Archived: Silvermead Residential Home

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 told us they were happy living at Silvermead. We found the service was not operating in accordance with the regulations and best practice guidance. The providers oversight and governance of the service was ineffective in identifying the serious failings in relation to the safety, quality and standard of the service as detailed in the safe and effective sections of this report.

Given the level of concerns identified at this inspection. We requested an urgent action plan from the provider to tell us what immediate action they have taken or proposed to take to address the concerns identified at this inspection to ensure people received safe, effective, high quality care and support. We have also shared the information with Plymouth City Council.

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. 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 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 were not always being recorded, followed up or accessible.

Medicines were not being managed safely.

There were insufficient numbers of suitable qualified, competent, skilled or experienced staff on duty to meet people’s needs safely.

People were not always protected from the risk and spread of infection. We were not assured that Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures.

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). In February 2021 the provider wrote to the Care Quality Commission to request an inspection. They were confident that all the concerns identified by the inspection undertaken in 2019 had been fully addressed and were concerned about the impact this rating was having on their business. An inspection was carried out in March 2021, the draft report has been issued to the provider as per our process and will be published shortly.

Why we inspected

The inspection was prompted by concerns we received about risks associated with nutrition and hydration, staff recruitment, induction, training and staffing levels. A decision was made for us to undertake a targeted inspection to examine those risks.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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, staffing and governance. 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.

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.

Staff confirmed they had received additional training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand sanitiser. However, this information was not clearly evidenced within the home’s training records or within staff files. This meant you could not be assured which member of staff attended which training session.

It was not evident from our observations that seating arrangements in the lounge or dining room enabled people to socially distance, in line with Public Health England's current Covid 19 guidelines.

The manager gave us assurance that individual risk assessments had been completed to identify staff who might be at higher risk or in a clinically vulnerable group because of their individual health needs. However, these could not be found at the time of the inspection.

Information regarding Covid 19 was available within the home for both staff and people in an easy read format. However, we found the provision of signage within the service could be enhanced. For example, information regarding hand washing could be in bathrooms/toilets and information regarding donning and doffing could be in the donning and doffing designated area.

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

Visitors to the service had been restricted. There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Staff provided instructions on arrival at the service to ensure visitors understood the infection prevention and control protocols they needed to follow to keep people safe.

Visitors to the service were asked to wear PPE, have their temperature checked, wash their hands and complete a health declaration questionnaire before they would be allowed to enter the main part of the building.

There were sufficient stocks of PPE available and staff were seen to be wearing PPE appropriately.

People and staff took part in regular COVID-19 "whole home" testing. People and staff who tested positive followed national guidance and self-isolated for the required amount of time.

Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches.

We were assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

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 12 people living at the service.

People’s experience of using this service and what we found

People told us they liked living at Silvermead. We found the service was not operating in accordance with the regulation 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. Although the provider demonstrated a strong commitment to people living at the service. They did not have sufficient oversight of the service to ensure people received the care and support they needed that promoted their wellbeing and protected them from harm.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Systems and processes to monitor the service were not effective and did not drive improvement. These included concerns with records, risk management, medicines, a lack of person-centred care, and the environment.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe.

Other risks were well managed, for example, risks had been identified in relation to people’s health care needs and records demonstrated that action had been taken to minimise these.

Whilst we did not find people were being disadvantaged, 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.

The service did not have good systems or processes in place to help ensure people received the care and support they needed in accordance with their wishes.

Whilst it was clear that staff care deeply for people, their right to privacy was not always understood or respected.

Staff told us they felt supported and appreciated by the provider and manager. We found the service did not have an effective system in place for recording what training staff had received. This meant that neither the provider or manager could be assured that staff had the necessary skills to carry out their roles.

People were not protected by safe recruitment procedures. We looked at the recruitment files for four staff members. Whilst some recruitment checks had been carried out, others had not.

People were encouraged to share their views through regular reviews and relatives felt comfortable raising complaints and were confident these would be acted on.

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

Rating at last inspection

The last rating for this service was requires improvement (published on 7 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in regulation in relation to safe care and treatment, safeguarding people from abuse, the need for consent, dignity and respect, training, recruitment, notifications, and governance. We have also made recommendations in relation to staffing levels and end of life care. Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is 'Inadequate' and the service is therefore 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 rating, 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 and continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme.

