This comprehensive inspection took place on 10 and 14 August 2017. The inspection was unannounced.

Silk Court is a care home providing accommodation for up to 51 older people, some of whom were living with dementia. The home is located in Bethnal Green close to shops and local amenities. The purpose built building has three units namely, Velvet (ground floor), Satin (first floor) and Cotton (second floor). The bedrooms were single occupancy with en-suite facilities. The building and units were accessible by wheelchair and had a passenger lift. At the time of our inspection, 49 people were living at the service.

At the last inspection of 4 and 5 August 2014, the service met the regulations inspected and was rated Good overall and Outstanding in Caring.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People living at the service and their relatives were extremely happy with the high standards of care they received. People using the service, their relatives and health and care professionals commended staff for their compassionate and caring manner. They were consistent in describing the positive impact of the care provided at Silk Court Care Home on people’s well-being.

The registered manager and provider actively promoted a person centred culture at the service. People knew the registered manager very well, said she was visible at the service, and spent time with them. The registered manager and provider demonstrated excellent leadership.

The registered manager and provider exceeded expectations in the provision of social activities and engagement for people using the service. People immensely enjoyed taking part in a variety of activities provided at the service and in the community. The registered manager engaged people and health and social professionals to design creative activities in ways which enriched each person’s life. Staff supported people to live an active, independent and full life as possible

People experienced exceptional high standards of care because the registered manager had developed solid relationships with external organisations, health and social care professionals and the local community. People living with dementia received specialist support which significantly improved the quality of their lives. Staff had a sound understanding of dementia care and used their specialist knowledge to provide care in line with best practice and to communicate effectively with people.

People using the service and staff were highly complimentary of the registered manager, her leadership and the running of the home. People felt very valued, listened to and were able to talk to the registered manager about any concerns about their welfare. The service was proactive and welcomed people using the service, their relatives, and health and social care professionals and staff to voice ideas about how to develop the service. The registered manager audited the quality of care and made changes when needed.

Staff delivered people’s care and support with respect for their dignity and privacy. People received all-inclusive care that enhanced their quality of life. Staff had developed positive relationships with people using the service and their relatives. People consistently praised staff for meeting their individual needs and preferences and going over and above to make them comfortable and happy.

The registered manager assessed each person’s needs and found creative ways of reviewing and anticipating changes in people’s health and well-being. Health and social care professionals were very pleased with the responsiveness of staff to people’s conditions and their application of guidance given.

Staff man

We followed up one area of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider’s compliance in this area. We spoke with three people using the service, two relatives and seven members of staff including the registered manager. We also spoke with the provider’s dementia care adviser.

People felt satisfied with the service provided at Silk Court and involved in their care. One person said, "it's lovely here, they treat me like their own." Family members were happy with the way staff cared for their relatives and the service they received.

The provider sent the Care Quality Commission an action plan to address the area of non-compliance and during the inspection we saw that this had been implemented. Care plans had been updated and staff received dementia training to improve how they worked with people who had dementia. Staff said they felt better skilled in supporting people who had dementia. This had a positive effect on the wellbeing of people who used the service.

At the time of our visit there were 49 people living at the home. We spoke with people using the service, their relatives and three members of staff including the registered manager.

People felt safe and were satisfied with the service provided at Silk Court. They felt involved in their care. One person said, “it’s nice here, I have been here for three years.” Another person said, “it’s very jolly here, everyone joins in.”

The Short Observational Framework for inspections highlighted that staff were not sure how to manage the behaviours of two people who were constantly asking to go home and getting agitated as lunchtime progressed.

The provider had systems in place for assessing and monitoring the quality of the service.

We carried out this responsive inspection as the result of a safeguarding concern that had been raised by relatives of one person using the service. The safeguarding investigation was carried out by the local authority and found no evidence of abuse having occurred. However, there were suggestions for learning points that the service would find useful. We found that the service had taken these seriously and were acting upon them.

Three people using the service spoke with us. When we asked about being treated with respect we were told “the staff are kind and treat me with respect and gentleness” and “I’m always allowed to be private”. When asked about their care we were told “the staff are kind and treat me with respect and gentleness”, “I like living here the staff are nice and you can have a laugh with them” and “I can join in, I like helping to do things”. When we asked about how safe people felt living at Silk Court we were told “I feel safe living at the home”, “I feel safe living here, the staff are kind and I like them”.

A relative who was visiting the home said the care at Silk Court was “excellent” and that it was “welcoming and not institutionalised”, “It’s a home where you would want to be”.

The inspection team was led by a Compliance Inspector, accompanied by a second Compliance Inspector and an expert by experience. We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs and not everyone was able to tell us their experiences.

We spoke with two relatives of people using the service. They told us”it’s like a little community, we love it”. They felt that staff were friendly and helpful and shared decisions about their relative’s care with them, “they talk with us it’s very informal”. This person also told us that prior to choosing Silk Court they visited without prior notice on a few occasions and found that the staff and standard of care were consistently good regardless of the day or time of their visit.

A relative told us they had “peace of mind knowing their [relative] was well cared for. We live hours way but we trust the staff here to look after my [relative]”. They also said that the staff were “helpful and friendly”. Another relative praised staff for “making the living environment feel personal” for their relative.

The six people who live at the home and spoke with us specifically did say that they “like living here”, “like the staff” and that the home is “Quite acceptable”.

Please refer to each essential outcome, below, for more detailed comments about specific aspects of the service that is provided at Silk Court and the main report for other comments that people made to us.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We undertook an unannounced inspection of Silk Court Care Home on 4 and 5 August 2014. The service provides care and support for up to 51 older people. There were 51 people using the service when we visited.

At our last inspection on 17 March 2014 the service met the regulations inspected.

The service had a registered manager who had been in post since July 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard the people they supported. Managers and staff had received training on safeguarding adults, the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005. Staff demonstrated a good understanding of their responsibilities.

People and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only people who were deemed suitable worked within the service. There was an induction programme for new staff, which prepared them to do their role. Staff were provided with a range of training to help them carry out their duties. Staff received regular supervision and appraisal to support them to meet people’s needs. There were enough staff employed in the service to meet people’s needs although some staff told us they felt under pressure when members of staff were absent due to sickness.

People were supported to eat and drink and their nutritional needs were closely monitored. People were supported effectively with their health needs and had access to a range of healthcare professionals. People were involved in making decisions about what kind of support they wanted.

Staff, people who used the service and relatives felt able to speak with the manager and provided feedback on the service. They knew how to make complaints and there was an effective complaints policy and procedure in place. We found complaints were dealt with appropriately and in accordance with the policy.

The service carried out regular audits to monitor the quality of the service and to plan improvements. Where concerns were identified action plans were put in place to rectify these.