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 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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 told us they felt safe and knew who to speak with if they had any concerns. One person said about the alertness of the staff, “The buzzer [call bell alarm / pendent] is my friend, they [staff] come very quick, all the same – morning afternoon, evening, especially good at night they pop in and check on me.” Relatives told us they felt their family members were safe and they knew they could speak with seniors in charge or management if they had any concerns. One relative shared, “They [management] are happy to have criticism. We had some issues. Seen the deputy twice as one agency staff had no empathy and was impatient [when supporting family member]. I asked for that person to be trained, but I have never seen that person again.” Management confirmed that swift action was taken including agency staff not returning to the service if quality of care standards were affected. We observed respectful, kind and meaningful interactions between staff and people. Staff understood how to keep people safe and the procedures to follow if they suspected abuse or harm. A member of care staff told us, “If I suspected abuse or harm was happening, I would follow the safeguarding procedures by reporting my concerns immediately to my manager or the designated safeguarding lead.” Staff had regular team meetings and supervision sessions which included discussions around safeguarding. The service had an up-to-date Safeguarding and Whistleblowing policy in place which staff were familiar with. Safeguarding concerns were logged, investigated, reported to relevant stakeholders where applicable and reflected actions and outcomes once concluded.

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. We observed staff following safe practices. They were attentive and responsive to people’s individual needs. People told us they felt comfortable and secure living at the service and were involved in managing their care risks where possible. One person said, “I like almost everything here, all my needs are met. I had a fall in my bedroom, rang the bell, nurse came within 5 minutes put a plaster on it and took a photograph of it.” A relative shared with us the mitigating actions to safely support their family member who was at risk of falls and living with dementia. This included a referral to the falls prevention team; regular welfare checks by staff and the use of specialist equipment to alert staff of movement. The relative said management, “Got unassisted movement aids [ sensor mat], got a crash mat, armchair alarm and wheelchair alarm” in place for family member. Staff understood the risks to people and said they were kept up to date with changes in people’s needs, through daily handovers and meetings with the management team. Care records provided information on people’s individual needs and preferences which enabled staff to provide care safely. Staff identified, monitored and responded to risks to support people to live their lives in the way they wanted. Risks to people’s health, safety and welfare were managed through assessments that were person centred, regularly reviewed and involved the person when able, relatives or advocates in decision making. Where referrals had been made, any advice or recommendations given, for example using specialist equipment were recorded and incorporated into the individual’s ongoing care arrangements.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

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. Staff were recruited safely, received training and supervision to assist them in their professional development. New starters received an induction to prepare them for their role and feedback about this was positive. One staff member staff said, “The training I had was relevant to my job, mostly online with some practical.” Several staff said they would like further training in end-of-life care, fire safety including what to do in an emergency and face to face training in de-escalation strategies to support people safely with behaviours that may challenge. The registered manager advised that refresher training in fire safety and workshops in de-escalation were currently being rolled out with a completion date of March 2025, records seen confirmed this. They added they would look into arranging further support and training for staff in end-of-life care. The registered manager used the provider’s system for determining staffing numbers, which was based on people’s needs. Staff rotas were compiled in line with this information taking into account annual leave, sickness and agency use.Feedback from people and relatives over staffing numbers varied. Most people said there were enough staff to meet their needs and requests for assistance were responded to in a timely manner but that the service relied on agency staff who did not always know people’s needs as well as the permanent staff. One person talking about their experience of personal care assistance said, “I thought I would have the same person, not different faces but I get whoever is free.” Another person shared. “Staff are changing all the time, with sickness and holidays there is bound to be change, they are very busy.” A relative said that the service, “Was very good, not perfect, weekend routines are different, home is quiet [no activities staff] no management at all. Weekends can be erratic with not so many staff.” Another relative shared, “99% of the time they have enough staff unless they get agency, they are not the same quality. [Family member] is safe, on the dementia floor people have more needs but staff steer them very well and [family member] is in the right place.” The management team advised they were taking steps to address the inconsistencies raised around staffing through recruitment of additional care staff and also activity staff to support both group and 1:1 activity provision within the service. There was mixed feedback from staff regarding staffing arrangements, some staff said there were enough numbers to meet people’s needs and shifts were well organised and they had no concerns, but some staff felt they were understaffed and overstretched. One member of staff said, “Lots of agency use that adds to the workload as your having to show them what to do. It depends on who is running the shift how your day will go. Some seniors and nurses are fair, communicate well and make sure everyone pulls their weight, and others have their favourites and then it is a stressful shift.” Overall staff said that management were visible in the service, but some staff said they could be more involved in assisting colleagues and that some shift leaders did not always utilise the management and flag up when the teams were struggling and could benefit from the additional support. The provider was taking steps to address workforce challenges such as staff turnover and retention through active recruitment, improved staff benefits and career progression. The registered manager confirmed reliance on agency use was decreasing with several new starters including care and activities staff due to commence their employment. We did not find any quality care issues or people’s needs not being met during our site visit. We observed that staff were visible in the service, responding to people’s needs promptly, efficiently and adapted their approach to meet individual’s needs. Overall the feedback received from staff was mixed regarding staffing numbers and deployments. Leaders and the provider were aware of these concerns and were working to improve this.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in their care arrangements including when changes in needs happened. One person who had recently fallen and was being monitored by staff shared, “Staff keep an eye on my bruise and take photos, I have to take a lot of meds, none been missed and none been late.” Staff were aware of how people needed to be supported with their medicine including those who had time specific medicines which was prioritised. We observed staff practice, and this followed safe practices laid out in national guidance. Staff explained people’s medicines to them, saying what they were for and ensuring a drink was to hand to assist with swallowing. Staff received medicines training, both theory and practical together with ongoing checks on their competencies to ensure safe practices. Medicines were regularly audited by the registered manager and provider to ensure practices were as safe as possible. Records showed that high risk medicines were given at appropriate times, courses of antibiotics were administered as the prescriber intended and staff liaised with the mental health team to explore non-pharmacological interventions alongside medication when managing anxiety.