We did an unannounced responsive inspection on the evening of 14 June 2016 due to concerns alerted to us about the number of staff on shift in the home. During that inspection we found there was not sufficient staff on duty to meet people’s needs safely. We also found other significant concerns relating to the safety and wellbeing of people and the quality of the service. We visited the home unannounced the next day 15 June 2016 and completed a comprehensive inspection. We also completed an unannounced focussed inspection on the evening of 30 June 2016 because of further concerns raised by relatives and visiting professionals to the home. We last inspected Silver Howe in September 2015. At that inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to fit and proper persons being employed. We issued a requirement notice in relation to that breach and asked the registered provider for an action plan to tell us how and when they would be complaint with the regulation.
During the inspection in June 2016 we found seven breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included a continued breach of Regulation 19 found during the last inspection. We also found that some of the incidents that had occurred in the home should have been reported to CQC and other agencies but the registered provider had failed to do so. These were breaches of Regulations of the Care Quality Commission (Registration) Regulations 2009.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Silver Howe is a residential care home that provides personal care and accommodation for up to a total of 30 people. Accommodation is provided over two floors and there is a separate unit with six beds for caring for people living with dementia (Bluebell unit). Silver Howe is located close to the town centre of Kendal. There are gardens and seating areas for people living there to use and car parking.
There was a registered manager in post. 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. However at the time of the inspection visits the registered manager was not present in the home or available to contribute to the inspection.
Concerns found during the inspection about the safety and wellbeing of some people who lived at the home led the inspectors to share information with the local authority and the service’s commissioners.
There were not sufficient numbers of staff to safely meet people's needs. The level of staffing during the time of the inspection required additional staff to be sourced from the registered providers other care homes to ensure people had their needs met. Staff and relatives told us they had concerns about the numbers of staff available to provide safe and effective care.
Medicines were being administered and recorded appropriately but were not stored in a safe way.
Staff had commenced working without all of the required checks of suitability. Two people had commenced employment without all of the checks required to ensure they were fit and proper persons.
Training records were not accurate and we could not determine if staff had commenced working with the appropriate skills. Staff told us about what training they had received however we were unable to confirm this with the records that were provided. Staff also told us that they had commenced working without some of the essential training required to ensure they had the appropriate skills and knowledge for the job.
There were no assessments of people’s needs made prior to people being admitted to the home. Care plans and risk assessments made were not always accurate about the needs of people’s health and support that they required.
Care records lacked vital information about peoples individual care needs. Care was not provided in a person centred way. People preferences and choices was not always recorded or considered. We did not see that people had always been involved in their care planning or had consented to their care.
When accidents and incidents had occurred these had not always been reported by to the appropriate authorities including CQC. A number of incidents of a safeguarding nature had not been reported to any external agency.
People had restrictive measures in place without risk assessments, consent or appropriate applications having been made to deprive them of their liberty. Requirements relating to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met.
The registered provider did not have effective systems in place to monitor the safety and quality of the service.
People living at the home told us they enjoyed the food served and that they had been able to personalise their bedrooms.
The interactions we observed that took place between the care staff and people living at the home was respectful and kind despite the low numbers of available care staff.
The home employed a designated person to coordinate activities for people living at the home. We saw a variety of activities were provided if people wanted to join in.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.