Silverdale Nursing 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 legal regulation in relation to staffing. This was because the provider had failed to ensure that staff were adequately trained and competent to meet the needs of people with learning disabilities.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they felt safe and they thought risks were addressed. However, some concerns were shared regarding the changing direction of the home in respect to how staff would be able to meet people’s differing needs. One relative told us they were concerned about how the provider would manage risk if they continued to admit people with learning disabilities. People were able to make their own choices and decisions and were supported by staff who gave them information regarding their health. However, people were not always supported by staff who felt confident when supporting people living with learning disabilities which may have placed them at risk of harm.

Staff told us learning was shared in handovers so they felt they knew how to keep people safe. However, they told us staff meetings were infrequent so this was not always an appropriate forum in which to share learning in a timely manner. The manager and nominated individual acknowledged there had been some incidents that had occurred that had not been reported to the local authority safeguarding team. Therefore, they could not be assured they had learnt from these incidents. Staff told us that when mistakes were made regarding medicines, competency checks were undertaken.

Team meetings were infrequent. Where the local authority had identified actions that required addressing to improve the quality of care, these had not been actioned in a timely manner. Incidents and accidents were reviewed but appropriate actions had not always been taken. For example, safeguarding referrals and statutory notifications had not always been submitted when required. The new manager had put together an action plan which they were in the process of working through but many actions remained outstanding at the time of the site visit.

People and relatives told us they were supported to access health professionals when needed. One person told us the management team were responsive when they had any health concerns and ensured appointments were arranged with appropriate health professionals if they needed. When people were moving into or out of the home, the provider liaised with relevant health professionals and relatives to improve the transitional process for people. Whilst people with learning disabilities were admitted despite the home not complying with RSRCRC guidance, the manager took proactive steps to try to ensure as smooth a transition as possible.

Staff told us they were not consulted with regarding admissions of people with learning disabilities to the home which was a change in direction in terms of the needs of people they supported. Staff did not feel listened to regarding these admissions. The manager told us there had been some issues with ensuring a smooth transition for people with learning disabilities due to the reluctance of external professionals to allow staff from their previous home to initially support them. However, steps were put in place where possible to try and ease this transition. The manager told us they liaised with professionals regarding transitions, and we saw evidence of this partnership working.

Partners told us the provider had been accommodating with them when supporting people’s transitions. Health professionals told us they communicated changes regarding people via email and were communicative and demonstrated positive partnership working. Some partners also told us they had attended review meetings at the home.

Systems were in place to ensure partners were involved when needed to aid people’s transitions between services. We saw evidence of appropriate referrals being made to partners and evidence of effective partnership working when needed. The effectiveness of processes were not always monitored but we did not find any examples of where people had not received professional input when needed.

People and relatives told us people felt safe at the home. Relatives were confident concerns would be shared where needed but we found some circumstances where safeguarding referrals had not always been submitted. For example, a safeguarding referral was not made when one person ate someone's food that was not in line with their SALT assessed diet. Relatives knew who to raise any safeguarding concerns with.

Staff knew where to find the safeguarding policy. Staff we spoke with told us they had completed safeguarding training and knew the types of abuse. Staff knew when to report abuse and the process for reporting abuse. Staff were not always confident that safeguarding referrals would be made when needed. The manager and nominated individual acknowledged they had reviewed accidents and incidents and had identified some circumstances where safeguarding referrals had not been made when needed. The manager and nominated individual gave us assurances they would retrospectively submit safeguarding referrals and statutory notifications.

People were relaxed around staff and staff were generally able to reassure them. We observed one person living with a learning disability in some minor distress who required reassurance but staff did not always respond or seem to know how to reassure them. However, we saw other positive examples where staff were reassuring towards people and understood how to meet their needs and keep them safe.

A safeguarding policy was in place and staff knew where to find it. The training matrix showed not all staff were up to date with safeguarding training. Safeguarding referrals had not always been submitted when needed. For example, where a person ate someone else’s lunch which was not in line with their SALT assessed diet and therefore placed them at risk of harm. Some statutory notifications had been submitted but we found some examples where they hadn’t been and should have. We asked the provider to submit these retrospectively. Systems in place to check whether safeguarding referrals had been made when needed were not sufficient to identify where concerns hadn’t been shared.

