Silverbirch provides accommodation for a maximum of nine people requiring nursing or personal care. There were nine people living at the home when we visited.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a registered manager in post when we inspected the home. 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 were comfortable and as ease around care staff that understood how to keep people safe. Staff had received updated training and understood people’s individual circumstances. Staff understood who to report concerns to as well as the risks to people’s health. Staff understood people’s health conditions and how they required supervision and support. The risks to people’s health were reviewed regularly and updated based on the known risk to people’s health. Staff working at the home undertook background checks. Staffing needed to support people safely was reviewed and updated based on people’s changing needs. People’s access to medicines was reviewed and checked to ensure people received their medicines in line with guidance for that person.

Staff were supported through access to training and supervision and received feedback on their performance. Staff supporting people understood the importance of obtaining their consent. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff supported people to maintain a healthy diet. People were also supported to attend appointments with healthcare professionals in order to aid their health and wellbeing.

People knew and liked the staff supporting them. Staff understood people’s individual care needs and preferences. Staff involved people in their care by explaining choices and supporting people to make decisions about their care. People were supported by staff who demonstrated an understanding of supporting people with dignity and respect.

People were supported to pursue hobbies and interests that were important to them. Staff understood how to support people. People’s care was reviewed and updated in response to their changing care needs. People understood they could speak with staff and the registered manager if they were unhappy about their care. Complaints were recorded and responded to inline with the registered provider’s policy.

People knew and liked the registered manager. Staff spoke positively about working at the home and understood their role within the team. Staff felt able to seek help and guidance as well as contribute ideas to care planning. Regular reviews of people’s care ensured people’s care planning was timely and up to date. The registered manager reviewed and updated people’s care regularly and sought advice and guidance to improve the care people received.

This unannounced inspection took place on the 11 July 2016. Silverbirch Home provides care and accommodation for up to nine people with learning and or physical disabilities. At the time of the inspection nine people were living at the service. The service is also registered to deliver personal care to people in their own homes although this was not currently not being provided.

We last inspected the service in July 2014 and found that the provider was breaching regulations in relation to monitoring the quality and safety of the service. Following that inspection the provider sent us an action plan detailing the action they would take to address the breach. At this inspection we found that whilst improvements had been made in some cases these improvements had not been sustained. The provider had identified risks to people but had not always put adequate measures in place to reduce the risk for the person. The systems in place to monitor these risks were not entirely effective.

The service has a registered manager who was present throughout the inspection. 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 and their relatives told us that people were safe at the service. People were supported by staff who were aware of the signs of abuse and the need to report any concerns. There were sufficient, suitably recruited staff available to meet people’s requests for support promptly.

Medicines were given safely and there were systems in place to monitor medicine administration. Staff had received training in how to support people with their medicines.

People were not always protected from risks associated with their care as the service had not always carried out assessments to minimise the risks to people. The registered manager was developing ways to rectify this concern.

Staff had some knowledge of the Mental Capacity Act (2005) and could explain how people communicated their needs. People were given choices in all aspects of their care. Staff had received sufficient training to understand and meet people’s individual needs. We have made a recommendation about accessing and making use of communication aids to support people who use the service to express their views and choices.

People had their healthcare needs met and we were provided with many examples of how people’s health had improved since they moved into the service. People were treated with dignity and respect and independence was promoted wherever possible.

People and their relatives were happy with the care provided and told us that staff were kind and caring in their approach. Care was planned with relatives to ensure care provided would meet people’s individual needs. Staff were enthusiastic about their role and knew people well and could explain how people preferred to be supported.

Care was reviewed at regular intervals. People had been supported to maintain relationships with those who were important to them.

People didn’t always have the opportunity for regular activities. We found that there was no schedule for activities and some people didn’t access the community very often. There were limited opportunities for people to undertake interesting or stimulating activities when they were at home.

People and their relatives were happy with how the service was managed. The registered manager had made improvements to the way they monitored the quality and safety of the service although some of these had not been sustained. The service had sought feedback from relatives and health professionals but had not sought feedback from people. Staff felt supported in their role and felt able to make suggestions for improvement.

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 did not give the home notice that we were going to carry out an inspection and arrived unannounced.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Silverbirch is a home for up to nine adults who had a learning disability. The home is an adapted residential property. Special bathing and lifting facilities had been provided for people who were unable to move independently and who needed support from staff to wash and bathe.

