Saltshouse Haven Care Home

Updated 28 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors, a specialist advisor and an Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. A second Expert by Experience made phone calls to people’s relatives. The specialist advisor looked at medicines.

Service and service type

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

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 8 June 2022 and ended on 14 June 2022. We visited the service on 8 June 2022.

What we did before inspection

We reviewed information we had received about the service. We sought feedback from the local authority. We used all this information to plan our inspection.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We spoke with the registered manager, deputy manager, care manager, five unit managers, head of housekeeping, maintenance manager and six care workers. We received feedback via email from 13 staff. We spoke with 14 people who used the service about their experience of the care provided and 12 relatives, some at the service and some via telephone. We reviewed a range of records. This included 11 people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We shared our findings and concerns with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 28 July 2022

About the service

Saltshouse Haven Care Home is a residential care home providing personal care to a maximum of 150 people aged 65 and over. At the time of the inspection 133 people were using the service. The service is separated into five 'lodges' called Bilton, Meaux, Preston, Coniston and Seaton. Each lodge can accommodate 30 people and has its own lounge, dining area, bathrooms and bedrooms. Bilton and Seaton lodge support people living with dementia.

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

There were inconsistencies in the quality of care being provided across the lodges. This was due to a lack of oversight and effective monitoring systems in place. Whilst some people received a good standard of care in their lodge, others didn’t.

The provider lacked the appropriate systems and processes to drive forward improvements in a timely manner. The provider's own systems of oversight had not identified the concerns we found during the inspection.

Systems in place to safeguard people from abuse were not always followed. The registered manager did not always responded to concerns in a timely manner and was not aware of how some people were spoken to by some staff.

There was insufficient staff to meet people’s needs. People and staff, from a number of lodges, reported delays in providing care due to staff shortages. The tool the provider used to calculate staffing levels demonstrated that staffing levels were too low. Staff did not always benefit from training and constructive supervision to support them in their role.

We identified a number of Infection Prevention Control (IPC) concerns. Whilst most of these concerns were identified on one unit, there were minor concerns on other units also. The majority of the concerns we identified had been raised with the registered manager at the last two inspections. Not enough action had been taken to reduce this risk.

The mealtime experience for people was poor and did not always follow best practice. People gave mixed feedback about the meals provided. We made a recommendation about this.

Staff did not have much contact with the registered manager. Whilst most staff felt supported by their lodge manager, we received mixed feedback about the approachability of the management team and if they would act on concerns raised.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Recruitment and selection processes were followed to ensure staff employed were safe to work with people.

For more details, please see the full report which is on the Care Quality Commissions (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (Last report published 7 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safety, staffing, safeguarding and provider oversight 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.