Salisbury Manor

Gracewell of Salisbury is a nursing home for up to 63 older people some of whom live with dementia. Accommodation is provided on three floors which are accessed by stairs or a lift. All rooms are en-suite and there are communal rooms such as lounges, dining rooms and bathrooms for people to use. People have access to landscaped gardens. At the time of our inspection there were 41 people living at the home.

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

Prior to this inspection CQC received concerns about food hygiene and lack of action taken by the registered manager in response to those concerns. We checked food storage and found no evidence to substantiate the concerns raised. Staff we spoke with told us they had confidence the registered manager would look into any concerns they raised.

People were living in a home that was cleaned daily and smelt fresh. Domestic staff were employed who followed cleaning schedules to make sure all areas of the home were covered. High contact areas, such as door handles were cleaned more often.

Visiting was planned and booked so staff could make sure the visiting room was clean and available. The provider had installed a visiting ‘pod’ on the lower ground floor for family members and people to use. Visitors were screened and provided with personal protective equipment (PPE) to wear. In addition to these safety measures the provider had also accessed ‘lateral flow’ tests which provide a rapid result for COVID-19. Visitors could be tested on the day of their visit to make sure they were COVID free.

The provider had supplied the home with electronic tablets so people could keep in touch with family members during the pandemic. Staff told us they supported people to call relatives and use video calls to keep in touch. The service facilitated ‘enhanced compassionate visits’ for families when people were nearing the end of their lives.

Staff had supplies of PPE available in cupboards around the home and told us this had been available throughout the pandemic. Staff had been given training on how to use PPE safely and had areas available so they could change their clothes on arrival and departure. There was a member of staff identified as the lead for infection prevention and control. They were responsible for areas such as audits and support for staff. Staff were also provided with training and guidance on infection prevention and control good practice such as handwashing, and had their competence checked regularly.

People and staff were being tested for COVID-19 as per the government guidance. The registered manager had identified a member of staff to be a ‘COVID Co-ordinator’. Their role was to organise the testing in the home and liaise with people and families for visiting. The registered manager told us this ensured there was a point of contact for all administration duties for activities relating to COVID.

The provider had contingency plans in place to manage an outbreak of COVID-19 and any other infections. Weekly meetings and briefings were provided so staff and management could be updated on changes to any guidance or new methods of safe working. The provider had a free and confidential staff helpline they could call if they needed to talk about their wellbeing, in addition to free counselling sessions to support mental health. One member of staff said, “The provider has been kind and helpful and provided me with transport to come to work.”

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 5 September 2018).

Why we inspected

This targeted inspection was prompted in part due to concerns received about food hygiene. A decision was made for us to inspect and review those concerns.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service has a dual registration which means there are two registered providers jointly managing the regulated activities at this one location. The service is subject to one inspection visit however, the report is published on our website twice, under each provider.

Gracewell of Salisbury is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 63 people in one adapted building. At the time of our inspection 58 people were residing at the home. The service is in the city of Salisbury. Accommodation is arranged over three floors which are accessed via a lift. All rooms are en-suite and there are landscaped gardens.

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.

At our last unannounced focused inspection in August 2016 we found the service was not meeting legal requirements. We found concerns relating to medicines management and records relating to incidents and accidents. At this inspection we found the necessary improvements had been made and we rated the service ‘Good’ overall.

Medicines were managed safely. Where appropriate people were supported to manage their own medicines. We observed staff administering medicines and found their practice to be safe. Staff had received training on medicines administration and had their practice observed to check for competence.

Accidents and incidents had been recorded in detail and action taken to minimise the risk of re-occurrence. There were opportunities for staff to discuss incidents and use reflection to learn any lessons. Risks had been identified and safety measures put in place to keep people safe from avoidable harm. All risk assessments were reviewed regularly. Care and support plans contained sufficient detail to support the staff to deliver personalised care.

The service had improved systems in place following falls. If people sustained a fall they were assessed by a nurse. If further medical advice or treatment was needed, this was sought. There were clear records of actions taken, and people were re-assessed as a precaution. Handover information was clear and up to date.

There were daily head of department meetings, regular team and ‘resident meetings’, where people and staff could share ideas. Minutes were kept and reflected on to make sure actions raised were closed. The service sought the views of people and their relatives, to try to improve the care and support.

Staff were recruited safely, and the required pre-employment checks had been completed. There were sufficient staff deployed to meet people’s needs consistently. Gracewell of Salisbury had a consistent and experienced staff team who knew people’s needs well.

Staff understood the different types of abuse and how to report any concerns. Training had been provided in a variety of topics and staff told us they felt well supported. Supervision was available, where staff could discuss any concerns, training needs or development opportunities.

The service was clean and free from unpleasant odours. We observed the staff used appropriate infection prevention and control good practice. The premises and equipment was maintained and serviced when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were assessed and where needed, referrals were made to healthcare professionals. Records demonstrated that people had access to services such as GP’s, physiotherapists, speech and language therapists, district nurses and dentists.

The dining experience was person centred and inclusive. A ‘whole home approach’ was used, which meant there were ample staff available to offer people the support they needed. People had choice at the table which meant they could choose what they wanted when they saw the options. Snacks and drinks were available in different areas and people were encouraged to help themselves.

People told us they were supported by a kind and caring staff team. Privacy and dignity were maintained and people were supported to maintain their independence. There were no restrictions on visiting so people could have visitors when they wished.

Complaints were managed well and records demonstrated the action taken. People, relatives and staff thought the service was well managed with an open and transparent management approach.

People had the opportunity to record their wishes for end of life care, this information was in people’s care plans. Where the service had provided end of life care the staff had worked with healthcare professionals to make sure people were as comfortable as possible.

There were comprehensive and robust quality monitoring systems in place. Audits were completed at service and provider level. Action plans were produced and the registered manager made sure the necessary action was taken where needed.