Archived: Silverdale Residential Home

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

On the day of our comprehensive unannounced inspection visit on 23 October 2018, there were seven people using the service.

At our previous inspection of 11 October 2017, this service was rated requires improvement overall, and in each of the key questions. There were breaches of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 12: Safe care and treatment, Regulation 17: Good governance, Regulation 11: Need for consent and Regulation 18: Staffing. Improvements were needed in how the service assessed and monitored the service provided, maintaining people’s care records, policies and procedures were out of date, and staff training. At this inspection of 5 November 2018, we found improvements had been made and the service was no longer in breach of Regulation.

There was a registered manager in place. 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. Recent events require registration changes, this is being addressed by the service.

People received a safe service. There were systems in place designed to reduce the risks of abuse and avoidable harm. Where incidents happened, the service learned from these to drive improvement. Risks to people were identified and guidance for staff in place to mitigate these. People were supported with their medicines in a safe way. Staff were available to support people and the systems to recruit staff safely were robust. Infection control systems were in place.

People received an effective service. People were supported by staff who were trained and supported to meet their needs. People had access to health professionals when needed. Staff worked with other professionals involved in people’s care. People’s nutritional needs were assessed and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The environment was well maintained and suitable for the people using the service.

People received a caring service. People shared positive relationships with staff. People’s privacy, independence and dignity was respected. People were listened to in relation to their choices, and they and their relatives, where appropriate, were involved in their care planning.

People received a responsive service. There were systems in place to assess, plan and meet people’s individual needs and preferences. People’s had access to social activities to reduce the risks of isolation and boredom. There was a complaints procedure in place.

People received a service which was well-led. The service provided was assessed and monitored to provide people with a good quality service. Where shortfalls were identified actions were taken to improve. People's views about the service and these were valued and listened to. As a result, the service continued to improve.

There was a registered manager in place. 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.

At our last inspection of 27 August 2015 this service was rated as Good. At this inspection of 11 October 2017 we found that the service had not kept up to date with changes in the care industry and there were breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The care records we reviewed for three people were detailed and guided staff on how their needs were assessed, planned for and met. However, the records for a fourth person did not have a recorded pre-admission assessment in place to show how the provider assessed their needs and were assured that they could meet them. In addition there was no care plan in place to show how this person’s needs were met.

The provider’s quality assurance systems in place were not robust enough to independently identify the shortfalls identified during this inspection. The service’s policies and procedures were out of date and in need of updating to provide staff with guidance on how to care and support people safely. Staff told us that they spoke with people on a daily basis to gain feedback on the service provided. However, there was no system in place to formally gain the views of the service from people, relatives, stakeholders and staff.

The service was not up to date with the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). We were not assured that people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. There were no policies in place relating to the MCA and DoLS.

Staff had not been trained to recognise potential and actual abuse or in the action they needed to take if they were concerned that a person was being abused.

There was limited training provided to staff and no records of supervision in place to show how they were supported in their role of meeting people’s needs effectively. Staff spoken with did tell us that they felt supported and that due to the service being small they discussed any concerns daily. The service’s induction processes for new staff was not robust enough to monitor and assess new starter’s performance and training needs.

The service had identified that due to changes in people’s needs and new people moving into the service, further staff were being recruited. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

There were systems in place to administer medicines safely and to maintain records relating to medicines management.

People were provided with the opportunity to participate in activities. People were treated with respect and compassion by the staff working in the service.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People were provided with enough to eat and drink.

This is a summary of what we found;

Is the service safe?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the staff understood when an application should be made, and how to submit one. A staff member confirmed that they had received training in this subject.

The service was safe. Records showed that there were regular health and safety checks carried out to make sure the service was well-maintained and met people's needs.

People were provided with their medication at the prescribed times and in a safe manner. Medication was stored safely.

Is the service effective?

People told us that they were happy living in the service. One person said, "I love living here." Another person said, "I am happy."

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 reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. People's dietary needs were met.

Staff were provided with the training and support that they needed to meet people's needs.

Is the service caring?

The staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, 'They (staff) are nice.'

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

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.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people were provided with a good quality service.

The service had a quality assurance system and records reviewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

The provider also sent us a copy of one person's care plan. This has been updated and amended to reflect the person's history and their general and medical health. The provider told us that all care plans had been updated to this standard.

We observed staff supporting people. They spoke with people appropriately and demonstrated that they knew their individual needs.

We saw that staff selection procedures were in place. Staff training, some of which was specific to the needs of people who used the service, had been planned.

The service had had a report prepared regarding legionella risk. The recommendations contained in the report had not been implemented.

We looked at the system for maintaining care records. We found that there were not fully completed and did not contain full details of the care required.