This inspection took place on 21 November 2018 and was unannounced.

We previously inspected this service in April 2018, where we found continued breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, governance, and person centred care. We also found new breaches of Regulations in relation to nutrition and hydration and staffing. The service was rated ‘inadequate’ overall and was placed in special measures.

Salisbury Residential Home 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 service accommodates up to 31 people in one adapted building. At the time of this inspection, there were 20 people living in the service, some of whom were living with dementia.

There was a registered manager in post. Since our last inspection in April 2018, the provider had registered as the registered manager. 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. In August 2018, a new manager was appointed, and they have made an application to be the registered manager, at which point the provider will step down from this post.

This inspection in November 2018, found improvements had been made in relation to people’s safety and care delivery, and the service was no longer in breach of Regulations in relation to safe care and treatment, staffing, person centred care and governance. We did however find a repeated breach in relation to nutrition and hydration. The overall rating for this service is now ‘requires improvement’. The service has been removed from special measures.

People’s nutritional intake was now being monitored more accurately and we found new systems in place had supported this improvement. However, we found that food was not always served at appropriate temperatures, and the dining experience for people remained poor.

There were systems in place to monitor the quality and safety of the service provided. Some areas of improvement had not been identified through the auditing processes, however, the manager was in the process of updating audits to ensure they were robust.

Staff understood safeguarding procedures and knew how to report any concerns they had.

The provider calculated staffing levels via a dependency tool. Additional staff were brought in at busier periods. However, feedback we received from some people indicated that at times they had to wait for staff. This is therefore an area that will require constant review to ensure people receive care in a timely manner, and we have made a recommendation about this.

There were group and individual activities which people could take part in. However, feedback from people indicated that this was not always meeting their individual and specialist needs. We have made a recommendation about this.

People were protected by the provider's recruitment procedures because checks were carried out on staff before they began work. However, we found some staff who had been employed for a longer period of time did not have robust checks in place.

Staff had an induction when they started work and had access to the training they needed to carry out their roles. The new manager had held supervision sessions with staff and had a schedule in place to ensure this was routinely undertaken.

There were safe systems of medicines administration and recording. Staff who administered medicines were trained and their competence observed before they were authorised to do so. However, when changes were made to medicines and new med

This inspection took place on 9 and 12 April 2018 and was unannounced.

At our last inspection in August 2017, we found the provider to be in continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations in relation to person centred care, governance and safe care and treatment. Following the inspection, we took enforcement action and placed conditions on the registered provider's registration to submit monthly reports to us setting out how they would assess, monitor and take action to improve the quality and safety of the care and support provided to people living at Salisbury residential home. We also met with the provider to discuss what they would do to improve the key questions to at least good.

Salisbury Residential Home 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. Salisbury residential home accommodates 31 people in one adapted building. At the time of this inspection there were 27 people living in the service.

There was not 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. One of the partners in the provider partnership had applied to become the registered manager, but this had not yet been completed. There was an acting manager in post, who came to the service in November 2017 to support the service with on-going improvements.

At this inspection on 9 and 12 April 2018, we found continued breaches of regulation in relation to safe care and treatment, governance, and person centred care. We also found new breaches of regulations in relation to nutrition and hydration and staffing.

Risk assessments in relation to moving and handling were not always accurate, and did not contain relevant information to support staff to move people safely. Behavioural risks assessments were not sufficiently detailed to ensure staff had guidance on what action to take when people were distressed. There were no risk assessments in relation to choking or the use of bed rails. We found that some improvements had been made in relation to the monitoring of risk in relation to people’s weights, their risk of developing pressure ulcers, and monitoring of falls.

Quality monitoring systems and audits had failed to identify the shortfalls we found during this inspection. Whilst there were quality assurance mechanisms in place, these had proved ineffective at identifying areas for improvement, and not all aspects of the service were being effectively monitored. This placed people at risk of harm.

