Archived: Silvermead Residential Home

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.

Silvermead Residential Home provides care and accommodation for up to 13 people. On the day of the inspection 11 people were living at the service. Silvermead provides care and accommodation for adults with a learning disability and associated conditions.

There was a registered provider for the service who 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 of the law. The registered provider/owner had appointed two managers to oversee the day- to- day running of the service and was also frequently in the home to provide support and undertake other management tasks.

At the previous inspection on the 14 July 2014 we found concerns in relation to the care and welfare of people. These concerns particularly related to the planning of care and opportunities for activities inside and outside the home. The provider wrote to us and told us how they would address these concerns. At this inspection we found some support plans had been developed to ensure people received appropriate and consistent care and the development of the support plans was ongoing. People were partaking in a wider range of activities.

At the time of this inspection Plymouth City Council had been undertaking a safeguarding investigation due to concerns raised about the management of people’s personal finances and some aspects of their care. Following the inspection Plymouth City Council concluded their investigation and informed us that people’s personal finances were safe and protected by the service. However, the investigation concluded that people’s support plans in relation to their finances were not personalised and did not demonstrate if their choice and views had been taken into account. Plymouth City Council had provided the service with an action plan to address these issues. Records and discussion with the managers during the inspection confirmed the provider was working closely with Plymouth City Council and other agencies to address these recommendations.

We saw people were supported to make choices about some aspects of their care and lifestyle, such as when they got up, what they had to eat and how they occupied their time. However, some of the support arrangements such as management of people’s finances and some decisions about people’s health needs were not personalised and did not take into account people’s rights, mental capacity and best interests. The managers said they recognised the culture in the service had historically been one of “making decisions and doing for people”, but said they knew this needed to change to ensure support was personalised and reflected people’s rights and choices.

We saw improvements were being made in the way people’s support arrangements were planned and documented. Some plans did not reflect the level of care needed and did not include information about the way people chose and preferred to be supported. However, the managers were in the process of working through each file to improve and update the information and had prioritised the files of people with the most complex needs first. We were able to see examples of where these improvements had been made.

People said they liked living at Silvermead and staff were kind to them. Relatives said there had been positive changes in the service since the two new managers had taken up post and comments included, “They seem to be really on top of things and people are getting out and about so much more”.

People were supported by caring staff who promoted their privacy and dignity. A number of very positive comments had been received from the service by visiting professionals and relatives, and included, “ Staff have done a fantastic job caring for […] I have seen so much compassion here, staff should feel so proud of the care they have provided” and “ I am always made to feel welcome, every time I come away I feel better, knowing […] is being looked after by special people”, and “As a visiting professional I have found Silvermead to be an inviting place to visit. All the staff are welcoming and receptive to advice and clearly care a lot about the residents”. Other agencies had been particularly complimentary about the care for people at the end of life, for example, one visiting professional had left a comment in the visitor’s book, which included “We are very grateful for the compassionate care that has been delivered. […] is currently peaceful and enjoying the care and comfort your team have delivered in a very professional manner”.

Recruitment practices were robust and staff were employed in sufficient numbers to keep people safe and meet their needs. People were protected by staff who knew how to recognise signs of possible abuse. Staff were able to talk confidently about the action they would take if they suspected or witnessed abuse in the home, and were confident their concerns would be taken seriously.

People had their medicines managed safely. People received their medicines on time and in a way they chose and preferred. People’s health and well- being were considered important and systems were in place so staff could recognise changes in people’s health and take prompt action when required.

Staff said they felt well supported by management and their colleagues and had good opportunities for training relevant to their role and the needs of people they supported.

It was apparent from talking to the new managers that they cared, and were passionate about the people who lived at Silvermead. Records confirmed they had worked hard within the first three months in post to improve systems and address areas of care, which had been highlighted as a concern. A professional we spoke with who had recently visited the home said, “The new managers are very keen to learn and have been very responsive to any advice given”.

A range of regular audits and checks were undertaken to ensure the quality and on-going improvement of the service.

An adult social care inspector carried out this inspection. The focus of the inspection was to look at how the provider had addressed the previous concerns and to answer five key questions; is the service safe, caring, effective, responsive and well-led?

People who used the service had a range of needs associated with their learning disability. Some people required a high level of support due to their needs in relation to dementia, sensory loss and autism, whilst some other people required less support and were able to access opportunities in the local community independently.

At the time of the inspection there were eleven people living in the home. Although we spoke to some of the people who used the service, the feedback from people about their experiences of the service and their care was limited. We spent time in the communal parts of the home observing people as they went about their day as well as observing the care and support being provided to them.

As part of this inspection we also spoke to the Registered Provider, who was also the Registered Manager for the service, the deputy manager, five care staff and two relatives. We also reviewed records relating to the management of the home, which included support plans and daily care records.

Below is a summary of what we found.

Is the service safe?

The service ensured that people were able to make decisions and have control over their lifestyle. When it was considered that people lacked capacity to make decisions the service requested multi- agency meetings to ensure that any decisions were made in the person's best interests. This ensured that people's rights were safeguarded by the service.