People who lived in the home, their relatives, staff and health care professionals who visit people at Silverbirch told us they felt people were safe. Staff we spoke with were aware of what abuse was and demonstrated in their conversations with us that they would not accept abusive practices in the home. Staff told us what they would do in the event of them witnessing abuse happening. People we asked told us this was a service they would be happy for a relative of theirs to use. However we found that the premises had not been kept clean. When we looked around the home the bathrooms, floors, tables and chairs were all dirty. This was unpleasant for people and could increase the risk of cross infection and bad smells. Broken furniture had not been removed or replaced and people could have hurt themselves on this. You can see what action we told the provider to take at the back of the full version of the report.

We observed staff working with people throughout the time of our inspection and heard how staff spoke with people. All our findings provided evidence that staff were kind and compassionate.  Staff spoke about people with enthusiasm and could share with us people’s needs and tell us about their family. This showed staff had taken time to get to know about the people they were supporting. However we did hear staff speaking to people in a way that was not respectful of them as adults.

Staff told us they had been trained and supported to meet the needs of the people they worked with. Staff were able to describe people’s needs to us, and the ways they worked to meet them. During our inspection we found evidence that people’s conditions had improved in the time they had lived at the home. This showed the care and support being offered was meeting their needs and being effective.

People were supported to be as involved in their lives as possible. We saw people were offered choices about what to do, what to wear and what to eat. We saw that people had been involved in making significant decisions about their lifestyle and treatment for health conditions as far as they were able. We observed staff using a variety of different ways to offer people choice according to the individual needs of the person they were supporting. Staff we spoke with were able to describe how each person expressed themselves, which was particularly important when people didn’t use words to communicate. This meant people could be confident staff would understand their needs and wishes.

People lived in an environment that was homely and had been adapted to meet their needs, however we found the home had not been kept as clean as it should have been or that repairs or replacement of broken furniture had not been undertaken as promptly as it should have been. People could choose how they wanted their rooms decorated and people had been involved in choosing colours, furnishings and carpets for communal areas of the home. People had been supported to obtain the specialist equipment they required included walking aids, adapted beds and mattresses and wheelchairs.

The management was strongly focussed on the needs of the people living at Silverbirch. The manager demonstrated a very detailed and active knowledge about each person and had “hands on” involvement every day in people’s care and support. However the management systems of the home were not well established and we found that some records had not been updated, and that systems to ensure quality and safety were routinely checked were not robust. The manager was already of aware of this prior to our inspection and was able to demonstrate what action he had taken and planned to address this.     

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.  You can see what action we told the provider to take at the back of the full version of this report

On the day of our inspection we were told that there were seven people living at the home. We spoke with six of the people living there and three of their relatives, five members of staff and two managers.

Staff knew how to support people to meet their needs. One person told us, "I like the staff here, they are all helpful to me and know what I like and don't like".

Arrangements were in place to protect people from the risk of harm or abuse. One relative told us, "My relative is safe there, I have no concerns, the staff are great, I trust them".

The requirements relating to staff employed were documented. Staff had the skills and experience for their job roles.

People and their relatives were asked for their views about the home. Systems to audit the quality of the service provided were completed.

Improvements had been made since our previous inspection.

There were three people living in the home on the day of our inspection. We spoke with one person living at the home and observed what life was like living there for two people on the day of the inspection. We also spoke with two relatives and / or representatives / advocate, the manager and four members of staff to find out their views about the service provided.

People were, wherever possible, involved in their care. Where people were unable to be involved in decisions about their care, we saw relatives and / or representatives and healthcare professionals were involved. This meant that staff knew about the things that were important to people. One relative told us, "They always keep me upto date with any changes".

We saw staff generally knocked on doors to respect people's privacy and saw staff speak with people in a respectful way.

People had care plans and risks were assessed. However, staff may not always have the skills and knowledge to deal with emergencies that may arise from time to time. We saw people were given opportunities to take part in some activities. This meant that people had interesting lives.

We saw that the organisation had systems in place to safeguard people so that staff had the information needed if they had any concerns or there was an allegation of abuse.

We saw some systems in place to measure the quality of the service, however these were not analysed. This meant comments could not be used to improve the quality of the service.

We met all five of the people who currently live at Silverbirch home. Not everyone was able to speak with us about their experience of the home, but people who could told us they were happy. We saw people smiling and looking relaxed.