People's health and safety were at risk because the provider had failed to identify where safety was being compromised in relation to environmental risks. Alterations made to the passenger lift had not been risk assessed or checked by a competent person to ensure they were safe. There were exposed hot water pipes in people’s rooms and communal toilets within the service which posed a risk of burns if people were to touch or fall against them. We found two stand aid slings which were available for use, but were not safe to use due to wear and tear. The provider, acting manager and care staff did not always recognise risks in the environment, such as items which could cause potential harm.

The provider was using a dependency tool to identify the number of staff required according to people's needs. However, this had been ineffective in identifying the number of staff required to meet peoples social, emotional and physical needs. The provider had accepted a high number of new admissions in February

The inspection took place on 16 and 17 August 2017, and was unannounced.

Salisbury residential home provides accommodation and personal care to a maximum of 31 people. This includes older people, some who may be living with dementia. At the time of our inspection there were 26 people using the service.

We previously carried out a comprehensive inspection of this service on 6 June 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of regulation 18 of the Care Quality Commission (Registration) Regulation 2009, as they had failed to notify us of an incident resulting in serious harm to a person. Regulation 11, because formal mental capacity assessment and best interests decisions were not always carried out, and Regulation 9 because the service had not ensured that people received responsive care that met their needs. We also identified a breach of regulation 17, because the service had failed to implement effective systems to monitor and improve the quality of the service. We issued a warning notice in relation to Regulation 17. In November 2016 we returned to check if the service had met the requirements of the warning notice, and we found that improvements had been made and they were no longer in breach of Regulation 17.

At this inspection in August 2017, we found a continued breach of Regulation 9, and a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We took enforcement action to impose conditions on the providers registration. We asked the provider to identify the root causes of the shortfalls in the oversight and governance of the service and what action is being taken to mitigate these from reoccurring. This must include and consider risks associated with nutrition and any associated weight loss, falls, and pressure area care. This condition continues on a monthly basis, whereby the provider informs us of actions which have or are being taken to mitigate identified risks. We decided to impose these conditions on the providers registration because people may be exposed to the risk of harm.

The registered manager had left the service in June 2017. 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. There was a manager in post who was still in their induction period, and they were planning to register with the CQC.

People's health, safety and well-being were at risk because the registered provider had failed to identify where safety was being compromised. Quality assurance and auditing mechanisms did not identify concerns we found during this inspection and had not been effective at driving and sustaining improvements. This constituted a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks associated with people's care and support were not always safely managed, monitored or reviewed in line with their assessed level of need. This constituted a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Whilst the registered provider had taken steps to improve the provision of activity, this was still not meeting the individual and specialist needs of people. Care plans were not always accurate or sufficiently detailed to reflect people’s needs and provide adequate guidance for staff. People's nutritional and hydration needs were not accurately documented or monitored to ensure their intake was sufficient. We could not be assured that re

We carried out an unannounced comprehensive inspection of this service on 6 June 2016. Four breaches of legal requirements were found and a warning notice was issued in relation to one of them which involved the governance of the service. We gave the provider until 13 September 2016 to meet the legal requirements of this regulation.

We undertook this focused inspection to check that the service had undertaken changes to meet the legal requirements of this regulation. This report only covers the findings in relation to the warning notice. You can read the report from our last comprehensive inspection in June 2016, by selecting the 'all reports' link for Salisbury Residential Home on our website at www.cqc.org.uk.

At this inspection carried out on 29 November 2016 we found that although further improvements were required, the service had met the requirements of the warning notice. We have not changed the overall rating for this service as a result of this inspection as it was only undertaken to follow up our enforcement action. The service and the domain of well-led, remains as requires improvement.

Salisbury Residential Home provides residential care for up to 31 people, some of whom may be living with dementia, a mental health condition or a physical disability. At the time of our inspection 27 people were living in the home. Accommodation is over two floors with a number of communal areas.

At the time of this inspection, the home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the inspection in June 2016, concerns were identified that demonstrated that the provider did not have effective systems in place to monitor the quality and safety of the service delivered. This had resulted in some people receiving a poor service.

At this inspection we saw that although some improvements were still required the service was no longer in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which relates to governance. However, we have made a recommendation about the auditing of the quality of the service delivered.

