Silverleigh

Silverleigh is a 'care home’. Silverleigh is registered to provide accommodation and nursing and personal care for up to 65 people. There were 49 people living at the service at the time of the inspection. The majority of people were living with dementia.

The service is in a large detached building located in the market town of Axminster in East Devon. The home is within walking distance of Axminster town centre, local church and post office and benefits from being next to the local GP surgery.

This targeted inspection took place on 19 April 2021.

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

The home had experienced a lot of changes and disruption in the last year. This included the Covid-19 pandemic, changes in leadership and staff. We undertook a targeted inspection of the home in September 2020 because we had received anonymous concerns. We found that people were receiving safe care and staff were adjusting to the sudden change in the management team. It was evident from staff feedback that the staff morale at the home was low with a lot of uncertainty. The interim management team were working with the staff to restore their trust and confidence and implement required changes.

Since that inspection the provider’s group manager had taken on the position of registered manager supported by a new deputy manager and a compliance manager.

Further anonymous concerns have been shared with CQC since March 2021. We monitored the concerns and sought feedback from the local authority safeguarding team, the local authority quality improvement team, the commissioners and local health and social care professionals. They raised no concerns about the service. However, we continued to receive anonymous concerns so undertook this inspection to assure ourselves that people were receiving safe care.

People were positive about the home. One person told us, “I am fortunate to end up in Silverleigh. The staff are really caring and attentive. They show respect to each of the residents.” A relative told us, “I think it has been excellent here. We have been here a lot and we have been very very pleased, and we like how the residents are entertained, there is masses going on.”

Staff confirmed it had been a difficult year and described a good staff team; working well together and morale was said to be good. Comments included, “I believe that Silverleigh is a good home with staff who really care about those individuals that they look after.”

Staff were encouraged to challenge any practice concerns in confidence. Where any concerns about staff skills, performance attitudes or performance were identified, these were dealt with in accordance with the provider's policies and procedures. Where staff had shared safeguarding concerns with the management team, they had informed the local authority safeguarding team and put in place measures to protect people.

Some staff and people raised concerns about staff shortages and the high use of agency staff. Staff rotas indicated that there had been a period of change in the staff team and that recruitment was in place to address this. Plans had been in place to ensure safety on occasions when staff numbers had been low. To ensure there were sufficient staff numbers the provider offered enhanced pay to encourage regular staff to undertake additional duties. Where needed to fill gaps the provider used agency staff.

People received their medicines as prescribed and the medicine champion supported staff to safely manage the medicines at the home.

Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. There were sufficient PPE (personal protective equipment) stocks available and sanitisation and PPE stations around the building. The home looked clean and hygienic. Infection prevention and control audits took place and spot checks were carried out. Regular COVID 19 testing was carried for both staff and people living there in line with the government guidance.

Staff were meeting people’s needs and risks were identified. Staff had guidance to help them support people to reduce the risk of avoidable harm. Staff had received the appropriate training to carry out their roles safely. People were confident staff were trained and competent and knew what to do. Where concerns were raised about staff practice. The registered manager had taken action and arranged additional training.

People were supported to meet their nutritional needs and maintain a balanced diet and most liked the food. Daily menus offered a variety of different choices and people chose what to eat and drink. People who required staff support to have a specialised diet were supported by staff who were trained to do so.

The home was adapted to meet the needs of people living with dementia. The adaptation, design and decoration of the service promoted people’s independence and well-being

Where people did not have the capacity to make decisions, they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

The registered manager and staff interacted with people in a positive manner and were focused on doing their best for the people they supported. People were involved in decisions about their care and support.

The management team were open and approachable; they were working with staff to improve morale and ways of working. Most staff expressed their confidence in the registered manager and senior management team. The service had effective quality assurance and monitoring systems that were used to identify shortfalls and drive improvements.

