Silver Mews Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care, the ways people’s medicines were managed and governance at the service.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Processes were in place to monitor accidents incidents and identify patterns and trends. However, care plans were not always updated following incidents and therefore did not always reflect learning or the most up to date information.

Although some lessons had been learned from audits this was not always embedded to ensure similar issues did not reoccur. For example, medicines audits showed that similar areas of concern continued to be identified every month.

The registered manager had identified that sharing lessons learnt with staff was more effective when done in small groups rather than larger all-staff meetings.

The provider did not always work well with people to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

Systems in the home did not always support safe care and continuity for people. Care records did not always reflect people’s current needs, recent incidents or measures to manage risk.

The provider had processes in place to ensure any moves within the service were appropriately planned and well managed. For example, when a person’s needs changed meaning they required a bedroom in another part of the service, staff had responded positively to ensure this was a smooth transition.

The provider did not always share concerns quickly and appropriately.

We identified one occasion where the provider had not reported an incident of a safeguarding nature to the local authority safeguarding team. CQC were not always notified of safeguarding concerns in line with regulatory requirements. Following our feedback, action was taken to address this.

The majority of staff had completed safeguarding training and told us they knew how to raise concerns. A staff member said, “[I’ve been on a] safeguarding course, yeah, and if I see anything I would report it.”

Where people were deprived of their liberty to ensure their safety, appropriate authorisations were in place. The registered manager demonstrated a positive and person-centred approach to deprivation of liberty safeguards (DoLS) and submitted applications for these in line with best practice. Although staff had undertaken training, not all staff we spoke with understood what was meant by DoLS and what it meant in terms of people’s care and support needs.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We observed risks to people were not always well managed. People’s records did not always include sufficient information about risks. Staff told us a person who required their food to be prepared in a way that minimised their risk of choking, sometimes preferred to eat food that went against this advice. They had capacity to make this choice but records did not reflect this and the additional risk involved. Records showed they had been regularly eating food that had been identified as placing them at a higher risk of choking.

Staff were able to give us examples of how they minimised risk. A member of staff told us, “By following the care plan and using the correct equipment when moving and handling - if it is a 2 carer resident I make sure that it is 2 of us that are doing it.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Chemicals used for cleaning were not always handled safely and in line with Control of Substances Hazardous to Health (COSHH) guidance and toiletries were left in communal bathrooms. High risk areas such as the sluice were not always secured.

Maintenance staff had not always ensured water temperatures were correctly checked or recorded to minimise the risks of scalding and legionella. During periods when maintenance staff were not available there were gaps in records where checks had not been completed.

Fire drills and practice evacuation had not been completed in line with the provider’s policy, placing people at increased risk in the event of a fire.

Some of the routine health and safety checks carried out by external professionals, for example boiler safety, were out of date.

Following our feedback, action was taken to address these risks, but prior to this they had not all been identified or addressed by the provider’s own governance processes.

The provider did not always make sure staff had completed all training relevant to their role. There were not always enough staff to cover all roles. However, staff received effective support and supervision.

Completion of required staff training was ongoing with some gaps identified. The provider was aware of this issue and was working to ensure all staff were up to date with required training.

The home was appropriately staffed in line with the providers dependency tool. A health professional told us, “I have no issue with staffing levels. I never hear buzzers ringing for a long time. One member of the day staff is always available to come around with us to each person we see.”

However, several staff told us they felt more staff were needed to safely meet people’s needs. A member of staff said, “I feel that we do not have enough staff on shift to ensure that the safety of residents is met adequately - there have been numerous occasions where we have had insufficient staffing numbers which I feel puts not only ourselves but also the residents at risk.”

There was a contingency in place for ensuring there was appropriate levels of care staff, using internal bank staff and agency to cover absence but there was no similar back-up plan for other roles. There were times when there were insufficient auxiliary staff. This impacted on the cleanliness of the environment, completion of required health safety checks and provision of activities.

Staff were safely recruited into the service, and required checks were carried out before they started work.

Staff gave us positive feedback regarding the supervision and support they received. A member of staff told us, “I do have supervision and appraisal, and they are supportive.” We reviewed records which showed that the majority of staff were up to date with their supervision in line with the provider’s policy.

The provider did not always assess or manage the risk of infection.

People were not always supported to maintain good personal hygiene in areas such as oral health and showering. Some of the relatives we spoke with expressed concerns about the delivery of personal care. One relative told us, “'Personal care could be better, we requested [my family member] has 3 showers a week and he hasn’t had one in 2 weeks.”

Clinical waste was not being disposed of appropriately, we found used personal protective equipment (PPE) in general waste bins in communal areas and people’s bedrooms..

Cross contamination risks were not always well managed. Where additional precautions were required to reduce the risks, these were not always in place. For example, signage on the door of one person suspected to have a contagious infection was not in place and appropriate PPE was not readily available.

Medicines storage rooms were not adequately cleaned. We found the floors and sinks in these areas to be dirty and these hygiene concerns were identified and discussed with the manager during the inspection.

Whilst the majority of communal areas were clean and tidy we noticed people’s bedrooms were not always sufficiently clean. We saw a room with a dirty floor and had received feedback from relatives which also raised concerns about the cleanliness of bedrooms. One relative told us, “The main areas are clean and presentable, but the bedrooms are not deep-cleaned and tray tables and behind furniture can be left for long periods without being cleaned.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

Medicines were not always stored and administered safely. Temperature monitoring of one medication fridge had gaps in recordings. For some medicines the dates of opening were not always recorded so it was not possible to confirm if they were in date and still safe to use. We also found medicines that had expired and continued to be administered to people.

Medicines administration records were handwritten, however not all entries were double signed for accuracy in line with national guidance. Care plans, clinical protocols for high-risk medicines and ‘as required’ protocols were not always in place. When these were in place they were not always updated to accurately reflect currently prescribed medicines. Stock balances of medicines were not always recorded or were inaccurate.

Where people had complex medicines regimes such as multiple eye drops, no care plans were in place and it was not always possible to evidence from the quantities of medicines available if the eye drops were being used as prescribed.

Medicines competencies were being completed to ensure staff had the skills necessary to administer medicines. However, they were not always done by the relevant senior staff.

Where concerns were raised during the inspection the homes manager and deputy manager took steps to address the concerns immediately.