Silverdale

Silverdale is a residential care home providing personal care to up to 47 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 46 people using the service.

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

There were systems and checks in place. However. these did not demonstrate that issues, such as those identified during inspection were being identified and therefore were not always as robustly completed as possible. People and relatives spoke positively about the management team and felt the service was well run and people were well cared for. Staff felt well supported and that as a team they all worked well together. There were various systems to obtain feedback and people, relatives and staff felt involved in service development.

There was not always enough staff to meet people’s needs in a timely way and we have made a recommendation about this. The service was clean and tidy, people’s needs and risks were assessed, and people received their medicines as they needed. People felt safe at the service, and staff were suitably recruited.

We found people’s capacity assessments were not always completed in line with the Mental Capacity Act and we have made a recommendation about this. There were suitable polices in place and staff supported people to make choices and decision.

People’s needs and choices were assessed, and care plans implemented. People were supported to access health care services as needed and helped to eat and drink well. Staff received a variety of training and felt well supported in their roles. The service had been adapted to meet the needs of people living with Silverdale including those living with dementia.

People’s care needs were being met in a personalised way and different approaches to communication were in place where this was needed. A range of activities and initiatives were in place for people to access. People felt able to raise concerns and make complaints and there were suitable policies and procedures in place.

Staff were kind and caring and knew the people they supported well. People’s privacy and dignity was respected, and decision making and independence encouraged.

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 good (published 18 October 2018).

Why we inspected

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

Recommendations

We have made a recommendation that the provider review staffing allocation and the systems of oversight in relation to the assessment of capacity under the Mental Capacity Act.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silverdale 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. The home is located in Bredbury, Stockport and can accommodate up to 47 older people, some of whom are living with dementia. At the time of our inspection there were 43 people living at the home.

The home was last inspected on 14, 15 and 16 March 2017 when we rated the service as ‘requires improvement’ overall and in the key questions safe, effective and well-led. We also identified four breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to preventing and controlling the spread of infection,

staff competency, supervision and training and the effectiveness of governance systems in place. We also made a recommendation about the deployment of staff around the home.

Following the last inspection, the provider sent us an action plan detailing what they would do and by when to address the breaches identified. At this inspection we found the provider had made the necessary improvements and was meeting all the requirements of the regulations.

At the time of the inspection the home had a 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.

The home had a clear management structure in place, with the registered manager being supported by two deputy managers. The home was further assisted by an area support manager, who spent at least one day per week in the home. Staff told us the management team were a visible presence in the home, were approachable and happy to help out when needed.

During the inspection we found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in bathrooms and toilets and personal protective equipment (PPE) such as gloves and aprons were available for staff to use to help prevent the spread of infections.

People living at the home told us they felt safe and well cared for. Relatives we spoke with also had no concerns about the safety of their family members and spoke positively about the standard of care provided. The home had appropriate safeguarding policies and procedures in place, with instructions on how to report safeguarding concerns to the local authority. Staff had received training in safeguarding vulnerable adults, which was refreshed and they demonstrated a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

People, their relatives and the staff we spoke with all told us enough staff were deployed to meet people’s needs. Staffing levels were determined by the registered manager based on peoples level of dependency and assessed needs. Our observations during inspection confirmed the home had

sufficient numbers of staff to meet people’s needs, with people’s request for assistance responded to promptly.

We found medicines were stored, handled and administered safely and effectively. Staff who administered medicines had received training and had their competency assessed. Medication Administration Record (MAR) charts had been completed correctly, as had topical medicine charts, which are used to record the administration of creams and lotions. We found guidance for ‘as required’ (PRN) medicines such as paracetamol were in place, to ensure people were given these medicines safely and when needed.

The home had a comprehensive induction programme, with ongoing support and observation provided to staff during the first 12 weeks of employment. Staff spoke positively about the training provided, telling us this consisted of both e-learning and practical sessions, with staff able to request additional training in areas of interest. Training completion was monitored and promoted, to ensure staff’s skills and knowledge remained up to date. Staff told us they received regular supervision and annual appraisals, which along with the completion of bi-monthly team meetings, ensured they were supported in their roles.

The staff we spoke with displayed a reasonable knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found the home was adhering to the principles of the MCA. DoLS applications had been submitted appropriately for people deemed to lack capacity to consent to their care and treatment. We saw best interest meetings had been conducted to support decision making when people were deemed to lack capacity to make these decisions independently.

