On Monday 9 June 2014 an adult social care inspector carried out this inspection. We spoke with nine people, three visiting relatives, four staff and the manager. We used SOFI and observed 14 people over two hours. We checked records relating to five people and four staff. We considered all of the evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well-led?
Below is a summary which describes what people using the service and the staff told us, what we observed and what we found from the records we looked at on the day. If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
Our findings on the day highlighted that not all the people who lived at Silver Lodge had their needs met in a timely manner. This was because there was a lack of staff availability which resulted in people getting agitated. This resulted in an altercation between two people which could have been prevented if staff were supervising the area. This meant people were not always safe and may be at risk of harm.
We have told the provider our findings and asked them to tell us what action they are going to take to remedy this.
There was enough well maintained equipment available to promote the independence and comfort of people. Staff and relatives confirmed this. We saw evidence that regular maintenance had been carried out to ensure equipment was safe to use.
The recruitment and selection processes in place were effective and ensured suitably qualified, skilled and experienced staff were employed.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, the manager told us that policies and procedures were in place. They said relevant staff have been trained to understand when an application should be made, and how to submit one.
Is the service effective?
We saw people's privacy and dignity was respected in the way people were cared for. Staff described how they maintained people's privacy and dignity while they delivered care. The examples included keeping the doors shut and curtains closed when delivering personal care. Staff said they ensured people did as much as possible for themselves so that they could maintain their independence.
We found care was planned by staff taking on board people's views, experiences and expectations so that people received care in the way they liked.
People's care and treatment needs were reviewed regularly and revised to ensure people were in receipt of appropriate care. We noted an example where a person started to lose weight, the staff referred them to their GP and the person received additional nutritious drinks as well as staff ensured the person received food and snacks when they wanted. We witnessed this on the day of our inspection.
People were helped to maintain their independence because there were aids, adaptations and moving and handling equipment available to manage people's needs effectively.
Is the service caring?
People were given choices and treated with respect by staff at the home. Two people said they were able to express their views and were involved in making decisions about their care and treatment. One person said, 'I keep forgetting what I have asked for but the staff know what I want. They are alright here.' Another person told us, 'They (care workers) help me. They are very kind. I like this home.'
We carried out observations in the two dining areas and the conservatory during our inspection. We noted staff respecting people's privacy and dignity. We observed people having their breakfast and lunch (mid-day meal). Staff when attending to people made sure people received the necessary support and encouragement. When people were trying to help themselves, there was food spillage due to minor accidents. Staff discreetly cleaned the spillage and continued to encourage people. This was one of the ways that staff respected people's dignity.
Care workers we spoke with had a good understanding of equality and diversity. They said they had received training. Relatives told us, care workers respected their family members. Visiting relatives also said they had observed staff 'treating people with respect and not showing favouritism'.
Is the service responsive?
Initial assessments of people's needs were carried out by the manager or senior staff so that they were able to make the necessary arrangements before people were accepted to live at the home.
Relatives said people were able to meet the manager before they moved into Silver Lodge. Staff told us that people's preferences, interests, aspirations and diverse needs were sought during the first few weeks of them moving into the home. They said these helped them respond appropriately to people's assessed needs. For example, a person may require a special chair to sit on or prefer to have their meals in their room.
Through records and when speaking with relatives we found out staff kept in close contact with relatives who were unable to visit regularly. We were informed by relatives that this helped them 'a lot'. Staff facilitated people to maintain their relationships with their friends and relatives.
Is the service well-led?
The manager told us that all staff had received training on equality, diversity and human rights. Staff we spoke with had a good understanding. One staff said, 'We are all individuals and we like different things and come from different backgrounds. I always remember that, which helps me respect people's values.' A relative said they could not ask for a better place.
There were arrangements in place to deal with foreseeable emergencies. Staff were knowledgeable about the procedures to follow if a person required immediate medical attention. The manager and the deputy said that they had a policy in place to deal with emergencies and the staff were made aware of this.
Staff told us that they had staff meetings where their views about the service were sought by the manager. They said it promoted good team working and good communication. Staff told us they could not remember receiving staff satisfaction surveys from the provider. However they informed us that it was 'a good place to work' and 'there was a lot of support among staff'. They said the manager was accessible and they could raise any concerns or ideas and talk openly.
Records on incidents and accidents were maintained and appropriate people had been involved and relevant authorities had been informed. Staff told us following any incidents or accidents they spoke about it in hand over and in staff meetings as to how they could prevent it happening again.
We were informed by the manager that the regional manager visited the home most months and produced a report on their findings. They said the report included comments from people, staff and their observations on the running of the home. We asked for and we were unable to see the last two provider visit reports since there was limited access to the manager's office due to maintenance work. We asked the manager to forward us the reports. However following our visit we spoke with a regional manager who informed us that they had taken over the responsibility for monitoring the home two weeks ago. They too were finding difficulty accessing previous monthly visit reports. This highlighted a lack of business continuity between the home and the organisation. The provider has been made aware of this.