Silver Howe

We found the following examples of good practice.

The provider had very robust procedures for preventing visitors from catching or spreading infection. Prior to anyone entering the building a range of checks were completed including taking temperatures and completing a risk assessment. Visitors were able to spend time seeing and speaking with loved ones in a suitable safe space by arranged appointments. Families had been supported to spend time with people at the end of their lives in a safe and dignified manner.

People who required isolating were supported in designated rooms and could access a personal lounge/social area. A dedicated team of staff were also allocated who could support all their needs. People had access to and were supported in the use of technology for Zoom or Facetime calls to keep in touch with friends and family.

The registered manager followed safe procedures when people were admitted to the home. Regular home testing was in place for both people who used the service and for the staff working there. People received a negative COVID-19 test result before they moved into the home and were supported to self-isolate in their rooms in line with current guidance and recommended practices.

Staff had been trained in infection control practices as part of their induction and further training had been completed with an external trainer to include any changes relevant to COVID-19. The home was clean and hygienic. There was a designated cleaning staff team and audits on cleanliness and infection prevention and control were completed.

People had been supported to access their own GP via virtual calls as and when they needed to. People had also been supported to be seen by the community nurses to receive care and treatment as they required. The registered manager had kept up to date with national guidance on working safely in care homes and had regularly shared best practice with the staff. They had robust and up-to-date infection prevention and control policies and procedures in place.

People’s experience of using this service:

There were sufficient numbers of suitably qualified staff to meet people’s needs in a timely manner. People and their relatives told us there were always enough staff available to assist them. One person told us, “There always seems enough staff.” Staff had completed training that enabled them to deliver good care and support to people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Medications were stored and managed safely and people received their medicines as they had been prescribed.

People’s individual preferences for food and drink were catered for this also included people’s specific health and dietary requirements. Staff gave the right level of support to those who required extra help in eating and drinking. One person told us, “The food is lovely. I enjoyed the fish pie, cake and custard, they make it all you know.” We saw the dinning experience was pleasant, sociable and very personalised.

Care provided to people respected their privacy, dignity and promoted their independence. It was clear from our observations that staff knew people's needs well. Kind and friendly interactions were observed taking place. One person told us, “It’s a lovely safe place to live, the staff are lovely.” Another person told us, “I am always well looked after and feel cared about.”

There was an activities coordinator employed. There was a varied and individualised activity programme in place that ensured people lived a fulfilled life of their choosing.

A variety of audits were in place that demonstrated the service was monitored and safe for people to live in. Feedback about the service was regularly collected and 99% of people said they were very satisfied or satisfied with the service. A relative we spoke with told us the home had improved since our previous inspections.

More information is in the full report.

Rating at last inspection:

REQUIRES IMPROVEMENT (The date last report published was 19 March 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service has improved to Good.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

Silver Howe 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. Silver Howe provides personal care and accommodation for up to a total of 30 people. On the day of the inspection there were 28 people residing at Silver Howe. Accommodation is provided over two floors and there is a separate unit (Bluebell) with seven beds for caring for people living with dementia related illnesses. The home is located close to the town centre of Kendal.

There was a registered manager in post. A registered manager is a person who has registered with the (CQC) 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.

We received mixed comments from people living and visiting at the home about whether there was sufficient staff. During the inspection we observed people were left unattended for short periods in the communal lounges and dining areas including on the dementia unit. However we saw most people had their needs met in a timely manner.

We have made a recommendation that the provider reviews the dependency needs of people living in the home to ensure the numbers of staff on each shift are sufficient to meet people’s needs at all times.

The storage and records for medications had improved since the recommendation we made at the last inspection. We saw medicines were being administered and were being kept safely. However the records for topical medications were not as consistent in quality as the ones for other medications.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

Staff had completed a variety of training that enabled them to improve their knowledge in order to deliver care and treatment safely.

People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Where the need for consent was required it was not always obtained from the relevant person.

We have made a recommendation that the provider review their best interest decision making process to ensure it follows guidance outlined in the Mental Capacity Act 2005 in order to gain the appropriate authority for consent.

People were supported to maintain good health and appropriate referrals to other healthcare professionals had been made.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them. People living in the home spoke highly of the staff and told us they were very happy with their care and support.

People were supported to access activities that were made available to them and pastimes of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate oversight of the safety and quality of the home. Areas of concern that we found during this inspection were promptly addressed by the registered manager.

During this inspection we saw that significant work had taken place since our last inspection to improve the safety and quality of the service and found no breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However we did find some areas still required to improve and be sustained to ensure a consistent delivery of safe care and treatment.

Silver Howe is a residential care home that provides personal care and accommodation for up to a total of 30 people. On the day of the inspection there were 18 people residing at Silver Howe. Accommodation is provided over two floors and there is a separate unit with six beds for caring for people living with dementia (Bluebell unit). Silver Howe is located close to the town centre of Kendal. There are gardens and seating areas for people living there to use and car parking.

There was a recently registered manager in post who had been appointed as the acting manager in the home since the last inspection in June 2016. A registered manager is a person who has registered with the (CQC) 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.

Medicines were being administered and recorded appropriately. However we found supporting information or 'protocols' were not always in place to guide staff to administer medicines which were prescribed to be given PRN (as or when required). Clear guidance is required to help ensure people are given these medicines safely and consistently for such things as pain relief. We also found the cupboard in which controlled drugs were kept did not meet legal requirements.

