This inspection took place on 15 and 18 January 2019; the first day of inspection was unannounced.

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

Silverwood (Nottingham) accommodates up to 80 people in two separate buildings; one building provides residential care for up to 39 people and the other building provides nursing care for up to 41 people. There were 38 people with nursing needs and 32 people with residential needs who were in receipt of personal care at the time of our inspection.

At our previous inspection on 14 and 16 March 2017, the service was rated ‘good’ overall and the question ‘Is the service safe?’ was rated as requires improvement.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found improvements were needed to show how the risks around depression and potential self-harm were assessed and followed up. Improvements were also required to how risks associated with the provision of people’s care were reviewed, analysed and reduced.

Care plans and risk assessments did not always accurately reflect people’s care needs and any associated risks. Care plans and risk assessments were not in place for when people presented with behaviours that could potentially harm themselves or others.

Whilst some aspects of medicines management and administration were managed well, some improvements were needed to ensure medicines were consistently managed and administered safely. Some people had experienced medicines being out of stock. Records of medicines administration required improvement.

People did not always receive timely help from staff when they used their call bell. People also told us they had not always experienced timely help from staff and on one occasion this had compromised their dignity. We observed staff were not always deployed to ensure a staff presence in communal areas.

People told us they felt safe, however records did not demonstrate what actions had been taken to investigate one incident. Staff had been trained, and understood what actions to take to report any safeguarding concerns.

Equipment and actions to monitor, help prevent and reduce risks from pressure area damage had not always been used effectively. Monitoring and actions in relation to pressure areas and other healthcare needs, such as fluid intake and output also needed improvement. Care plans did not always reflect people’s current healthcare needs to ensure staff understood how to provide them with consistent care.

People told us they thought staff were caring, however some people felt this was compromised when staff were too busy to spend time with them. Some improvements were needed to ensure people’s experiences of staff were caring. Staff respected people’s privacy and promoted their independence; we identified one occasion when a person’s dignity could have been promoted better. People, and where appropriate, their relatives or representatives had opportunities to be involved in care planning.

Not everyone experienced responsive and timely care and some people did not have baths or showers as frequently as they would have preferred.

The service was kept clean and actions were taken to help prevent and control risks from infections. Other risks, such as falls risks and risks identified in the environment were assessed and actions taken to reduce risks from them.

The provider was keen to improve the

This inspection took place on 14 and 16 March 2017 and was unannounced.

Accommodation for up to 80 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 66 people using the service at the time of our inspection.

At our last inspection on 29 and 30 March 2016, we asked the provider to take action to make improvements in the areas of person-centered care and staffing. We received an action plan setting out when the provider would be compliant with the regulations.

At this inspection we found that improvements had been made and the provider was now compliant with the regulations.

A registered manager was in post and was available 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 did not always receive medicines administered at the right times. Medicines were not always safely managed and records were not always completed accurately. The registered manager assured us that further action would be taken to address the issues that were found.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe infection control practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and promoted their independence. An incident which affected a person’s dignity was observed but immediate action was taken by the registered manager to address the issue.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved. Complaints were handled appropriately. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising concerns with the management team and that appropriate action would be taken. The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

This inspection took place on 29 and 30 March 2016 and was unannounced.

Accommodation for up to 80 people is provided in the home in two buildings and over two floors in each building. The service is designed to meet the needs of older people. There were 54 people using the service at the time of our inspection.

At the previous inspection on 14 and 15 April 2015, we asked the provider to take action to make improvements to the areas of person-centred care, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all areas, however, more work was required in the areas of person-centred care, good governance and staffing.

A registered manager was in post and she was available during 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.

Sufficient numbers of staff were not on duty to meet people’s needs. Staff did not always safely manage identified risks to people. People felt safe in the home and staff knew how to identify potential signs of abuse. The premises were managed to keep people safe. Staff were recruited through safe recruitment practices. Safe infection control and medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People did not always receive personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection team who carried out this inspection consisted of three inspectors to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We held conversations with ten people who used the service and one visitor to the home. We spoke with representatives from the management team and three members of staff. We looked at some of the records held at the service which included care plans, auditing records, staff recruitment records and the providers service user satisfaction survey which twenty three people responded to in 2013. We also observed the support people received from staff and carried out a tour of the buildings.

