This inspection took place on 8 March 2018 and was unannounced.

At the last inspection the service was rated as requires improvement. We found the provider was not meeting all the requirements of the law. The provider had not ensured that people’s medicines were managed safely. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to ensure they were meeting the regulations. During this inspection we found that the provider had done what they said they would do and were no longer in breach of regulations.

Silverdale Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Silverdale Nursing Home accommodates up to 27 people in one adapted building. At the time of this inspection there were 24 people using the service.

There was a registered manager in post at the time of 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 were protected from avoidable abuse and harm by trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were managed safely and were kept clean and tidy. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Medicines were now managed safely, following improvements to the systems in place. The registered manager had systems in place to learn when things went wrong.

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 support this practice. People were supported by trained staff and received effective care in line with their support needs. Staff received regular supervision and had access to continuous training. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. The environment was designed to support people effectively. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices. People were treated with dignity and respect by staff who knew them well.

Staff understood people and their needs and preferences were assessed and regularly reviewed. Activities were organised by staff and people were supported to participate in activities that they preferred. People's diverse needs were considered as part of the assessment and care planning process. Complaints were managed in line with the provider's policy. People were supported to consider their wishes about their end of life care.

A registered manager was in post and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback that was acted upon. We found the registered manager and provider had systems in place to check on the quality of the service and used this to make improvements.

This inspection took place on 7 and 8 February 2017 and was unannounced.

At our inspection in February 2016 we had serious concerns that people who used the service were not safe and the service was not well led. We had rated the service as 'Inadequate' and placed it into special measures.

At our last inspection in July 2016 we judged the service was still not meeting the required fundamental standards of care. We had continuing concerns regarding the safety of people who used the service. The service remained in special measures as we judged the overall rating of the service as Inadequate.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We worked closely with the provider, local authority safeguarding team and the commissioning department at the local authority to ensure people were provided with an improved service and their safety and welfare was ensured.

During this inspection 7 and 8 February 2017 we saw improvements had been made to ensure people were provided with a safe, effective, caring, responsive and well led service. The provider had reviewed the internal management team and changes had been made. We judged sufficient improvements had been made; no areas now had an inadequate rating so the service will no longer be in special measures. However, we will continue to closely monitor and review the service to ensure further improvements are made and people are provided with a safe service.

Silverdale Nursing Home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 14 people used the service.

The service did not have 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 2008 and associated Regulations about how the service is run.

Improvements were needed to ensure that medicines were managed safely and effectively.

People were supported with their daily nutritional requirements, however one person's specific nutritional requirements was not always provided.

Staff were aware of the action they should take where they had concerns regarding the safety of people. Appropriate action was taken when allegations of abuse and concerns with people’s safety were identified.

Sufficient staff were available to keep people safe and meet people's care

This inspection took place on 13 and 15 July 2016 and was unannounced. At our previous inspection in February 2016 we found that people who used the service were not always safeguarded from abuse as staff were unsure of what to do if they suspected someone had been abused. People’s privacy and dignity was compromised. There were insufficient staff to keep people safe and the service was not well led. We told the provider that improvements were needed and we rated the service as 'Inadequate' and placed it into special measures.

At this inspection we found that some improvements had been made to respecting people’s privacy and dignity, and safeguarding people from abuse but further improvements were needed. We continued to find insufficient suitably trained staff to keep people safe and the systems the provider had in place to monitor the quality of the service were ineffective. There were also concerns with gaining people’s consent, the safe care and treatment of people and the recruitment processes.

The overall rating for this service is Inadequate which means it will remain in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Silverdale Nursing home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 25 people used the service.

The service does not have a registered manager. A person had been recruited into the manager’s position but they were not registered with us. 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.

Staff we spoke with all knew what constituted abuse and told us they would report it if they suspected abuse had taken place. However allegations of neglect were not always investigated.

Risks to people were not always minimised through the effective use of risk assessments. There were insufficient suitably trained staff to keep people safe and meet people's care needs in a timely manner.