We have made a recommendation that the provider completes written individual care plans to manage PRN medications and ensure the storage of controlled drugs met with legal requirements.

There had been a high number of new staff appointed since the last inspection and we saw they had been recruited using a more systematic process to ensure all checks of suitability had been completed before commencing employment. However we found that for some people recruited the process had not been completed in full and there had been no oversight by the registered manager on the new process at the time of the inspection.

We have made a recommendation that the provider follows their own policy and procedures when employing people. This was to ensure that all the checks of suitability made were robust. In addition the registered manager completes checks or audits to ensure the recruitment process has been completed in a robust way.

We saw that all staff had completed a programme of induction training and that improvements to how the ongoing training of staff was managed had been made. Staff told us how they felt supported through supervision and training to fulfil their roles.

The level of staffing on the day of the inspection was sufficient to ensure that the current number of people living in the home had their needs met in a more timely manner. The numbers of staff on shift during the day and night were seen to be consistent.

Since the last inspection the provider had been responsive and proactive in improving the systems used in the recording of information about people’s needs and the planning of their care. However we found that some areas still needed to show consistency such as obtaining consent to care and treatment and recording information when changes in the needs of people had occurred.

We saw a range of staff had been actively involved in supporting people with activities that had been arranged. We also saw that a variety of meaningful activities had been planned for the Christmas period.

We observed staff displayed caring and meaningful interactions with people and they treated them with respect. People living and visiting the home spoke highly of the registered manager and staff team and told us they were happy with the care and treatment at Silver Howe.

Following the last inspection in June 2016 we took action to ensure the breaches of the regulations were addressed. Following the improvements made the overall rating for Silver Howe is now Requires Improvement and therefore in line with our guidance the service is now removed from special measures.

We last inspected Silver Howe in September 2015. At that inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to fit and proper persons being employed. We issued a requirement notice in relation to that breach and asked the registered provider for an action plan to tell us how and when they would be complaint with the regulation.

During the inspection in June 2016 we found seven breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included a continued breach of Regulation 19 found during the last inspection. We also found that some of the incidents that had occurred in the home should have been reported to CQC and other agencies but the registered provider had failed to do so. These were breaches of Regulations of the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Silver Howe is a residential care home that provides personal care and accommodation for up to a total of 30 people. Accommodation is provided over two floors and there is a separate unit with six beds for caring for people living with dementia (Bluebell unit). Silver Howe is located close to the town centre of Kendal. There are gardens and seating areas for people living there to use and car parking.

There was a registered manager in post. A registered manager is a person who has registered with the (CQC) 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. However at the time of the inspection visits the registered manager was not present in the home or available to contribute to the inspection.

Concerns found during the inspection about the safety and wellbeing of some people who lived at the home led the inspectors to share information with the local authority and the service’s commissioners.

There were not sufficient numbers of staff to safely meet people's needs. The level of staffing during the time of the inspection required additional staff to be sourced from the registered providers other care homes to ensure people had their needs met. Staff and relatives told us they had concerns about the numbers of staff available to provide safe and effective care.

Medicines were being administered and recorded appropriately but were not stored in a safe way.

Staff had commenced working without all of the required checks of suitability. Two people had commenced employment without all of the checks required to ensure they were fit and proper persons.

Training records were not accurate and we could not determine if staff had commenced working with the appropriate skills. Staff told us about what training they had received however we were unable to confirm this with the records that were provided. Staff also told us that they had commenced working without some of the essential training required to ensure they had the appropriate skills and knowledge for the job.

There were no assessments of people’s needs made prior to people being admitted to the home. Care plans and risk assessments made were not always accurate about the needs of people’s health and support that they required.

Care records lacked vital information about peoples individual care needs. Care was not provided in a person centred way. People preferences and choices was not always recorded or considered. We did not see that people had always been involved in their care planning or had consented to their care.

When accidents and incidents had occurred these had not always been reported by to the appropriate authorities including CQC. A number of incidents of a safeguarding nature had not been reported to any external agency.

People had restrictive measures in place without risk assessments, consent or appropriate applications having been made to deprive them of their liberty. Requirements relating to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met.

The registered provider did not have effective systems in place to monitor the safety and quality of the service.

People living at the home told us they enjoyed the food served and that they had been able to personalise their bedrooms.

The interactions we observed that took place between the care staff and people living at the home was respectful and kind despite the low numbers of available care staff.

The home employed a designated person to coordinate activities for people living at the home. We saw a variety of activities were provided if people wanted to join in.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

During this inspection we spoke with people who used the service who had previously expressed dissatisfaction with the way they were cared for. People told us that the home had improved and that they were now receiving a a good service. One person said, "I'm quite happy here." Another told us, "It's very good, I rely on it." And another added, "It's a grand spot!" A relative told us, "There are definite improvements and you can see that will continue."

We found that the home was now being managed by a new management team who had made many improvements. A substantial refurbishment of the home was underway which included a new kitchen and a new laundry. Some bedrooms were being increased in size and improvements were being made to the grounds and gardens. We observed that people's dignity was being respected and that improvements had been made to the way their care was planned and recorded. People's nutritional needs were being met because the assessments were being carried out around their needs and the outcomes were being acted upon. Medication was being correctly stored and managed and the home was being kept clean and tidy. We noted that staffing levels were sufficient to meet people's needs in a timely manner and that the management team had a system in place to measure the quality of service the home provided.