This inspection took place on 15 and 18 January 2019; the first day of inspection was unannounced. Silverwood (Nottingham) is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Silverwood (Nottingham) accommodates up to 80 people in two separate buildings; one building provides residential care for up to 39 people and the other building provides nursing care for up to 41 people. There were 38 people with nursing needs and 32 people with residential needs who were in receipt of personal care at the time of our inspection.
At our previous inspection on 14 and 16 March 2017, the service was rated ‘good’ overall and the question ‘Is the service safe?’ was rated as requires improvement.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At this inspection, we found improvements were needed to show how the risks around depression and potential self-harm were assessed and followed up. Improvements were also required to how risks associated with the provision of people’s care were reviewed, analysed and reduced.
Care plans and risk assessments did not always accurately reflect people’s care needs and any associated risks. Care plans and risk assessments were not in place for when people presented with behaviours that could potentially harm themselves or others.
Whilst some aspects of medicines management and administration were managed well, some improvements were needed to ensure medicines were consistently managed and administered safely. Some people had experienced medicines being out of stock. Records of medicines administration required improvement.
People did not always receive timely help from staff when they used their call bell. People also told us they had not always experienced timely help from staff and on one occasion this had compromised their dignity. We observed staff were not always deployed to ensure a staff presence in communal areas.
People told us they felt safe, however records did not demonstrate what actions had been taken to investigate one incident. Staff had been trained, and understood what actions to take to report any safeguarding concerns.
Equipment and actions to monitor, help prevent and reduce risks from pressure area damage had not always been used effectively. Monitoring and actions in relation to pressure areas and other healthcare needs, such as fluid intake and output also needed improvement. Care plans did not always reflect people’s current healthcare needs to ensure staff understood how to provide them with consistent care.
People told us they thought staff were caring, however some people felt this was compromised when staff were too busy to spend time with them. Some improvements were needed to ensure people’s experiences of staff were caring. Staff respected people’s privacy and promoted their independence; we identified one occasion when a person’s dignity could have been promoted better. People, and where appropriate, their relatives or representatives had opportunities to be involved in care planning.
Not everyone experienced responsive and timely care and some people did not have baths or showers as frequently as they would have preferred.
The service was kept clean and actions were taken to help prevent and control risks from infections. Other risks, such as falls risks and risks identified in the environment were assessed and actions taken to reduce risks from them.
The provider was keen to improve the service and sustain those improvements and learn from when things had gone wrong. The provider had action plans in place to help implement the improvements identified as required.
Staff were trained in areas relevant to people’s needs and understood how to support people’s diverse needs. Staff had systems in place to aid communication between them; the registered manager had in addition, identified some areas where communication could improve. Staff were supported by the registered manager, however arrangements for staff appraisals required improvement.
Improvements were needed to the systems and processes used to check on the quality and safety of services. This was because audits had not always been used as intended or had not always been effective at identifying shortfalls in the service.
Statutory notifications for abuse, or allegations of abuse, had not always been submitted in a timely manner as required.
People were offered a balanced diet and told us they enjoyed their meal choices. People also had opportunities to engage in a range of activities.
A range of other healthcare professionals were involved in people’s care; referrals for other services had mostly, but not always, been made in a timely manner.
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’s preferences regarding whether they preferred male or female care staff were known and respected. People had access to information in a range of other formats to help them understand their choices. A system was in place to help manage, investigate and resolve any complaints raised.
Advance care plans were in place to ensure people and their families and representatives if appropriate had the opportunity to express their wishes for their end of life care.
The building had been adapted to help meet people’s needs, with such things as lifts and handrails along corridors. People had been supported to personalise their rooms to their own tastes.
The latest CQC rating was on display. The registered manager was viewed as approachable and wanting to improve the service. People and relatives felt they could be involved in the service and offer their views and opinions for consideration in the development of the service. Policies and procedures were in place to help with the governance of the service.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009.
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.
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.