Silver Birch 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 Requires Improvement. At this assessment the rating has remained Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation related to safe care and treatment, because the provider had failed to ensure service users safety through risk assessment and audits of the environment. This meant that some potential risks to people were not managed safely.

This service scored 62 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and report safety incidents. Incidents were not always investigated, and lessons were not always learnt to identify and embed good practice.

Whilst the service had made improvements in some areas of auditing since the last inspection, the service had failed to identify risks relating to the premises which could pose a significant risk of harm to service users.

Systems were in place to review accidents and incidents. These were analysed for themes such as falls and identified how incidents could be reduced and risks mitigated.

Records from team meetings were in place to show how learning was shared with staff.

Daily handover meetings enabled staff and the registered manager to maintain oversight of the service and be informed of any recent events. Where needed duty of candour, which is the provider’s legal responsibility to be open and honest with people when something goes wrong, was considered and outcomes shared with relatives. There was a complaints policy in place.

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 had systems and processes to support safe admissions and transfers of care. People were assessed by the registered manager, to ensure they were able to meet people’s needs before moving to the service.

Staff were informed of people’s needs through care plans and handovers. A person told us “They [staff] came to visit me in hospital first to check they could look after me.” Another told us “They [staff] take me to all my appointments at the hospital and doctors, I get all the care I need.”

Healthcare professionals confirmed staff were proactive in making referrals. They told us the service listened to and followed any recommendations about people’s healthcare requirements.

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 in accordance with their legal obligations.

Staff received training in safeguarding and the Mental Capacity Act. These areas were discussed in meetings and supervisions to check staff understanding and to enable staff to share any concerns.

Staff understood how to recognise and respond to allegations of abuse. A staff member said, “I have regular safeguarding training, and we talk about keeping people safe in staff meetings. If I have any concerns, I would go to the manager or owner.”

Staff also knew which external agencies they could share their concerns with. The registered manager understood how to respond to allegations of abuse, and notifications were shared with relevant agencies.

Safeguarding information was displayed for everyone to access in the reception area.There were appropriate policies to guide staff including a whistle-blowing procedure.

People told us they felt safe in the service. A relative told us, “I trust them (staff) all with [Name of family member’s] care. I feel happy that they are taken care of and safe. I can relax when I leave knowing [Name] is safe."

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems to audit and ensure care plans and risk assessments were up to date. They contained sufficient guidance for staff to support people with their risks effectively when providing care and support. However, the provider had failed to identify some environmental risks. For example, people living with dementia were able to walk around the home and could easily access restricted areas of the building which may present a risk of harm. The risk assessments did not include details identifying environmental risks such as open doors and how the risk would be managed for that person.

Staff told us they had cared for people for a long time and would let management know if there was a change to someone’s needs. A staff member said “We have regular reviews of the care plans and risk assessments. We know how people like to be supported”

Risk assessments considered people’s physical and mental health needs and showed measures to manage risk were as least restrictive as possible. The provider was in the process of transferring to a new electronic record system to enable staff, service users and their loved ones have better access and oversight of the care plan and risk assessments.

Most people and relatives told us they felt they and their loved ones were supported to manage risks well.

The provider did not always detect and control potential risks in the care environment. They did not make sure that facilities and the environment always supported the delivery of safe care.

During our assessment we observed a lack of window restrictors throughout the premises which is a legal requirement. Doors which should be locked containing electrical equipment and chemicals were consistently open. We found some rooms had radiators without covers in communal areas, this meant people were at risk of burns if they became too hot.

We saw infection control stations located throughout the service which had large bottles of hand sanitiser which were not labelled and secure. This meant that people with Dementia could open and ingest the chemicals. Whilst we are aware that there had been no reports of this, no assessment of risk had been completed in either environmental or individuals risk assessments

We shared all of these concerns with the management team who took immediate action to address these risks and most of this work had been completed by the end of the assessment.

We saw the home was clean and maintained to a good standard. People had the equipment they needed to support their mobility and safety.

Records demonstrated staff had received the required training to ensure they provided safe care.

Most people told us they were happy with their living environment and their bedrooms.

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 received support from a consistent staff team. This ensured people were able to build trusting relationships with staff who knew their needs well. Training ensured the care skills of staff met people’s support needs.

Staff received good quality training in all areas relevant to their role. This included additional training in specialised health conditions such as Parkinson’s, Diabetes and end of life care. Management also conducted regular observations of staff practice to ensure learning and good practice was being embedded.

Staff had completed nationally recognised qualifications in health and social care, including the Care Certificate, which encouraged them to provide safe and compassionate care.

Staff received regular on-going supervision which monitored staff wellbeing and identified possible learning needs.

Staff told us they felt supported by the management team.
Senior staff used safe and effective recruitment and selection processes to recruit new staff into the service. We saw evidence of enhanced Disclosure and Barring Service checks (DBS) These are checks where employers can check the criminal record of someone applying for the role.

Full reference checks of previous employment were carried out and there was a detailed induction policy and programme for new starters.

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.

An infection prevention control policy was in place to guide staff. Staff completed infection prevention and control training as part of their induction and refreshed at regular intervals. Cleaning schedules were completed to demonstrate what areas had been cleaned including when certain areas were deep cleaned.

Systems were in place to support safe infection control practices. Audits and regular checks were undertaken to monitor the standards within the home. We saw posters displayed to guide staff and visitors on how to wash their hands in accordance with best practice.

Staff told us they always had access to personal protective equipment such as gloves and aprons. The management team told us they completed spot checks to ensure staff worked in line with infection prevention and control principles. Domestic staff had a good knowledge of infection control procedures.

We saw the home was clean, tidy and uncluttered. The décor was generally well maintained as were the gardens.

People and relatives told us the home was clean. One person said, “My bedroom is cleaned daily, the cleaning staff are very good.” Another person said, “The staff wear gloves and aprons when they support me in the bathroom."

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.

At the last inspection the provider had failed to ensure the proper and safe management of medicines. At this inspection, we saw the provider had made robust changes to ensure the management, storage and administration had been significantly improved.

People were supported by trained senior care staff who followed systems and processes to administer, record and store medicines safely. Staff made sure people received information about medicines in a way they could understand. We observed staff wearing a medication tabard during administration times so people could clearly identify who the responsible person was on shift for medication.

Staff followed effective processes to assess and provide the support people needed to take their medicines safely. Considerations were given when medicines needed to be taken before or after food, or when medicines had specific dose intervals.

Staff were seen to be caring when a medicine round was observed.

The GP and pharmacy reviewed each person’s medicines regularly to monitor the effects on their health and wellbeing and give advice to people and carers about their medicines.

People who had prescribed medication to take as ‘when required’ (PRN), had clear medicine care plans which gave staff sufficient information to support people when administering required medicines. For example, clear instructions for staff supporting someone living with dementia unable to verbally communicate when they required pain relief.