Silver Lodge is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Silver Lodge has 32 beds providing accommodation and personal care to older people with a variety of support needs including those living with dementia. It is located in its own grounds in Chapeltown, Sheffield, close to transport links.

At the time of our inspection 27 people were using the service.

This inspection took place on 7 December 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

At the last inspection on 29 September 2016 we found the registered provider had not ensured the premises were properly maintained. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to Regulation 15: Premises and equipment. The registered provider sent us a report of the actions they would take to meet the legal requirements of these regulations. We checked whether this regulation had been met as part of this inspection. We found that sufficient action had been taken to meet the requirements of the regulation.

People we spoke with told us they felt ‘safe’ and did not express any worries or concerns.

Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

Staff were aware of safeguarding procedures and knew what to do if an allegation was made or they suspected abuse.

We found systems were in place to make sure people received their medicines safely so their health was looked after.

Staff recruitment procedures ensured people’s safety was promoted.

There were sufficient staff to meet people’s needs safely and effectively.

We did not find any concerns about the cleanliness of the service. This was supported by people and relatives we spoke with.

Staff received regular training and support so they were skilled and competent to carry out their role.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

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 supported this practice.

People were treated with dignity and respect and their privacy was protected. People and relatives we spoke with made positive comments about the care provided by staff.

We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs.

We saw people participated in a range of daily activities which were meaningful and promoted independence.

People and relatives said they could speak with the registered manager or staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to.

Staff, people living at Silver Lodge and their relatives said the registered manager was approachable and supportive, and communication was good within the service.

This was an unannounced inspection which took place on the 29 September 2016. The service was last inspected in June 2014 and was not compliant with all the regulations in force at that time; non-compliance was related to care and welfare and staffing.

Silver Lodge is a two-storey building situated in the Chapeltown area of Sheffield. It can accommodate up to 32 people who require personal care and may have a diagnosis of dementia.

The service had a long standing registered manager in post. 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.

People told us they felt safe living at the service and that staff knew how to act to keep them safe from harm. However the building and equipment were not always well maintained and able to be kept clean. Infection control best practice was not always followed by staff and some areas of the service were in need of maintenance and repair.

There were enough staff available during the day and night to meet people’s sometimes complex needs and the staff were trained, supervised and supported to effectively meet these needs. Staff felt they could ask for support or additional training and the registered manager would support them.

Medicines were managed well by the staff and people received the help they needed to take them safely. A new computerised system was now in place and staff had been trained in using the equipment. Where people’s needs changed the staff sought medical advice and encouraged people to maintain their well-being. External healthcare professionals’ advice was sought quickly and acted upon. Improvement was needed to the temperature control of the medicines storage room.

People were supported by staff who knew their needs and how best to support them throughout the day. Staff were aware of people’s choices and how to support those people who no longer had the capacity to make decisions for themselves. Families felt the service was effective and offered them the reassurance that their relatives were being looked after. Where decisions had to be made about people’s care, families and external professionals were consulted as part of the process. Care plans were easy to understand and described in detail how best to support people.

People were supported to maintain a suitable food and fluid intake. We observed a pleasant mealtime experience with staff supporting people to enjoy their meal. Staff responded flexibly to ensure people maintained their physical wellbeing and worked with people as individuals.

Staff were caring and valued the people they supported. Staff showed kindness and empathy in responding to people’s needs. Families felt their relatives were cared for by a staff team who valued them and would keep them safe and well.

Privacy and dignity were considered by the staff team, who ensured that people’s choices and previous wishes were respected. Our observations confirmed there was genuine empathy and warmth between staff and people living at the home. People who were receiving end of life care had their needs appropriately supported. External professional advice was sought where needed to promote advance care planning where this was required.

The service responded to people’s needs as they changed over time, sometimes responding promptly to sudden changes in people’s needs as their condition changed. The service supported people to access appropriate additional support so the staff could keep them safe and well.

The registered manager led by example, supporting staff to consider the best ways to meet people’s needs. The registered manager regularly consulted families and staff to look for ways to improve the service. Audits and regular reviews of care delivery were carried o

On Monday 9 June 2014 an adult social care inspector carried out this inspection. We spoke with nine people, three visiting relatives, four staff and the manager. We used SOFI and observed 14 people over two hours. We checked records relating to five people and four staff.

We considered all of the evidence against the outcomes we inspected to help answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary which describes what people using the service and the staff told us, what we observed and what we found from the records we looked at on the day. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Our findings on the day highlighted that not all the people who lived at Silver Lodge had their needs met in a timely manner. This was because there was a lack of staff availability which resulted in people getting agitated. This resulted in an altercation between two people which could have been prevented if staff were supervising the area. This meant people were not always safe and may be at risk of harm.

We have told the provider our findings and asked them to tell us what action they are going to take to remedy this.

There was enough well maintained equipment available to promote the independence and comfort of people. Staff and relatives confirmed this. We saw evidence that regular maintenance had been carried out to ensure equipment was safe to use.

