Silverdale Nursing Home

Silverdale Nursing Home is a care home providing personal and nursing care for up to 27 people in one adapted building. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

Medicines were not always administered safely. Where people’s medicines had not been signed for as administered, staff did not always escalate this as soon as they could. Protocols for as required medicines were not always consistent with how people’s medicines were prescribed. People’s diverse needs were not always considered in full in line with the Equality Act 2010. Regular staff supervision had not yet been implemented to ensure oversight of staff competency. People and relatives told us they were not always asked for feedback regarding the home and were not always kept up to date with changes. The provider did not always share information with other agencies. Audit systems were in place, but documentation was not always completed in full to show where actions had been addressed.

Relatives told us people were safe. Systems were in place to manage accidents and incidents and there had been a reduction in reported incidents at the home. People were supported by staff who knew how to keep them safe and who had completed safeguarding training. Risk assessments were followed by staff and there was clear oversight of clinical concerns. People were supported by staff who had been safely recruited. Environmental improvements had been made at the home to prevent the spread of infection and staff complied with infection prevention and control policy. Where things went wrong, action had been taken to reduce the risk of reoccurrence.

People’s assessments were personalised and included their life stories. People were supported by staff who were knowledgeable and were provided with enough training opportunities. People’s mealtime experience was positive, and they were provided with choice of meals and drinks. People’s dietary needs were met in line with their care plans. The home had been adapted to make it more suitable to meet the needs of people living with dementia. People’s health needs were monitored, and referrals were made to health professionals when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring to them. People were supported by staff who promoted their independence and enabled them to do what they could for themselves. Staff supported people’s privacy and dignity.

People were given choice and control and their care was delivered in a person-centred way. People had communication care plans in place and staff communicated with them in a way that maximised their understanding. People were encouraged to engage in a wide range of activities of their choice. A complaints policy was in place that was followed. Where people were at the end of their life, their wishes had been discussed and recorded.

The provider worked closely with commissioners and health professionals to improve the quality of care provided. Systems in place for staff deployment ensured an appropriate number of suitably skilled staff worked on each shift. The manager and staff were clear about their roles and responsibilities. There was a positive culture at the home that promoted positive outcomes for people and staff told us it was now a much better place to work.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 14 June 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 14 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silverdale Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silverdale Nursing Home is a care home providing personal and nursing care to up to 27 people in one adapted building. The service provides support to older people some of who are living with dementia. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

People were not safe and were not protected from abuse. Accidents and incidents were inconsistently managed and safeguarding referrals were not made when they were needed. Risks to people were not always assessed and were not reviewed when needed. People’s clinical needs were not managed safely. Medicines were not stored safely which may have affected their efficacy and placed people at risk. The home was unclean and poorly maintained. Infection prevention and control practices were insufficient to keep people safe. Where things went wrong, no action was taken to address it and mitigate risk to people.

People’s current needs were not fully assessed, and their diversity was not explored. People’s assessments were inconsistent, and it was unclear how their assessed needs had been determined and whether there had been professional input. People were supported by staff who were not adequately trained to meet their needs and had little support to ensure they were competent. People were not supported to eat and drink in a way that met their dietary preferences. People had experienced a significant amount of unintended weight loss, but no action had been taken to address this. People were not supported to access health professionals in a timely manner which placed them at risk. The home had not been adapted to meet the needs of people living with dementia.

People were not treated with dignity and were not well treated. People were supported by staff in a task centred way that failed to respect their individual needs. People were supported with some personal care tasks with the door open which did not maintain their privacy. People were not supported to be involved in their own care and express their views.

People were not given choice and control and involved in planning their own personalised care. Care was delivered in a task centred way. People’s care plans were not always current and were inconsistent which meant staff did not have clear guidance to follow to meet people’s needs. People were not always supported by staff who communicated with them effectively. People felt isolated and were not supported by staff who engaged positively with them. People were not encouraged to participate in activities of their choice. A complaints policy was in place but where a complaint had been made, this had not been followed. People’s end of life care needs were not consistently considered.

There was little management oversight at the home. The home had a poor culture and some institutionalised practices remained in place. Staff and the registered manager were unaware of their roles and responsibilities which placed people at risk. Systems in place to check the quality of the service were minimal and failed to identify concerns meaning they were not addressed. Systems in place to monitor accidents and incidents were inconsistent which meant that risk was not managed effectively. The provider failed to seek feedback from people at the home, their relatives and staff to improve outcomes for people. The provider and registered manager did not engage in learning to improve the quality of care. The provider did not work positively with other agencies and failed to submit mandatory COVID-19 data when required.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about how risks were being managed at the home and concerns around people being unlawfully restricted. A decision was made for us to inspect and examine those risks. We initially intended to undertake a focused inspection to review the key questions of safe, effective and well-led only. However, due to concerns we identified during inspection, we undertook a fully comprehensive inspection and reviewed the key questions of caring and responsive.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken some immediate action and has given assurances that steps have been put in place to mitigate immediate risk to people. The provider immediately implemented a fire safety induction for agency staff at the home and all staff were provided with fire safety cue cards which guided them how to respond in the event of an emergency. Rotas were also amended to ensure that all shifts had staff allocated to them who were trained in fire safety. A rota was also put in place to provide management cover to ensure that one of the consultants or management from the provider’s other home were overseeing the location each day. The provider has given us assurances that they will contact CQC immediately if there is any intention for the consultants to no longer be supporting the home.

Enforcement

We have identified breaches in relation to people’s safe care and treatment, safeguarding, obtaining people’s lawful consent, treating people with dignity and respect, supporting people to eat and drink, the home environment, management oversight of the home and having competent and well trained staff who can meet people’s needs safely.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection the service was rated as requires improvement. We found the provider was not meeting all the requirements of the law. The provider had not ensured that people’s medicines were managed safely. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to ensure they were meeting the regulations. During this inspection we found that the provider had done what they said they would do and were no longer in breach of regulations.

Silverdale Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Silverdale Nursing Home accommodates up to 27 people in one adapted building. At the time of this inspection there were 24 people using the service.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from avoidable abuse and harm by trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were managed safely and were kept clean and tidy. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Medicines were now managed safely, following improvements to the systems in place. The registered manager had systems in place to learn when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported by trained staff and received effective care in line with their support needs. Staff received regular supervision and had access to continuous training. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. The environment was designed to support people effectively. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices. People were treated with dignity and respect by staff who knew them well.

Staff understood people and their needs and preferences were assessed and regularly reviewed. Activities were organised by staff and people were supported to participate in activities that they preferred. People's diverse needs were considered as part of the assessment and care planning process. Complaints were managed in line with the provider's policy. People were supported to consider their wishes about their end of life care.

A registered manager was in post and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback that was acted upon. We found the registered manager and provider had systems in place to check on the quality of the service and used this to make improvements.

At our inspection in February 2016 we had serious concerns that people who used the service were not safe and the service was not well led. We had rated the service as 'Inadequate' and placed it into special measures.

At our last inspection in July 2016 we judged the service was still not meeting the required fundamental standards of care. We had continuing concerns regarding the safety of people who used the service. The service remained in special measures as we judged the overall rating of the service as Inadequate.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We worked closely with the provider, local authority safeguarding team and the commissioning department at the local authority to ensure people were provided with an improved service and their safety and welfare was ensured.

During this inspection 7 and 8 February 2017 we saw improvements had been made to ensure people were provided with a safe, effective, caring, responsive and well led service. The provider had reviewed the internal management team and changes had been made. We judged sufficient improvements had been made; no areas now had an inadequate rating so the service will no longer be in special measures. However, we will continue to closely monitor and review the service to ensure further improvements are made and people are provided with a safe service.

Silverdale Nursing Home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 14 people used the service.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements were needed to ensure that medicines were managed safely and effectively.

People were supported with their daily nutritional requirements, however one person's specific nutritional requirements was not always provided.

Staff were aware of the action they should take where they had concerns regarding the safety of people. Appropriate action was taken when allegations of abuse and concerns with people’s safety were identified.

Sufficient staff were available to keep people safe and meet people's care needs in a timely manner. Staff had training opportunities to acquire the knowledge and skills necessary to meet people’s individual care and support needs. Recruitment and vetting procedures were in place that ensured appropriate people were employed.

Risks to people's health and wellbeing were identified, assessed and reviewed to ensure the actions needed to mitigate the risks were recorded and the risks were minimised.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA and Deprivation of Liberty Safeguards (DoLS) when they provided support.

People were supported to access other healthcare professionals to maintain and improve their health and wellbeing.

Staff showed care and kindness towards people who used the service. Improvements had been made to ensure people's rights to privacy and dignity were upheld.

There was a range of daily activities arranged for people to enjoy. People were offered the choice of whether they wished to participate or not and staff respected their choices.

The provider had a complaints procedure and people knew how and who to complain to.

Systems were in place to monitor the quality and safety of the service had improved but further improvements were needed. Changes had been made to the internal management structure of the service, which provided leadership and guidance for staff to deliver an improved service for people.

At this inspection we found that some improvements had been made to respecting people’s privacy and dignity, and safeguarding people from abuse but further improvements were needed. We continued to find insufficient suitably trained staff to keep people safe and the systems the provider had in place to monitor the quality of the service were ineffective. There were also concerns with gaining people’s consent, the safe care and treatment of people and the recruitment processes.

The overall rating for this service is Inadequate which means it will remain in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Silverdale Nursing home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 25 people used the service.

The service does not have a registered manager. A person had been recruited into the manager’s position but they were not registered with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with all knew what constituted abuse and told us they would report it if they suspected abuse had taken place. However allegations of neglect were not always investigated.

Risks to people were not always minimised through the effective use of risk assessments. There were insufficient suitably trained staff to keep people safe and meet people's care needs in a timely manner.

Staff did not always have the knowledge and skills required to meet people’s individual care and support needs. The provider did not have robust recruitment and vetting procedures. Staff did not always have the induction, training and supervision they needed.

People did not receive care that was personalised and reflected their individual needs and preferences.

The principles of the Mental Capacity Act 2005 were not followed to ensure that people were consenting or being supported to consent to their care and support.

Care was not always personalised and did not meet people's individual needs. Advice was not always sought from other professionals to ensure everything possible had been done to mitigate the risks of people coming to harm.

People's medicines were not managed or stored safely.

Some leisure and social activities were provided, but not all people got the support they needed to engage in any meaningful activity. People’s right to privacy and dignity was compromised.

People knew how to complain but complaints were not always managed appropriately.

Systems in place to monitor the quality of the service were ineffective. No improvements had been made since the last inspection.

The provider was not notifying us routinely of safety incidents that occurred at the service.

Silverdale Nursing Home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 27 people used the service.

The service had a registered manager. However, the person currently named on our register was not the same person who was now managing the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not always protected from the risk of abuse as some staff were unaware of the actions they should take. Some unexplained injuries had not been identified as potential abuse; they were not reported or investigated.

Staff did not always receive the training they needed to be able to support people in a safe or effective way.

The provider did not have effective systems in place to assess, monitor and improve the quality of care.

Some leisure and social activities were provided, but not all people got the support they needed to engage in any meaningful activity. People were not always treated with dignity and compassion and their privacy was not always promoted.

People generally told us they enjoyed the food and had enough to eat and drink. The mealtime experience could be improved to ensure it was an enjoyable experience for all people.

People's medicines were managed safely, and people received their medicines in a timely way.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

People were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

The provider had a complaints procedure and people knew how and who to complain to.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People who used the service and their relatives told us they were happy with the care. One person told us, 'I love it here, I'm happy. I've been here years'. One person's relative told us, 'X seems very happy being here. I've got no concerns about them at all'.

At a previous inspection completed on 06 October 2013, we identified areas of non-compliance against the regulations we inspect against. We asked the provider to provide us with an action plan of how they would ensure that people were protected against the risks of unsafe administration of medication. During this inspection, we checked and found that improvements had been made. There was adequate information within people's medication administration records (MAR) and their care records to indicate that they required their fluids to be thickened. We noted that the provider kept accurate records of people's medication quantities. This meant that people were protected from the risks of unsafe administering of medication.

