19 April 2021
During an inspection looking at part of the service
Silverleigh is a 'care home’. Silverleigh is registered to provide accommodation and nursing and personal care for up to 65 people. There were 49 people living at the service at the time of the inspection. The majority of people were living with dementia.
The service is in a large detached building located in the market town of Axminster in East Devon. The home is within walking distance of Axminster town centre, local church and post office and benefits from being next to the local GP surgery.
This targeted inspection took place on 19 April 2021.
People’s experience of using this service and what we found
The home had experienced a lot of changes and disruption in the last year. This included the Covid-19 pandemic, changes in leadership and staff. We undertook a targeted inspection of the home in September 2020 because we had received anonymous concerns. We found that people were receiving safe care and staff were adjusting to the sudden change in the management team. It was evident from staff feedback that the staff morale at the home was low with a lot of uncertainty. The interim management team were working with the staff to restore their trust and confidence and implement required changes.
Since that inspection the provider’s group manager had taken on the position of registered manager supported by a new deputy manager and a compliance manager.
Further anonymous concerns have been shared with CQC since March 2021. We monitored the concerns and sought feedback from the local authority safeguarding team, the local authority quality improvement team, the commissioners and local health and social care professionals. They raised no concerns about the service. However, we continued to receive anonymous concerns so undertook this inspection to assure ourselves that people were receiving safe care.
People were positive about the home. One person told us, “I am fortunate to end up in Silverleigh. The staff are really caring and attentive. They show respect to each of the residents.” A relative told us, “I think it has been excellent here. We have been here a lot and we have been very very pleased, and we like how the residents are entertained, there is masses going on.”
Staff confirmed it had been a difficult year and described a good staff team; working well together and morale was said to be good. Comments included, “I believe that Silverleigh is a good home with staff who really care about those individuals that they look after.”
Staff were encouraged to challenge any practice concerns in confidence. Where any concerns about staff skills, performance attitudes or performance were identified, these were dealt with in accordance with the provider's policies and procedures. Where staff had shared safeguarding concerns with the management team, they had informed the local authority safeguarding team and put in place measures to protect people.
Some staff and people raised concerns about staff shortages and the high use of agency staff. Staff rotas indicated that there had been a period of change in the staff team and that recruitment was in place to address this. Plans had been in place to ensure safety on occasions when staff numbers had been low. To ensure there were sufficient staff numbers the provider offered enhanced pay to encourage regular staff to undertake additional duties. Where needed to fill gaps the provider used agency staff.
People received their medicines as prescribed and the medicine champion supported staff to safely manage the medicines at the home.
Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. There were sufficient PPE (personal protective equipment) stocks available and sanitisation and PPE stations around the building. The home looked clean and hygienic. Infection prevention and control audits took place and spot checks were carried out. Regular COVID 19 testing was carried for both staff and people living there in line with the government guidance.
Staff were meeting people’s needs and risks were identified. Staff had guidance to help them support people to reduce the risk of avoidable harm. Staff had received the appropriate training to carry out their roles safely. People were confident staff were trained and competent and knew what to do. Where concerns were raised about staff practice. The registered manager had taken action and arranged additional training.
People were supported to meet their nutritional needs and maintain a balanced diet and most liked the food. Daily menus offered a variety of different choices and people chose what to eat and drink. People who required staff support to have a specialised diet were supported by staff who were trained to do so.
The home was adapted to meet the needs of people living with dementia. The adaptation, design and decoration of the service promoted people’s independence and well-being
Where people did not have the capacity to make decisions, they 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 supported this practice
The registered manager and staff interacted with people in a positive manner and were focused on doing their best for the people they supported. People were involved in decisions about their care and support.
The management team were open and approachable; they were working with staff to improve morale and ways of working. Most staff expressed their confidence in the registered manager and senior management team. The service had effective quality assurance and monitoring systems that were used to identify shortfalls and drive improvements.
Rating at last inspection
The last rating for this service was Outstanding (published 2 April 2020)
Why we inspected
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about staff practice; infection control practice; lack of PPE; poor personal care; risk management; medication management; staff training; manual handling practices; poor nutrition; staff levels; people not being given choices; liberties being restricted; the management of the service. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from these concerns. We found the provider had systems in place to monitor and take action to mitigate risks. The overall rating for the service has not changed following this targeted inspection and remains Outstanding.
Please see the safe, effective and well led section of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Silverleigh on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.