Saffron House

Saffron House is a care home supporting people across two floors of accommodation. The service is registered to provide care and accommodation for up to 48 younger and older people, people with physical disabilities and people living with dementia. At the time of our inspection there were 29 people using the service.

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

Staff did not consistently follow the provider's procedures for the safe storage, return and disposal of medicines. People's medicine records did not always evidence people had received their topical medicines as prescribed. People's care plans did not include robust guidance and information as to how staff should support a person when they became distressed. Risks around people's distress were not well managed as staff lacked the skills and knowledge to support people safely and effectively.

Systems and processes to ensure good oversight of the service were not being used effectively by the registered manager. Improvements driven by the provider had not been fully embedded in staff working practices. There was insufficient oversight and monitoring of staff to ensure people always received safe care.

Although some improvements had been made around the assessment of people's mental capacity, further improvements were required. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice.

The provider had made significant improvements to the environment to ensure people were protected from the risk of infections and some improvements were still in progress at the time of our inspection. However, we found improvements were still required around staff awareness of the risk of cross infection.

Most staff felt supported within their roles and told us they received regular supervision and meetings. Staff were recruited safely. Relatives did not always have confidence that staff received the clear direction and guidance they needed from the management of the service.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 1 August 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 6 June 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. safeguarding, consent and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to the assessment and mitigation of people's risks and medicines, safeguarding people and good governance at this inspection.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Saffron House is a residential care home providing personal care to up to 48 people. The service provides support to people living with dementia, a physical disability, older people and younger adults. At the time of our inspection there were 33 people using the service. The home accommodates people across 2 floors in 1 building.

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

People were not kept safe from known risks. Where risks were identified there was not always guidance to inform staff how to support people safely and consistently. Action had not been taken to reduce fire risks. Medicines were not managed safely which exposed people to the risk of harm. Infection prevention and control measures were not robust, and some areas of the service were visibly dirty, unhygienic and malodorous.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's nutritional and hydration needs were generally met although people's dining experiences were varied.

People's choice and dignity was not always maintained. Communal bathrooms and toilets were locked, meaning people could not easily access them when needed. Relatives told us about personal items going missing at the service. People were left to sleep in unclean mattresses and bedding.

Systems and processes to ensure good oversight of the service were ineffective. When we raised concerns during the inspection, further action was taken by the management team – for example replacing soiled mattresses and arranging staff training. People were at risk of receiving care that did not meet their needs or wishes. Records were either inaccurate or lacked detail to provide staff with guidance on how to support people appropriately.

People's communication needs were met. People were able to engage in activities at the home. Staff felt supported within their roles and told us they received regular supervision and meetings. Staff were recruited safely.

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

Rating at last inspection and update

The last rating for this service was requires improvement (21 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about infection control and staffing. We made a decision to inspect and consider risks at 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.

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

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

Enforcement and Recommendations

We have identified breaches in relation to consent, safe care and treatment, safeguarding and governance at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Saffron House is a residential care home providing accommodation and personal care to 24 people at the time of the inspection. The service can support up to 48 younger and older adults with needs including dementia and physical disabilities.

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

The provider and registered manager had made significant improvements to ensure the risks associated with infections, including COVID-19, were assessed and managed effectively. Improvements included enhanced cleaning schedules, the use of effective cleaning products, staff refresher training and safer staff working practices in personal protective equipment (PPE) and infection prevention and control (IPC).

Staff underwent regular testing for COVID-19 in line with current government guidance. Visitors were required to complete robust screening and testing prior to visiting their family members.

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 requires improvement (published 26 March 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

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

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.

Saffron House is purpose built and registered to provide personal care and support for up to 48 adults with physical or age-related care needs. The accommodation is provided over two floors, with communal facilities which include lounges and dining rooms. At the time of the inspection the service was supporting 24 people, some of whom were living with dementia.

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

Systems to assess, prevent and manage the risk of infections required improvement. Staff did not consistently follow safe practices in donning and doffing (putting on and taking off) personal protective equipment (PPE). Risks of infection were not mitigated because of a lack of staff awareness and adherence to current guidance, including cleaning and laundry procedures. Records did not identify specific risks for individual people during an outbreak.

Oversight of the service required improvement. Concerns found on inspection had not been identified. The provider did submit an action plan detailing improvements they intended to make following our inspection visit.

People were protected from abuse, systems and processes were in place to identify and report any abuse or harm. Staff were safely recruited and people received their medicines as prescribed.

People's relatives felt their family members' were safe using the service and felt informed and involved in their care and support. Staff strove to maintain effective communications between people and their families. Staff and relatives spoke positively about the registered manager as being open and approachable. The registered manager was committed to improving and developing the service.

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 the service was Good, (published 17 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 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.

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

Enforcement

We have identified breaches in relation to regulation 12 infection prevention and control at this inspection. You can see what action we have asked the provider to take at the end of this full 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.

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.

People’s experience of using this service:

¿People felt safe living at Saffron House and staff knew how to keep people safe whilst supporting them, however we found that safety checks around water temperatures were not robust and not all fire doors were closing properly.

¿People felt there were enough staff to be able to support them with their needs safely, risks associated with people’s care had been assessed and managed appropriately.

¿People were supported to take their medicines, staff followed systems and procedures to ensure medicines were administered safely and timely.

¿People were supported with their dietary needs and to access healthcare in a timely manner.

¿People were cared for by staff who were appropriately trained to support people with their needs in line with national guidance and legislation.

¿People felt they received kind and caring support from staff. We observed staff talking kindly to people and treating them with respect. One relative said, “If there’s a better place I have yet to hear of it.”

¿People had personalised plans of care which gave staff the knowledge and information to support them in a way that they preferred.

¿People had the choice to engage with a variety of activities including those with local school children and a PAT dog.

¿People and their relatives felt that the service was well-led, that management were approachable and that any concerns they raised would be dealt with efficiently.

¿The registered manager had comprehensive monitoring systems in place, they were aware of their responsibilities and worked in partnership with others to ensure people received safe care and support.

More information can be found in the detailed findings below.

Rating at last inspection: This was the service’s first inspection since it registered with the commission in 2018.

Why we inspected: This was a scheduled inspection.

Follow up: We will continue to monitor the service through the information we receive.

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