Is the service safe?

We found that all the people we spoke with felt they were safe and said the staff would always promote their safety and well-being. One person told us, “I feel very safe and I really don’t have anything to complain about.”

We found that an on call system was in operation to ensure a member of the management team would be available at all times should they need to be contacted in an emergency situation.

We found that an effective recruitment system was in place to ensure that staff were only employed once they had been assessed as suitable to work with vulnerable adults. We also found that staff were able, from time to time, to obtain further relevant qualifications pertinent to their roles and responsibilities at the home.

Is the service effective?

We found that systems were in place to highlight people’s individual care needs and how they could be met by the care staff. People told us that they were happy with the quality of care they received and told us they felt that staff had a good knowledge of their individual needs and preferences.

Is the service caring?

People told us that staff were respectful at all times. We found that staff were proactive in promoting people’s respect and dignity. We saw staff listening to, and respecting people’s views and when they spoke with people it was in a dignified manner. We also saw that when staff were delivering care or meeting people's comfort needs it was undertaken a caring way.

We also observed staff utilising effective communication skills when they were interacting with people. We saw that conversations were unrushed and people were provided with sufficient time to respond. We also observed staff speaking slowly and clearly when needed and used short, simple words and sentences to minimise confusion. We also saw people were offered reassurance and explanation before care was provided and staff listened to and respected people's decisions.

Is the service responsive?

We found that systems were in place to ensure that effective needs assessments could be performed to ensure people's individual needs could be met. We also found that the management team would utilise information from people’s relatives and health care professionals to build a comprehensive picture of people’s individual needs.

We also found the reviewing procedures at the home had been amended since our previous inspection to ensure the care plans were up to date and reflected people’s individual needs.

Is the service well-led?

We found that since our previous inspection the management structure had changed. People told us they felt confident in discussing any areas of service provision with the management team and felt confident that their opinions would be respected.

Staff told us they received appropriate support and direction from the management team in the form of bi-monthly staff supervision sessions,. They also told us they felt comfortable in expressing their views at staff meetings which were performed on a monthly basis.

Records showed that people had been supplied with a satisfaction survey in 2013 so they could make comments about the quality of the service. We found that following the consultation process an analysis of the results had been undertaken. This was to provide a facility to develop the quality of the service whilst recognising where improvement could be made.

This inspection took place on 14 and 15 April 2015 and was unannounced.

Accommodation for up to 80 people is provided in the home in two buildings and over two floors in each building. 57 people were living in the home at the time of the inspection. The service is for older people.

There is a registered manager and she was available 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.

Staffing levels did not always meet the needs of people who used the service and staff were not always recruited safely. The premises were not always secure enough to keep people safe. Safe infection control procedures were not always followed.

There were processes in place to help make sure people were protected from the risk of abuse and medicines were managed safely.

Staff were not consistently supported to ensure they had up to date information to undertake their roles and responsibilities.

People were not always well supported to eat and drink and documentation was not fully completed to ensure that people received sufficient to eat and drink. People did not always receive support to maintain good health and limited adaptations had been made to the premises to support people living with dementia.

People’s rights under the Mental Capacity Act 2005 were protected.

People’s privacy and dignity were not always respected. People were not always involved in making decisions about their care and the support they received.

Some staff were compassionate and kind and had a good knowledge of people’s likes and dislikes; however, some staff provided care in a task-focussed way and had limited knowledge of people’s likes and dislikes.

People did not always receive assistance promptly. Care plans were in place outlining people’s care and support needs but did not always contain sufficient information to make sure people’s individual needs and preferences were taken into account.

People were listened to if they had complaints and appropriate responses were given.

Audits carried out by the provider had not identified all the issues found during this inspection.

People and relatives were involved in the development of the service and a registered manager was in place.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.