Archived: Silverdale

Updated 15 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out the inspection.

Service and service type

Silverdale is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Silverdale is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. A manager who was registered to manage a different service run by the same provider was overseeing the service.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the site visit we viewed a range of records including the person’s medicines and health records, as well as health and safety checks completed on the service. We spoke with the manager overseeing the service and the acting deputy manager. We spoke to the person living in the service, but they were unable to share their views with us, so we observed how staff interacted with them.

Following the site visit, we continued to request and review records. These included the person’s care plan and information about how they spent their time, as well as recruitment records and risk assessments. We spoke with the person's relative and three professionals who worked with the person and the service. We also spoke with two staff members. We wrote two letters to the provider requesting they provide us with the person’s records.

Updated 15 October 2022

About the service

Silverdale is a residential care home providing personal care for up to four people with learning disabilities. At the time of our inspection the service was supporting one person. The service is a detached two-story property with a front garden. It is located in Redruth, Cornwall within walking distance of shops and other local facilities.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The design and culture of the service did not maximise the person’s choice, control and independence. Staff were planning to support the person to change the furnishings in their flat, to better reflect their tastes; but had not been able to because they could not access their own bank account.

The care model did not always focus on the person’s strengths or identify clear paths to achieving their aspirations and goals. The person’s control over their own lives was limited which meant they did not consistently have a fulfilling and meaningful everyday life. The person’s capacity had not always been assessed before staff made a decision on their behalf.

Staff had not all received the right training to help ensure restrictive practices were only used by staff if there was no alternative. Plans to guide staff on how to support the person who experienced periods of distress were not all up to date.

Safety checks of the service had not all been completed as required.

Staff were supporting the person to reduce the number of medicines they took.

The person was supported to join discussions about their support in a way that limited their anxiety.

Right care

Significant risks to the person had not been assessed and therefore control measures to protect them from abuse and poor care were not all in place.

The person was doing more than at the previous inspection, but this was still affected by limited access to their finances and staffing. The service did not have enough appropriately skilled staff to meet their needs.

The person did not always receive support that met their needs and aspirations, focused on their quality of life and followed best practice.

The person was able to communicate with staff and understand information given to them.

Right culture

The ethos and values in the service did not always meet best practice. This meant the person did not always experience an inclusive and empowered life. Staff did not always have a good understanding of best practice models of care. The service was based on restrictions and a punitive approach to the person’s behaviour.

There was not enough management time or support by the provider to enable real development or improvement in the service. The provider had failed to minimise the risk of a closed culture forming at the service.

The culture created in the service meant the person was not always treated as an equal. The staff team had not been designed in a way that met the person’s preferences.

Various professionals were involved in monitoring the person’s care.

The person was not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not effectively support staff to maximise the person’s choice and control.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement overall (published 20 August 2021), but was rated inadequate in well led. As a result, we required the provider to report to us on a monthly basis on staffing levels, details of any gaps in staff training and experience, and the number of hours the manager was unable to complete management tasks because they were required to support the person living in the service. We also required them to detail how they had assessed their staffing capacity for the following month. We received these reports on a monthly basis.

At this inspection we found the provider remained in breach of regulations. This is the third time the service will have been rated below ‘good’.

At our last inspection we recommended the provider sought advice from a reputable source on how to support staff and ensure they understand and follow agreed guidelines. At this inspection we found some guidelines were out of date; however, staff understood and were following up to date, agreed ways of working.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, the safety of the service provided, safeguarding the person from abuse, and the recruitment processes. We also identified a breach relating to the requirement on the provider to notify us of certain events. We identified continued breaches in relation to the governance of the service and staffing.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

We began the process of preventing the provider from operating this service. However, before the provider's representations against our proposal had been reviewed, the provider took the decision to transfer the service to another provider.