The provider had robust recruitment procedures in place to ensure that people were cared for by suitably qualified staff. There was an induction programme in place for newly recruited staff to ensure that they received the necessary training to support them to provide care to people in a safe manner.

Is the service effective?

People's care records were person centred and the provider ensured that people's relatives were involved in ensuring that staff had necessary information about people's wishes and preferences in order to provide them with effective care The provider used a 'Getting to Know you' document. This document was given to relatives to provide staff with as much information as possible if the person could not do this themselves.

We saw that staff always explained to people what they were about to do before they engaged in any planned activities with them. We observed a doctor carrying out physical health checks on some people who used the service in response to concerns raised by the staff. We noted that he took time to explain to the people what he was doing.

Relatives of people who used the service told us that care staff always kept them informed of any concerns relating to their relatives. One relative said, 'They're quite proactive in doing things and telling me what they've done'.

Staff members we spoke with told us that they were well supported by their managers. We saw that staff had regular supervision and training to ensure that people received effective care.

Is the service caring?

People were supported by kind, attentive and friendly staff. All the people we spoke with told us that they were happy with the care and treatment provided. One person we spoke with said, 'I can't fault them. The doctor's always asking if I'm alright and if X (her son) if alright'. A relative of a person who used the service said, 'I've always felt that the staff here have provided good care for my mum'.

Staff we spoke with told us they enjoyed caring for the people who used the service. One staff member said, 'I love it; I'm happy doing this job. It's a nice little home; it's friendly'.

A social worker told us that staff were very caring and very supportive. The social worker told us how the carers had supported of a couple who were initially apprehensive about receiving care and support. The social worker said that care provided had been a very positive experience for the couple. The relative of the couple told us that, 'We're very impressed with the care'.

Is the service responsive?

The provider ensured that a full assessment of people's needs and support plan was provided by a social worker prior to their staff going in to complete their own risk assessments and management plans.

The service worked well with other agencies and services to make sure care was joined up and effective. We saw records to demonstrate the involvement of other health and social care professionals in the care of people.

Staff were able to describe to us what actions they would take to manage people who presented behaviours that were challenging or in response to people's anxieties. One staff member told us, 'Sometimes, when people get a bit stressed, we bring them here (the relaxation room) to relax them. It's very calming'.

Is the service well led?

We saw that the provider had systems in place to regularly monitor the quality of services being provided. We saw records that people's care records were reviewed and updated as their needs changed.

Relatives and staff told us that the manager was approachable and they would go to her if they had any concerns. A relative of a person told us, 'The business manager is very approachable and you can talk to him about anything.

We noted that the provider obtained the views of people and their relatives, and acted on concerns raised.

We saw that where appropriate people's consent for their day to day care and support was sought by the staff. We saw that where people were unable to consent, best interest decisions were made in accordance to legal guidelines.

We saw that staff received appropriate training to enable them to meet people's individual needs and provide compassionate care in a responsive and timely manner.

We saw that effective systems were not in place to keep people safe from the risks associated with medicines. Medicines were not always kept secure and accurate records were not always in place to demonstrate that people received their medicines in a safe and effective manner.

We saw that people had support plans which were updated to reflect their changing needs and there were written records to demonstrate that people's conditions were monitored as advised by healthcare professionals.

We looked at the way that the service provided care to people with dementia and saw that staff provided them with kind and sensitive support that met their individual needs. One relative said ''The staff are wonderful and look after people with dementia well''.

We spoke with staff about the care and support they provided and they all had a good understanding of people's daily lifestyle needs and preferences.We saw that care plans were in place that detailed a person centred approach to needs.

We were told by relatives and visitors the home was always clean and people looked well cared for. One person said that 'staff go that extra mile and always make sure X's clothes match'.

We spoke with people about their understanding of safeguarding people from abuse. Staff spoken to had a good understanding of the safeguarding principles. Staff said that they had received training in safeguarding. Relatives spoken to said they would tell the manager if they had any concerns.

We saw that staff were present in all areas of the home and were quick to respond to calls for assistance.