Rating at last inspection

The last rating for this service was Outstanding (published 2 April 2020)

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about staff practice; infection control practice; lack of PPE; poor personal care; risk management; medication management; staff training; manual handling practices; poor nutrition; staff levels; people not being given choices; liberties being restricted; the management of the service. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. We found the provider had systems in place to monitor and take action to mitigate risks. The overall rating for the service has not changed following this targeted inspection and remains Outstanding.

Please see the safe, effective and well led section of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Silverleigh on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this inspection following a COVID 19 outbreak at the service, we also received concerns about poor infection prevention and control practices at Silverleigh.

We found the following.

Staff had received infection control training. Most staff were seen using PPE correctly and in accordance with current guidance to minimise risks to people. After a discussion with the registered manager they put in place a more robust monitoring system to ensure all staff were always compliant wearing their PPEs correctly.

Staff were entering the home through the main entrance after putting on a mask and using hand gel. They then put on gloves and aprons. After discussions with the registered manager they changed where staff entered the building and introduced a more effective donning and doffing location. They also made changes regarding staff uniforms/clothing not being worn to and from the service. These changes were made to improve infection prevention and control.

We found the following examples of good practice.

Staff and people were regularly tested in line with the government’s current testing programme. The provider’s infection control policy was up to date with the current Covid 19 guidance.

Staff had received update training on how to keep people safe during the COVID-19 pandemic and had plentiful supplies of personal protective equipment. Systems were in place to ensure safe visiting could take place.

The home was clean with no unpleasant odours. There was a robust cleaning schedule in place and touch points were cleaned using chemicals which are effective against Covid 19.

Further information is in the detailed findings below.

Silverleigh is registered to provide accommodation and nursing and personal care for up to 65 people. The service is intended for older people, who may also have a physical disability, mental health needs or a dementia type illness. The service is in a large detached building located in the market town of Axminster in East Devon. The home is within walking distance of Axminster town centre, local church and post office and benefits from being next to the local GP surgery.

This targeted inspection took place on 2 September. There were 53 people living at the service at the time of the inspection. One of these was staying for a respite stay and told us they were considering staying permanently. The majority of people were living with dementia.

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

People said they were happy with the care they received. They said staff were always available if they wanted them. Relatives were positive about the home and the arrangements which had been made to keep them informed and in contact. Comments included, “We always get a warm welcome when we visit…the Home always inform us if there is any incident, such as a fall, or they're under the weather. Communication is very good, and we get a monthly programme sent to us.”

Since the last inspection in February 2020, the service had been impacted by Covid 19. This had meant that staff had worked under very difficult circumstances to provide care and keep people safe. The provider had also put in place an interim management team to manage the service.

Staff said they had found the past six months very difficult and were adjusting to the sudden change in the management team. It was evident from staff feedback that the staff morale at the home was low with a lot of uncertainty. The interim management team were aware of the concerns and anxieties and were trying to restore staff trust and confidence. Staff said they had seen some improvements since the interim manager had been at the home. Most said they would be confident to raise a concern with the interim management team.

To manage during the pandemic, changes had been made to the provision of care and a reduced menu was implemented at the home. We discussed with the management team about the need to return to their previous level of service, action was being taken to address this.

There were enough staff to meet people’s needs on the day of our inspection. We observed people in communal areas received the support they required to meet their physical needs. The provider told us they had needed to use a lot of agency staff to cover staffing shortfalls. Staff did not always feel there were enough staff to give people the same level of care they had before the outbreak, as people’s needs had increased. The group manager demonstrated on the provider’s staffing tool that they had above the required staff hours allocated. However, they said they would review people’s dependencies again with a nurse and a staff member to ensure they had the correct information to allocate staff numbers.

Staff said they had been able to provide people with their personal and continence needs. They also confirmed people had been monitored in the communal areas.

Alleged concerns had been raised with Care Quality Commission (CQC) about people being abused at the home. These concerns had been shared with the local authority safeguarding team who have investigated and closed the concerns.

Concerns had been raised with CQC that the low staff morale and anxieties were leading to disagreements within the staff team had impacted on people. Staff confirmed there had been staff disagreements, but these had been aired in private. Accidents and incident records showed there had not been an increase in people’s altercation in the past few months caused by the unrest.