People were supported to manage risks to them. Relatives told us people’s risks to them were managed safely and staff knew people well. However, risk assessments were not always up to date and consistent which meant people may have been placed at risk of harm. Where the support people needed to manage risks to them changed, relatives told us the provider spoke with them about it. People were supported to engage in some activities they wanted to such as gardening and people living with learning disabilities were supported to access the community on occasions. People’s clinical risks were monitored and concerns were escalated if needed. However, guidance to staff was sometimes inconsistent which meant people could be placed at risk of harm. For example, one person’s moving and handling document stated they needed 30 minute health checks through the night but a 60 minute observation chart was in place. This person had not been harmed but may have been at risk of harm.

Staff knew people well and knew how to manage risks to them. Staff told us about how they monitored people’s clinical risks and when they would escalate concerns. Staff told us about how to support people safely with their mobility and were aware of people’s dietary requirements. However, staff told us risk assessments were not always up to date. One staff member told us, “The care plans and risk assessments aren’t up to date. We know people well so know what to do.” However, this may have placed people at harm where new staff were supporting people. The manager confirmed that care plans and risk assessments were not always up to date. The manager confirmed they were mitigating risk by putting handwritten notes on documentation where it had been identified it was not up to date and they were in the process of working through people’s care documentation.

Staff did not always intervene promptly when there were risks to people. For example, we observed a bath that had been left full of warm water. We raised this with staff but they did not immediately drain it so we had to wait by the bath until it was made safe. We also observed one person trying to communicate with staff and they did not give them sufficient time to understand them. However, we did observe some positive examples where staff responded quickly. For example, where one person was coughing, a staff member quickly got a nurse to review them and make sure they were safe. We also observed multiple examples where staff engaged with people with warmth and compassion which helped to de-escalate any potential distressed behaviour. People were empowered to take positive risks where appropriate.

Risks were assessed and staff understood risks to people. However, risk assessments were not always thorough and were not always consistent with care plans. The manager told us they were in the process of reviewing and updating them. Where one person’s risk assessment had been recently reviewed, it was thorough and detailed and provided clear guidance to staff how to manage risk to the person. Risk assessments that had not been reviewed were not always person centred but improvements had been made to the new risk assessment documentation to make them more person centred. Mental capacity assessments (MCA’s) had been completed but they did not always clearly evidence discussions that had been undertaken with people to determine their capacity. We saw best interests meetings had been held for some people where they lacked capacity but where people had been recently admitted, we did not always see evidence of best interests meetings taking place to ensure decisions were made in a person’s best interests.

People and relatives told us people felt safe when they were being supported with equipment. People had access to the equipment they needed. People had ‘maintaining a safe environment’ care plans in place so staff knew how to support them to keep them safe. However, staff did not always recognise environmental risks and take immediate action to maintain people's safety. For example, where we observed a bath full with water that had been left unsupervised, staff did not immediately respond to mitigate the risk despite us repeatedly making them aware of the risk. People's Personal Emergency Evactuation procedures were not always up to date and consistent which meant staff may not know how to safely evacuate them in the event of an emergency.

The manager told us they had reviewed the home environment and had identified some actions that required addressing to improve the home environment. The manager told us they had devised an action plan that they intended to work through to address the concerns they had identified. However, the majority of these actions remained outstanding at the time of the site visit. Whilst the provider's failure to address these actions in a timely manner did not place people at immediate risk of harm, improvements were required to the home to ensure people's safety continued to be maintained. Staff knew how to support people with using hoists and other mobility equipment. Staff told us they had completed moving and handling training and were confident in supporting people with their mobility.

We observed a bath that was full of water and had not been drained that was not being supervised by staff which placed people at risk of harm. We spoke with 2 staff members about this and this was eventually drained but there was little urgency to mitigate this risk meaning we were required to continue to observe until action had been taken to drain the bath. Doors were locked when they needed to be locked to maintain people’s safety. Where people required equipment such as bed rails and bed sensors to mitigate risk to them, these were in place. People’s equipment was stored safely. Where people required equipment to mobilise, these were readily available for them without causing an obstruction for other people.

Personal Emergency Evacuation Procedures (PEEPs) were in place where needed but systems in place had not always identified where these were not up to date. This meant the provider could not be assured that staff would be able to safely evacuate people in the event of an emergency. Systems in place to identify whether environmental checks had been undertaken in the required timescales were not always robust and made it difficult for the provider to identify whether environmental checks were in date. The provider sent us confirmation checks were in date but this information was not readily available. Where actions had been identified following electrical testing, these were addressed and this was deemed satisfactory. The provider had an in date gas safety certificate and satisfactory legionella tests had been undertaken. Fire risk assessments had been undertaken.

