Silomarg Ltd

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 requires improvement. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

The provider promoted a positive culture of learning and improvement. Systems were in place to record, investigate and respond to incidents, accidents, complaints and safeguarding concerns. Staff understood their responsibilities to report concerns and there was evidence lessons learnt were shared across the service to support continuous improvement. Policies and procedures ensured appropriate action was taken following incidents, including notifying family members and safeguarding authorities when required.

The provider had made significant improvements since the previous inspection and had addressed previous regulatory breaches relating to safe care and treatment, staffing, governance and fit and proper persons employed. During the assessment, we identified some opportunities to strengthen documentation, including recording the specific location of prescribed cream applications, reviewing a personal emergency evacuation plan within the provider's stated review timeframe, and further developing behaviour support plans

to provide more detailed, person-centred guidance. The provider responded promptly to this feedback and took action to address the areas identified. The concerns identified were minor, did not result in people experiencing harm. Staff demonstrated a good understanding of people's needs and risks, and people continued to receive safe, personalised care. This meant the provider had reflected on feedback, implemented improvements and sustained positive changes to support safe and effective care.

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. The provider ensured people experienced safe and effective care, treatment and support that was well coordinated within and across organisations.

People received care and support from a consistent team of staff who knew them well and understood their individual needs, preferences and routines. Relatives told us staff were reliable and communicated effectively, including informing them when they were running late. Care plans were regularly reviewed and updated to reflect people's changing needs and circumstances.

Where people had specific risks or may require support from external agencies, important information was readily available and could be shared promptly. For example, a detailed information profile had been developed for a person at risk of going missing, enabling key information to be provided quickly to relevant professionals if required.

Staff monitored people's wellbeing and acted on concerns appropriately. Records showed referrals were made to healthcare professionals when people's needs changed, and staff worked collaboratively with relatives and other services to support continuity of care. This included liaising with GPs and supporting communication about medicines and ongoing care needs. Relatives told us the management team responded quickly to requests and changes in care arrangements. This meant people experienced coordinated, person-centred care which reflected their changing needs and supported positive outcomes across services.

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.

Issues were identified quickly and staff followed the organisation’s procedures correctly and informed the registered manager without delay. The registered manager demonstrated strong oversight of safeguarding. They assessed concerns promptly, took proportionate action based on the level of risk, and made timely referrals to the relevant external agencies, including the local authority safeguarding team, health professionals, and the Care Quality Commission, to help prevent recurrence and promote people’s safety.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA). Relatives with the appropriate legal authority or advocates were involved in best-interest decisions where their family member lacked capacity to make specific decisions themselves. This meant people experienced care that protected them from the risk of avoidable harm and abuse and protected their right to live safely.

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.

People, and their relatives where appropriate, were involved in deciding how their individual risks would be managed and mitigated. Information about changes in people’s care needs was shared with staff so support could be changed to reduce any recurrences. Any risks were identified and recorded with guidance for staff on how to manage those risks. Staff used this information to work collaboratively with people, helping them understand identified risks and agree on practical strategies to keep themselves and others safe.

People were encouraged to express their views, preferences and concerns, and staff supported them to make informed decisions about how risks should be managed. For example, where someone’s health had deteriorated and their family believed they needed to explore the person being cared for in residential care.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risks associated with people's home environments were assessed and managed wherever possible. Where required, personal emergency evacuation plans (PEEP) were in place to provide guidance for staff in the event support was needed during an emergency evacuation.

This meant people were protected from avoidable risks and received care in an environment where equipment and support arrangements promoted their safety and wellbeing.

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.

Recruitment of staff was done safely and included relevant checks such as Disclosure and Barring Service (DBS) checks. DBS checks help providers assess the suitability of individuals for roles, particularly those involving vulnerable people. People received support from sufficient numbers of suitably trained and competent staff. Relatives consistently described staff as reliable and told us people were supported by a regular team who knew them well.

Staff received training appropriate to their roles and demonstrated a good understanding of the needs of people they supported. Relatives told us staff were competent in the safe use of equipment, including hoists, walkers and profiling beds.

Staff told us they felt supported within their roles and were able to seek guidance from the registered manager when required. If staff became unwell or unavailable at short notice, there were cover arrangements in place to ensure safe care would resume. This meant people received timely care and support, as staff worked flexibly to maintain safe staffing levels while the service actively addressed recruitment.

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.

The provider had systems and processes in place to reduce the risk of infection. Relatives told us staff followed good infection prevention and control practices whilst providing personalised care. For example, staff used separate towels for different aspects of personal care, helping to reduce the risk of cross-contamination and promote people's health and wellbeing.

Staff received training and had access to personal protective equipment (PPE) to support safe care delivery. Relatives told us staff followed infection prevention and control procedures and used PPE appropriately during care visits. Staff demonstrated an understanding of their responsibilities for maintaining hygiene and preventing the spread of infection. This meant people were protected from avoidable infection risks and received care in a safe environment.

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 who required assistance with their medicines had them appropriately administered in line with relevant legislation. Although people’s medicines were sometimes managed by the person themselves, or their relatives, the provider worked with people to ensure they had the necessary prescribed medicines available to them. The registered manager ensured people’s individual support plans specified exactly what support each person needed from care staff in respect of their prescribed medicines. Medicines audits were completed to identify any errors in recording, or with the timing of prescribed medicines given to people.

Staff received medicines training and understood their responsibilities in relation to safe medicines administration. We identified an opportunity to improve recording about the specific location where prescribed creams had been applied to strengthen documentation and auditing processes. We also identified a medicine which had changed to, ‘as required’ but had not been updated on the system to reflect this. This was rectified immediately by the provider, and people had still received their medicines safely, so this did not impact on the safe management of medicines. This meant medicines were managed safely and people received the support they required.