Silversprings

Updated 26 February 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 26 January 2022 and was announced. We gave the service 24 hours notice of the inspection.

Updated 26 February 2022

About the service:

Silversprings provides residential and nursing care for up to 64 people, some of whom are living with dementia. The premises are divided into three units, Bluebell provides nursing care, Tenpenny provides care and support to people living with varying levels of dementia. Caroline provides support for older people. At the time of our inspection 52 people were using the service.

People’s experience of using this service:

Governance systems had improved since our last inspection. However, further improvements were needed to ensure these were used robustly to demonstrate how the quality of the service continually improved and developed to provide good outcomes for people. Poor outcomes identified in safeguarding concerns, complaints, incidents and accidents were looked at in isolation, rather than looking at the root causes in relation to a lack of staff training, poor recording, communication and ineffective leadership on the units.

Staff lacked knowledge and understanding on how to support people with dementia, including managing high levels of anxiety. Therefore, staff were not always providing care that was effective and person centred. People were treated with kindness and respect; however, staff were focussed on completing tasks rather than focussing on promoting people’s independence and emotional wellbeing, and they did not always respect people’s privacy and dignity.

Although sufficient staff were employed, there were key times throughout the day where more staff were needed, specifically on Tenpenny unit, to ensure people’s needs were met and to keep them safe. People with advanced dementia were not sufficiently supported at mealtimes to ensure they ate enough and were protected from malnutrition, and risk of choking.

Care records did not contain enough information for staff around supporting people’s wellbeing or complex, long term specific needs, such as dementia. People’s past life, hobbies and interests was not used to help them lead fulfilled and meaningful lives, through activity, therapy and social inclusion. Although the provider had consulted with other reputable resources for guidance and support in identifying activities for people with dementia, and how to engage effectively, these had not yet been imbedded to drive the required improvements.

Where things had gone wrong, systems were in place to share learning across Care UK services in the Essex region. Whilst this was a good initiative, the process needed expanding to reflect the root cause of the issues and how changes in practice had improved outcomes for people.

Management and senior staff had inconsistent understanding of the legal framework, relevant consent and decision-making requirements of the MCA 2005 and associated best interest decisions. The registered manager was working with people and their relatives to complete Preferred Priorities of Care (PPC) forms to plan for their future end of life care.

Safeguarding concerns had been managed well. Systems were in place to manage people’s medicines safely and to reduce the risks associated with the spread of infection. People had access to various healthcare professionals, when they needed them.

People, their relatives and staff were engaged in the service and had been consulted on and created a set of vision and values specific to Silversprings that puts people at the centre of the service. The values focused on being passionate, caring and developing good team work.

Rating at last inspection: The scheduled inspection on 27 March 2018 and 29 March 2018 was rated Requires Improvement (Report published 17 May 2018)

The focussed inspection on 19 September 2018 and 03 October 2018 was brought forward due to information of concern; about people’s catheter care. The rating remained, Requires Improvement (Report published 20 November 2018)

This service has been rated Requires Improvement at the last three inspections, since 11 May 2017. Following this inspection, the rating, Requires Improvement has not changed.

Why we inspected: This inspection was brought forward due to information of concern about people’s care and welfare.

Follow up: During this inspection we found whilst some improvements had been made, further improvements were needed, in relation to good governance, staff training, dementia care and deployment of staff. We will continue to monitor all intelligence received about this service to ensure that the next planned inspection is scheduled accordingly.

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