The audits in place for monitoring the completion and accuracy of care plans and associated records were not fully effective and had not identified some issues in relation to this.

Whilst the service had assessed its adherence to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) further monitoring was required to ensure it was fully meeting its responsibilities.

Improvements had been made in meeting people’s social and leisure needs and an action plan was in place to further address these issues.

The service was auditing staffing levels and its ability to meet people’s needs in a timely and person centred manner. These were effective at identifying any issues and rectifying them.

Additional audits had been completed on the service and we saw that these were effective. They covered areas such as health and safety, accidents and incidents and medicines management.

The views of those that used the service, their relatives, staff and health professionals had been sought and information acted upon in order to develop the service.

This inspection took place on 6 June 2016 and was unannounced.

Salisbury Residential Home provides accommodation and support to a maximum of 31 people. This includes older people some of whom may be living with dementia, people with physical disabilities, or people with mental health conditions. It does not provide nursing care. At the time of our inspection there were 25 people living in the home.

We last inspected this service on 30 June 2015 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of Regulation 17 as they had not identified some areas where actions for previously required improvements were still outstanding or had not been appropriately maintained. The provider was also in breach of the Regulation 11 because formal mental capacity assessments and best interests decisions were not always carried out and clearly recorded in people’s care plans and Regulation 12 because people’s medicines were not managed safely.

At this inspection in June 2016, we found continued breaches of Regulation 11 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

There was a manager in post who had been appointed in March 2016. At the time of our inspection, the manager had submitted an application to the Care Quality Commission (CQC) to become a registered manager. A registered manager is a person who has registered with the CQC 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.

Some improvement was still required regarding the safe management of people’s medicines. External medicines had not been stored securely and assessments regarding the administration of medicines were not reviewed. Staff were not always sufficiently trained and their competency was not always checked. This included the administration of medicines as some staff were not trained or assessed as competent to do so.

Staff had the knowledge to recognise, prevent, and report harm and knew how to raise concerns. They understood individual risks to people and how to manage these.

We received mixed feedback regarding whether staffing levels were sufficient enough to meet people’s needs. We have made a recommendation that the service review this.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements were still required in this area as not all staff demonstrated knowledge of the MCA and DoLS and the home was not working within its requirements.

People’s preferences and needs around meals were accommodated and people were assisted with eating and drinking when unable to do this for themselves. People were supported to receive the health care they needed. People at risk of not eating and drinking were identified; however where some people required their food and fluids to be monitored this was not always done.

People were supported by kind and caring staff, who ensured people felt involved and able to make decisions regarding their care. However some practices did not always promote people’s dignity.

People and their relatives were involved in the planning and reviewing of their care. People and their relatives felt able to raise concerns. Concerns were listened to, responded to appropriately and action taken to resolve them.

People did not always receive

This inspection took place on 30 June 2015 and was unannounced

Salisbury Residential Home provides accommodation and care for a maximum of 31 older people, many of whom are living with dementia. At the time of our inspection there were 26 people living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The service was rated Inadequate following our last inspection. We met with the provider and the manager, who acknowledged the amount of work that needed to be done, in order to improve the service provided for people living in the home. During this inspection we saw that significant improvements had been made to the running of the home and mostly positive comments were received from people living in the home, relatives and staff.

Our previous inspection of November 2014 identified concerns that people’s medicines were not managed safely. During this inspection we acknowledged that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.

People were still not fully protected against the risks associated with unsafe medicines management because some records were inaccurate and some had not been completed. In addition, some people’s PRN information was not sufficiently detailed and some prescribed ‘external use’ medicines were not stored securely.

Our previous inspection of November 2014 identified concerns that staff, the manager and the provider did not have a good understanding of the Mental Capacity Act (2005) or the Deprivation of Liberty Safeguards. Therefore, there was a risk that people who lacked capacity to make their own decisions did not consistently have their rights protected. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.

