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Inspection carried out on 15 March 2017

During a routine inspection

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.

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 relatio

Inspection carried out on 10 July 2016

During an inspection to make sure that the improvements required had been made

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. Since the last inspection the provider has increased the number of places at the service from 54 to 65.

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.

Inspection carried out on 29 June 2015 and 15 July 2015

During a routine inspection

Silverleigh is registered to provide accommodation and nursing and personal care for up to 54 people. The service is intended for older people, who may also have a physical disability, mental health needs or a dementia type illness.

This inspection took place on 29 June and 15 July 2015 and was unannounced. There were 51 people living at the home at the time of the inspection.

We last inspected this service on 9 January 2014. At that time we found improvement was needed to ensure the systems in the laundry promoted good infection control and a compliance action was issued. In May 2014 we followed up on our inspection of 9 January 2014 to check that action had been taken to meet the compliance action. We did not revisit Silverleigh as part of that review because Silverleigh were able to demonstrate that they were meeting the standards without the need for a visit. We found the service had taken action to comply with the compliance action.

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.

People using the service, their relatives and visiting professionals said they felt the service was safe, effective, caring, responsive and well led.

People said they were well cared and felt safe at the service. Comments included, “No-one shouts or is rude. Staff are gentle, never rough with me…” and “I do feel safe. There is always someone around when you need them. That is reassuring for me.” Relative’s said “I have been impressed by the home…I have not seen any concerning practice…the staff are very caring…” and “I feel my relative is absolutely safe here…this place is wonderful.” Visiting health and social care professionals had no concerns about the service. Their comments included, “They are looking after people with complex needs… I am very impressed every time I visit” and “It is a pretty impressive service. We have no concerns about people’s safety or the care provided”

The service worked in a way which ensured people were safe. Staff were knowledgeable about how to identify and respond to safeguarding concerns if they arose. Clear guidance and policies were available if they needed to raise a safeguarding concern. Risks to people’s health and wellbeing were managed in ways which least restricted people’s freedom and choices. People were protected against the risks associated with medicines as there were good systems in place for the management of medicines. Staffing levels were appropriate to meet people’s needs and preferences. People said staff were always available when needed. Robust recruitment checks ensured people were protected from unsuitable staff.

People were protected by good practice in relation to decision making processes at the service. Practice was in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to maintain their health. They were provided with varied and nutritious meals and received support from a variety of external health professionals. Staff received training, induction and supervision to ensure they understood people’s needs and were able to work effectively and safely. Staff said they were well supported to do their job.

Throughout the inspection we observed people were comfortable and relaxed with the staff who supported them. People living at the service were free to move around and were able to choose how and where they spent their day. Staff practice within the home meant people's privacy and dignity was respected, and the standard of personal care was good.

People had access to a wide variety of activities, including regular outings to places of interest. The service had an activities team of nine staff, led by a staff member who had achieved a diploma in activities specifically for people living with dementia. The service focused on creative ways to enable people to enjoy daily life. Activities were varied and planned to meet people’s preferences and abilities.

The service was well-led by the registered manager, who was described by many as approachable, helpful and knowledgeable. There were effective quality assurance processes in place to monitor the service and plan on-going improvements. There were systems in place to share information and seek people’s views about the running of the service. Accidents and incidents were appropriately recorded and analysed and action taken when necessary to reduce foreseen risks.

During a check to make sure that the improvements required had been made

We visited Silverleigh on 9 January 2014 and we made a compliance action to improve the infection control measures in the home's laundry. The registered manager updated us the day after the inspection to advise us of the action they had taken to address concerns relating to the management of the home's laundry and the systems within it. They had requested advice from another regulator, which was confirmed when we spoke to the professional who had visited the home. This demonstrated the provider's commitment to improve.

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.

Inspection carried out on 9 January 2014

During a routine inspection

Our inspection was unannounced and lasted approximately nine hours. During this visit, we inspected five outcome areas linked to dignity, care, safeguarding, infection control and staffing levels.

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.

Inspection carried out on 21 September 2012

During a routine inspection

The provider had effective systems to monitor the quality of the service, with people’s views and experiences taken into account. Individuals and their representatives were involved in making decisions about their care.

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.

Reports under our old system of regulation (including those from before CQC was created)