Silvermead is a residential care home, which provides accommodation, and supports the needs of people with a learning disability and associated conditions such as autism. 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 service was registered to accommodate and support a maximum of 13 people. At the time of the inspection 11 people were living at the service.

The requirements of the provider’s registration meant the service had to have a registered manager in place. 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 2008 and associated Regulations about how the service is run. At the time of this inspection a registered manager was in post.

We reviewed whether or not the service was being run in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. The Care Quality Commissions policy relating to ‘Registering the Right Support’ states that people with learning disabilities and autism can live an ordinary life as any citizen. The values that underpin this policy include choice, promotion of independence and inclusion. We found improvements were needed in the overall culture and running of the service to help ensure these values continued to be maintained and promoted.

The planning and delivery of care was not in all cases personalised and did not always take into account people’s choice, preference and aspirations. Staff were very caring and observations we made clearly demonstrated that people felt safe and cared for in their home. Other agencies were positive about the service and said the management and staff were very caring and provided particularly good support when people were unwell, or at end of life. However, the care planning process did not demonstrate that consideration had been given to people’s lives beyond their immediate need for the service. Care plans did not include information about people’s goals or how the service would support people to develop their skills and independence.

The culture and some of the practices we observed were not personalised and did not always promote people’s independence, privacy and dignity. For example, we saw staff doing tasks for people, instead of encouraging people to do for themselves. Practices in relation to medicines and the management of finances were not personalised and did not take into account people’s preferences, skills and independence. Some of the language used by staff about people did not respect their age or promote people’s dignity.

Systems were in place to monitor the quality of the service. However, the provider did not have a clear set of values and aims against which to measure quality and outcomes for people and auditing processes had not identified areas of concern found during this inspection.

Staff were aware of risks associated with people’s care. For example, some people had risks associated with their diet and eating. Referrals had been made to speech and language therapists and any guidance was followed by staff to keep people safe. However, information about some known risks and how staff would mitigate them had not been clearly detailed for staff to follow. The absence of this written detail could mean staff did not have the information required to provide consistent care and to keep people safe.

The registered manager had worked closely with the local disability services to understand people’s behaviours and to ensure they were managed appropriately. However, incidents had occurred when people were unable to communicate verbally, and had not had their needs responded to promptly by staff. Information about people’s communication methods and staff awareness needed improvement to help prevent incidents of behaviours esacalating.

People had access to a range of activities and social opportunities. The registered manager said these opportunities had improved following the recruitment of additional staff. The care planning and review process did not demonstrate how the service continued to monitor and ensure that activities remained appropriate and were what the individual wanted.

People were supported by staff who cared about them and wanted to keep them safe. The registered manager was passionate about providing good care, and had been a strong advocate for people, particularly in relation to ensuring people had equal access to healthcare services. Other agencies were very positive about the registered manager and said they had been very impressed about how pro-active they had been when people had been unwell and needed prompt support.

People had their healthcare needs met. Systems were in place to monitor people’s health and prompt action had been taken when people’s health changed and/or deteriorated. People were supported to have a healthy and well-balanced diet.

Staff were employed in sufficient numbers to meet people’s needs and to keep them safe. Staff undertook regular safeguarding training and understood when and how to report concerns about potential abusive or poor practice. Robust recruitment practices helped ensure staff employed in the home were safe to work with vulnerable people.

Medicines were administered safely. Staff were trained in the administration of medicines and systems were in place to identify and address any concerns or errors. We did have a concern in relation to the safe storage of medicines. This was discussed and addressed by the registered manager on the day of the inspection.

Staff undertook regular training, which was relevant to the service and needs of people they supported. Staff said they felt well supported and had opportunities for discussion and to reflect on practice.

Management and staff understood their role with regards to the Mental Capacity Act (2005). When people lacked the capacity to make significant decisions about their care and lifestyle discussions had taken place with their representatives to ensure decisions made were in their best interest.

The registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. The registered manager had learned from experiences and made improvements to the service when required.

As part of this inspection we have made recommendations in relation to training and mealtimes.

We found breaches of the regulations. The actions we have taken can be found at the back of the full version of the report.