Some staff had completed training in MCA and DoLS and some were booked to do it. Appropriate Deprivation of Liberty Safeguard (DoLS) applications had been made for some people, who lacked capacity, although formal mental capacity assessments and ‘best interest’ decisions were not always clearly recorded in people’s care plans and capacity assessments or best interests decisions were not in place for people receiving crushed or covert medicines. However, staff consistently respected people’s choices and obtained consent from people before doing anything.

Our previous inspection of November 2014 identified concerns that the provider had not taken proper steps to protect people from the risks of receiving inappropriate or unsafe care as they had not always assessed the risks to peoples safety, carried out an assessment of people’s needs or planned and delivered care to ensure people’s welfare and safety. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.

People’s care plans had been updated and guidance for staff was much improved. Detailed assessments of risks for people had been completed and staff had a good understanding of how to support people appropriately to minimise the risks.

Issues and concerns regarding infection prevention and control were identified during our previous inspection in November 2014 and an audit was carried out by an NHS infection control nurse in February 2015. During this inspection we saw that a number of improvements had been made, with a cleaner environment overall and equipment that was clean, hygienic and fit for purpose. Procedures had also been improved to reduce to possibilities of infection and cross contamination.

Following a visit from the local authority’s Fire Officer in May 2015, some areas for improvement and action were identified. During this inspection we saw that some of the required works had already been completed and a quote had been obtained for an upgrade to the current fire detection system.

Our previous inspection of November 2014 identified concerns that there were not always enough staff to meet people’s needs or to keep them safe. During this inspection we saw that improvements had been made to the consistency of staffing levels and concluded that this was no longer a breach. Staff were deployed appropriately and there were sufficient staff to meet people’s needs and ensure their safety most of the time.

Our previous inspection of November 2014 identified concerns that some staff members training was out of date and some had not received appropriate training to enable them to provide people with safe and effective care. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.

Staff were appropriately trained for the roles they carried out. Although some updates were still required, further relevant training was already planned. Supervisions, observations, handover meetings and staff meetings also helped enhance staff’s knowledge and skills to be able to support people safely and effectively.

Our previous inspection of November 2014 identified concerns that people were not always supported to eat their meals where it was required. During this inspection we saw that sufficient improvements had been made and concluded that this was no longer a breach.

Staff supported people who needed assistance to eat and drink, according to their individual needs. People were also given sufficient amounts and choices of food and drink and were encouraged to be as independent as possible with regard to eating and drinking. A number of people were having their mealtimes monitored in order to ensure they were eating and drinking sufficient amounts and any concerns were referred to the dietician and, where necessary, the speech and language team, in a timely way.

Our previous inspection of November 2014 identified concerns that staff did not always treat people with consideration or respect. People did not always have choice and there was little evidence to show that people were involved in making decisions about their care. During this inspection we saw that improvements had been made and concluded that this was no longer a breach.

People’s choices were considered and respected and staff took time to listen to people and provide reassurance, particularly when their mood was low. Staff respected people as individuals. People were also involved as much as possible in planning their own care.

Our previous inspection of November 2014 identified concerns that assessments of people’s needs had not been carried out appropriately and care records did not contain enough information within them to enable staff to understand what care people required. During this inspection we saw that improvements had been made and concluded that this was no longer a breach.

People’s needs had been assessed and were regularly reviewed. Care plans described people’s individual circumstances and provided clear guidance for staff to know how to support people effectively and in line with their wants and needs.

People were also able to access other healthcare professionals and services as and when needed and referrals for specialist input, such as the falls team or dietician were made in a timely fashion.

Our previous inspection of November 2014 identified concerns that some people’s care records contained inaccurate information and some records had not been completed as required by the provider. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.

Care plans and records relating to people’s daily care had been completed appropriately and were up to date. However, formal mental capacity assessments and ‘best interests’ decisions were not always clearly recorded in people’s care plans and some of the records relating to the administration of medicines were inaccurate or incomplete.

Our previous inspection of November 2014 identified concerns that people who used services and others were not protected against the risks associated with unsafe or inappropriate care due to ineffective systems to monitor the quality of the service provided. During this inspection we saw that although significant improvements had been made, there were some areas that still required improvement and concluded that there remained a breach.

