Archived: Silverdale

Silverdale is a residential care home providing personal care for up to four people with learning disabilities. At the time of our inspection the service was supporting one person. The service is a detached two-story property with a front garden. It is located in Redruth, Cornwall within walking distance of shops and other local facilities.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The design and culture of the service did not maximise the person’s choice, control and independence. Staff were planning to support the person to change the furnishings in their flat, to better reflect their tastes; but had not been able to because they could not access their own bank account.

The care model did not always focus on the person’s strengths or identify clear paths to achieving their aspirations and goals. The person’s control over their own lives was limited which meant they did not consistently have a fulfilling and meaningful everyday life. The person’s capacity had not always been assessed before staff made a decision on their behalf.

Staff had not all received the right training to help ensure restrictive practices were only used by staff if there was no alternative. Plans to guide staff on how to support the person who experienced periods of distress were not all up to date.

Safety checks of the service had not all been completed as required.

Staff were supporting the person to reduce the number of medicines they took.

The person was supported to join discussions about their support in a way that limited their anxiety.

Right care

Significant risks to the person had not been assessed and therefore control measures to protect them from abuse and poor care were not all in place.

The person was doing more than at the previous inspection, but this was still affected by limited access to their finances and staffing. The service did not have enough appropriately skilled staff to meet their needs.

The person did not always receive support that met their needs and aspirations, focused on their quality of life and followed best practice.

The person was able to communicate with staff and understand information given to them.

Right culture

The ethos and values in the service did not always meet best practice. This meant the person did not always experience an inclusive and empowered life. Staff did not always have a good understanding of best practice models of care. The service was based on restrictions and a punitive approach to the person’s behaviour.

There was not enough management time or support by the provider to enable real development or improvement in the service. The provider had failed to minimise the risk of a closed culture forming at the service.

The culture created in the service meant the person was not always treated as an equal. The staff team had not been designed in a way that met the person’s preferences.

Various professionals were involved in monitoring the person’s care.

The person was not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not effectively support staff to maximise the person’s choice and control.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement overall (published 20 August 2021), but was rated inadequate in well led. As a result, we required the provider to report to us on a monthly basis on staffing levels, details of any gaps in staff training and experience, and the number of hours the manager was unable to complete management tasks because they were required to support the person living in the service. We also required them to detail how they had assessed their staffing capacity for the following month. We received these reports on a monthly basis.

At this inspection we found the provider remained in breach of regulations. This is the third time the service will have been rated below ‘good’.

At our last inspection we recommended the provider sought advice from a reputable source on how to support staff and ensure they understand and follow agreed guidelines. At this inspection we found some guidelines were out of date; however, staff understood and were following up to date, agreed ways of working.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, the safety of the service provided, safeguarding the person from abuse, and the recruitment processes. We also identified a breach relating to the requirement on the provider to notify us of certain events. We identified continued breaches in relation to the governance of the service and staffing.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

We began the process of preventing the provider from operating this service. However, before the provider's representations against our proposal had been reviewed, the provider took the decision to transfer the service to another provider.

Silverdale is a residential care home providing personal care to four people with a learning disability and/or autism. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. Silverdale is a detached two-storey property with an enclosed front garden. It is located in Redruth, Cornwall within walking distance of shops and other local facilities. At the time of our inspection two people were living in the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability with the choices, dignity, independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support,

Low staffing numbers had restricted people’s choices and meant they were unable to go out for a walk or live like ordinary members of the community. People were not always supported by enough staff on duty who had been trained to do their jobs properly.

Right Care,

People received care and support that was person-centred. However, people had not been consistently supported by staff that knew them well due to the staffing shortages at the service.

Right Culture.

The organisation exhibited many of the risk factors and warning signs associated with the existence of a closed culture including; people’s level of dependence on staff for basic needs, reliance on staff support to enable them to access the community, staff working excessively long hours , consistent staff shortages, and a lack of effective external oversight. In addition, the provider had failed to appropriately respond to staff requests for support and guidance on how to manage a complex issue.

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

At this inspection we again found that the service was inadequately staffed to meet people’s needs with higher permanent staff vacancy rates than those identified during our March 2020 inspection. Rotas and other records showed the service had regularly been operated at emergency minimum staffing levels and reports to the providers senior management demonstrated the service had been short staffed since December 2020. The action plan developed by the provider following our last inspection in March 2020 had failed to ensure the service was appropriately staffed.

Low staffing levels restricted people’s freedoms and unnecessarily exposed them to risk of harm. Staff reported that low staffing levels had prevented people from leaving the service and that they had come in on their days off to enable people to go outside.

Five days prior to the inspection, the provider had introduced the use of agency staff at Silverdale in response to inspection findings and safeguarding investigations related to staffing levels identified during previous inspections of four other Spectrum services.

The agency staff had limited knowledge of the people they supported at the time of our inspection. In addition, the commission is concerned about the sustainability of these arrangements as the agency staff were from Northampton and were being accommodated locally by the provider. Documents showed the provider’s senior managers had been aware that the service had been short staffed since December 2020. Managers had phone the service daily to check on staffing levels and any issued relating to the COVID pandemic. Staff had consistently reported the understaffing of the service, but this issue had not been resolved prior to the introduction of agency staff.