The recruitment and selection processes in place were effective and ensured suitably qualified, skilled and experienced staff were employed.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, the manager told us that policies and procedures were in place. They said relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We saw people’s privacy and dignity was respected in the way people were cared for. Staff described how they maintained people’s privacy and dignity while they delivered care. The examples included keeping the doors shut and curtains closed when delivering personal care. Staff said they ensured people did as much as possible for themselves so that they could maintain their independence.

We found care was planned by staff taking on board people’s views, experiences and expectations so that people received care in the way they liked.

People’s care and treatment needs were reviewed regularly and revised to ensure people were in receipt of appropriate care. We noted an example where a person started to lose weight, the staff referred them to their GP and the person received additional nutritious drinks as well as staff ensured the person received food and snacks when they wanted. We witnessed this on the day of our inspection.

People were helped to maintain their independence because there were aids, adaptations and moving and handling equipment available to manage people’s needs effectively.

Is the service caring?

People were given choices and treated with respect by staff at the home. Two people said they were able to express their views and were involved in making decisions about their care and treatment. One person said, “I keep forgetting what I have asked for but the staff know what I want. They are alright here.” Another person told us, “They (care workers) help me. They are very kind. I like this home.”

We carried out observations in the two dining areas and the conservatory during our inspection. We noted staff respecting people’s privacy and dignity. We observed people having their breakfast and lunch (mid-day meal). Staff when attending to people made sure people received the necessary support and encouragement. When people were trying to help themselves, there was food spillage due to minor accidents. Staff discreetly cleaned the spillage and continued to encourage people. This was one of the ways that staff respected people’s dignity.

Care workers we spoke with had a good understanding of equality and diversity. They said they had received training. Relatives told us, care workers respected their family members. Visiting relatives also said they had observed staff “treating people with respect and not showing favouritism”.

Is the service responsive?

Initial assessments of people’s needs were carried out by the manager or senior staff so that they were able to make the necessary arrangements before people were accepted to live at the home.

Relatives said people were able to meet the manager before they moved into Silver Lodge. Staff told us that people’s preferences, interests, aspirations and diverse needs were sought during the first few weeks of them moving into the home. They said these helped them respond appropriately to people’s assessed needs. For example, a person may require a special chair to sit on or prefer to have their meals in their room.

Through records and when speaking with relatives we found out staff kept in close contact with relatives who were unable to visit regularly. We were informed by relatives that this helped them “a lot”. Staff facilitated people to maintain their relationships with their friends and relatives.

Is the service well-led?

The manager told us that all staff had received training on equality, diversity and human rights. Staff we spoke with had a good understanding. One staff said, “We are all individuals and we like different things and come from different backgrounds. I always remember that, which helps me respect people’s values.” A relative said they could not ask for a better place.

There were arrangements in place to deal with foreseeable emergencies. Staff were knowledgeable about the procedures to follow if a person required immediate medical attention. The manager and the deputy said that they had a policy in place to deal with emergencies and the staff were made aware of this.

Staff told us that they had staff meetings where their views about the service were sought by the manager. They said it promoted good team working and good communication. Staff told us they could not remember receiving staff satisfaction surveys from the provider. However they informed us that it was “a good place to work” and “there was a lot of support among staff”. They said the manager was accessible and they could raise any concerns or ideas and talk openly.

Records on incidents and accidents were maintained and appropriate people had been involved and relevant authorities had been informed. Staff told us following any incidents or accidents they spoke about it in hand over and in staff meetings as to how they could prevent it happening again.

We were informed by the manager that the regional manager visited the home most months and produced a report on their findings. They said the report included comments from people, staff and their observations on the running of the home. We asked for and we were unable to see the last two provider visit reports since there was limited access to the manager’s office due to maintenance work. We asked the manager to forward us the reports. However following our visit we spoke with a regional manager who informed us that they had taken over the responsibility for monitoring the home two weeks ago. They too were finding difficulty accessing previous monthly visit reports. This highlighted a lack of business continuity between the home and the organisation. The provider has been made aware of this.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Food and drink met people’s individual dietary needs. One person said, “The foods not bad. I like the people. We get a choice [of food]. We have drinks throughout the day, I’ve just had a cup of tea. We have a few laughs along the way.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Some people living at the home were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people at this inspection to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI). During the observation we saw some examples of good communication skills by staff that utilised eye contact and touch to engage people who used the service.

People that we could communicate with told us that they were happy living at the home and that they were very satisfied with the care they received. People's comments included, "I enjoy it here everyday, it’s lovely. We listen to the music, we have a sing song. We all get on well, we all enjoy it. I’d miss it (Silver Lodge) if I left.”

We spoke with three relatives who were visiting the home and they confirmed that they were very happy with the care provided. One person told us, "I’m happy with the care. It’s a lovely old house, it needs redecorating but the care is very good which is the main thing. Their room is clean and tidy. It’s a really warm, welcoming place. It’s got atmosphere.”