The manager, one of the providers and senior care staff were regularly monitoring the quality of the service provided by way of audits, check lists and observations. However, these audits were not always effective as some did not identify gaps or inconsistencies in care provision and record keeping.

The level of staff training had improved and was ongoing. Senior staff and management constantly carried out observations and any poor care practice was picked up quickly and dealt with promptly by the care coordinator or manager.

A quality assurance survey had recently been carried out, with questionnaires being given to people using the service, their relatives and staff and all the results were mostly positive

The management team were approachable and supportive and people were able to make a complaint if they needed and any concerns raised were listened to and responded to appropriately.

Staff morale had improved and was good and improvements had been made to how the home was run and organised overall.

We found that the provider was in breach of three regulations. You can see the action we have told the provider to take at the back of the full version of the report.

The inspection took place on 26 November 2014. The inspection was unannounced. At the last inspection, in July 2014, the provider was meeting the standards that were inspected.

Salisbury Residential Home is a service that provides accommodation and care to older people, people living with dementia, people with a physical disability and people living with a mental health condition. It is registered to care for up to 31 people. At the time of our inspection, there were 26 people living at the Salisbury Residential Home.

This service requires a registered manager to be in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The manager running the service is not currently registered with the CQC. An application has been received from them to register and this is being processed.

Staff knew what actions to take in the event of an emergency and how to reduce the risk of people experiencing abuse. However, risks to their safety had not been consistently assessed. Where risks had been identified, the actions required to reduce this risk had not always been identified or followed. People did not always receive their medicines when they needed them and there were not always enough staff to make sure that people were safe. Therefore, people were at risk of harm or of not receiving the care they required to meet their needs.

Staff told us that they were happy working at the service and that they received good support from the manager and provider. However, staff had not received sufficient training to give them the knowledge and skills they needed to care for people effectively, particularly those living with dementia or who lacked capacity to make their own decisions.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the service was meeting the requirements of DoLS as they had recently requested authorisation from the Local Authority to deprive people of their liberty in their best interests. However, the provider had not always followed the principles of the MCA when making decisions for people and therefore, people who lacked capacity to make their own decisions may not have had their rights protected.

People told us that they enjoyed the food and the provider had referred people for specialist advice where they were concerned that they were at risk of malnutrition. However, some people did not receive the assistance they needed or were not provided with adaptive cutlery to eat their meals that the provider had assessed was needed. This placed people at risk of not receiving sufficient food to eat or not being able to eat their meals independently.

When staff interacted with people, this was done in a kind manner. However, staff did not always treat people with dignity and respect and there were no mechanisms in place for people to be involved in making decisions about their own care.

Some staff did not know the people that they provided care for very well. They did not know their preferences, likes or dislikes. People who were living with dementia were not always given a choice of what they wanted to eat or drink or where they wanted to spend their day. There was a lack of stimulation for people and they couldn’t always follow their interests.

People’s care needs had been assessed by the provider but guidance for staff on how to meet these needs was not always clear. This led to confusion amongst staff about what care people should receive which placed them at risk of receiving unsafe or inappropriate care.

The leadership of the service had embedded a culture amongst the staff that was not based on providing care to people that was based on their individual preferences and needs. Some practices used were regimental in nature such as providing people with personal care before mealtimes without offering them a choice and staff assisting people to get up in the morning from a written list in alphabetical order. Therefore the care that was being provided was institutionalised.

The systems in place to monitor the quality of the service provided was not effective and people’s care records were often incomplete or contained inaccurate information which placed people at risk of receiving unsafe or inappropriate care.

There were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up concerns in relation to whether people who used the service were protected against the risk of abuse. We needed to answer the key question; is the service safe?

As part of this inspection we spoke with the manager of the service, and looked at the records relating to investigations into recent safeguarding issues.

Below is a summary of what we found. The summary describes what we observed and the records we looked at.

Is the service safe?