At the time of our inspection the registered manager, deputy manager and a member of care staff had resigned and were working their notice periods. Staff were consistently complimentary of the registered managers leadership but reported the provider’s systems for supporting the service were ineffective.

The provider required its registered managers to raise safeguarding issues internally for review and approval by senior managers before safeguarding alerts were made. This was contrary to best practice and introduced risk of delayed.

Medicines were managed safely and we were assured there were appropriate infection control procedure in place.

Care plans reflected people’s current needs and had been regularly updated. However, on the day of our inspection specific guidelines used to recognised one person’s engagement with tasks and activities were not being used. We have made a recommendation in relation this issue.

People’s communication needs had been identified and recorded. Staff varied the style of their communication, and used stock phrases, objects of reference and other tools to support people to make choices and decisions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 May 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we again found the service was short staffed and in breach of regulation 18. In addition, issues were identified with the leadership and quality assurance systems which is breach of regulation 17.

The service remains rated requires improvement. This will be the second inspection that the service has been rated overall as requires improvement.

Why we inspected

We received concerns in relation to staffing at a number of services operated by the provider. As a result, we undertook a number of focused inspections to inspect for these concerns. At this service we reviewed the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions of Effective and Caring. 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.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silverdale on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and good governance. 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 request an action plan for the provider 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Silverdale is a residential care home providing personal care for up to four people with learning disabilities. At the time of our inspection the service was supporting two people on a full-time basis and providing regular respite support to another person.

The service is a detached two-story property with front garden. It is located in Redruth, Cornwall within walking distance of shops and other local facilities.

The service supported a small number of people and was designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who used the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service’s location meant people could walk to local shops and the environment of the service had been adapted to people’s individual needs.

The service had been short staffed prior to our inspection and incident records showed that staffing levels had impacted on people’s safety. An analysis of rotas in the month prior to the inspection found the service was aiming to achieve minimum safe staffing levels and this had not been achieved on a number of occasions. Records showed the provider had identified that staffing levels in the service had been unsafe. This was a breach of the regulations.

Although the providers quality assurance systems had failed to ensure the service was compliant with the regulations they had, prior to the inspection, identified a number of issues in relation to the service’s performance. As a result a new manager had been appointed, respite placements had been cancelled when staffing was unavailable and an action plan developed to drive improvements in performance. This had been regularly reviewed by the provider’s regional manager and demonstrated significant changes had been made. Staff, relatives and professionals all recognised that the service’s performance and staffing levels were improving.

Staff recruitment practices were safe and training had been provided to ensure staff had the skills necessary to meet people’s support needs. Risks had been identified and staff were provided with clear guidance on how to meet people’s individual support needs.

Records showed people’s medicines were managed safely and there were systems in place to ensure people were protected from financial abuse.

People were comfortable in the service and approached staff for support or reassurance without hesitation. All staff had completed safeguarding training and understood their role in ensuring people were protected from all forms of abuse and discrimination.

The care plans was detailed and informative. They provided staff with sufficient information to enable them to meet people needs and included information on people’s individual likes and preferences. Staff told us, “I have read them all, they tell you everything you need to know. You can tell straight away what people like” and “The care plans are regularly updated, when I first started they were really helpful to give you and understanding of people needs. They are really helpful.”

Relatives understood how to report concerns and records showed complaints received had been appropriately investigated.

The service’s new manager was providing effective leadership and support to the staff team. Staff had confidence in the new manager and the changes they had introduced. They told us, “[The new] manager is doing really well”, “She is firm in the way that she needs to be, she is approachable and a nice person. It is getting better with her in charge, definitely!” and “Silverdale is not a house that is going to turn around in a week, it is definitely turning round. I would say that is down to the manager. She is doing well.” Relatives and professionals also recognised the new manager was impacting positively on the service performance.

Rating at the last inspection

This service was previously inspected in January 2018 when it was found to be good in all areas.

Why we inspected

This inspection was brought forward because of concerns in relation to staffing levels identified during inspections of other services operated by the provider.

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.

Silverdale accommodates up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection one person was living at the service and two people were receiving regular respite care including overnight stays. The service consists of a two story detached house set within its own gardens.

The service 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 registered manager was also responsible for providing leadership at two of the providers other services in the west of Cornwall. At Silverdale the registered manager was supported by a deputy manager who was based in the service full time and allocated four hours of administration time each week.

People were relaxed and at ease in Silverdale and their relatives told us, “I think people are very safe.” Staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse and harm. All staff had received safeguarding training and information about how to report concerns outside of the service was readily available.

People’s relatives told us, “[My relative] likes it there” and “I am happy with the care they provide.” During the inspection we observed numerous interactions between people and their support staff. People were comfortable requesting support and did so without hesitation. Staff provided support with kindness and compassion and took pleasure in describing people achievements. Staff comments included, “I love it, I really enjoy it here” and “It is nice to watch [Person’s name] grow.”