Where staff had raised concerns with the interim management team, we were assured that they were investigating and taking action. Most staff said they had confidence that if they raised concerns with the interim management team, they would take the appropriate action. Staff comments included, “I am glad to see new management and they seem to be more proactive…”, “Our management team is very good and professional even though they are under lot of pressure at the moment.”

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our thematic review of infection control and prevention in care homes. We found that staff were following up to date infection prevention and control guidance to help people to stay safe. However, the provider’s infection control policy was not up to date with the current Covid 19 guidance.

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

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about staffing levels, the high use of agency staff, some staffs’ skills, a poor atmosphere with low staff morale. Also, concerns that people were not having their personal care needs met, allegations of abuse, and concerns about the leadership and interim management at the home. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. We found the interim management team had already identified the concerns we found and were taking action. The overall rating for the service has not changed following this targeted inspection and remains Outstanding.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Silverleigh is registered to provide accommodation and nursing and personal care for up to 65 people. The service is intended for older people, who may also have a physical disability, mental health needs or a dementia type illness. The service is in a large detached building located in the market town of Axminster in East Devon. The home is within walking distance of Axminster town centre, local church and post office and benefits from being next to the local GP surgery.

This inspection took place on 3, 5 and 6 February 2020, the first day was unannounced. There were 61 people living at the service at the time of the inspection. The majority of people were living with dementia.

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

People continued to receive kind, compassionate care from a team of highly motivated staff who were very well trained and skilled. People received an excellent quality of care because the provider and management team set high expectations about standards of care and led by example. The provider used evidence based best practice and had developed models of dementia care from learning from their own services.

Everybody gave very good feedback about how caring, well managed and supportive the staff and management team were. We saw many examples of where staff went the extra mile to support people to live fulfilling lives. People were very relaxed and happy in the company of staff. Staff were very attentive and responded to people’s needs promptly and appropriately in a calm non-judgemental manner. People were involved in decisions about the home and their personal needs.

The provider’s ethos continued to focus on an entirely holistic approach to the provision of care and specialist dementia care. They had gone to extraordinary lengths to ensure that the building was adapted to meet people’s needs and ensure their accommodation was truly individualised and personal. They were continually updating, adding and improving the environment at the home. The atmosphere at the home was very welcoming and relaxed.

The provider, registered manager and staff team were very highly motivated and proud of the service they delivered to people. The whole team demonstrated they shared responsibility for promoting people's wellbeing, safety and quality of life.

There were consistently high levels of engagement with people using the service, families and other professionals.

People who lived with dementia continued to receive excellent care tailored to their individual needs. Staff

completed bespoke dementia training to increase their understanding of the condition.

A brilliant activities team promoted inclusion and empowered people to do activities, hobbies and interests which gave them a feeling of well-being and being valued.

People experienced end of life care in an individualised and dignified way. Staff recognised the importance of holistically supporting people at the end of their lives. They also supported relatives with a booklet of information about end of life and what families and friends might expect and experiencing grief.

People received personalised care which was centred around them as individuals. Care plans were in place which reflected people’s wishes. They were used by staff to meet people’s assessed needs and preferences and to help them achieve their goals. Staff knew people well, cared about them and understood their care and support needs. Staff recognised the importance of promoting people’s independence and supporting them to live fulfilling lives.

Staff recruitment and staffing levels supported people to stay safe while going about their daily lives. Staff also understood their role and responsibilities to protect people from abuse.

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.

People had their nutritional needs assessed and met. Everyone praised the standard of food provided at the home. People received their medicines when they were needed and in ways that suited them. There were systems in place to check that medicines were administered correctly and safely.

Governance was well-embedded into the running of the home. There was a strong framework of accountability to monitor performance and risk leading to quality improvements within the home. The provider and the management team saw this as a key responsibility and a means to continually learn and adapt. The provider believed in succession planning and the continuous development of their services.