Our inspection concentrated on how the service protected people from abuse or the risk of abuse. We found that they had learned from recent incidents and amended their policies and practice to ensure that people's safety was paramount.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications had needed to be submitted, policies and procedures were in place and under review. Relevant staff had been trained to understand when an application might be necessary and how to submit one. This meant that people’s rights were protected and they were not subject to unnecessary restrictions .

We found that quality assurance procedures were in place which, amongst other things, considered the safety of people who used the service.

Individual risk assessments were in place within people’s care plans. These ensured any risks were identified and minimised and sufficient staff were in place to ensure people were safe.

Prior to our inspection the Care Quality Commission (CQC) received a concern about the care provided at The Salisbury Residential Home. We made a safeguarding referral to the local authority safeguarding team regarding this information and this was in the process of being investigated.

The purpose of this inspection was to check that people who used the service were provided with safe and effective care that met their needs. We spoke with the manager and staff members who told us about the improvements made in the service to meet people's needs.

We conducted this inspection to establish the following about The Salisbury Residential Home: Was the service safe? Was it effective? Was it caring? Was it responsive and was it well-led?

Below is a summary of what we found. This summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, people’s relatives and from reviewing records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Most of the people we spoke with who lived at The Salisbury told us that they felt safe and secure and that staff treated them with respect and dignity. Some people we could not communicate with but we did observe and note how they were treated, how they were provided with assistance and what efforts were made to keep them safe.

People we were able to speak with told us that they knew who to speak to if they didn’t feel safe or were unhappy about something. They indicated that staff took great care to ensure that they felt safe and secure. The relative of one person we spoke with told us "It was a sudden respite admission. We were so unprepared and just not sure what to do or what to expect. Of course we checked out the Care Quality Commission reports on the website, but that was only a part of the decision for us. It was how helpful and careful the manager was during the admission process that swung it. We haven't looked back and now they [the relative] have decided to stay permanently."

We inspected the staff rotas and found that there was sufficient staff on duty to meet people's needs, and to keep them safe, throughout the day and night.

There was a system of identifying and rectifying equipment and building faults and the home employed a maintenance technician. Health and Safety records were up to date as were maintenance records for servicing equipment. This meant that people were not exposed to unnecessary risk.

We saw that the home was clean and well maintained.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

All aspects of people’s care had undergone a rigorous review since January 2014 to measure and ensure quality, safety and people’s satisfaction.

The Salisbury demonstrated that it took great care to ensure the care and wellbeing of the people who used the service. This was shown in individual care plans, continuing risk assessments, daily records and communication records. Where it had been possible we saw evidence of people being involved in decisions about their care and that their needs and wishes were known.

There was a system of recording and managing incidents and complaints. We saw evidence of how the home responded to issues, or requests, which resulted in the home increasing its levels of effectiveness and satisfaction.

We saw evidence that care plans and risk assessments were reviewed on a monthly basis or as and when required. Reviews with people using the service and their family members were also noted to take place. This told us that the home took reasonable steps to work with families to deliver care in a way which was both satisfactory and re-assuring.

Is the service caring?

The Salisbury operated an ‘open door’ policy to people living at the service, their families and staff. This meant that staff and management could be approached at any time to listen to and act on any concerns or suggestions.

We noted that people were supported respectfully and courteously. We also noted that people were regularly spoken with in a polite manner by staff. Smiles and words of comfort were offered and interactions seen to be understood by the person spoken with.

Care and support provided was individual and informative.

We noted that other healthcare professionals worked with the home to ensure continuity of care where necessary.

Was it responsive?

We saw that the home responded to people on an individual basis. People’s likes/dislikes were acted on and we saw every effort made to put the interests and wellbeing of the individual first.

One person we spoke with said “It's lovely here, they are so kind and cannot do enough for me.” We saw staff responding to people's needs and questions in a proficient manner. We noted that whilst staff were busy during the inspection that they still took time out to re-assure people, interact with them and engage with them.

Food could be eaten in private or in the dining room. We noted that hot and cold drinks were made available throughout the day.

We noted that comments and thoughts were shared in daily records and shared across the management and care teams as part of regular reviews.

Was it well-led?