Staff did not always have the knowledge and skills required to meet people’s individual care and support needs. The provider did not have robust recruitment and vetting procedures. Staff did not always have the induction, training and supervision they needed.

People did not receive care that w

This inspection took place on 24 February 2016 and was unannounced. At our last inspection in April 2014 we found that the service was meeting the required standards in the areas we looked at.

Silverdale Nursing Home provides support and care for up to 27 people, some of whom may be living with dementia. At the time of this inspection 27 people used the service.

The service had a registered manager. However, the person currently named on our register was not the same person who was now managing the service. 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 not always protected from the risk of abuse as some staff were unaware of the actions they should take. Some unexplained injuries had not been identified as potential abuse; they were not reported or investigated.

Staff did not always receive the training they needed to be able to support people in a safe or effective way.

The provider did not have effective systems in place to assess, monitor and improve the quality of care.

Some leisure and social activities were provided, but not all people got the support they needed to engage in any meaningful activity. People were not always treated with dignity and compassion and their privacy was not always promoted.

People generally told us they enjoyed the food and had enough to eat and drink. The mealtime experience could be improved to ensure it was an enjoyable experience for all people.

People's medicines were managed safely, and people received their medicines in a timely way.

The Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider followed the principles of the MCA by ensuring that people consented to their care or were supported by representatives to make decisions.

People were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

The provider had a complaints procedure and people knew how and who to complain to.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than

During this inspection we looked at the care provided to people at the home. The Silverdale Nursing Home was providing care and support to 24people on the day of the inspection. We spoke with three people who used the service and four people’s relatives. We also spoke with five members of staff, the registered manager and the provider.

Is the service safe?

People who used the service and their relatives told us they were happy with the care. One person told us, “I love it here, I’m happy. I’ve been here years”. One person’s relative told us, “X seems very happy being here. I’ve got no concerns about them at all”.

At a previous inspection completed on 06 October 2013, we identified areas of non-compliance against the regulations we inspect against. We asked the provider to provide us with an action plan of how they would ensure that people were protected against the risks of unsafe administration of medication. During this inspection, we checked and found that improvements had been made. There was adequate information within people’s medication administration records (MAR) and their care records to indicate that they required their fluids to be thickened. We noted that the provider kept accurate records of people’s medication quantities. This meant that people were protected from the risks of unsafe administering of medication.

The provider had robust recruitment procedures in place to ensure that people were cared for by suitably qualified staff. There was an induction programme in place for newly recruited staff to ensure that they received the necessary training to support them to provide care to people in a safe manner.

Is the service effective?

People's care records were person centred and the provider ensured that people’s relatives were involved in ensuring that staff had necessary information about people’s wishes and preferences in order to provide them with effective care The provider used a “Getting to Know you” document. This document was given to relatives to provide staff with as much information as possible if the person could not do this themselves.

We saw that staff always explained to people what they were about to do before they engaged in any planned activities with them. We observed a doctor carrying out physical health checks on some people who used the service in response to concerns raised by the staff. We noted that he took time to explain to the people what he was doing.

Relatives of people who used the service told us that care staff always kept them informed of any concerns relating to their relatives. One relative said, “They’re quite proactive in doing things and telling me what they’ve done”.

Staff members we spoke with told us that they were well supported by their managers. We saw that staff had regular supervision and training to ensure that people received effective care.

Is the service caring?

People were supported by kind, attentive and friendly staff. All the people we spoke with told us that they were happy with the care and treatment provided. One person we spoke with said, “I can’t fault them. The doctor’s always asking if I’m alright and if X (her son) if alright”. A relative of a person who used the service said, “I’ve always felt that the staff here have provided good care for my mum”.

Staff we spoke with told us they enjoyed caring for the people who used the service. One staff member said, “I love it; I’m happy doing this job. It’s a nice little home; it’s friendly”.

A social worker told us that staff were very caring and very supportive. The social worker told us how the carers had supported of a couple who were initially apprehensive about receiving care and support. The social worker said that care provided had been a very positive experience for the couple. The relative of the couple told us that, “We’re very impressed with the care”.

Is the service responsive?