Throughout the inspection we saw positive interactions between staff and people living at the home. People and their relatives told us staff were extremely kind and caring, which was evidenced in the exchanges we observed. Staff had access to a range of personalised information about people, and clearly knew the people they supported, being able to recall background and personal information during conversations.

As part of the inspection, we looked at five care files which contained detailed information about the people who lived at the home and how they wished to be cared for. Each file contained informative, yet easy to read care plans and risk assessments, which helped ensure people’s needs were being met and their safety maintained. Staff were able to tell us about the importance of ensuring care was person centred, and this approach was evidenced within people’s care files.

The home had a comprehensive activity schedule in place, which included a variety of in house activities, along with community based outings and events. Five staff were in the process of being trained to facilitate armchair exercises, with the intention of running three sessions per week once qualified.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed both internally and at provider level, with action plans and checklists completed to ensure improvements were made.

We last inspected the service on 29 February and 1 March 2016 when we rated the service as requires improvement. At that time we found the service was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to consent and care for treatment, the proper and safe management of medicines, doing all that is practicable to mitigate risks and maintaining accurate, complete, contemporaneous records.

Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed. At this inspection we found that the provider was now meeting some of the requirements of these regulations. However we identified other areas where the provider was not meeting the legal requirements.

We identified breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to preventing and controlling the spread of infection, staff competency, supervision and training and the effectiveness of governance systems in place. We have made a recommendation about the deployment of staff around the home.

This inspection was to check improvements had been made following last inspection and to review the ratings. You can see what action we have told the provider to take at the back of this report.

Silverdale is a two storey building located in Bredbury, Stockport and is registered with the Care Quality Commission (CQC) to provide accommodation for up to 47 older people some of whom are living with dementia. People were accommodated in single bedrooms and six of these provided an en suite toilet and wet room facility. Bedrooms were located over two floors which could be accessed via a passenger lift or staircase. At the time of the inspection 44 people were using the service. Silverdale is one of eleven care homes owned by Borough Care Limited which is a not-for-profit registered charity.

A registered manager was in place at the time of the inspection. 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.

We saw some positive and caring interactions between staff and people who used the service; however we saw some people were not supported by sufficient numbers of staff to make sure their wellbeing was promoted.

We saw a housekeeper who was not trained to use moving and handling equipment, supported a care worker whilst using a stand hoist to mobilise a person. This placed the person at risk of receiving unsafe and inappropriate care.

We saw records to show not all staff had received regular supervision or an annual appraisal to help make sure they were carrying out their duties safely and effectively.

Weekly cleaning audits were not fully completed and up to date. Moving and handling equipment to assist in transferring people required cleaning to maintain a good standard of cleanliness and help to prevent cross infection.

Not all staff used the protective personal equipment (PPE) in place such as disposable aprons and gloves when delivering care to people. This meant people were not protected against the risk of cross infection.

Auditing systems in place to ensure the quality of services provided were not fully utilised to make sure the service provided was safe, effective and well led.

Arrangements were in place to help protect people from the risk of abuse. The service had an up- to-date safeguarding policy and procedure in place and staff members spoken with were able to give a good account of the risks associated to vulnerable adults, the safeguards in place to minimise these risks and explain how they would recognise and report abuse.

Care staff we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was available to them.

People’s nutritional and hydration needs were being met. People had choice about what they wanted to eat and drink and where required they were supported to eat their meals with prompts from staff.

Staff had developed a good rapport and understanding of the people who used the service and treated the people and their belongings with respect.

People were supported to take part in hobbies and interests and individual or group daily leisure activities were provided for people who used the service.

A complaints policy was in place and copies of the policy were displayed in communal areas in the home. We examined the services complaints log and found where complaints or comments had been made records were kept of the actions taken to resolve the issue to the satisfaction of the complainant.

We last inspected the home in January 2014. At that inspection we found the service was meeting all the regulations that we reviewed.

Silverdale is located in a residential area in Bredbury, Stockport, and is a purpose built two –storey home accommodating up to 47 older people most of whom have a diagnosis of a dementia type illness.

The layout of the home covers a large area and includes several communal lounges, some of which had been decorated to reflect bygone times, such as a 1950’s style living room and kitchen.

