Silverdale Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was previously in breach of the legal regulation in relation to delivering person- centred care. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were assessed and reflected their wishes, including physical, emotional and communication needs. However, care plans did not always reflect current needs and changes in behaviour were not consistently recognised or followed by reassessment.

Care plans lacked clear guidance for some health needs. For example, 1 person’s records did not include the correct blood glucose range or actions for readings outside this range. For another person, records stated blood glucose monitoring should take place, but this was not done. The provider advised monitoring only occurred when directed by the GP. Following our feedback, records were updated.

Changes in behaviour for 1 person had not been monitored or referred for reassessment. The provider explained a referral had been made on the first day of inspection; however, there had been previous incidents over a sustained period with no evidence of review or reassessment.

Relatives said people were supported safely and received updates about changes in health and wellbeing. Staff told us how they accessed care plans, shared information during handovers, and described regular reviews with involvement from people, relatives and professionals.

Records included guidance for specific needs such as catheter care and mobility support, and staff demonstrated understanding of these areas.

The provider did not always ensure care and treatment were planned and delivered in line with best practice. At the previous inspection, concerns were identified regarding the principles of ‘Right support, Right care and Right culture’ for people with a learning disability. At this inspection, there was limited assurance care and support were always delivered in line with evidence-based guidance and good practice. Concerns identified earlier in this report, included repeated incidents between people, inconsistent review and oversight, and missed safeguarding referrals, showed approaches to care were not always informed by learning or best practice.

People’s dietary intake was appropriately monitored and recorded, and meals were well prepared. Mealtimes were observed to be a positive and social experience. People told us they enjoyed the food provided, which reflected their preferences and met their individual needs, including modified consistencies where required. However, on both days of the inspection, the easy-read menu was not up to date, which meant accessible information was not always available for everyone. The provider told us they used 'show plates' to ascertain and inform people's choice when selecting their meal preference, 1 person also confirmed they had seen the 'show plates' prior to selecting their meal.

The provider did not always work effectively with other teams and services to support people. Partnership working and communication with external professionals were inconsistent.

Feedback from professionals was mixed. Some described the provider as receptive, responsive and willing to seek guidance, highlighting a professional approach and timely action in certain areas. However, others raised concerns about delays in responding to requests and a lack of effective analysis of incidents and accidents.

Information sharing was not always effective. Behavioural incidents were not consistently reported to relevant professionals, including the safeguarding team. This reduced opportunities for external oversight and timely multi-agency collaboration to support people safely.

Despite these concerns, we observed health professionals visiting the service during the inspection. Staff told us people received regular input from healthcare professionals to monitor and support their wellbeing.

The provider supported people to maintain and improve their health and wellbeing, promoting independence, choice and control.

People and relatives told us they were able to access healthcare services when needed and how concerns were escalated to relevant professionals. Staff described how they monitored people’s health, including weights and dietary intake, and recorded this information to support ongoing care.

Staff supported people to follow healthier lifestyles. People had access to a range of healthcare services, including GPs and dentists, and were supported to attend appointments to maintain their health.

The provider did not always effectively monitor people’s care and treatment to ensure good outcomes.

Systems were in place to record key aspects of care, including fluid intake, oral care, repositioning, weight, bowel movements and dietary needs. These were clearly documented. However, where people experienced diabetes, further improvements were needed to ensure consistent monitoring. For example, 1 person’s blood glucose levels were not consistently recorded, and care plans did not include clear guidance on safe parameters. Where monitoring had taken place, records did not demonstrate consistent evaluation or appropriate escalation when results fell outside expected ranges. This placed people at risk of their health needs not being met. Despite these concerns, staff described how they regularly monitored people’s health and wellbeing, recorded care provided and escalated concerns to nurses or the management team when required.

Following feedback during the inspection, the provider took action to strengthen care plans and introduced clearer guidance and monitoring systems.

Feedback about outcomes and quality of life was mixed. While people told us they were happy living at the home, some said they experienced limited opportunities for meaningful activity and could feel bored. Relatives also commented on a lack of personalised activities and staffing levels impacting on one-to-one time. The registered manager told us they were in the process of recruiting an activities coordinator to improve this.

The provider supported people to understand their rights in relation to consent and respected these when delivering person-centred care and treatment.

Mental capacity assessments were in place and completed to a good standard. Records were detailed and reflected people’s decision-making abilities. Where people were assessed as lacking capacity, appropriate best interest processes had been followed. Applications for Deprivation of Liberty Safeguards (DoLS) had been made appropriately where required.

Staff demonstrated an understanding of the principles of the Mental Capacity Act and how these applied in practice. They described how they sought consent wherever possible and supported people to make choices about their care and daily lives.

People told us they were given choices in their day-to-day lives, including decisions about meals, activities and routines such as when to get up or go to bed.