Silver Oaks Residential Care Home

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 69 (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 positive culture of safety where concerns were reported and investigated. However, improvements were needed in oversight where some people experienced distress, confusion or anxiety on a daily or regular basis as a result of their mental health condition. Although monitoring was in place, analysis of incidents was not always effective in identifying learning or ways staff could consistently respond to incidents to promote people’s wellbeing. For example, by looking at whether strategies or techniques staff had used in response were effective. We saw incidents where staff had been physically assaulted by people. There was a lack of further information recorded around these incidents including how to prevent it in the future. We discussed this with the registered manager who took immediate action following our inspection visit. Systems were in place to identify other themes and trends, which were analysed and then acted on in a timely manner to minimise future harm, for example falls monitoring procedures and protocols.

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. Staff worked with various professionals to ensure people's care needs were met when they moved in. Staff worked with district nurses to ensure people who needed it received specialist support with managing their skin integrity. Prior to admission people and families were involved in the pre-assessment and information gathering process and were able to personalise the room before people’s arrival to help people settle and feel more at ease. One relative told us, “When [Name] moved in, staff were lovely, helping [Name] to settle. They know [Name] loves dogs, so staff gave them lots of pictures for them to put on their walls to personalise the room. How nice is that?”

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 with external agencies quickly and appropriately. People told us they felt safe in the service, and this was confirmed by relatives. A person told us, “The staff look after me here. They are very good and make me feel safe.” A relative told us, “[Name] is absolutely safe here. The care staff give me confidence that they would never hurt [Name]; they always do their absolute best.” Staff received safeguarding training. They understood how to recognise and report poor care and abuse. A staff member told us, “We know people really well so we can tell if something is not right. We report it and concerns are listened to.”

The provider worked with people to fully understand and manage risks by thinking holistically. People’s care plans provided sufficient, personalised guidance to support staff to manage risks. These included risks associated with people’s health conditions. A person told us, “Staff help me to transfer by using the rotunda (transfer aid) in a way that makes me feel safe and comfortable.” However, the review and mitigation of risks associated with people’s distress and anxiety, particularly around the area of personal care, required further development. Staff described approaches which were used to reassure people and we found variance in these, and additional approaches staff had found effective but were not included in people’s care plans. The registered manager acknowledged this and acted by seeking advice and guidance from external agencies and support from the provider around positive behaviour strategies and interventions. This would help promote a more consistent response and intervention from staff with clearer guidance to reduce the risk of harm for people and staff. The provider had systems and processes in place to monitor food and fluid intake of people who were at risk from dehydration or poor nutrition. However, we found staff did not always complete accurate monitoring records and there was a lack of assessed daily fluid intake for each person to ensure they had consumed sufficient fluids each day. This meant there could not be effective oversight of the risk of dehydration, though there was no evidence people had been harmed as a result of this. Additionally, where people required support to change their position to prevent pressure wounds or to monitor health needs, records did not always evidence support had been provided in line with people’s assessed needs. The registered manager acted immediately by liaising with people’s GP and providing further guidance and information for staff to improve care records.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There were no visible hazards to people living there. Maintenance records were kept up to date, for example water, gas and electrical appliance testing. All policies had been reviewed and updated for all maintenance areas. Cleaning products were stored securely. People had access to equipment to safely support them to mobilise and transfer between areas, and this was regularly checked and maintained. People and relatives were overall happy with their environment, though some relatives felt some areas looked ‘tired and in need of decoration’, including people’s rooms. The provider had undertaken some decorating and further work was planned.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Most people and relatives felt staffing levels were usually okay but there were times when staff were pressured. A person told us, “The staff here are great but they are stretched at peak times, like the morning, lunchtime and helping people to bed.” Relatives provided mixed views about staffing, with some feeling levels were sufficient and others observing their family member had to wait for some time before they were assisted. Comments included, “I have been with [Name] and we have waited up to 10 minutes for someone to respond after ringing the call bell”, “If I need to find staff, there’s usually someone in the corridor. I would say when two staff are busy with someone, it leaves things rather stretched. Generally, I see them working incredibly hard just to keep up” and “If I need to find staff for [Name], it’s not any trouble to find someone.” Staff told us they felt there was usually enough staff, but they were ‘on the go’ constantly. The registered manager determined the staffing levels according to people’s needs and was flexible in their approach. All staff had access to training and development of skills via a range of training routes including workbooks and face to face courses. Staff were recruited safely and on starting employment completed an induction booklet prior to supporting people.

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. Overall, the service was clean and tidy. We found some areas of flooring required repair and deep cleaning, including the laundry room. The registered manager addressed this following our assessment visit. The registered manager had all relevant policies in place and daily cleaning schedules were completed by housekeeping staff. Cleaning products were stored securely. There were supplies of personal protective equipment, (PPE), with safe disposal areas throughout the home which were easily accessible to staff. Protocols were in place for the containment and management of any outbreak of infection.

People’s medicines were managed safely, and they received their medicines as prescribed. Systems were in place to safely administer and store medicines. People and relatives told us they were happy with their medicines, with many relatives telling us, “Staff administer medicines on time and watch [family member] take it.” We found minor concerns around the monitoring of fridge and room temperatures used to store medicines and stock count errors for a person’s medicines. The registered manager rectified these as part of this assessment. People’s care plans included guidance and information around their specific medicines and how they liked to take these. Staff followed safe practices around the application of topical and transdermal medicines applied via creams or patches directly onto the skin. This included the use of body maps and rotation charts. Staff received training in administering medicines and this was assessed to ensure they remained safe and competent.