Saffron House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed a limited number of quality statements in the effective key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. We received mixed comments from people about the support they receive from the service. Some people felt staff were responsive and met their needs in a timely way, whilst other people described having to wait long periods for support and did not always receive the personal care support they required. Systems were in place to assess people's mental capacity and support decisions made in people's best interests. Staff demonstrated an understanding of DoLS authorisations and conditions. However, some staff were unaware they were restricting people's freedom by taking walking aids away from them. We found people's care plans were not always fully reflective of their needs and including contradictory information. The provider was undertaking an update of people's care plans and this work was in progress at the time of our assessment. People told us they were happy with the meals provided and had good access to healthcare to maintain their health and well being. However, care records were not consistently completed by staff to evidence the care provided was in line with gnce in people's care plans.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives were involved in the initial assessment of their needs. However, we were not assured about the involvement of people in their ongoing assessment of needs. People’s comments included, “There was consultation initially, but I haven’t seen my care plan or been involved with it since” and “ I haven’t seen a care plan; my care isn’t discussed with me.”

Staff told us they knew people well and had access to the information they needed to support people. A staff member told us, “We are introduced people and spend time getting to know them; they have a care plan which has everything about them.” The registered manager told us care plans had been reviewed and updated and this was in progress at the time of our assessment. However, there was little evidence of people's involvement in this process.

People’s care plans contained guidance for staff on how to support people with their risks, needs, preferences and choices and who was involved and to be consulted about their care. As recorded in the risk section of this report, some areas of the care plan required review to ensure information was updated and reflective of people’s needs. Care reviews within the care records did not evidence people or their relatives were involved in ongoing assessments.

Whilst processes were in place, feedback from people and relatives was mixed in relation to co-ordinating care and support. Some people told us they did not always receive care at the time they wanted it. A person told us, “I should have a shower once a week. I last had one 2 weeks ago and I’m still waiting for one today. I don’t get one every week.” A second person told us, “I don’t feel like I have had a proper wash in months and they don’t wash my hair. It is awful.” A relative told us they had observed their family member having to wait for support as they required 2 staff to assist them and these weren’t always available. This meant their family member had to wait for support leaving them uncomfortable.

Staff completed a range of training to give them the skills and knowledge they needed in their role. Managers were undertaking work to ensure this was applied and embedded in staff working practices, though spot checks, supervision and monitoring. This work was in progress at the time of our assessment.

People’s care plans did not always include clear information for staff to provide effective care. For example, a person’s care plan instructed staff to provide fluids through a straw whilst other sections of the care plan instructed staff to provide fluids through a lidded beaker. A person’s care plan advised staff they used hand gestures and facial expressions to communicate and staff should use picture cards to support the person to make choices. We did not see staff using these communication methods with the person and when we asked, they did not know where the picture cards were and hadn’t used them. Staff did not consistently complete monitoring or care notes with sufficient information to support effective monitoring. For example, re-positioning charts were not completed consistently or in line with care plan directions and staff did not always include sufficient or clear information in care notes in relation to changes in people’s needs.

People’s told us they received support from visiting health professionals and staff arranged for them to see their GP through weekly ward rounds. A person told us, “If I ask for the doctor, staff sort this quickly, there are no delays.” A relative told us their family members’ GP and dietician visited regularly and worked with staff to mee their health needs.

Staff told us the provider worked in partnership with other professionals and we observed health professionals visiting the service. People’s care plans included information and guidance from health professionals, such as dieticians. Staff and managers made timely referrals to services where people’s needs changed.

We did not receive any concerns from health professionals around working with staff.

The provider worked in partnership with agencies. However, records did not always clearly record people’s care in accordance with health professional’s recommendations, for example gaps in re-positioning charts. The registered manager was working to improve the standards of staff recording.

People felt staff supported them to keep healthy; this included having sufficient amounts to eat and drink. A person told us, "The food here is good, we get 2 choices of meals and staff will make a sandwich if I don't fancy anything. They also make sure we have drinks and snacks." A relative told us staff were quick to identify if their family member was not well and to refer to external agencies if needed.

Staff told us they encouraged people to make healthy choices about eating and drinking, although they respected the person’s decision. We observed staff supporting a person who became unwell. Staff consulted with the person as to what they wanted and needed.

Records did not always provide sufficient detail as to how people were supported to live healthier lives. For example, re-positioning monitoring to protect people from the risk of pressure wounds were not always completed consistently. People were not sufficiently stimulated or engaged through activities. We observed many people who were sat for long periods of time in communal areas with little or no interaction from staff. This presented a risk people were isolated and excluded from mainstream activities, such as bingo, due to their cognitive impairment.

Most people told us staff supported them when requested, though some people told us this did not always happen in a timely way. 2 people told us staff did not consistently support them to achieve positive outcome from their personal care support, such as regular showers or washing their hair. A person told us, “Most staff are caring and kind. There is one who shouts a lot and another who doesn’t help me very well with personal care. I don’t like these too, but the others are lovely.”

Staff told us they monitored people regularly. However, they did not consistently record the care and support provided. For example, gaps in monitoring charts and lack of detail in people’s daily care notes. We also observed staff failing to monitor a person with a new health condition. We discussed this with the registered manager who agreed this needed to be addressed and assured us they would implement improvements following our site visit.

Processes for ensuring peoples care and treatment met their needs and had good outcomes required further development and improvement to be effective. This was because there was inconsistency in the oversight, provision and recording of the care people received. Although people told us their needs were being met, there was a risk of people receiving either a poor standard of care, or care which did not fully meet their needs. The registered manager had begun to make improvements to processes which were in progress at the time of our assessment.

People told us they made their own choices and decisions. One person told us, “I am given choices I look after myself and like that. If I don’t want to do anything I say ‘no’ and that is okay.” A second person described how they liked to spend their time and staff respected this.

Staff told us about people who lacked capacity over specific decisions and people who had fluctuating capacity. A staff member told us, “Most people have DoLS. I have had MCA (Mental Capacity Act) and DoLS training. People are given choices all through the day. Capacity assessments are carried out for each person. This is to make sure we work as we should in protecting rights and their safety.” Staff were aware many people were subject to DoLS authorisations and were aware of any conditions attached to these. Although staff demonstrated this understanding, we observed they did not always follow this in practice. For example, staff took away people’s walking aids to store them without people’s consent.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Appropriate DoLS applications were submitted for people who required this level of protection to keep them safe and meet their needs. Assessments of people’s mental capacity and best interest meetings had taken place to ensure decisions made were appropriate and least restrictive for people’s decisions.