People are accommodated in single bedrooms on two floors, with lift access to the upper floor. There were 42 people using the service at the time of the inspection, including one person who was there for a short period of time.

The home had a manager registered with the Care Quality Commission (CQC) who was present on both days of the inspection. A registered manager is a person who has registered with 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.

We found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We found that following an injury to a person using the service medical advice was not sought, and recorded details following incidents did not provide sufficient information about the cause and consequences of incidents. The records of the administration of medication did not give us confidence that medicines were always being managed safely. We saw that when people were unable to consent to their care and treatment because they lacked capacity the service had not sought the appropriate authorisation. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us that they felt safe and believed there were enough staff to meet their needs. One person told us, “I know they are busy, but they will check if I am OK. If I ring my buzzer they always come quickly”.

We found people were cared for by experienced staff who were safely recruited. Staffing was planned to ensure that the same staff worked in the same area of the home, which allowed for continuity of care and familiarity for people who used the service. The service was clean and tidy, with communal areas and corridors kept free from clutter to minimise the risk of accidents.

There were systems in place to ensure that people who used the service were protected from the risk of harm. Staff had received training in whistleblowing and safeguarding adults, and were able to tell us what they would do if they had any concerns about the people who used the service.

There was information in people’s care records to guide staff on the care and support needs required and this included information about their likes and preferences.

People and their relatives were involved and consulted (where appropriate) about the development of their care records. This helped to make sure, wherever possible; the wishes of people who used the service were considered and planned for. The staff we spoke with had a good understanding of people’s individual needs and the support they required, and we found that care was delivered consistently by a team of workers who knew how to support people and meet their assessed care needs.

We saw people had enough food and drink and there was good interaction between staff and the people who used the service at mealtimes. Specific dietary requirements such as sugar free were provided as required.

People were supported to see health professionals as and when required. One GP (General Practitioner) visited every week and there were regular visits from a visit podiatrist, optician and dentist.

The staff we spoke with had an in- depth knowledge and understanding of the needs of the people they were looking after. We saw that staff provided respectful, kindly and caring attention to people who used the service, and people told us they were given choice in how their support was delivered.

The people who used the service told us that there was enough to do during the day. Some had formed friendship groups and would seek each other’s company. Care staff arranged activities such as bingo each afternoon, and would organise parties to celebrate people’s birthdays.

The registered manager was held in high regard by staff and visitors to the service. The staff team had confidence in the management structure and received regular supervision. Staff worked well together and were supportive to each other as well as to the people who used the service.

To help ensure people received effective care, checks were undertaken by the management of the home and people could comment on the facilities and the quality of the care provided.

We saw that systems were in place to monitor the quality of the service provided, but these did not always identify issues of concern, such as the administration of medicine.

The provider had a policy in place which provided instruction for staff on the procedure for safe handling of medicines. All medicines were administered by staff who had completed medicines training.

One person living at the home told us they chose to remain in their room most of the time. They said 'It's my flat. I love it. I have everything I want in here'. One relative described the home as 'very comfortable'. Another said the home was 'clean' and the bedrooms 'adequate'.

One person whose relative lived at Silverdale told us they thought the home was 'relaxed and calm'. They told us that the staff did not appear rushed and responded quickly if they were called. We asked members of staff how they found the staffing levels at the home. One told us it could be 'hard but not unbearable'. Another said told us they would like to be able to spend more one to one time with people.

One member of staff told us they thought the staff team were 'very good at working together'. They said there was 'always someone to help you if you need it'.

Suitable arrangements had been made to ensure that personal care and support was provided to people in a dignified, private and respectful manner. People received the support they needed to maintain their independence by making decisions in relation to the way their care and support was provided. The six people we spoke with said that they were happy living in the home. They told us that they got to know staff well and they described staff as supportive and caring.

The service had robust systems in place to ensure that people living in the home received safe care and support. Staff working in the home had been trained in how to recognise the signs and symptoms of abuse and what action they must take if they suspected someone was at risk of abuse.

Staff had received training that was relevant to the work they undertook. They had the knowledge and skills required to meet the needs of the people they cared for in a confident and competent manner.

The home had a robust system in place to monitor, and review the quality of the service provided. People living in the home were encouraged to express their views and participate in decisions about how the service was run.