may have been abusive and had not reported it to the appropriate authorities.

People were supported to take their medications as prescribed by their doctor. Systems to ensure that medicines were stored, recorded and administered safely were in place. However people could not always be sure that their skin would be maintained safely.

Risk associated with the environment and equipment used had been assessed to identify hazards, and measures were in place to prevent harm. Records of these checks were however not readily available for the provider to refer to..

People could not be sure that they received care from staff who had the knowledge and skills to carry out their roles and responsibilities. Staff had not received regular training and support to enable them fulfil do their roles. Staff did not feel supported.

Nutritious Meals were provided and where people had dietary requirements, these were met.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not met. Decisions were not made in people’s best interest in line with the Act. Staff were not clear on their role and how to lawfully meet the requirements of DoLS

People told us that staff treated them with kindness but that they did not always give them the time that they needed. People were not always supported to maintain their appearance to the standard that they would like. People told us that staff respected their privacy and dignity but that they did not always feel that their bedrooms were respected as their own.

People’s care plans included information that guided staff on the activities and level of support people required for each task in their daily routine. People’s needs were not always adequately assessed to ensure that the service could meet their care needs.

People were not always supported to engage in activities that were meaningful and of interest to them. We did observe some activities taking place during our inspection such as a ball game and singing. However we also observed periods of time when people in the lounges were provided with no stimulation or interaction

People’s views were not always asked and acted upon. We saw that complaints had not been recorded and addressed by the registered manager.

The registered manager had not informed CQC of significant events that happened in the home. We identified occasions when we had not been made aware of safeguarding events.

The registered manager had failed to ensure that robust records and data management systems were in place. Effective systems were not in place to monitor the quality of the service being provided.

Staff did not have faith in the registered manager and did not feel supported. The regional manager was overseeing the service. They told us that this was in order to monitor the activities that were taking place, support the registered manager and to support the staff team in the implementation of new care planning documentation.

This inspection took place on 6 and 9 October 2014 and was unannounced.

Saffron House is a care home without nursing and registered to accommodate up to 47 people. The home specialises in caring for adults and older people, and people with physical disabilities or living with dementia. There were 46 people living at the home when we visited. The home is purpose built and all the bedrooms are single with en-suite washroom. There was a lift and a set of stairs to access the first floor The garden was easily accessible to people with limited mobility or for those people who used a walking frame or wheelchair.

A registered manager was 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 and associated Regulations about how the service is run.

People who used the service told us they felt safe. People were confident to speak with staff if they had any concerns or were unhappy with any aspect of their care.

People who used the service had their care needs assessed to ensure the care to be provided was safe and appropriate. Risks associated with individual needs were assessed to ensure measures were put in place to remove or minimise them. For instance people at risk of falls or those who needed support with their personal care, had been assessed and guidance provided to staff to ensure those risks were reduce and managed safely.

The provider’s recruitment procedures ensured as far as possible that only staff suited to work with people who used the service were employed. Records we looked at showed the staff were employed after all the pre-employment changes were carried out.

There were enough suitably trained staff on duty to meet the needs of people using the service. The provider had a process for determining how many staff should be on duty. That process took into account people’s dependency levels and matched with the skills, experience and qualification of the staff required to meet their needs.

People were supported to receive their medicines at the right time. The service had safe arrangements for storage and the management of medicines.

The provider had taken steps to provide a safe and comfortable home environment that promoted people’s safety and independence. All areas of the home could be accessed safely including the outdoor space.

We saw people were cared for and supported in order to meet their individual needs. Staff were confident to raise concerns about the wellbeing of people and knew how to access appropriate support from health care professionals.

The management team understood their responsibility with regard to the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguard (DoLS). This legislation that protects people who are not able to make decisions for themselves. It also protects people who are or may be deprived of their liberty through the use of restraint, restriction of movement and control. At the time of our inspection visit no one that used the service was subject to DoLS.

People had a choice of meals and drinks which were nutritionally balanced and reflected their preferences and specific dietary needs. People’s nutritional health was monitored and advice from health professionals was sought when required.

People’s plans of care were updated regularly to ensure that people’s changing care needs, including health care needs and personal preferences were met. Staff sought appropriate medical advice and support from health care professionals when there were any concerns about people’s health and their recommendations were acted upon.

People were treated with care and compassion. They received support that was tailored to meet their needs. Staff showed respect towards the people they looked after and ensured their privacy and dignity was maintained. They showed concern and acted quickly when people expressed concern or discomfort.

People were encouraged to develop and share their experience of the service at meetings to review their care needs, ‘resident’s meetings’ and through satisfaction surveys. They told us the management team acted on their feedback to improve the quality of care people received and the home environment.

Staff had a good understanding of the needs of people and they helped people to take part in activities that were of interest to them.

The provider’s complaints procedure was accessible to people who used the service, relatives and other visitors to the home. People had access to advocacy services if they needed them. Concerns were acted on quickly and improvements were made that showed lessons were learnt to avoid a repeat.

The registered manager understood their responsibilities and demonstrated a commitment and clear leadership to continually improve the service. The registered manager was supported by the deputy manager and senior staff. They were open and welcomed feedback from people who used the service, relatives of people who used service, health and social care professionals and staff.

Staff knew they could make comments or raise concerns about the way the service was run with the management team and knew it would be acted on. There was a clear management structure and procedures in place to ensure concerns were addressed.

