Background to this inspection
Updated
9 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a targeted inspection to check on concerns we had about people’s care and support relating to their care and treatment.
Inspection team
This inspection was undertaken by 1 inspector and a specialist advisor on the first day. On the second day of the inspection 1 inspector attended and 2 inspectors attended on the third day.
Service and service type
Handsale Limited – Silver Trees is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Handsale Limited – Silver Trees is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection, there was a registered manager in post.
Notice of inspection
This inspection was announced on the first and second day of the inspection. We visited the location on the 30 March and the 14 and we gave notice on the 28 April 2023 so we could ensure someone was available to support with the official records.
What we did before the inspection
Prior to the inspection, we reviewed the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also reviewed the information we had received about the service since the last inspection. We used all this information to plan our inspection.
During the inspection
During our inspection, we spoke with 10 people living at the service, 3 relatives and 1 health and social care professional. We spoke with the registered manager, the deputy, the clinical lead, the handyman, 2 senior care staff, and 4 carers.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed 6 people’s care plans and other supporting information along with, 4 staff files, training records, medicines records and quality assurance records.
Updated
9 June 2023
About the service
Handsale Limited – Silver Trees is a residential care home providing regulated activities of nursing care to up to 62 people. At the time of our inspection there were 58 people using the service.
People’s experience of using this service and what we found
People’s records were not always accurate and up to date to provide assurance that people were having their needs assessed and met. Governance arrangements were not always identifying these shortfalls.
People had personal evacuation plans in place; however, improvements were required to some fire doors and the loft area. The registered manager confirmed action was being taken to address this following our inspection and they were awaiting confirmation of the work required. People were at risk of not receiving adequate care and support due to no assessment or support plan being in place in relation to their individual specific health needs.
Medicines were not being managed safely, and body maps were not in place for people supported with topical creams. Following our inspection action had been taken to implement body maps for people and staff had received training in applying topical creams.
Improvements were required to recruitment procedures. Not all staff had a reference in place and risk assessment before starting work. People on the nursing floor had no dining room set up on the first day, so they could eat their meals in a communal dining experience.
People were supported with optometrist and podiatrist appointments, and GP rounds were conducted weekly. Referrals to speech and language therapy were not always made when the need arose. Following the inspection the registered manager confirmed the speech and language therapy team have visited those who have been identified as needing a review. This team were working with the service to embed these improvements.
Improvements were required to ensure staff received training in the Care Certificate along with refresher training and identified training. People were supported by staff who felt well supported.
The registered manager was accessible to people, relatives and staff. They were open to CQCs feedback. People were supported to keep in touch and receive visits from family and friends.
During the inspection, the registered manager took action to address some of the issues raised as part of the inspection. This included updating some of the paperwork and liaising with the GP and so that improvements could be made.
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 12 March 2019)
Why we inspected
This inspection was prompted by a review of the information we held about this service. We received concerns relating to safe care and treatment. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to assure CQC that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
Enforcement
We have identified breaches in relation to safe care and treatment, training, best interest decisions, records, and good governance at this inspection.
We recommend the provider seeks training to ensure staff have the skills and competency to undertake their role.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider and request an action plan. To understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.