Rating at last inspection

The last rating for this service was outstanding (published 9 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

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

This inspection took place on 15 and 22 March 2017 and was unannounced. There were 59 people living at the service at the time of the inspection. The majority of people were living with dementia.

We undertook a focussed inspection on 10 July 2016 in response to concerns about staffing levels and the possible impact this had on people’s care. We found the number of staff and deployment of staff did not always ensure people’s needs were met in a timely way. We found a breach of regulation and made a requirement. The registered manager had developed an action plan to ensure improvements were made and sustained and had kept the Care quality Commission (CQC) informed of the progress made. We found that improvements had been made at this inspection.

The service had a comprehensive inspection in July 2015 when it was rated as good overall. Responsive was rated as outstanding.

Following the site visit, Devon County Council implemented a safeguarding process in relation to one person and the police were undertaking lines of enquiry. The registered manager and other senior staff were co-operating with the investigation.

A registered manager was 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 environment had been creatively adapted to help meet people’s needs, in particular people living with dementia. It provided clear dementia friendly pictorial signage and points of interest. The layout and design helped to maintain people’s independence and to reduce restrictions on their movements. Comments from relatives and professionals included, “The facilities are great and well used”; “The place is beautifully kept” and “The environment is very good for people; stimulated at the right level…” People were cared for in a clean, hygienic and safe environment.

The service continued to provide outstanding responsive care. People received a personalised service which was responsive to their individual needs. The registered manager, provider and staff continually looked at innovative ways to improve the service by exploring and implementing new ideas to improve people’s experience and wellbeing. Activities provided were varied and enabled people to live fulfilled and meaningful lives. For example two people with dementia were supported to volunteer at a local charity shop. People had regular opportunities to enjoy activities outside of the service, for example swimming sessions and frequent trips were organised to places of interest.

People experienced positive outcomes regarding their health care as the service had developed excellent working relations with a number of health care professionals. Relatives spoke about the improvements to their family health. One said, “I have noticed a tremendous difference. He is so calm and settled.” Health professionals consistently described the service as professional, effective and caring. A professional said, “Silverleigh is our ‘go to service’ for people with complex needs. They manage very well.”

People’s dietary needs and preferences were well met. The service offered an extremely wide and varied daily choice of freshly prepared food made from good quality ingredients. People’s dining experience was sociable and support was at hand where needed. The service had been the first care home to gain membership of the ‘Taste of the West’.

The service was exceptionally caring. People were supported by very kind and empathetic staff who knew them well and positive relationships had been formed. End of life care was provided by compassionate staff who were skilled and competent and ensured people were comfortable and that pain and other symptoms were effectively management. Staff often “went the extra mile” to provide people with high quality care, which enhanced people’s wellbeing.

The service was safe. Comments from relatives included, “I never worry about Mum when I leave here, I know she is well looked after” and “He is safe, he has got friends, every member of staff is wonderful with him…” There were safe systems in place for receiving, administering, storing and disposing of medicines. People received their medicines as prescribed.

Staff understood their responsibilities relating to safeguarding. The registered manager had responded appropriately to safeguarding concerns and the necessary alerts had been made to the local authority to ensure any concerns were dealt with. Risks to people’s health and wellbeing had been identified and staff understood how to keep people safe. There were sufficient numbers of well trained staff within the service to keep people safe and meet their needs. The atmosphere within the service was calm and organised; staff worked in an unhurried way and were able to spend time with people.

People’s rights were protected by practice in place in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been appropriately made when needed.

Care plans and risk assessments had been developed with people and/or their relative. Care plans provided detailed information to help staff deliver the care people needed, in a way they preferred.

The service was well managed by an experienced and qualified manager. People were able to express their views and opinions and knew how to raise a concern or complaint. They were confident their concerns would be listened to and acted upon. There were systems in place to monitor the quality of the service and action was taken where shortfalls were identified.