Staff had the skills and information they required to meet people's needs and to keep people safe.

Risk assessments were up to date and provided detail about any risks relating to people's care as well as the need to allow people to develop their skills and to maintain their independence.

We observed that people with complex healthcare needs had a consistent staff team who knew them well and had the skills and knowledge to respond promptly and appropriately to any changes in the person's health and well-being. This ensured that people's needs were met and they remained safe.

Records in the home had been reviewed and updated to ensure that they remained fit for purpose and kept people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards aim to ensure that people are protected from the risk of inappropriate restraint in any form. The deputy manager told us no applications had needed to be submitted. We saw no evidence that anyone was being inappropriately restrained. The deputy manager and staff had received training to enable them to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people' s care and support needs and that they knew them well.

One person said 'I do most things for myself, but the staff help me when I ask them'.

Staff we spoke to had a good understanding of people's different communication methods and used their skills and knowledge to ensure that people were involved in decisions about their care and lifestyle.

Some of the support plans we looked at identified people's needs, but did not in all cases provide sufficient information about how these needs should be met. The absence of this information could mean that people's needs were not always met in a way that was needed and preferred.

Is the service caring?

We observed that people were happy and relaxed within their environment. We heard lots of friendly conversation and laughter between staff and people who used the service.

We observed staff supporting one person who required one to one support for all their daily care needs. We spoke to the staff member supporting this person at the time of the inspection. The member of staff was able to give a detailed account of the person's needs and spoke with compassion and commitment about their role and about the needs and rights of the individual concerned.

We saw that the staff had taken time to consider the needs of people who spent most of their time being cared for in the home and within their bedroom area. Staff had given thought to ensuring that the environment was warm, comfortable and suitable to meet the person's specific care needs.

Is the service responsive?

Records confirmed that the service regularly liaised with other agencies such as community healthcare teams and the specialist learning disability services. We saw that the roles of other agencies had been clearly documented as part of people's support plan for the service.

We saw that the service had provided one to one support from a designated staff team for one person who had complex healthcare needs associated with dementia. The staff we spoke to said 'It is important that staff working with this person knows them well so that they can respond quickly to any changes in their health'. A relative we spoke to said 'I always see the same staff, they know my relative well and are very aware of when they are happy or if there are any problems'

We met one person who we were told had been feeling unwell at the time of our visit. Staff told us that although the person concerned was unable to communicate verbally, they had noticed changes in their mood and behaviour. Staff told us this was a likely indicator that they were unhappy or unwell. The service had arranged for a doctor to visit the home on the day of the inspection.

Is the service well-led?

The service was managed on a day to day basis by a deputy manager who was present throughout the inspection. We spoke to the Registered Manager and owner of the service who told us that they visited the service regularly and were available by telephone each day. A relative we spoke to said 'The deputy manager is always available and always deals with any issues I raise'.

The Registered Provider advised us that they undertook regular quality auditing visits and that this involved speaking to staff and residents as well as an audit of the environment and records. It was noted that these visits were not documented and this was raised with the Registered Manager at the time to further improve the service's on- going quality monitoring process.

We saw that the service had addressed concerns raised during the last inspection and had also taken action relating to recommendations raised with them by the local authority quality monitoring team. The home's complaints procedure had been developed to make it accessible to people who used the service. We saw that formal procedures had been put in place for ensuring the health and safety of people as well as maintenance checks of the environment.

We were told and could see within records that people who used the service and their relatives had opportunities to express their views about the service and that any feedback was recorded and acted on when required.

We saw all of the people who lived at the home and spoke with those people who were able to communicate with us. Some of the people were unable to fully express their views and throughout the day we observed these people.

The deputy manager managed the home on a daily basis for the registered manager who kept in regular touch by either telephone or by visiting the home. We spoke with a senior carer, four support staff, a support worker employed by an outside agency and a relative.

The home had a welcoming and friendly atmosphere. We saw that people who lived at the home were comfortable and at ease with the staff who supported them.

People's care needs appeared to be being met. However, plans of care did not contain all the information that was required to meet these needs in a safe and consistent manner.

We saw that people received balanced and nutritious food based on their individual choices.

We saw that staff who worked at the home had been employed in an appropriate manner.

The home had a complaints procedure but this was in a format that made it difficult for people to understand. Records did not show that people's concerns were listened to and acted upon appropriately.

We looked around the home and found that it was clean and hygienic. We examined the care files belonging to three people who lived in the home and the home's quality assurance processes.

People told us that they were happy living in the home and talked to us about their personal routines and the activities they enjoyed. We found that people were involved and supported to make decisions about their care and support needs and their needs were well met by the staff team. Comments from people who lived in the home and relatives included "I get on with the staff" and "my [relative] is well looked after and seems happy".

Staff were friendly and respected people's rights to privacy, dignity, and independence. They had received training so that they understood people's needs and knew how best to meet them.