Silverleigh Cedars

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. At our last assessment we rated this key question good. At this assessment the rating has remained good.This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Policies and procedures were in place for responding to incidents, accidents and complaints and staff were aware of these. This ensured timely reporting of events. The provider had a system to enable the analysis of incidents and accidents, and the registered manager and senior management team used this to identify themes and learning. The falls data showed a significant decrease in falls over previous months. Daily staff handover meetings were held to promote effective communication between staff at shift changes. These provided staff with information regarding any changes in people’s needs and any service improvements and lessons learnt.

The senior management team demonstrated accountability when errors or shortcomings occurred, acknowledging responsibility for issues within their control. Appropriate actions were taken to address matters identified, with an emphasis on learning and improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s individual needs, risks and wishes were assessed prior to moving to the service and reviewed regularly to ensure they reflected people’s needs. People and their relatives felt confident their needs would be met by staff, and any health-related details would be shared with the appropriate professionals to promote continuity in care.

A relative told us how staff had noticed changes in their loved one’s condition and had acted quickly to obtain medical attention. The relative added, “If it wasn't for the nurse, and senior carer’s swift action, my relative would have not survived, I am eternally grateful to them…”

Health and social care professionals described the service as proactive and collaborative. They noted the team’s responsiveness and prompt information sharing were crucial in helping meet people’s changing needs. One professional said, “We have an excellent relationship with the staff at Silverleigh… I have no concerns to raise”. Another said, “We receive appropriate and timely referrals from Silverleigh. I have always found the staff to be caring, responsive and lovely to their clients”.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Feedback from people living at Silverleigh indicated they felt safe living at the service. Comments included, “Yes, I feel safe. The staff are friendly and jolly and easy to talk to”. Similarly, relatives and professionals said the service was safe and that they were informed of any incidents or changes. One relative told us, “The staff are great, the care is good, and I feel I don’t have to worry”.

Following reports from 2 people who felt unsafe due to uninvited visitors attempting to access their rooms, action was taken by the management team. New door locks were fitted, and both individuals reported feeling much safer as a result of the steps taken.

The provider had safeguarding policies and procedures in place and staff were trained to recognise and respond to concerns, potential abuse and harm. Staff told us they felt confident any concerns would be managed appropriately. Concerns were shared appropriately with the local authority safeguarding team and the Care Quality Commission (CQC).

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes/hospitals], this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found where people needed to be deprived of their liberty to keep them safe, the provider ensured a Deprivation of liberty Safeguard (DoLS) authorisation was applied for through the relevant local authority. All legal applications had been made in accordance with DoLS, this meant people’s rights were fully respected.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to identify and manage risks within the service. Risk assessments were used to assess, monitor and minimise risks associated with people’s health and support needs. Guidance was provided to staff. For example, where one person was at risk of choking due to swallowing difficulties, recommendations made by a speech and language therapist had been included in the care records.

We reviewed risks associated with the care of people, living with diabetes. Care plans were generally well detailed and included guidance for staff if someone’s blood sugar level was above the expected range. However, we noted guidance was not included about steps staff should take if the blood sugar levels fell below the expected range. The registered manager and director agreed to review diabetic care plans.

Pressure relieving equipment was used appropriately where a person was at risk of developing pressure damage to their skin. Several people had sensor mats in place to alert staff to their movements due to risks of falls. One sensor mat did not sound to alert staff when triggered. This was reported and addressed during the inspection.

We observed staff working in safe ways during our visit to the service, for example, ensuring people were safe when mobilising. One person said, “I am safe. They (staff) knew what they are doing with the equipment”.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.Environmental and maintenance checks were carried out and recorded regularly to ensure any concerns were identified and rectified. For example, regular checks on window restrictors, hot water and fire safety systems were carried out. However, we found the water temperature in one bathroom was higher than recommended and a window restrictor was broken. The maintenance team took immediate action to address these concerns. All equipment and systems, such as hoists and fire safety systems were subject to periodic inspection and servicing to ensure they were safe and fit for purpose.

