Silver Court

We found the following examples of good practice.

People were well supported by staff to have telephone and internet contact with their family and friends. There were technology champions amongst the staff who promoted and supported residents with technology solutions. The service facilitated in person visits in a manner which minimised the risk of infection spread, including outside visits.

Plans were in place to isolate people with COVID-19 to minimise transmission. The service had good supplies of personal protective equipment (PPE) that were readily available in stations throughout the service.

Visitors were asked screening questions and to sanitise their hands when they arrived. Visitors were also provided with appropriate PPE prior to entering the home.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter. Internal gates within the gardens had been removed to reduce the number of high touch areas.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as themed crafts, quizzes and music sessions. Activities were often repeated to enable smaller groups to participate.

Smaller themed seating areas had been created in different areas of the home, for example one small seating area was decorated like a library and had a selection of books available for residents.

Silver Court is a residential care home providing accommodation and personal care to 41 people aged 65 and over. People living at the home had a variety of care and support needs, such as dementia and physical disabilities. The service can support up to 42 people in one adapted building.

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

Risks associated with people's care and support had been appropriately assessed and managed. People felt safe living at the service and with the staff team who supported them. One relative said, “They support [person] well to the best of their ability and make her has comfortable as possible. Overall, they understand her and her risks and put measures in place to keep her safe.” Staff told us they knew how to manage risks effectively and identify signs and symptoms of abuse and who to report concerns to.

The home was clean, and people were protected from the risk of infection. Lessons were learned when things went wrong, and the registered manager had oversight of accidents and incidents. People’s medicines were managed safely. One relative told us, “They are pretty good with medicines, there have been several changes, but we have been notified and everything is recorded.”

People and their relatives thought the home was well led. One relative told us the home was, “Very well managed, always clean. Meals are on time, there is a good boss, everyone does their best for my wife.” Quality assurance systems were in place to drive improvement to the care people received. People their relatives and staff were engaged in the running of the service and staff worked well with other professionals. People were supported in a person-centred way and we observed friendly interactions between them and staff.

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 10 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received about moving and handling practices and potential safeguarding concerns. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

The inspection was also prompted in part by notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The provider and registered manager had taken action to reduce risks to people by working openly with the local authority safeguarding team and by welcoming support from external agencies such as local authority moving and handling assessors.

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 remained the same, good. This is based on the findings at this inspection.

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.

Silver Court provides care and accommodation for up to 42 people. On the day of our inspection there were 40 people living at the home. The home provides residential care for the elderly and frail and people living with dementia.

Prior to this inspection we received some information of concern about the management of people’s skin and the staffing levels, mainly at weekends.

There was 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. At the last inspection on the 26 August 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People told us they felt safe. One person said; “Safest place for me (living here not at home). Another said; “Security at the door makes me feel safe.” Staff said; “People are safe because we know them and what they like.” A relative said; “Want to express deepest gratitude for making mums quality of life in past few years something she could cope with and enjoy.”

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff mostly said there were sufficient staff to keep people safe. However a few relatives and staff commented that weekend staffing levels were not always as good. Other staff said they were able to meet people’s needs and support them with activities and trips out.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People who required additional input to protect their skin integrity had input from the district nurse team. Professionals stated people were safer now as all staff had received training and worked with them to keep people’s skin integrity safe. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s end of life wishes were documented. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy was mostly respected. However we did note that on occasions not all staff knocked on people’s door before entering. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the registered manager confirmed any complaints received would be fully investigated and responded to.

The service continued to be well led. People lived in a service where the registered manager’s values and vision were embedded into the service, staff and culture. People, relatives and staff mostly said the registered manager was approachable. However a few commented that the registered manager was not always visible in the service. The registered manager said they walked around the service regularly to see and speak to people.

The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the registered manager and provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service.

We looked at a range of records including accident, incident and safeguarding reports, health and safety checklists and the care plans for five people. We found that the standard of record keeping had improved since our last inspection. We met with the registered manager and one of the home's team leaders. We found that staff had maintained documentation to evidence that people had received appropriate care and treatment.

We found that the home was clean and tidy and the provider had taken appropriate action to improve infection control standards within the home. We saw that sluices were now suitably maintained and that there were systems in place to ensure that these areas were regularly checked. This meant that people were now better protected because the home had taken steps to reduce the risk of the spread of infection.

We found that people received care which met their needs. However there was a lack of information on managing challenging behaviour which meant that staff could not ensure that support in this area was given confidently and consistently.

Staff told us they were aware of safeguarding procedures and were confident in identifying possible abuse. They told us that they had training in safeguarding and understood the procedures to follow and who to contact.

We found that people's rooms and the communal environment were clean and free from unpleasant odours. However, sluice areas were poorly maintained and did not protect people from the risk of infection.

Staff were supported through a wide range of training and regular supervision. Comments received from staff included "I really enjoy it here", "It has changed for the better" and "The manager is understanding".

We identified that there were gaps in care plans and other records which meant that the provider could not be certain that people were receiving appropriate care. Records were kept securely and were accessible to those that needed to see them.