Silvanna Court

Silvanna Court is a care home providing personal and nursing care to up to 83 people. The service provides support to older people and people with dementia. At the time of our inspection there were 79 people using the service. The home is split over 3 separate floors, each with communal lounges and dining areas.

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

People and their relatives gave us positive feedback on their experience of using the service. One person said, “Staff are very good, no complaints at all. If I ask for something, it is done straight away.” Another person said, “The staff always look after me. I like to walk around and talk to people.”

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had received appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training 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 and in their best interests; the policies and systems in the service supported this practice.

Staff were caring and promoted positive outcomes for people. Opinions on people’s care were sought from them and their relatives and care was planned in a person centred way.

The registered manager had been successful in driving improvements at the service. Systems had been put in place to monitor the service and improve outcomes for people.

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 June 2022). The registered manager completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silvanna Court is a care home providing personal and nursing care to up to 83 people. The service provides support to older people and people with dementia. At the time of our inspection there were 78 people using the service. The home is split over three separate floors, each with communal lounges and dining areas.

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

Medicines were not always managed safely as some PRN (as required) medicines were given routinely without the appropriate records to identify the reason the PRN was given or the outcome. Risks were not always effectively assessed or addressed. There were not always enough staff on duty to support people safely. Accident and incidents were analysed but key information was often missing to ensure the analysis was effective. Staff were trained to recognise and respond to concerns of abuse. There were adequate infection prevention and control measures in place.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care was not always responsive to people's assessed choices and support needs. People and relatives told us people were not always supported with their personal care needs in the way they wanted.

There were gaps in management oversight and systems for auditing at the service did not identify the concerns we found during the inspection. There was a new manager in post who was not yet registered with CQC.

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

The last rating for this service was good (published 6 July 2018). At this inspection the service has deteriorated to requires improvement.

Why we inspected

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.

We received concerns in relation to staffing levels, and people’s personal care needs. As a result, we undertook a focused inspection to review the key questions of safe, caring and well led and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well led relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silvanna Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed. We have identified breaches in relation to safe care and treatment, staffing, dignity and respect and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silvanna Court is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 83 older people, some of whom may be living with dementia related needs. At the time of our inspection, 81 people were living at the home.

At our last inspection in January 2016, we rated the service ‘good’. At this inspection, we found the evidence continued to support the rating of good, and the key question ‘Is the service Caring?’, has improved to outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. 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.

Why we rated the service good.

There was a strong emphasis on person centred care. Staff knew people very well and were exceptionally kind and caring. They were committed and passionate about supporting and enabling people to live fulfilled and meaningful lives. People, and their relatives, were extremely complimentary about the kindness and quality of care they received. Care plans were comprehensive and contained detailed information and guidance, including people’s preferences and individual needs and how they wished to be cared for. Care plans were reviewed regularly and people and, where appropriate, their relatives had been involved in the review and planning of their care. Staff shared information effectively which meant any changes in people’s needs were responded to appropriately.

People were kept safe by trained and competent staff. There were effective systems in place to ensure suitable staff were recruited. There were enough staff to safely meet people’s care and support needs and to protect them from harm and abuse. Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and well-being were appropriately assessed, managed and reviewed. There were effective systems in place for the safe management of medicines. People received their medication as prescribed, and systems were in place for the receiving, administering and disposal of medicines.

Staff received regular supervision and support to enable them to fulfil their roles. People’s nutritional needs were met and people were supported to maintain a healthy and balanced diet. People were supported to access health care professionals and services when required.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff knew people very well and were kind and sensitive to their needs, ensuring people’s privacy and dignity was respected at all times. People’s independence was promoted and they were encouraged to do as much as they could for themselves.

People were provided with the opportunity to participate in activities and pursue their hobbies and interests. There was an effective complaints procedure in place, and complaints had been dealt with in line with the registered provider's policy.

There were effective systems in place to regularly assess and monitor the quality of the service and drive improvements. This included opportunities for people, relatives and staff to say how they felt about the home and to make suggestions.