The registered manager was responsible for overseeing three local services. There was a full time deputy manager at Silverdale and Staff told us they were well support by the registered manager who visited regularly. Staff comments in relation to the registered manager included, “[The registered manager] visits three times each week and the deputy manager does have four hours administrative time each week”, “[The registered manger] is as good as gold”, and “I think the managers are great.”

Staff were well motivated and relations between the service and the providers senior management had improved since our last inception. Staff said, “I think there has been a lot better communication” and “[The Operations director] was here on Monday.” The registered manager had focused on encouraging and fostering the development of a positive culture within the home and a staff compliments book had been introduced to enable staff to share positive feedback. Staff said, “It’s a good place to work, we have quite high morale and that’s quite rare for a care home” and the registered manager told us, “I am very proud of this house.”

The service’s complaints procedures was available in accessible formats and care plan’s included guidance for staff on how to support people and members of the public to make complaints. Where complaints had been received these had been investigated and acted upon by the registered manager to improve the service’s performance.

Information was stored securely and there were systems in place to monitor the service’s performance, gather feedback from people and their relatives and identify where improvements could be made.

The service was adapted to meet people’s needs and maintained to a reasonable standard. Each person had their own self-contained flat and there was an additional communal kitchen, dining room and lounge. All Firefighting equipment had been regularly serviced and utilities had been regularly tested by appropriately skilled contractors.

Staff and the registered manager took a positive and empowering approach to risk management. People were encouraged to identify challenging goals and staff supported people to develop the skills necessary to safely achieve their goals. Where accidents or incidents occurred these had been investigated by the registered manager to identify any further actions that could be taken to improve people’s safety.

People’s medicines were managed safely. Medicine administration records had been accurately complete and there were safe systems in place to ensure people in receipt of respite care were safely supported with their medicines.

Although the service had two full time vacancies it was fully staffed on the day of our inspection. People’s relative told us, “We haven’t heard of any shortages or things like that” and we found planned staffing level had routinely been achieved. Staff were appropriately trained and well supported by the registered manager. Records showed all necessary staff pre-employment checks had been completed and that supervision was provided regularly.

Detailed assessments of people’s needs were completed before they moved into the service. This was done to ensure the service could meet the person’s needs without impacting on people already using the service. The assessments process included visits to the person’s home and the person visiting the service to meet staff and other residents. People’s initial care plans were based on information gathered during the assessment process combined with background information from commissioners and relatives.

People care plans were highly detailed and informative and staff were observed successfully using techniques described in people’s care plans successfully during our inspection. People’s care plans had been updated regularly to reflect observed changes in care needs and staff told us, “The care plans are up to date. They are reviewed each month”. A health and social care professionals said, “The care plans are very person centred and accurate.”

People were able to choose how to spend their time and to access the community when they wished. During our inspection people were supported to engage with a wide variety of meaningful activities both within the service and in the local community. On the day of our inspection people were supported to go shopping in a local town and to engage with various activities within the service including; cooking, craft activities, and domestic chores. Relative told us, “The do try to encourage [my relative] to do quite a lot” while staff commented, “[Person’s name] has a very busy activities schedule”. A Health and social care professional told us, “They try to engage [Person’s name] as much as possible with new activities.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People capacity to make specific decision had been assessed and where necessary decision had been made in the person’s best interests. Necessary DoLS applications had been made. Were authorisations had been granted with condition these conditions were understood by staff and had been complied with.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

At the time of our inspection we found that Silverdale provided a safe service due to:

We saw that staff communicated and responded to people who used the service with respect.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service.

Spectrum had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that they were using these protections appropriately.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

Medication systems were robust so that people who used the service received their medication as prescribed.

Is the service effective?

At the time of our inspection we found that Silverdale provided an effective service due to:

We noted from care records that people's health and care needs were assessed with them, and their care plans were discussed with them. We saw the persons care plan was up to date and accurately reflected their current needs. There were good arrangements in place to gain consent from the person in relation to the care they received.

The person's preferences, interests, aspirations and different needs had been recorded and care and support had been provided in accordance with their wishes.

We found all people who used the service had a care plan and found the information was up to date and had been reviewed regularly.

Is the service caring?

At the time of our inspection we found that Silverdale provided a caring service due to:

We saw people who used the service were treated with respect and dignity by the staff. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the person they cared for.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

At the time of our inspection we found that Silverdale provided a responsive service due to:

We found people who used the service were involved in making day to day decisions. During the inspection we noted that people were given choices in how they wanted to occupy their time, this meant they had opportunities to pursue their interests.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of our inspection we found that Silverdale provided a well lead service due to:

The service had a quality assurance system, and records showed problems and opportunities to change things for the better were addressed. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We saw minutes of regular meetings held with the staff and management team. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people's care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home. We noted that people received a varied and nutrious diet.

We noted that minimum staffing levels were met on the majority of occasions at the home. Staff said they had received sufficient training and support to enable them to carry out their roles competently.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights. Secure access to the premises needs to be maintained at all times to ensure peoples safety.