Silverleigh Cedars

Updated 20 May 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This was a targeted inspection to check on specific concerns we had about staff practice; infection control practice; lack of PPE; poor personal care; risk management; medication management; staff training; manual handling practices; poor nutrition; staff levels; people not being given choices; liberties being restricted; the management of the service.

Inspection team

The inspection was carried out by three inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Silverleigh is a ‘care home’. 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced. We announced the inspection from outside of the home because of the COVID-19 pandemic so we could assess the risks prior to entering the care home.

What we did before the inspection

We reviewed information we had received about the service since the last inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection-

We spoke with five people who used the service and one relative about their experience of the care and support provided. We spoke with 16 staff during the inspection, including the registered manager, deputy manager, compliance manager, medicine champion, clinical lead nurse, nurses, senior care staff, care staff, activity staff, housekeeping staff, maintenance person and the executive chef. We also spoke with the provider and agency staff working at the home.

We reviewed a range of records. These included five people’s care records and medicine records on the provider’s electronic system and records relating to the management of the service, such as incident and accident records, health and safety records, audits and staff recruitment records.

Throughout the inspection we were able to observe staff interactions with people in the communal areas to see how staff cared for and supported people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us to understand the experience of people who cannot talk with us. We observed the lunchtime mealtime experience in the dining room and for those people who ate in their rooms.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We emailed 70 of the staff who we had not met at the inspection to ask them their views about the home. We received responses and/or spoke with 20 staff.

Updated 20 May 2021

About the service

Silverleigh is registered to provide accommodation and nursing and personal care for up to 65 people. The service is intended for older people, who may also have a physical disability, mental health needs or a dementia type illness. The service is in a large detached building located in the market town of Axminster in East Devon. The home is within walking distance of Axminster town centre, local church and post office and benefits from being next to the local GP surgery.

This inspection took place on 3, 5 and 6 February 2020, the first day was unannounced. There were 61 people living at the service at the time of the inspection. The majority of people were living with dementia.

People’s experience of using this service and what we found

People continued to receive kind, compassionate care from a team of highly motivated staff who were very well trained and skilled. People received an excellent quality of care because the provider and management team set high expectations about standards of care and led by example. The provider used evidence based best practice and had developed models of dementia care from learning from their own services.

Everybody gave very good feedback about how caring, well managed and supportive the staff and management team were. We saw many examples of where staff went the extra mile to support people to live fulfilling lives. People were very relaxed and happy in the company of staff. Staff were very attentive and responded to people’s needs promptly and appropriately in a calm non-judgemental manner. People were involved in decisions about the home and their personal needs.

The provider’s ethos continued to focus on an entirely holistic approach to the provision of care and specialist dementia care. They had gone to extraordinary lengths to ensure that the building was adapted to meet people’s needs and ensure their accommodation was truly individualised and personal. They were continually updating, adding and improving the environment at the home. The atmosphere at the home was very welcoming and relaxed.

The provider, registered manager and staff team were very highly motivated and proud of the service they delivered to people. The whole team demonstrated they shared responsibility for promoting people's wellbeing, safety and quality of life.

There were consistently high levels of engagement with people using the service, families and other professionals.

People who lived with dementia continued to receive excellent care tailored to their individual needs. Staff

completed bespoke dementia training to increase their understanding of the condition.

A brilliant activities team promoted inclusion and empowered people to do activities, hobbies and interests which gave them a feeling of well-being and being valued.

People experienced end of life care in an individualised and dignified way. Staff recognised the importance of holistically supporting people at the end of their lives. They also supported relatives with a booklet of information about end of life and what families and friends might expect and experiencing grief.

People received personalised care which was centred around them as individuals. Care plans were in place which reflected people’s wishes. They were used by staff to meet people’s assessed needs and preferences and to help them achieve their goals. Staff knew people well, cared about them and understood their care and support needs. Staff recognised the importance of promoting people’s independence and supporting them to live fulfilling lives.

Staff recruitment and staffing levels supported people to stay safe while going about their daily lives. Staff also understood their role and responsibilities to protect people from abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had their nutritional needs assessed and met. Everyone praised the standard of food provided at the home. People received their medicines when they were needed and in ways that suited them. There were systems in place to check that medicines were administered correctly and safely.

Governance was well-embedded into the running of the home. There was a strong framework of accountability to monitor performance and risk leading to quality improvements within the home. The provider and the management team saw this as a key responsibility and a means to continually learn and adapt. The provider believed in succession planning and the continuous development of their services.

Rating at last inspection

The last rating for this service was outstanding (published 9 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk