Silver Howe

We assessed the quality statements from all the key questions; safe, effective, caring, responsive and well-led. We found breaches of the regulations safe care and treatment and good governance. The overall rating for this service has changed to requires improvement.

A variety of records associated with care and treatment were not always accurate, current or recorded sufficiently. These included records for accidents and incidents and the monitoring of them, along with assessments of risks relating to people’s care and needs. We also found medicines were not always managed safely. We not fully assured there were always sufficient staff. Staff were aware of their safeguarding responsibilities. Staff had received training and supervision to support them in delivering safe and effective care. However, not all staff had completed any specialised dementia training. The home was clean, and processes were in place to manage infection prevention.

Decisions were made in people’s best interests where they did not have capacity to do so themselves, but these were not always recorded or always completed in line with best practice. Staff involved people and those important to them in their care planning. People were supported with eating and drinking. However, records for monitoring fluid intake were not always effectively completed. The staff team worked well with other organisations and services to support people to manage their health and wellbeing.

People were supported to maintain relationships with family and friends. People told us there was not a lot of regular activities or things to do. There were 10 hours per week committed to supporting people by an activity’s coordinator with individual and group activities. We observed a member of the staff team who at different points during the day completing some activities with people who were sat in the main lounge. We did not see how people who were being cared for or chose to stay in their rooms and at risk of social isolation were supported with activities.

People were encouraged to maintain their independence. People were treated as individuals and with kindness, dignity and compassion and staff knew them well. People’s personal, cultural, and religious needs were supported. The registered manager cared about and promoted the wellbeing of their staff team, valued them and supported them to deliver person-centred care.

People’s individual communication needs were identified, and information was provided in an accessible way. People and their relatives were able to give feedback on the service. Staff understood about equality and diversity. The service contacted emergency services when required and knew when to involve specialist services in people’s care. There was a system in place for responding to concerns or complaints. People’s end-of-life wishes were noted and reflected in their care records.

There were a range of quality monitoring and auditing processes in place. However, issues seen during this assessment had not always been identified through those oversight processes and systems. The registered manager and staff took immediate action to address some areas of concern that required it. The registered manager demonstrated a positive, compassionate, listening culture that promoted an understanding between them, the staff and people using the service. Staff felt very supported by the registered manager and were able to report concerns and said they were listened to. There was a company compliance manager who visited the home regularly to monitor and oversee the quality and safety on behalf of the provider.

We have asked the provider for an action plan in response to the concerns found at this assessment.