The Care Home UK website uses feedback from people and relatives from the online reviews. Silverleigh had a review score of 9.2 (maximum of 10). The review score was based on 14 reviews since the last inspection. These comments and ratings were independently verified by Care Home UK. All of those responding said they were 'extremely likely' to recommend the service to others. On-line feedback demonstrated the very caring ethos at the service.

We carried out an unannounced comprehensive inspection of this service on 29 June 2015 and 15 July 2015. At the time of this inspection the service was meeting the necessary legal requirements and the overall rating of the service was “Good”.

We received concerns in relation to staffing levels at the service, especially at weekends. As a result we undertook a focused inspection to look into those concerns. We also recently received information from the registered manager which showed an increase in incidents between people using the service. The Devon County Council safeguarding team were investigating how the incidents were handled by the service. We took this opportunity to review the incidents and the measures in place to reduce any harm to people.

This inspection took place on 10 July 2016 and was unannounced. There were 60 people living at the service at the time of the inspection. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Silverleigh on our website at www.cqc.org.uk

There was a manager at the service who was registered with CQC. 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 registered manager was on duty at the time of this inspection.

The deployment of staff around the service was not always ensuring people's needs could be met or that their safety was assured. One person living at the service and two relatives raised concerns with us about the lack of staff presence in communal areas. On occasions we observed people did not always receive support from the appropriately staff when needed, which meant they had to wait for assistance.

People said they felt safe living at Silverleigh and described the staff as kind and caring. Relatives were happy with the overall standard of care and support and felt their family member was safe. One said, “The care is generally excellent…” Staff provided care and support for people with patience and kindness. People's privacy and dignity were respected. People were involved in decisions about how and where they spent their time.

The registered manager was aware of their responsibility in relation to safeguarding people from abuse or harm. Where necessary, alerts had been made to the local authority and notifications sent to CQC. As a result of recent safeguarding alerts, the Devon County Council safeguarding team and health care professionals had reviewed people’s care. The safeguarding team were satisfied with the actions taken by the registered manager to reduce future incidents, and no further action was needed.

There were effective systems in place to reduce the risk and spread of infection.The registered manager sent us comprehensive evidence of the work undertaken to improve the environment to help prevent the risk of cross infection. This evidence included photographs showing the refurbishment that had taken place, which included new signage and storage, new flooring, a new hand basin and clear areas designated for soiled and clean laundry. We were also sent a new laundry audit to show how this area of the home would be monitored and checked. We were also sent confirmation of infection control training for a senior staff member. These changes helped reduce the risk of cross infection and promoted good practice.

There were 46 people living at the home; many of whom had care needs relating to dementia and/or their mental health needs. We spoke with people living at Silverleigh and we also spent time with people in communal areas so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We spoke with seven staff members and the manager, as well as two visitors. We looked at a selection of care records, and focussed on how people's well-being was supported.

We saw people looking relaxed and at ease with staff and each other. A visitor told us 'this is a fantastic place'. Staff practice within the home meant people's dignity was respected, and choice was promoted. Care was assessed, well planned, reviewed and action taken when people's care and emotional needs changed. Staff were clear about their responsibility to protect people from abuse, and staff practice and staffing levels helped keep people safe. The home was clean and people looked well care for. However, improvement was needed to ensure the systems in the laundry promoted good infection control.

People told us they could speak to any of the staff or management if they had any concerns. They used phrases such as 'good friendly people' and 'extremely well organised and thoughtful,' to describe the home. 'A wonderful home ' I can't speak highly enough of them' was another typical comment.

Their privacy and independence were respected, with their various needs met through individualised care planned for them. Staff were supported to deliver care safely and to an appropriate standard, with other measures in place to safeguard people. Comments from people included that staff noticed if they were 'not themselves,' with one person saying 'The staff are very quick to pick up on anything like that'. Another said, 'It's a very happy place ' we're well looked after.'

People were enabled to be part of the community they lived in. One person told us about outings to local shops and trips to the local swimming pool with staff. Some people told us the home's summer fete had been very good, to which the local community had been invited.