The Salisbury was undergoing a thorough review of its quality assurance system. A recently appointed manager had introduced, for example, new ways of monitoring food intake, hydration, personal care and how the provider worked with other healthcare providers. Other recent efforts to ensure a well led service included the introduction of a monthly newsletter for residents and relatives. A suggestion box had been placed in the main entrance. A recent survey of services provided had taken place and the provider was considering results at the time of the inspection.

Learning from incidents/complaints was recorded and shared with residents, staff and relevant interested parties. Any shortfalls in service provision were put right such as a recent change in catering supplier.

We found that people’s personal care records, and other records kept in the home, were accurate, safe and filed appropriately and securely.

Prior to our inspection we received a concern on the Care Quality Commission (CQC) website where people could share their comments about the service provided to people. We made a safeguarding referral to the local authority safeguarding team regarding this information and this was in the process of being investigated.

The purpose of this inspection was to check that people who used the service were provided with safe and effective care that met their needs. We spoke with the manager and a staff member who told us about the improvements made in the service to meet people's needs.

We looked at the care records of two people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. People's nutritional needs were met.

We spoke with three people who used the service who told us they were happy with the service they were provided with. One person said about the care and support they were provided with, "It is pretty good, well I should not say pretty good, it is good." Another person said, "We don't complain about it."

We did not speak with people who used the service during this inspection. The purpose of this inspection was to check that improvements had been made following our last inspection of 21 August 2013. During this inspection we found that improvements had been made.

During this inspection we found that concerns regarding abuse were made to the appropriate professionals who were responsible for investigating safeguarding issues. The provider had notified us of incidents, as required by Regulation 18.

We found that people were provided with a clean and hygienic environment to live in. The shortfalls identified in our last inspection had been addressed, this included replacing soiled mattresses.

Our last inspection found that there were sufficient staff numbers to meet the needs of the people who used the service. However, prior to this inspection we had received information from an anonymous source, which told us that the staffing levels during the night had been reduced. Therefore, we checked the staffing levels at night met the needs of the people who used the service and the arrangements in place to monitor the staffing levels. We found that there were sufficient staff numbers to meet people's needs.

Prior to our inspection the local authority told us that they were concerned about the provider's delay in reporting concerns of abuse to the safeguarding team, who were responsible for reporting concerns of abuse. We found that reports to the local authority had not been made promptly. This meant that people were not protected by the provider's safeguarding procedures and processes. We also found that the provider had failed to notify us of incidents that they must inform us of.

We found that people were not cared for in a clean and hygienic environment.

We found that people were cared for by staff who were trained and supported to meet their needs.

We looked at the care records of six people who used the service and found that people's needs and how these needs were met were documented.

We spoke with six of the 29 people who used the service. They told us that they were satisfied with the service they were provided with and that the staff treated them with respect and kindness. One person said, "I'm very happy with how I am treated. They (staff) are all very good." Another person said, "I get what I need." During our inspection we saw that the staff interacted with people in a caring, respectful and professional manner.

We found that the provider's complaints procedure explained how people could raise concerns if they were not satisfied with the service. There were systems in place for people to share their views about the service.

We spoke with nine of the 26 people who were using the service at the time of our inspection. They told us that they were happy with the service provided and that they were consulted about the care that they were provided with. One person said, “We are very well looked after.” Another said, “There is always someone there to help you.”

People told us that the staff treated them with respect and listened and acted on what they said. One person said, “They are very kind.” Another person said, “The staff are excellent.”

People told us that they were provided with enough to eat and drink. One person said, “There are always two choices but you can change your mind and they will get something else for you.”

On the day of our visit on 15 February 2012 we were told that staff helped when needed. People told us that staff were good and that they knew how to help in a way that suited the person.

We saw that staff worked in a relaxed way and they were prompting and talking in a considerate way that respected the fact that people in the home needed things done in a way that suited them. People confirmed that staff were available when needed and helped if anything was worrying them or if they asked for assistance.

While a choice of meal was available at lunch time, people told us that they had a choice of the meals being cooked on the day. One person said their meal was good on the day of our visit, while two people having a different meal, did not like what was provided.