Silverdale Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to person centred care. This was because the provider had failed to ensure care was provided in compliance with current guidance in relation to supporting people with learning disabilities and care plans and assessments were not always up to date.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always have assessments in place completed by the provider despite living at the home for around 5 months. People and relatives were not always involved in assessment reviews. Assessment and care plan documentation was not always consistent and up to date. Where assessment documentation had been completed, consideration had been given to people's communication style. Where people had primary needs of learning disabilities, their needs were not always assessed in line with RSRCRC guidance. This meant that assessments did not always include maximising people’s outcomes in respect to areas such as their independence and living environment.

Staff told us care plans were not always up to date but they knew people well and knew how to meet their needs and manage risks to them. One staff member told us, “The care plans and risk assessments aren't up to date but we know people well so know what to do.” Staff also told us they did not always have time to read care plans and assessments and they were also not always in place when people were admitted to the home. Staff told us about people’s specific risks and how they would mitigate this risk. For example, they told us about people’s SALT assessed diets and how to support them with their mobility. The manager told us they would be reviewing all assessments and care plans as they knew they were not up to date. The manager told us they would be involving relatives in their assessments and would be prioritising people whose needs were higher first. The manager told us they would also seek professional input where needed.

People did not always have their needs assessed when they were admitted to the home. We asked the provider for copies of people’s assessments and they confirmed they had not yet been completed despite people living at the home for a number of months. However, care plans were in place to guide staff how to meet their needs. Checks in place to review the quality of the assessments and care plans were not always sufficiently robust to ensure documentation had been completed and remained up to date. Where people had primary needs of learning disabilities, their needs were not assessed in line with RSRCRC guidance.

People and relatives told us people received the support they needed to meet their needs. Relatives told us where people needed help to eat or support with their mobility, this was provided in line with their care plan. However, despite positive feedback provided by relatives, people with a learning disability were not always supported in line with ‘Right Support, Right Care, Right Culture’. People were not provided with person centred care in a home that complied with the guidance in that it did not provide a homely small scale environment. This was not compliant with RSRCRC and did not enable them the opportunity to promote their independence and improve outcomes for them in the most optimum way.

Staff knew people well and knew how to meet their needs. However, staff told us they felt less confident in meeting the needs of people living with learning disabilities as they had not had sufficient training. Staff or the management team were not knowledgeable around current learning disability guidance, ‘RSRCRC’ when supporting people with learning disabilities. Staff told us how they monitored people’s nutritional and fluid intake when needed in line with current guidance.

Systems were in place to monitor people’s weights, food intake, fluid intake and skin integrity. Concerns were escalated to nurses when identified by care staff and escalated to external professionals when needed. Records showed evidence of the provider working with health care professionals to ensure people’s health needs were met. Systems failed to ensure that the management team and staff were up to date regarding current learning disability guidance, ‘Right Support, Right Care, Right Culture’. This meant people did not always receive care in line with best practice in order to achieve optimum outcomes.

People’s documentation was not always up to date to provide accurate information regarding people’s current care and support needs. However, staff did know people well from informal information sharing and were able to safely deliver care to them. People with a learning disability were not always supported by staff who were confident with meeting their needs and had the knowledge to ensure they were meeting their needs in the most optimum way. Where people moved between services, information was shared between services. Concerns around people’s clinical needs were shared appropriately between care staff and nursing staff to ensure timely escalation of concerns.

Staff told us they did not have regular team meetings. The manager told us they had undertaken an initial team meeting and supervision for introductions but intended to make them more constructive going forward. Staff told us people did not always have up to date care plans and assessments in place. This meant information sharing between the provider and professionals may not always have been effective as information additional clarificaiton was required to ensure it was up to date and consistent. Staff engaged positively with other external professionals to ensure people received good outcomes. Staff were aware of escalation procedures and there was a positive relationship between care staff and nurses within the home.

Partners told us there were discrepancies in care documentation which meant information related to people's needs was not always accurate and up to date and required clarification. Partners were complimentary about the new manager and confirmed they had acknowledged the discrepancies and they were trying to implement changes to improve documentation at the home and improve consistency. However, at the time of the site visit, actions were still in place to review assessment and care plan documentation so this had not yet been addressed. Partners told us the provider shared information with them when needed. Professionals told us the provider had worked hard to ease transitions for people when they had moved into the home.

