Silverwood (Nottingham)

Silverwood (Nottingham) is a residential care home providing personal and nursing care for up to 80 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 74 people using the service. Silverwood (Nottingham) accommodates 80 people across two separate wings, each of which has separate adapted facilities. One of the wings specialises in providing nursing care.

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

People were protected from this risk of neglect. Risks to people’s health and safety had been assessed, monitored and reviewed. We noted some cupboards and rooms that needed to be locked were not. The registered manager took action to address this. There were enough staff to provide safe care. Medicines were managed safely. The home was clean and tidy, and action had been taken to reduce the risk of the spread of infection. Accidents and incidents were reviewed, and action take to reduce the risk of recurrence.

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.

The service was well managed. The registered manager led by example and staff respected their open and honest approach. People liked the registered manager. They also liked living at Silverwood (Nottingham) and felt there was a “homely” atmosphere.

People, relatives and staff felt their opinions mattered and the registered manager listened to and acted on feedback. Robust auditing processes were in place, this helped to identify any areas of concern before they impacted people’s health and safety. People and relatives would recommend this service to others.

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

Rating at last inspection

The last rating for this service was good (published 7 February 2020).

Why we inspected

The inspection was prompted in part due to the CQC receiving a high number of notifications relating to people’s health and safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

Please see the Safe and Well-led sections of this report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained as good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silverwood (Nottingham) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silverwood (Nottingham) is a care home with nursing providing personal and nursing care to 54 people aged 65 and over at the time of the inspection. Silverwood (Nottingham) accommodates up to 80 people in two separate buildings; one building provides residential care for up to 39 people and the other building provides nursing care for up to 41 people.

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

People said they felt the personal care they received was safe. People’s needs were assessed, and any risks associated with health conditions recorded. Risks associated with the environment were assessed and mitigated. People received their prescribed medicines safely. Staff received training in safeguarding and felt confident to raise concerns. There were enough staff to keep people safe. The service was kept clean. Where things went wrong, the registered manager explored the reasons and took steps to reduce the risk of it happening again.

People’s personal and nursing care was provided in line with national guidance and best practice guidelines. The provider ensured staff had training and support to develop their personal care and nursing skills. People were supported to maintain a healthy balanced diet and to eat and drink well. The provider had taken steps to ensure the environment was suitable for people's needs. People were supported by staff to access healthcare services when required.

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 told us staff were kind and caring and they looked after them well. Staff had received training on equality and diversity and respected people's wishes and needs in accordance with the protected characteristics of the Equality Act. People were encouraged to make decisions regarding their day to day routines and express their views about their personal preferences. People’s care was provided in ways which promoted their dignity and respected their independence. Staff respected people's right to confidentiality.

People were regularly asked for their views about their care. People were supported to practice their faith if this was important to them. The service identified people’s information and communication needs by assessing them. People and relatives were positive about the support they had to take part in activities both within the service and out in their local community. The provider had a system in place to respond to complaints and concerns. People could be confident that at the end of their lives they would receive kind and compassionate care.

People and relatives felt the service was well-led. Since our last inspection systems for monitoring the quality of the service had become embedded and were more effective in identifying shortfalls and driving improvement. The registered manager clearly understood their roles and responsibilities. Staff understood their roles in providing good quality care and felt confident and supported to do this well. The service worked in partnership with health and social care professionals to achieve good outcomes for the people who lived at the home.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 8 May 2019) and there were three breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 8 May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

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

Silverwood (Nottingham) accommodates up to 80 people in two separate buildings; one building provides residential care for up to 39 people and the other building provides nursing care for up to 41 people. There were 38 people with nursing needs and 32 people with residential needs who were in receipt of personal care at the time of our inspection.

At our previous inspection on 14 and 16 March 2017, the service was rated ‘good’ overall and the question ‘Is the service safe?’ was rated as requires improvement.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found improvements were needed to show how the risks around depression and potential self-harm were assessed and followed up. Improvements were also required to how risks associated with the provision of people’s care were reviewed, analysed and reduced.

