Silvermere Care Home

We found the following examples of good practice

People told us staff had supported them well during the pandemic. They said the care and support provided by staff had been invaluable during the periods when they were unable to have family visits. One person told us, “We have been looked after wonderfully well.”

Staff had given information to people about COVID-19 and had considered how to do this in accessible ways where necessary. People who lived at the home were given the choice of whether or not to wear PPE.

People had been able to see a doctor if they felt unwell. The home’s GP carried out a virtual round every week and the registered manager said the GP visited to assess people face-to-face if necessary. COVID-19 screening was carried out on any professionals who needed to visit the home, such as the GP and district nurses.

During a recent outbreak of COVID-19, people had been supported to isolate in their rooms. Staff provided one-to-one support in people’s rooms, including activities, and people’s meals were delivered to them.

Since the COVID-19 outbreak, the provider had begun to reopen communal areas in a safe way. For example, tables in the dining rooms were well-spaced and had two places at each to enable people to socially distance. The use of table linen had been temporarily suspended.

Activities had restarted in the communal areas. Attendance at each session was limited to six people to enable social distancing. Activities co-ordinators provided additional sessions so all those who wished to take part could do so.

Prior to lockdown restrictions, the provider had enabled indoor visiting in allocated rooms which were cleaned after each visit. The provider had recently installed a visiting ‘pod’ in the home’s garden for future visits. The visiting ‘pod’ was designed to enable safe visiting, with separate entrances for people and their visitors and a floor to ceiling screen.

The home was clean and hygienic. Additional cleaning schedules had been implemented, including of frequently touched areas. All staff had attended in-house IPC and COVID-19 training. Staff had access to the PPE they needed and used this safely and effectively during our visit. There were appropriate arrangements for the disposal of clinical waste.

Staff travelled to and from work in their own clothes and changed into a clean uniform on arrival at the home. There was a staff changing room, which was used by one member of staff at a time, and an allocated room for donning and doffing PPE on each floor. Staff temperatures were taken and recorded before each shift and staff were required to take a lateral flow test (LFT) for COVID-19 twice a week. Staff breaks were staggered to ensure only one member of staff at a time used the staff room.

Staff retention during the pandemic had been good and staff sickness levels had been low. This meant people received their care from a consistent staff team. Some agency staff were used, although the provider had an arrangement with the agency that the staff supplied worked only at Silvermere. The registered manager told us agency staff undertook the same screening procedures, including LFT testing, as permanent staff.

The provider’s IPC policy had been reviewed and updated in the light of COVID-19. IPC audits were carried out regularly and 'Rapid improvement audits' had been introduced following the outbreak of COVID-19 at the home.

The provider had a contingency plan. which addressed risks related to COVID-19, such as an increase in staff absence. Risk assessments had been carried out for people who may be disproportionately at risk of COVID-19, such as staff in vulnerable groups, and measures implemented to reduce risks where necessary.

Further information is in the detailed findings below.

Silvermere is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate a maximum of 72 people, some of whom may be living with dementia. There were 61 people living at the home at the time of our inspection.

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 and associated Regulations about how the service is run.

At our last inspection in February 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Why the service is rated Good.

People felt safe and secure at the home. People told us staff were available when they needed them and responded promptly if they used their call bells. Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place. People were protected by the provider’s recruitment procedures.

Any risks involved in people’s care were identified through assessment and action taken to minimise them. Medicines were managed safely. Health and safety checks were carried out regularly to keep the premises and equipment safe for use. The home was clean and hygienic and staff maintained appropriate standards of infection control. There were plans in place to ensure people would continue to receive their care in the event of an emergency.

People’s needs were assessed before they moved into the home and kept under review. Staff encouraged people to make choices in their day-to-day lives and understood the importance of supporting people to make decisions for themselves. Some documentation relating to mental capacity assessments and DoLS applications had been completed inappropriately, although this had not led to inappropriate applications being made. The registered manager acted promptly to address these issues when we pointed them out during the inspection.

Staff had the induction, training and support they needed to do their jobs. All staff had an induction when they started work and access to ongoing training relevant to the needs of the people they cared for. Staff attended regular one-to-one supervision with their line managers, which gave them the opportunity to discuss any further training they needed.