Further information is in the detailed findings below.

Silvanna Court provides accommodation and support for up to 83 people who may need assistance with personal care and may have care needs associated with living with dementia. There were 81 people living at the service at the time of our inspection. The home does not provide nursing care.

There was a registered manager in post. 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.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. People were treated with kindness, dignity and respect by staff who knew them well. The registered manager ensured that staff had an understanding of people’s support needs and had the skills and knowledge to meet them.

People were cared for by staff that had been recruited and employed after appropriate checks had been made. There were sufficient numbers of staff available to meet the needs of people.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

We found there were policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of what these meant and the implications for people living at the service. Where people had been deprived of their liberty, applications had been submitted to the local authority for a DoLs authorisation.

Medicines were stored and administered in a safe way.

People were provided with sufficient food and drink to meet their needs. They were provided with a choice of meals.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

There was a programme of social activities available to people that promoted their health and wellbeing.

Systems were in place to gather people’s views. These included surveys, manager ‘drop in’ surgeries, staff meetings and talking with relatives. People knew how to raise concerns or complaints and the service had a clear complaints procedure which was clearly displayed.

There were quality assurance systems in place which assessed and monitored the quality of the service. These included audits on medication management, incidents and accidents and health and safety.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We saw that the staff were provided with regular training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff had the knowledge that they needed to ensure that people were safeguarded. The service had recently made a DoLS referral to the local authority.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

We saw records which showed that the health and safety in the service was regularly

checked.

Staff and relatives told us that the code to get in through the front door was regularly changed to prevent unauthorised access. People living in the service told us that they felt safe living there. One person told us, 'I do feel safe here and the staff are very helpful and very good.' Another person told us, 'All the carers and the cleaners are smashing."

Is the service effective?

We saw that the service conducted regular staff supervision and training was delivered as required. This meant that staff had the support and skills to deliver care effectively.

We saw that people were supported to maintain their privacy and dignity with some people having a key to their room.

Is the service caring?

We observed staff treating people with care and respect. Staff knocked on people's doors prior to going into rooms or if the door was open they called out to the person to alert them they were entering.

One person living in the service told us, 'They don't rush me and they help me in the shower.'

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been

identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, mental health teams and chiropodists. A visiting district nurse told us that, 'They know their people well.'

We saw a suggestion box on the first floor.

Is the service well-led?

We observed the manager and senior staff interacting with people living in the service and saw that they knew them by name and were friendly and accessible.

Staff told us they felt supported by the management and would go to them if they had any problems.

People were asked for their consent before support was being given. Where they lacked capacity, assessments were completed. We saw that people's care and treatment was planned and reviewed with their and their relative's involvement. Risks to people's health, welfare and safety were identified and well managed. Our inspection and discussions with people afterwards showed us that the service was safe, responsive and caring.

We saw that there were systems in place to ensure there were sufficient numbers of maintained equipment.

We found that people were cared for by staff that were sufficiently trained and supported. There were sufficient numbers of staff however they could be distributed more appropriately.

We found that there was a process in place for reporting complaints and people were aware of how to raise a complaint.

We saw that records relating to people using the service, staff and day to day running of the service were accurate and stored securely.

We directly observed care within the service, so as to help us determine what it was like for people living there. We found that staff interactions with people who live at the service were positive and staff were seen to have a good rapport with individuals. Staff on duty at the time of our visit were observed to have a good understanding and awareness of people's support needs. People told us that they liked living at Silvanna Court and found staff to be kind and caring. Staff confirmed to us that they liked working at the service and that team work was good.

There was evidence to show that care plans were person centred and look at all areas of an individual's life. People who use the service have the opportunity to develop and maintain important personal and family relationships. People are given the opportunity to take part in a variety of 'in house' and community based activities. The service has efficient systems in place to ensure effective safeguarding.

The provider may find it useful to note that consideration should be given to reviewing the service's staffing levels and/or deployment of staff, based on comments recorded within the main text of the report from staff and relatives.