Care plans and risk assessments did not always accurately reflect people’s care needs and any associated risks. Care plans and risk assessments were not in place for when people presented with behaviours that could potentially harm themselves or others.

Whilst some aspects of medicines management and administration were managed well, some improvements were needed to ensure medicines were consistently managed and administered safely. Some people had experienced medicines being out of stock. Records of medicines administration required improvement.

People did not always receive timely help from staff when they used their call bell. People also told us they had not always experienced timely help from staff and on one occasion this had compromised their dignity. We observed staff were not always deployed to ensure a staff presence in communal areas.

People told us they felt safe, however records did not demonstrate what actions had been taken to investigate one incident. Staff had been trained, and understood what actions to take to report any safeguarding concerns.

Equipment and actions to monitor, help prevent and reduce risks from pressure area damage had not always been used effectively. Monitoring and actions in relation to pressure areas and other healthcare needs, such as fluid intake and output also needed improvement. Care plans did not always reflect people’s current healthcare needs to ensure staff understood how to provide them with consistent care.

People told us they thought staff were caring, however some people felt this was compromised when staff were too busy to spend time with them. Some improvements were needed to ensure people’s experiences of staff were caring. Staff respected people’s privacy and promoted their independence; we identified one occasion when a person’s dignity could have been promoted better. People, and where appropriate, their relatives or representatives had opportunities to be involved in care planning.

Not everyone experienced responsive and timely care and some people did not have baths or showers as frequently as they would have preferred.

The service was kept clean and actions were taken to help prevent and control risks from infections. Other risks, such as falls risks and risks identified in the environment were assessed and actions taken to reduce risks from them.

The provider was keen to improve the service and sustain those improvements and learn from when things had gone wrong. The provider had action plans in place to help implement the improvements identified as required.

Staff were trained in areas relevant to people’s needs and understood how to support people’s diverse needs. Staff had systems in place to aid communication between them; the registered manager had in addition, identified some areas where communication could improve. Staff were supported by the registered manager, however arrangements for staff appraisals required improvement.

Improvements were needed to the systems and processes used to check on the quality and safety of services. This was because audits had not always been used as intended or had not always been effective at identifying shortfalls in the service.

Statutory notifications for abuse, or allegations of abuse, had not always been submitted in a timely manner as required.

People were offered a balanced diet and told us they enjoyed their meal choices. People also had opportunities to engage in a range of activities.

A range of other healthcare professionals were involved in people’s care; referrals for other services had mostly, but not always, been made in a timely manner.

People 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 support this practice. People’s preferences regarding whether they preferred male or female care staff were known and respected. People had access to information in a range of other formats to help them understand their choices. A system was in place to help manage, investigate and resolve any complaints raised.

Advance care plans were in place to ensure people and their families and representatives if appropriate had the opportunity to express their wishes for their end of life care.

The building had been adapted to help meet people’s needs, with such things as lifts and handrails along corridors. People had been supported to personalise their rooms to their own tastes.

The latest CQC rating was on display. The registered manager was viewed as approachable and wanting to improve the service. People and relatives felt they could be involved in the service and offer their views and opinions for consideration in the development of the service. Policies and procedures were in place to help with the governance of the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Accommodation for up to 80 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 66 people using the service at the time of our inspection.

At our last inspection on 29 and 30 March 2016, we asked the provider to take action to make improvements in the areas of person-centered care and staffing. We received an action plan setting out when the provider would be compliant with the regulations.

At this inspection we found that improvements had been made and the provider was now compliant with the regulations.

A registered manager was in post and was available throughout the 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 did not always receive medicines administered at the right times. Medicines were not always safely managed and records were not always completed accurately. The registered manager assured us that further action would be taken to address the issues that were found.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe infection control practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and promoted their independence. An incident which affected a person’s dignity was observed but immediate action was taken by the registered manager to address the issue.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved. Complaints were handled appropriately. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising concerns with the management team and that appropriate action would be taken. The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

Accommodation for up to 80 people is provided in the home in two buildings and over two floors in each building. The service is designed to meet the needs of older people. There were 54 people using the service at the time of our inspection.