People and their relatives spoke highly of the food provided at the home. People were encouraged to give feedback about the food and their views were considered when developing the menu. Relatives told us they enjoyed joining their family members for meals at the home. People’s nutritional needs had been assessed and were known by care and catering staff. Staff supported people to maintain adequate nutrition and hydration.

People’s healthcare needs were monitored effectively and people were supported to obtain treatment if they needed it. Referrals were made to healthcare professionals if staff identified concerns about people’s health or well-being. Any guidance about people’s care issued by healthcare professionals was implemented and recorded in people’s care plans.

The design and layout of the home was suitable for people’s needs. People lived in an environment that was furnished and decorated to a high standard and had access to large, well-maintained gardens. Adaptations and equipment had been installed to maximise people’s mobility and safety. People were able to personalise their bedrooms to reflect their individual tastes and preferences.

People told us staff were kind and caring. They said staff treated them with respect and maintained their dignity when providing their care. Relatives praised the caring nature of staff, including when people neared the end of their lives. Several relatives highlighted the welcoming atmosphere as an aspect of the home that they and their family members valued.

People and relatives told us the activities programme was one of the home’s strengths. People enjoyed the wide range of activities available and valued the opportunity to go on trips and outings. The activities programme also provided opportunities for people to engage with others from their local community. Staff ensured that people who did not participate on group activities or outings were protected from social isolation.

People and their relatives knew how to complain and were confident any concerns they raised would be addressed. Complaints were investigated and responded to appropriately and used to improve the service.

The home had an established management team which maintained a good oversight of the service. Managers were accessible and provided good role models for staff in their own attitudes and behaviours. People and their relatives were encouraged to give their views about the home and their suggestions were acted upon. There were effective systems in place to monitor the quality of care people received.

Further information is in the detailed findings below.

The service did not have a registered manager in post on the day of the inspection visit. ‘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 and associated Regulations about how the service is run. A general manager, deputy manager and regional manager assisted us with our inspection.

Risks were well managed and when risks were identified assessments were in place to minimise the risk to people. These were supported by guidance in people’s care plans to help keep them safe.

There were sufficient numbers of staff who were appropriately trained to meet the needs of the people who lived at the service. Staff received regular support in the form of annual appraisals and formal supervision.

Staff recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

People were protected from the risk of abuse. One person said “I feel safe here.” Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. They told us they would report anything they were uneasy with to the person in charge. The provider was familiar with the process of making referrals to the local authority if they suspected abuse had taken place.

People had their medicines when they needed them. All medicines were administered and disposed of in a safe way.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA) and whether any conditions on authorisations to deprive a person of their liberty were being met. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the persons rights were protected.

Health care needs were being met. People had access to a range of health care professionals, such as a GP, district nurses, a community psychiatric nurse, dentist and opticians.

People told us the food was very good and there was lots of choice. One person said “The food is very good here.” We saw people had access to drinks and snacks at any time during the day or night.

People were encouraged and supported to be involved in their care. People’s bedrooms had been decorated to a good standard and were personalised with their own possessions.

Staff were kind and compassionate. We saw people were treated with and respect and their privacy and dignity were maintained at all times. For example staff knocked on people’s doors before they entered their room.

People had individual care plans which gave clear guidance to staff on what support people needed. They were detailed and updated regularly. Relatives told us they had been consulted regarding people’s care plans and were able to attend reviews of care.

The general manager, deputy manager and regional manager operated an open door policy and we saw several examples of people, relatives and staff visiting the office to discuss people’s care and treatment or issues regarding the operation of the service. The management team visited people in their rooms if they were unable to access the office.

People were aware of the complaint procedures and told us they would know how to make a complaint. A relative told us they were confident any issues they had would be addressed by the management team.

The management team had maintained accurate records relating to the care and treatment of people and the overall management of the service. The provider had systems in place to record and monitor the quality of the service provided and to make improvements where necessary. Accidents and incidents were recorded and acted upon.

People would be protected in the event of an emergency at the home. Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

Staff had received training in relation to safeguarding vulnerable people and knew what to look out for, and how to report such matters if they should arise. People living in the home said they felt happy with staff and were confident in their skills. We saw that there were thorough recruitment procedures in place, which ensured that only suitable staff were employed.

The service took into account the views of people living there and also monitored the standards of its services through a range of different methods, including surveys and audit. People expressed positive comments on the service, such as, "I made a marvellous choice, I am delighted", "I have everything I need here", and, "If I wasn't happy, I would speak to the manager."