Systems in place to ensure care plan and assessment documentation was consisent and up to date were not robust. This meant people's assessments had not always been documented and where they had been, were not always consistent so were not always readily available to share with partners and other professionals. The provider could also not always be assured information that was shared with professionals regarding people's assessed needs was accurate and up to date. Team meetings had been minimal over recent months and there was no set frequency for them but the manager told us of plans to reintroduce these more formally. Information from health professionals was shared on a more informal basis via handovers and verbal communication. Systems were in place to ensure health professionals were involved when needed. Where health professionals provided input, we saw evidence in people’s communication records of feedback given. People had letters in their care files from professionals when needed along with other guidance documentation provided by external professionals.

People and relatives told us they were supported to access health professionals when needed. One person told us about an optician’s appointment that had been arranged for them. Relatives told us about referrals being submitted to Speech and Language Therapists (SALT) and other health professionals. People were supported by staff who knew when to escalate health concerns to nurses and external health professionals when needed.

Staff and the management team told us they escalated concerns around people’s health when needed and made referrals to health professionals when required. The manager gave examples of where referrals had been made to SALT, opticians, physiotherapists, Occupational Therapists and GP’s in order to ensure people received the care they needed. Staff knew about people’s physical health conditions and how to meet their needs. Staff were aware who had a learning disability but did not feel confident in their knowledge regarding how to meet the needs of people living with learning disabilities. Staff lacked knowledge of ‘RSRCRC’ guidance and how they could support people to live healthier lives, promote their independence and where possible reduce their need for care and support.

Systems were in place to monitor people’s clinical needs. People’s weights, nutritional intake, fluid intake and skin integrity were all monitored where needed and documented. Systems in place to check the quality of health monitoring were not always effective in ensuring any concerns were identified. Where care plan documentation was not always consistent with monitoring records, this was not picked up by any audits. For example, one person’s moving and handling plan indicated they required 30 minute checks but there was a 60 minute observation chart in place.

People and relatives told us people’s health had improved since living at the home. Relatives provided positive feedback regarding the care received and how this had impacted on people. However, despite receiving positive feedback from the relatives of people living with learning disabilities, there was a lack of meaningful goal setting in place to measure any progress made. This was not compliant with 'Right Support, Right Care, Right Culture' guidance which is centred on ensuring there is a stronger focus on outcomes for people.

Staff told us they monitored people’s clinical needs and escalated to nurses if they had concerns. Staff told us this included nutritional/fluid input, skin integrity monitoring and repositioning. Nurses told us they would review people where there were concerns and escalate further to health professionals if additional specialist input was required. Staff told us there was no goal setting in place for people with learning disabilities to their knowledge. The manager and nominated individual told us staff and nurses checked clinical monitoring but there were no specific audits in place to ensure oversight of clinical monitoring.

Systems in place to identify care plan goals and measuring outcomes were not robust and did not enable the provider to see where people were meeting their goals. These systems failed to ensure compliance with 'Right Support, Right Care, Right Culture' guidance in respect to best practice and focusing on people's outcomes. Some care documentation had goal setting sections in them but information that had been completed was not always consistent with goal setting and at times was more like guidance for staff how to meet people’s needs. Systems were in place to monitor people’s clinical needs. Staff escalated concerns appropriately and nurses and health professionals reviewed when needed to ensure appropriate actions were implemented to improve outcomes for people. However, quality checks of clinical monitoring was minimal which meant that any errors may not have been identified placing people at risk of harm.

People were asked for their consent by staff prior to delivering support, for example when administering medicines or providing personal care. People and relatives told us staff supported them in their preferred way and listened to their choices. People were supported by staff who knew them well and knew how to meet their needs and what was important to them. Where people lacked capacity to make decisions, staff supported them in their best interests.

Staff understood the principles of the mental capacity act. Staff told us they would make decisions in people’s best interests where they lacked capacity. Staff knew people well and knew their wishes and preferences. The manager told us staff asked people for consent where they were able to and if they lacked capacity, decisions were made in their best interests. The manager explained some people had lasting power of attorney (LPA) in place and if this was the case, decisions were discussed with their LPA and documented. The manager told us staff were encouraged to return to people later in the day if they initially did not consent. The manager told us, “It’s about initially giving people choice and the ability

Mental capacity assessments had been completed but were not always detailed and did not always fully evidence people’s active involvement. Best interests’ meetings had been documented on occasions and there was some evidence of relatives and relevant professionals being involved. However, we found some examples where best interests meetings had not been undertaken when needed which meant decisions may not have been made in people’s best interests. Systems in place failed to identify where there were gaps in mental capacity assessments and best interests’ documentation.