Archived: Silvermead Residential Home

Updated 30 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 15 and 21 February 2017 and was unannounced. One Inspector undertook the inspection.

Some of the people living at Silvermead had limited verbal communication and were therefore unable to tell us about their experiences of the services, whereas others were able to speak with us. We spoke with people where possible and also spent time in the communal parts of the service observing people’s daily routines and as they were being supported by staff. This helped us understand if people’s needs were being met and if they were happy and well cared for in the home.

Prior to the inspection the provider completed a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what they do well and improvements they plan to make. We also reviewed information we held about the service. This included previous inspection reports and notifications we had received. A notification is information about important events, which the service is required to send us by law.

During the inspection we spoke with six members of the staff team. The registered provider had appointed a manager to oversee the day to day running of the service. The manager was present throughout the inspection.

We looked at the care records of three people who lived at the home, as well as other records relating to the service. This included staff recruitment records, health and safety records and quality audits.

Following the inspection we spoke with a relative and three professionals from other agencies who had or have involvement with people living at the home. This included a social worker, a healthcare professional and a member of the quality team for Plymouth City Council.

Updated 30 March 2017

The inspection took place on the 15 and 21 February 2017 and was unannounced.

Silvermead Residential Home provides care and accommodation for up to 13 people. On the day of the inspection 12 people were living at the service. Silvermead provides care and accommodation for adults with a learning disability and other associated conditions such as Autism.

The registered provider for the service was also the owner of the home. A registered Provider is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements on the Health and Social Care Act 2008 and associated regulations about how the service is run. A manager had been appointed to oversee the day to day running of the service and was available throughout the inspection. The manager informed us they were in the process of registering with the Care Quality Commission, which they recognised would give them additional responsibilities and duties. The PIR stated the manager was attending a Plymouth City When we refer to the manager in the report we mean the person who had been appointed by the registered provider to oversee the day to day running of the service. The registered provider supported the manager and visited the service on a regular basis each week.

At the previous inspection on the 9 and 15 December 2015, we found concerns in relation to people’s rights when they lacked the capacity to make decisions for themselves. We also found concerns in relation to the way the home supported people who may display behaviours, which could be challenging and put them or others at risk. Support plans did not in all cases provide staff with sufficient information to help ensure behaviours were understood and managed safely and appropriately. People’s support plans were not in all cases sufficient in detail to reflect the level of care being provided and did not always describe how people chose and preferred to be supported. The provider sent us an action plan to tell us how they had addressed the concerns.At this inspection we found improvements had been made.

The manager had worked hard to develop people’s support plans, which reflected their current care needs. The manager had liaised with the local authority quality team and other providers of care to support them in this process. People had up to date support plans with information about their daily routines and how they chose and preferred to be supported.

Staff had undertaken updated training in the Mental Capacity Act (MCA) 2005. Care records demonstrated when people had made decisions for themselves or when best interest discussions had been needed to support them. For example, one person had been assessed as being able to make decisions about whether or not to receive treatment for a specific health need. We saw they had been supported to make these decisions and their views and choices had been respected by the staff supporting them.

Since the last inspection the manager had improved the guidelines available to staff about people’s behaviours that could be challenging or put them or others at risk. People’s support plans had been developed to include more detail about the types of behaviours people could display, possible triggers and how staff should respond if the behaviours occurred. Advice and guidance had been sought from the specialist learning disability service.

We were told about some people’s wishes and goals for the future. However, this information was not always documented as part of their support plan, therefore it was not possible to see how the service supported people to achieve their goals, wishes and aspirations. The manager told us they undertook regular reviews of people’s support arrangements, and records were dated to show they were up to date. However, the review process was not documented; therefore it was difficult to see if people were involved in this process and how their views and wishes were considered.

Staff told us the staffing levels were safe. We saw people who had been assessed as requiring 1:1 staffing levels had these arrangements in place. The manager had also recruited an Enabler to support some people on a 1:1 basis at set times during the week. However, two care staff would normally support eleven people, which staff said did at times restrict their ability to support people with personalised activities, or to be spontaneous and take people out when they requested. This meant people’s opportunities could at times be limited and not specific to their particular needs and requests.

Throughout the inspection we found staff to be compassionate and caring. There was a friendly and homely atmosphere. People greeted us at the door and staff ensured they knew who we were and why we were visiting. This demonstrated that people were supported to see Silvermead as their home and were helped to feel comfortable and relaxed when people they didn’t know visited.

Relatives and other agencies spoke highly of the care provided at Silvermead. They said there had been significant improvements during the last twelve months since the new manager had been in post. Relatives said the staff and management went “Over and above” to support them and people in the home. Health and social care professionals said communication was good and professional appointments were never missed.

A thorough admissions process took place for any new people considering moving into the home. The manager gathered information about the person and met with them and other key people including relatives. Health and social care professionals said they were very impressed with how the staff and manager had supported two people who had recently moved into the home. They said the planned transition and support from the service had resulted in both people settling well in their new environment.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook training and understood the importance of safe administration of medicines.

People’s health and dietary needs were well met. People were supported to maintain good health and when required had access to a range of healthcare services. Annual health checks were arranged and ‘hospital passports’ were in place to support any admissions to hospital. Hospital passports contained important information about the person to help ensure their needs were appropriately met if they should require an admission to hospital or other healthcare facility. People’s health needs were monitored closely and any concerns or changes were dealt with promptly.

People’s privacy and dignity was respected and staff provided dignified and compassionate end of life care. . A relative said, “They told us they would support us all as a family day or night, outside working hours, they have done all they can and more”. Feedback within correspondence received by the home included, ‘Nothing was left unattended, throughout […] stay, they received the utmost care, love and attention’. People’s end of life wishes were recorded and respected. One person had requested a celebration of their life as part of their end of life wishes, so the manager had organised a big gathering in the home with people the person wanted to attend. The family said the occasion was very special and just as the person would have wanted.

We saw good examples of care being personalised and responsive to people’s needs. One person had started to display behaviours, which were out of character and suggested they were distressed. The manager and staff recognised these behaviours occurred at a certain time and during a particular activity. Plans were put in place, which included the use of pictures to help the person communicate their concerns and understand what was happening. This action resulted in the person becoming less anxious and the behaviours ceased. This demonstrated the service knew people well and were proactive in supporting people to express their needs and concerns.

Staff, relatives and other agencies all spoke highly of the management of the service, and said there had been significant improvements since the new manager had been in post. Comments included, “The service needed the stability of a manager and the care delivered to people has really improved”. The manager said they felt well supported by the registered provider and felt both were clear about their responsibilities and a desire to further improve the quality of the service.

The manager said they recognised the service had a culture in the past of wanting to over protect people, which at times resulted in their rights and independence being restricted. They said they had worked hard to change this culture by providing training to staff and modelling appropriate practices of care. This was reflected in the practices we observed and the discussions we had with staff.

The provider had a good quality assurance system in place and gathered information about the quality of the service from a variety of sources, including people who used the service, relatives and other agencies. Learning from quality audits, incidents, concerns and complaints were used to drive continuous improvement across the service.