The provider had systems in place to ensure the service was managed and run properly. There were regular audits and checks to assess and monitor the quality of service. Processes were in place to effectively analyse and monitor the quality of the service.

People said they were well cared for and satisfied with the care received. People were treated with respect and involved to ensure sure their care and supports needs were provided in a manner that suited them. Comments received included: 'Staff really do look after me well', 'there's plenty to eat and drink', 'the care has been very good; staff are kind and know more about mum that we do now' and 'we visit regularly and found mum is always clean and so is the home.'

People had a range of assessments in place that detailed their needs, routines and preferences. Records showed people's health and care needs were met and monitored by staff and health professionals. Medicines were prescribed and administered safely.

People lived in an environment that was clean and well maintained. All areas of the home were clean and staff ensured the hygiene protocols were followed at all times.

People's using the service and visiting relative told us 'There is always a staff member around to help.' The skills mix of staff and the numbers of staff on duty was sufficient to meet people's needs.

The provider had an effective quality assurance system in place to monitor and manage the quality of service provided. People had opportunities to make comment about the service individually, through surveys and complaints. People's views were listened to and acted on. All records about the people using the service, staff and the management of the service were accurate and stored securely.

People we spoke with told us about their positive experiences of the service. People were complimentary about the care and support they received. People said 'You can see how well staff treat everyone, especially those who have dementia' and 'this is a wonderful place, there's always a member of staff around, and if you're in your bedroom you just need to press the bell and they come.'

People had a range of assessments and care plans which detailed the care and support they needed. People's health and care needs were monitored and reviewed regularly by staff. People had access to a range of health and social care professionals that ensured their health, safety and wellbeing. People told us about the daily lifestyle, interests and told us how they liked to spend their day.

People told us they always had a choice of meals and were satisfied with the quality and choices available. Most people said they were satisfied with the meal portions. People said they received food and drink that met their dietary needs. People who required help with their meals were supported in a sensitive manner that respected their dignity.

During our visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. The SOFI tool allowed us to spend time watching how staff support people, practices within the home. We observed whether people had positive experiences with regards to the support they received that promoted people's rights and independence. People with dementia were supported by staff trained in dementia awareness and recognised the importance of providing personalised care. Overall we found people were supported positively by staff that ensured their care needs were met and their wellbeing promoted.

People told us they had opportunities to make comment about the service. People were aware of how to express concerns or make a complaint about the service and were confident that the concerns would be addressed quickly. One person said 'I don't think we would have a make a formal complaint because any minor grumbles are put right straight away.'

People were supported by staff who underwent a formal recruitment and selection process, with suitable experience and qualifications.

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, and the management and delivery of care, staff and health and safety. People using the service and their relatives had opportunities to comments and give their views about the quality of services experienced.

Saffron House has made significant improvements to address the issues identified at the previous review of compliance visits to assess whether the service was meeting and maintaining the quality and safety standards.

The cleanliness and management of malodours within the service has improved and is being maintained. There is evidence of staff receiving regular training, support and supervision. The scope of quality assurance and management systems have increased to assess the quality of service provision people experience.

People who use the service appeared clean, comfortable and settled within the home. Staff were responsive to people's requests and sensitive to people's needs when supporting them.

A visiting relative found staff and the acting manager approachable and knowledgeable in looking after caring for people.

Visiting district nurses commented on the marked improvement when entering the service and the cleanliness. There was improved staff morale and stability in people using the service. Staff appeared more confident to request advice and visits.

Comments received from people who use the service, a visiting relative and visiting professionals:

'Staff cleans the bedroom, en-suite and changes the bedding'

'I'm very happy with the laundry arrangements and so far they haven't lost any of my clothing'.

'Have not had problems about the care mother receives because I speak out and do find the staff are very good'

'Mum always looks clean and well dressed'

'We've noticed that the staff morale has increases and the staff look happier'

We did not on this occasion talk to people who used the services as the purpose of this visit was to monitor compliance with the compliance actions and enforcement actions arising form the visit on the 10 December 2010. Previously people who used this service had told us that they were happy using this service.

We spoke with several people who use the service who felt that they were well cared for by the staff. Some people were able to tell us about their immediate experience, but the majority were unable to recall previous experiences due to their disability.

The visiting relatives also confirmed their family member had their care needs met promptly. They said staff were approachable and could brief them about their family member's wellbeing.

The visiting GP felt people's needs were met and that they were contacted in a timely manner, when required. Some of the comments we received included:

'We are aware of care plans'

'The staff look after me and communicate well'

'Happy with the home and staff communicate with me'

'Very happy in the home, staff look after me well'

'When I came to the home I was on the ground floor, but when a gentleman entered my

room and displayed himself, they moved me upstairs. That was not pleasant and so I like

to stay in my room'

'It is clean here I must say'

'I like to have my clothes ready and put on the chair ready to wear'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Saffron House

All Inspections

4 April 2017

During a routine inspection

23 June 2016

During a routine inspection

6 and 9 October 2014

During a routine inspection

3 April 2013

During a routine inspection

8 August 2012

During a routine inspection

4 July 2011

During an inspection looking at part of the service

2 March 2011

During an inspection looking at part of the service

12 October and 10 December 2010

During an inspection in response to concerns

Reports under our old system of regulation