At the previous inspection on 14 and 15 April 2015, we asked the provider to take action to make improvements to the areas of person-centred care, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all areas, however, more work was required in the areas of person-centred care, good governance and staffing.

A registered manager was in post and she was available during the 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.

Sufficient numbers of staff were not on duty to meet people’s needs. Staff did not always safely manage identified risks to people. People felt safe in the home and staff knew how to identify potential signs of abuse. The premises were managed to keep people safe. Staff were recruited through safe recruitment practices. Safe infection control and medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People did not always receive personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken.

We found 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 this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We held conversations with ten people who used the service and one visitor to the home. We spoke with representatives from the management team and three members of staff. We looked at some of the records held at the service which included care plans, auditing records, staff recruitment records and the providers service user satisfaction survey which twenty three people responded to in 2013. We also observed the support people received from staff and carried out a tour of the buildings.

Is the service safe?

We found that all the people we spoke with felt they were safe and said the staff would always promote their safety and well-being. One person told us, 'I feel very safe and I really don't have anything to complain about.'

We found that an on call system was in operation to ensure a member of the management team would be available at all times should they need to be contacted in an emergency situation.

We found that an effective recruitment system was in place to ensure that staff were only employed once they had been assessed as suitable to work with vulnerable adults. We also found that staff were able, from time to time, to obtain further relevant qualifications pertinent to their roles and responsibilities at the home.

Is the service effective?

We found that systems were in place to highlight people's individual care needs and how they could be met by the care staff. People told us that they were happy with the quality of care they received and told us they felt that staff had a good knowledge of their individual needs and preferences.

Is the service caring?

People told us that staff were respectful at all times. We found that staff were proactive in promoting people's respect and dignity. We saw staff listening to, and respecting people's views and when they spoke with people it was in a dignified manner. We also saw that when staff were delivering care or meeting people's comfort needs it was undertaken a caring way.

We also observed staff utilising effective communication skills when they were interacting with people. We saw that conversations were unrushed and people were provided with sufficient time to respond. We also observed staff speaking slowly and clearly when needed and used short, simple words and sentences to minimise confusion. We also saw people were offered reassurance and explanation before care was provided and staff listened to and respected people's decisions.

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed to ensure people's individual needs could be met. We also found that the management team would utilise information from people's relatives and health care professionals to build a comprehensive picture of people's individual needs.

We also found the reviewing procedures at the home had been amended since our previous inspection to ensure the care plans were up to date and reflected people's individual needs.

Is the service well-led?

We found that since our previous inspection the management structure had changed. People told us they felt confident in discussing any areas of service provision with the management team and felt confident that their opinions would be respected.

Staff told us they received appropriate support and direction from the management team in the form of bi-monthly staff supervision sessions,. They also told us they felt comfortable in expressing their views at staff meetings which were performed on a monthly basis.

Records showed that people had been supplied with a satisfaction survey in 2013 so they could make comments about the quality of the service. We found that following the consultation process an analysis of the results had been undertaken. This was to provide a facility to develop the quality of the service whilst recognising where improvement could be made.

We spoke with three people using the service and with six relatives. The Expert by Experience also spoke with eleven people and with two relatives.

We found that people were not always involved in making decisions about their care and treatment.

One person using the service said to us, 'Things are quite good. We are looked after, no doubt about that.' However, another person said, 'I have to wait a long time to get dressed.' We found people's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan.

Five relatives told us they felt their family members were safe. However, we found gaps in safeguarding training.

We found some areas of the care home to be unclean and unhygienic.

We found there were not always sufficient numbers of appropriate staff. One person said, 'They're always short of staff. I have to wait a long time before they come to my assistance. They're always too busy.'

We found gaps in staff supervision, appraisal and training.

We found that the provider did not always identify, assess and manage risks appropriately to maintain the health, safety and welfare of people using the service. We also found records were not always fit for purpose and were not always kept securely.