Saffron House

We assessed a limited number of quality statements in the safe key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was inadequate. We identified shortfalls with the deployment of staff to ensure people were consistently provided with timely, effective care and support. Staff did not always demonstrate an understanding of potential restrictions for people in removing mobility aids from them once they were seated. We observed staff did not always follow best practice in supporting people to transfer or mobilise. There was a lack of oversight in the monitoring of a persons' health condition. People's care plans were in the process of being updated with some care plans containing contradictory information about people's needs. We found variance in the standard of staff record keeping, which meant people's care records did not always evidence the care provided or support effective monitoring of peoples' needs. The registered manager was aware of these concerns and addressed immediate concerns during this assessment. There were notable improvements to the management of people's medicines and standards of hygiene and cleanliness. Medicines were given as prescribed and there were clear records to demonstrate this. There was a process for medicines to be administered covertly, including mental capacity assessments and obtaining pharmaceutical advice from an appropriate healthcare professional. There were clear records in place to describe any allergies and full medicine audits were recorded. The provider had made sufficient improvements to the management and administration of medicines and was no longer in breach of regulation 12. The provider was undertaking a redecoration plan which was in progress at the time of our assessment. Staff continued to be recruited safely.

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.

We assessed a limited number of quality statements in the well led key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. The provider had developed more effective governance arrangements to help identify shortfalls and drive improvements. We found improvements had been made in areas such as medicines and infection prevention and control. However, further improvements were needed to ensure care and support was delivered in line with evidence based practice and standards. We observed improvements were not yet fully embedded in staff working practices. Records relating to people's care were not always fully up to date or completed consistently to evidence the care provided. Work was in progress to update people's care plans. Staff spoke of an improved, positive culture within the service and of a sense of trust and confidence in the skills of the leadership team who they felt were visible within the service, supportive and made them feel valued. Staff told us they were encouraged to raise concerns without the fear and team meetings could be used to share suggestions or ideas.