Background to this inspection
Updated
1 July 2021
The inspection
This was a targeted inspection to check whether the provider was meeting the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to specific concerns we had about the management of risks associated with nutrition and hydration, staff recruitment, induction, training and staffing levels.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was undertaken by one inspector.
Service and service type
Silvermead Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission at the time of the inspection. A manager had been appointed by the provider to oversee the running of the service and had made an application to register.
A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection we reviewed the information we held about the service, including information we had received about the service since the last inspection, information related to the specific concerns raised with the Commission and attended a multi-professional safeguarding strategy meeting.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spent time with people living at the service, we spoke with two members of staff, the manager and the provider. To help us assess and understand how people's care needs were being met we reviewed three people's care records. We also reviewed a number of records relating to the running of the service. These included staff recruitment, induction and training records.
After the inspection
We continued to seek clarification from the service to validate evidence found. We spoke with the provider and shared information with Plymouth City Council.
Updated
1 July 2021
About the service
Silvermead Residential Home, hereafter referred to as Silvermead, is a residential care home that provides personal care and support for up to 13 people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were 13 people living at the service.
People’s experience of using this service and what we found
People who were able to share their views with us were happy living at Silvermead and told us they liked the staff that supported them. Relatives we spoke with did not raise any significant concerns and spoke positively about the staff and the care and support they provided.
Whilst we found a number of improvements had been made following the last inspection, the service was not operating in accordance with the regulations and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.
During the inspection, we made five safeguarding referrals to the local authority and asked the manager to make another, which they did.
Systems and processes in place to monitor the service were not undertaken robustly. This meant they were ineffective, did not drive improvement and did not identify the issues we found at this inspection. These included concerns with regards to recruitment, staffing, infection prevention and control, fire safety, care planning, management of risk, nutrition and hydration and the implementation of The Mental Capacity Act 2005 MCA.
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. Neither the manager or staff were aware of the Right support, right care, right culture guidance or how these underpinning principles could be used to develop the service in a way which supported and enabled people to live an ordinary life, enhanced their expectations, increased their opportunities and value their contributions. This meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.
People were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests.
People were not always protected from the risk of avoidable harm. We found where some risks had been identified, sufficient action had not always been taken to mitigate those risks and keep people safe. Key pieces of information relating to people's care and support needs were not always being recorded or followed up. Other risks were well managed.
People were not always protected from the risk and spread of infection. We were not assured the provider was admitting people safely or that staff were using personal protective equipment (PPE) in accordance with the government guidance. Following the inspection, the manager confirmed action had been taken to resolve the concerns in relation to PPE.
People were not protected by safe recruitment procedures and staffing levels were not always sufficient to meet people's needs and to keep them safe.
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 inadequate (published 22 September 2020). The provider completed an action plan after the last inspection to show what they would do and by when the improvements would be made. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted by concerns raised by the provider regarding their current rating and the impact this was having on their business.
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.
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 regulation in relation to safe care and treatment, safeguarding people from abuse, the need for consent, staffing, recruitment, nutrition and hydration, notifications, and governance. We have also made recommendations in relation to training, medicines, management of complaints and person-centred care. Please see the action we have told the provider to take at the end of this report.
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
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.