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Inspection carried out on 30 March 2021

During an inspection looking at part of the service

Silver Tree Lodge is a care home registered to provide accommodation and personal care for up to eight people with a learning disability. At the time of this inspection seven people were living there.

We found the following examples of good practice:

The service had a policy in place which set out the arrangements for visitors. As from 8 March 2021 pre-booked in-house visits had been arranged. Face masks, hand gel, a temperature check and a health questionnaire were completed after a negative lateral flow COVID-19 test (LFT) was received. People’s family and friends were kept informed of the visitor’s policy and procedures that had to be followed.

People were supported to maintain contact with friends and family in alternative ways as well. Door step visits, telephone or video calls were arranged for people. People were also supported in different ways in order to meet their social and emotional needs. For example, people were supported to access the local park at quieter times, or alternatives were used rather than using public transport.

Since the start of the pandemic the service had admitted one person. The person had a negative COVID-19 test result on admission and was then isolated in the flat for 14 days. The registered manager was in the process of assessment for a new person to move in. If any person was admitted to hospital they would not be able to return to the service without a negative test result. The person would then be isolated in their bedroom for 14-days.

The staff team ensured peoples’ health care needs were met. People had been supported to safely attend GP, dental and hospital appointments. The community nurse visited the home daily as part of one person’s treatment plan. One essential health care professional in-house visit had been arranged and this followed the visitor’s policy. People had received both doses of the COVID-19 vaccination and some staff were due to have their second dose soon.

There was a weekly COVID-19 testing programme in place for the staff team. People who lived at the service were tested every four weeks. Additional tests would be performed if anyone was unwell or presented with COVID-19 symptoms. For those persons who regularly accessed the local community, they were tested on a weekly basis.

The staff maintained social distance from their work colleagues and only one staff member was allowed in the staff room at a time. Staff supported people to be socially distant from others, both inside and when outdoors. Staff wore face masks on duty but added gloves and an apron when delivering personal care. There was a supply of additional PPE to be used in the event of any outbreak of infection.

Although each person had their own self-contained flat within Silver Tree Lodge, there were communal areas. To the rear of the property there was a courtyard and people were using this space during the sunshine. If there was an outbreak of COVID-19 people would be isolated in their flats and staff had prepared each person, explaining how they would support them.

The service had plentiful supplies of PPE and cleaning products. We saw PPE being worn appropriately. Staff supported people to maintain the cleanliness of their flat. Communal areas were cleaned four times a day with attention paid to all ‘touch-points’. The registered manager monitored the staff going about their duties to check compliance with PPE and cleanliness of all areas.

All staff had refreshed their infection prevention and control training via an e-learning module. They had received training regarding the correct procedures for donning and doffing PPE. Six members of staff had completed the rapid flow test training (LFT) and were competent in undertaking the tests.

The provider’s infection prevention and control policies were in date and in line with best practice. Infection control audits were completed by the registered manager and acted upon. The registered manager

Inspection carried out on 12 July 2018

During a routine inspection

We undertook an unannounced inspection at Silver Tree Lodge on 12 July 2018. The last inspection of the service was carried out on 31 May and 1 June 2017. At that time, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches concerned the assessment and planning of risks relating to people's safety in the premises, the safe management of medicines and the effectiveness of quality assurance systems to ensure areas for improvement were identified and acted upon.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘safe’ and ‘well-led’ to at least good.

The provider sent us an action plan in June 2017. This described what they were planning to do to comply with the regulations and improve in specific areas. At this inspection, we found that necessary improvements had been made.

Silver Tree Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Silver Tree Lodge can accommodate eight people in one adapted and extended Victorian house. At the time of our inspection seven people were living there. Silver Tree Lodge consists of eight individual apartments. Each apartment is en-suite with a separate lounge and bedroom area. Two of the apartments have their own kitchen facilities. Communal living spaces include a living and dining room, kitchens and gardens.

The service works 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.

A registered manager was in post at the time of our inspection. 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 told us that they felt safe at Silver Tree Lodge. We saw systems and processes which helped to keep people safe. These included risk assessments and individual safety measures, as well as equipment checks and the investigation of accidents and incidents.

People received their medicines when they needed them from staff who had been trained and were competent to do this task.

Safe recruitment and selection procedures were in place to ensure staff were suitable to work in the service. There were enough staff in post and they had enough time to spend with people to make sure they received safe and effective care.

Staff understood their roles in relation to the Mental Capacity Act 2005. This meant that people were supported to have choice and control in their lives. Their privacy and dignity was respected and people were encouraged to be as independent as possible; the policies and systems in the service supported this practice.

Staff had a good understanding of people's needs and preferences, and were compassionate, kind and caring. People were comfortable in the presence of staff and confident in their abilities.

When there were concerns about a person’s physical health or wellbeing staff liaised with healthcare professionals. Staff helped people to access appointments when necessary.

Systems were in place to monitor and review the quality of care provided. Checks were carried out regularly, and there were clear action plans to achieve improvement when this was needed.

People spoke positively about the service and the staff who supported them. Relatives found the staff team to be supportive, compassionate and car

Inspection carried out on 31 May 2017

During a routine inspection

This inspection took place on 31 May and 1 June 2017 and was unannounced. It was carried out by one adult social care inspector.

Silver Tree Lodge provides support for up to eight people with learning disabilities. There are two self-contained flats within the home and six bedrooms with their own lounge areas. There is also a communal kitchen, a ‘training kitchen’, a dining room and lounge. At the time of the inspection there were seven people living at the home.

There was a registered manager 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.

Some improvements were required to ensure people’s medicines were stored safely and recorded correctly.

Risk assessments had been carried out and they contained guidance for staff on protecting people. Current risks to people were not always clear in care plans. People were not fully protected from the risk of being exposed to hot surfaces.

There were quality assurance processes in place to monitor care and safety and plan on-going improvements. These processes were not fully effective in identifying the shortfalls we found during our inspection or ensuring improvements were always carried out.

People told us they felt safe. Staff also felt the home was a safe place for people. People were protected from abuse and avoidable harm. People received effective support to help them manage their anxieties.

People were supported by a sufficient number of staff to keep them safe. Staff had enough training to keep people safe and meet their needs. Staff recruitment was managed safely.

There was a stable staff team at the home. They had a good knowledge of people’s needs. People received support from health and social care professionals.

People were involved in planning and reviewing their care and support. People interacted well with staff. Staff had built trusting relationships with people over time.

People’s diverse needs were well supported; they chose a range of activities and trips out.

People were part of their community and were encouraged to be as independent as they could be.

People were aware of the complaints procedure and felt able to raise any concerns. There were systems in place to share information and seek people's views about their care and the running of the home.

There was a management structure in the home, which provided clear lines of responsibility and accountability. All staff worked hard to provide the best level of care possible to people. The aims of the service were well defined and adopted by the staff team.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.