The provider did not always make sure staffing levels were consistent. Staff received effective support, supervision and development. They worked together well to provide safe care to meet people’s individual needs.

We received varied feedback regarding staffing levels; 2 people felt their needs and requests were not responded to promptly. One person said, “Staff usually came quickly but I could wait for more than 10 minutes sometimes”. 3 relatives told us staffing levels varied, their comments included, “Not always (enough staff) when I’m there. (Person) doesn’t have as much attention as (they) sometimes need” and “There isn’t enough staff available during the day when I visit”. Prior to the assessment concerns were shared with us about a reduction in staffing levels and the impact this had on care delivery.

Staff said they felt staffing levels had reduced in the previous months and shifts were not always covered, and there had been a reduction in housekeeping staff.The registered manager told us a number of staff had left the service, but recruitment was underway for care staff, a clinical lead and housekeeping staff.

On the first day of the site visit, the provider’s preferred staffing levels were not met. One senior and 9 care staff were on duty, along with 1 registered nurse from 10am, one housekeeping staff and 1 activities person. At 10am 2 additional staff arrived, one member of care staff and one activities person.

The provider completed a dependency tool, which was reviewed weekly to assess the staff needed at the service. The regional director shared a copy of the staffing review analysis. The review concluded that nursing and care staff hours meet the required direct care hours based on current dependency levels. The director was confident the review demonstrated the service consistently exceeded the required care hours every day. The regional director attributed the recent decline in clinical risks, notably falls, to adequate staffing levels providing the support people required to ensure their wellbeing and safety.

The registered manager audited call bell response times at various points during the month. The providers preferred response time was five minutes. From the audits, we could see most call bells were answered within this preferred timescale. Where a response time was over 10- minutes, the registered manager explored the reasons.We suggested further observations and review of staff deployment to help identify any times where people may require additional assistance, such as mealtimes.

Staff were recruited safely and received suitable training.Staff confirmed and the training matrix showed they had completed training in areas relevant to people’s care and support needs. People, relatives and professionals were confident in staff’s skill and experience. Comments included, “They seem to know what they are doing. They can answer all my questions” and “Yes very much so, the nursing staff are really good”. A visiting professional said, “Whenever I have visited the home I have been received with politeness and extreme efficiency”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff said the housekeeping team had reduced due to people leaving the service. Staff rotas showed housekeeping staff were not always allocated on Tuesdays, due to shortages. The director explained new housekeeping staff had been recruited and were due to start work in the coming weeks. Overall, the housekeeping team maintained a satisfactory standard of cleanliness despite a staff shortage in their area. 2 people mentioned that their room was not as clean as they would like or expect, but most people and relatives said the service was clean and odour free. The kitchen team had effective systems for managing food safety and keeping the kitchen clean. There were appropriate facilities and arrangements for managing laundry.Staff were trained and policies and procedures were in place to support effective infection control and prevention.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.People received their medicines safely as prescribed for them. When medicines were prescribed to be taken ‘when required’ there was information in place for each person to guide staff when these might be needed. Risk assessments were in place for higher-risk medicines such as anticoagulants and flammable paraffin-containing topical preparations.

There were suitable arrangements for ordering, storage and disposal, including medicines needing increased controls and for those needing cold storage. Temperature monitoring was carried out to make sure medicines would be safe and effective.

Staff had training and competency checks to make sure they gave medicines safely. Regular medicines checks and audits took place, and we saw that these identified some areas and actions for improvement. Any errors or incidents were recorded and investigated so that actions could be put in pace to prevent recurrence.

There were some improvements needed to the way creams and external preparations were recorded. The name of the product was not always specified on application records. This meant that if people were prescribed more than one product it was not always possible to tell which had been applied, and whether they had been applied in the way prescribed for people. The registered manager and director addressed this during the assessment.