The provider ensured that a full assessment of people’s needs and support plan was provided by a social worker prior to their staff going in to complete their own risk assessments and management plans.

The service worked well with other agencies and services to make sure care was joined up and effective. We saw records to demonstrate the involvement of other health and social care professionals in the care of people.

Staff were able to describe to us what actions they would take to manage people who presented behaviours that were challenging or in response to people’s anxieties. One staff member told us, “Sometimes, when people get a bit stressed, we bring them here (the relaxation room) to relax them. It’s very calming”.

Is the service well led?

We saw that the provider had systems in place to regularly monitor the quality of services being provided. We saw records that people’s care records were reviewed and updated as their needs changed.

Relatives and staff told us that the manager was approachable and they would go to her if they had any concerns. A relative of a person told us, “The business manager is very approachable and you can talk to him about anything.

We noted that the provider obtained the views of people and their relatives, and acted on concerns raised.

During our inspection we spoke with four people who used the service and two people’s relatives. We also spoke with six members of staff and the provider. People who used the service and their relatives told us they were happy with the care. One person told us, “It’s very good here. They are very caring and look after me”. Another person told us, “It’s very nice here. The staff do lots of things for me”. One person’s relative told us, “I am happy with the care and I don’t know what more they could do. They always show concern for my relative’s wellbeing”.

We saw that where appropriate people’s consent for their day to day care and support was sought by the staff. We saw that where people were unable to consent, best interest decisions were made in accordance to legal guidelines.

We saw that staff received appropriate training to enable them to meet people’s individual needs and provide compassionate care in a responsive and timely manner.

We saw that effective systems were not in place to keep people safe from the risks associated with medicines. Medicines were not always kept secure and accurate records were not always in place to demonstrate that people received their medicines in a safe and effective manner.

We saw that people had support plans which were updated to reflect their changing needs and there were written records to demonstrate that people’s conditions were monitored as advised by healthcare professionals.

During this inspection we saw that people and their representatives were supported to make decisions and where practicable to be involved in the planning of their care. We saw that when people found it difficult to make decisions, systems were in place to support them.

We looked at the way that the service provided care to people with dementia and saw that staff provided them with kind and sensitive support that met their individual needs. One relative said ''The staff are wonderful and look after people with dementia well''.

We spoke with staff about the care and support they provided and they all had a good understanding of people's daily lifestyle needs and preferences.We saw that care plans were in place that detailed a person centred approach to needs.

We were told by relatives and visitors the home was always clean and people looked well cared for. One person said that 'staff go that extra mile and always make sure X's clothes match'.

We spoke with people about their understanding of safeguarding people from abuse. Staff spoken to had a good understanding of the safeguarding principles. Staff said that they had received training in safeguarding. Relatives spoken to said they would tell the manager if they had any concerns.

We saw that staff were present in all areas of the home and were quick to respond to calls for assistance.

On the day of our visit on 10 February 2012 we spoke with four people who lived at Silverdale, five members of staff and two relatives.

We saw the nursing home was clean and tidy, people appeared happy and relaxed. We saw staff interacting with people in a kind and considerate manner and people responded positively. Staff spent time talking with people and giving reassurance.

People told us there were activities they could be involved in such as playing bingo and art to reduce boredom. People commented they did not have to take part and were able to make choices.

People said they enjoyed their meals and the food was good. We saw meal times were organised and relaxed; people were supported into the dining area and offered assistance. This showed people had care centered on them as individuals which reflected their needs.

Staff we spoke with showed understanding in areas of safeguarding and equality diversity. Staff felt appropriately trained and supported to provide good quality care. This demonstrated people were cared for by competent staff and were not at risk of inappropriate or unsafe care.

Relatives we approached spoke highly of staff, they told us their family member received the care they needed. Relatives said they felt involved and staff kept them informed of changes, this showed consideration was given to relatives acting on behalf of people living at Silverdale.

We found quality assurance systems in place and the service was improving as a result of findings. This meant arrangements were in place to reduce risk and improve the delivery of care.

None of the people or relatives we spoke with on the day of our visit reported concerns and were aware of how to raise complaints.