People and relatives told us there were enough staff to meet people’s needs safely. One relative told us, “There’s always enough staff.” Where people needed 1 to 1 support, this was provided in line with their care plans. One relative told us, “There’s always enough staff to meet their needs. We have the option of keeping the 1 to 1 when we visit but we say no. As soon as we’re done, the 1 to 1 is ready to take back over.” People and relatives told us staff were kind and caring and knew them well. One person told us, “[Staff Member’s name] is fantastic, nothing is too much trouble but that’s all of the staff.” Despite people and relatives providing positive feedback regarding staff, we found that staffing was not always safe and effective as staff did not feel confident in supporting people with learning disabilities.

Staff told us there were a sufficient number of staff to meet people’s needs. One staff member told us, “I have no problems with the staffing levels.” Staff also told us that people received 1 to 1 support when needed in line with their care plans. Staff did not feel confident in meeting the needs of people with a learning disability and told us they had not received adequate training. Staff told us they had completed some online training but they did not feel this was sufficient and they did not feel competent but they had not had any choice in the changing direction of the home.

We observed a sufficient number of staff being available to meet people’s needs. People did not wait long for their care. We observed people being supported on a 1 to 1 basis when needed in line with their care plan. We observed staff support people with empathy and compassion. Staff did not seem to be rushing and there were always staff present in communal areas. Staff engagement was generally positive, but staff did not always seem to know how best to meet the needs of people living with learning disabilities. For example, one person with a learning disability presented with some minor distress and was seeking out staff but they did not engage with the person to reduce their distress. This was not typical to staff interaction with other people living at the home.

Senior staff produced the rota which ensured there was a sufficient number and balance of staff deployed. Additional bank staff were employed to ensure people who required one to one support received this when needed. A training matrix was used but the manager and nominated individual told us they were in the process of moving to a new online training system. This was implemented during the assessment process. However, the training matrix showed that staff were not adequately trained to meet the needs of all people who were living at the home. There were low completion rates for autism and learning disability training and a lot of staff were also out of date with mandatory training. Staff were required to undergo a satisfactory Disclosure and Barring Service (DBS) check before they commenced employment. We found gaps in one staff member’s employment history in their staff file.

People and relatives told us the home was generally clean and tidy. People were supported by staff who wore Personal Protective Equipment (PPE) in line with guidance. However, there was an odour from one carpet and some chipped paint which may have increased the risk of infection. There were plans in place to change the carpet and the chipped paint was repainted prior to the second day of the site visit.

The manager told us they were aware of some maintenance that was required to reduce the risk of spread of infection. The manager showed us that each room and communal area in the home had an action plan of maintenance tasks required. This included chipped paint to banisters and replacing the remaining carpet in the communal areas of the home with vinyl to reduce the risk of infection. Staff told us cleaning schedules were in place and they were followed. One staff member commented that the carpet was soiled in one area and there was sometimes an odour from it but it was still regularly cleaned.

The home was clean and tidy and there was evidence of regular cleaning throughout the day. However, there was some staining on one of the female toilet’s ceilings and chipped paint on banisters. There was also some odour on one of the carpets. The banisters were painted by the second day of our visit. The manager showed us evidence they were in the process of replacing the carpets. Staff wore PPE in line with current guidance.

Cleaning schedules were in place and followed. A recent audit had been completed for the home environment which had identified actions. There was a plan in place to address the actions but these had not yet been addressed. An infection control audit had been undertaken in September 2024 which identified not all staff had completed their PPE training. This had not yet passed its date for action to be taken.

People and relatives told us their medicines were administered safely and on time. People’s medicine administration records (MAR) indicated people received their medicines as prescribed and on time. People’s medicines were administered in the way people liked to receive them in line with their recorded needs.

The manager told us that medicines are only administered by trained nurses. The manager told us they check medicines competencies via supervisions. The manager told us improvements had also been made to medicines storage and administration through reviewing local authority audits and observing nurses on both the day and the night shift. Staff told us they completed their medicines training online. They told us they had completed medicines competencies but not recently.

Medicines were stored safely. All stock counts were correct. Protocols were in place to guide staff when to administer ‘when required’ medicines and the reason for administration was recorded when needed. Where people needed medicines to be administered covertly, MCA’s, best interests and a letter from GP authorising this was on file. Pain patches were rotated in accordance with guidance. Temperatures of the fridge and medicines room were recorded and indicated medicines were stored at a safe temperature. MAR’s were completed and there were no missing signatures. However, there was not always an ongoing stock count recorded for some tablets. Medicines audits were undertaken but they did not always identify where errors had occurred such as not having a running stock count for some medicines.