Silvermere 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 72 (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.

Accidents and incidents were recorded by staff. When concerns arose, staff took action to ensure people were safe. All incidents were reviewed by the senior management team with clear actions to reduce further risks to people. For example, where 1 person had fallen, their care plan was updated to reflect the risk and guidance was that staff were to now accompany the person when walking. They were also referred to the GP who requested that the person’s eyesight was checked and blood pressure reviewed for the week. One relative told us, “(Family member) had a fall a few weeks ago, they contacted me, and I arrived at the same time as the paramedic.” They told us they felt staff managed the incident well.

Accidents and incidents were reviewed for trends every month to continually improve the service. For example, de-briefing for staff took place following incidents to address the concerns and look at what could have been done better. Analysis of the incidents included looking at the person’s health, time of day the incident occurred and the deployment of staff.

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.

People’s needs were assessed prior to moving into the service. People, their relatives, staff, and health professionals were involved in facilitating the move, to maximise a successful transition into the service. People had the opportunity to visit their home and meet staff to ensure they were happy with their decision prior to moving in. Comments from people included, “I came and visited here. They made sure they got to know me” and “I was in hospital, and the deputy manager came to Epsom and talked to the staff there and talked to the hospital staff to make sure they got all the information.” A relative told us, “Before (person) went in the manager went to our home, lots of questions to build care plan.” When people attended health appointments, they were supported by care staff who knew them well.

Staff told us before a person moved in; they were given information about the person’s needs. One member of staff told us, “We get firsthand information about a person’s care needs before they move in and the chance to read information from their previous place. We are told important information such as skin integrity.”

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.

People communicated with us that they were happy and felt safe. One relative told us, “I feel he is safe, staff know what they are doing.” The manager and staff understood their role and responsibilities to safeguard people from abuse and had taken appropriate actions to address allegations of abuse in the service. This included raising safeguarding alerts to the local authority, undertaking investigations and notifying the CQC. Comments from staff included, “I am always communicating with the managers and if something doesn’t seem right, I would let them know” and “We always have to report bruises or skin tears. I have no concerns about any safeguarding issues here.” Safeguarding was discussed in staff supervision and team meetings, and staff were reminded where to locate the safeguarding policy and procedures.

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 relatives felt the risks associated with their care were managed well by staff. Comments included, “He has had skin pressure on bottom of back, I like him to be out not just lying in his room…the new deputy is fantastic, we have been able to talk about things like this” and “She has always been a good eater, she now has food she can eat with her hands, at the moment she is maintaining or possibly putting on a bit of weight.”

There was a proactive approach to involving people and their families in managing risks to their health and in enabling positive risk taking. If people wanted to take risks, they were supported to do so. For example, one relative told us, “Two months ago (person) rolled out of bed onto the floor. We had a discussion and manager said we don’t used rails and wondered about a floor bed. She likes sitting on the side of the bed and also getting out independently and a floor bed would prevent this. She hasn’t fallen out again.”

We did observe that 3 people’s pressure mattresses where not always set to the correct weight of the person. This reduced the effectiveness and placed people at increased risk of developing pressure sores. We raised this with the manager who immediately addressed this. They confirmed they had increased the monitoring of this. They provided evidence of notices that had been placed on the machines to remind staff to check them. Staff had a good understanding of the risks people faced and how to provide support to people. Risk assessments were reviewed regularly with people and their relatives. They were updated to reflect people’s changing needs, and staff followed the measures in place to support people safely.

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

People benefitted from an environment that was adapted to suit people’s individual needs. The flooring throughout was clean and free from obstruction. Window restrictors were in place and functional, both in communal areas and in people’s bedrooms. There were adaptable showers and bath equipment for people so those using wheelchairs could bath or shower.

Records showed that health and safety checks were carried out regularly. These included electrical installation, gas safety and water management. Care equipment such as moving and handling aids were serviced and records of maintenance kept.

The service had ensured all actions had been taken to safely evacuate people in the event of an emergency including personal emergency evacuation plans (PEEPs) in place to guide staff to support people to leave their home safely. Fire drills, to check staff had the practical skills needed, had taken place with all staff. The service had ensured that people had the equipment in place to safely evacuate them in the event of a fire, and there was clear and appropriate signage to the fire doors and exits.

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.

People felt there were sufficient staff at the service and said staff were deployed well. Comments included, “I might call the bell sometimes and they come quickly”, “(Staff are) always in communal areas. When I am in my bedroom, I will press a button and they will come” and “I wave someone down to move elsewhere, and I don’t have to wait long.”

We observed there were sufficient staff to support people during the day. During lunch we observed people received the support they needed without being rushed by staff. Staff told us there were sufficient staff on duty. One told us, “We have more than enough staff. If a staff member calls in sick, we have enough of our own staff to call up for cover. If there’s no one available, then we call agency staff.” Rotas showed there were always the correct numbers of staff on duty.

Staff were provided with appropriate training and supervisions. The manager told us training was ongoing and any additional opportunities for specialist training would be provided. One member of staff told us, “They give you a lot of training here. Mangers monitor the training as well and will remind you if any training that has not been completed. There is enough training in place, so I have never had to ask for anymore.” We observed supervisions were an opportunity for managers to talk through any development needs for staff as well as discussions around good practice.

Controls were in place to ensure staff were recruited safely; all the necessary checks had been carried out and their documents were up to date.

The provider did not always proactively manage the risk of infection.

During the visit we did identify that where people had urinary incontinence, their mattresses had not always been cleaned appropriately on 1 floor. We raised this with the management team on the day, and this was addressed immediately. They also followed up with an action plan to mitigate further risks.

However, people and relatives felt the home was clean and well maintained. Comments included, “We spent time looking at homes, cleanliness was one of the things we liked, it is still good” and “Staff wear PPE (personal protective equipment) all the time. They are very careful about gloves.” The remaining environment appeared clean and tidy and there were no malodours on the other floors. The sluice rooms were clean and tidy and the items on rack looked clean. The laundry room was set up well to ensure good infection control. We saw staff cleaning the service throughout the day. One person had an accident in the corridor and staff immediately got the carpet cleaner to clean the carpet.

Staff had received infection prevention and control training (IPC) and were familiar with the IPC processes to mitigate infection risks.

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 told us they received their medicines when needed. One relative told us, “(Person) wasn’t sleeping well and was wandering at night, now on medication and this is improving.”

People’s medicine records were digital and were detailed with how they wanted to be supported to take their medicines. One member of staff told us the system was easy to use, and it alerted them if anything had been missed. Medicines were stored safely, in a secure, temperature-controlled environment and medicines were disposed of safely as required and in accordance with the provider’s policy. When people were prescribed “as and when” medicines, for example, pain relief, there was information for staff about these, such as what they were for and when they should be offered to people. There was also information for staff to help them identify when people were in pain, when people could not express this.

Medicines were reviewed when required with people, the GP, and other health care professionals involved in their care. The medicine rooms were clean and well-organised. The medicines trolley was clean, and each person’s medicines were in individual labelled boxes.