We carried out an unannounced comprehensive inspection on 12 and 13 December 2017.

Silver Court provides care and accommodation for up to 42 people. On the day of our inspection there were 40 people living at the home. The home provides residential care for the elderly and frail and people living with dementia.

Prior to this inspection we received some information of concern about the management of people’s skin and the staffing levels, mainly at weekends.

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. 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. At the last inspection on the 26 August 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated good:

People told us they felt safe. One person said; “Safest place for me (living here not at home). Another said; “Security at the door makes me feel safe.” Staff said; “People are safe because we know them and what they like.” A relative said; “Want to express deepest gratitude for making mums quality of life in past few years something she could cope with and enjoy.”

People remained safe at the service. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff mostly said there were sufficient staff to keep people safe. However a few relatives and staff commented that weekend staffing levels were not always as good. Other staff said they were able to meet people’s needs and support them with activities and trips out.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. People who required additional input to protect their skin integrity had input from the district nurse team. Professionals stated people were safer now as all staff had received training and worked with them to keep people’s skin integrity safe. People received their medicines safely by suitably trained staff.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.

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’s end of life wishes were documented. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy was mostly respected. However we did note that on occasions not all staff knocked on people’s door before entering. People or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personal

The inspection took place on the 26 August 2015 and was unannounced.

Silver Court provides care and accommodation for up to 42 people. On the day of our inspection there were 40 people living at the home. The home provides residential care for the elderly and frail and people living with dementia. The home is a purpose built home all on one floor with communal lounges with dining areas.

The home had 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.

People felt safe living at the home. There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. One person told us “I have always felt safe, staff really look after me”. The registered manager made sure there was enough staff on duty at all times to meet people’s needs. When the provider employed new staff they followed safe recruitment practices.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people they were happy for them to undertake care tasks before they proceeded.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed.

Staff supported people to eat and they were given the time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy.

The activities co-ordinator organised a weekly (seven day) programme of different activities on a two week rota. This included arts and crafts, baking, exercise and a visiting PAT (pet as therapy) dog Some activities were organised around assisting the kitchen, for example we observed three people enjoying peeling potatoes and carrots and other people making cakes.

Staff felt fully supported by management to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example staff were offered to undertake additional training and development courses to increase their understanding of needs if people living at the home. A member of staff told us “We get lots of good training, If I felt I wanted anymore I can just ask and they will arrange it”.

There was a positive and open atmosphere at the home. The registered manager was visible and active within the home. Staff and people told us they liked having regular meetings and felt them to be beneficial, the provider took action in response to feedback received. One person told us “The manager is nice, I can go and see her anytime”.

This was a targeted inspection to follow-up on concerns that we raised about record keeping when we inspected the home on 12 June 2013. We did not seek specific feedback from people who used the service on this occasion.

We looked at a range of records including accident, incident and safeguarding reports, health and safety checklists and the care plans for five people. We found that the standard of record keeping had improved since our last inspection. We met with the registered manager and one of the home's team leaders. We found that staff had maintained documentation to evidence that people had received appropriate care and treatment.

This was a targeted inspection to follow-up on specific concerns that we raised about infection control when we last inspected the home on 12 June 2013. We did not seek specific feedback from people who used the service on this occasion.

We found that the home was clean and tidy and the provider had taken appropriate action to improve infection control standards within the home. We saw that sluices were now suitably maintained and that there were systems in place to ensure that these areas were regularly checked. This meant that people were now better protected because the home had taken steps to reduce the risk of the spread of infection.

We spoke with seven people who lived at the home, two visiting relatives and five members of staff during our visit. People told us they liked living at the home. One person said "Everyone is very nice" and another commented it was "Beautiful" and that they were "Happy here". Visiting relatives told us that they were able to visit unannounced at any time.

We found that people received care which met their needs. However there was a lack of information on managing challenging behaviour which meant that staff could not ensure that support in this area was given confidently and consistently.

Staff told us they were aware of safeguarding procedures and were confident in identifying possible abuse. They told us that they had training in safeguarding and understood the procedures to follow and who to contact.

We found that people's rooms and the communal environment were clean and free from unpleasant odours. However, sluice areas were poorly maintained and did not protect people from the risk of infection.

Staff were supported through a wide range of training and regular supervision. Comments received from staff included "I really enjoy it here", "It has changed for the better" and "The manager is understanding".

We identified that there were gaps in care plans and other records which meant that the provider could not be certain that people were receiving appropriate care. Records were kept securely and were accessible to those that needed to see them.

People told us that they liked living at the home. They said that they were “happy here and had no complaints”. People stated that staff “treat me well” and they had nice rooms. People informed us that they received “good food” which they described as “lovely”, “plentiful” and “I’m never hungry”.

People living at Silver Court told us that they liked being there. One person described it as being a “home form home” and another person told us it was “marvellous” and “I can’t fault it at all”.

Relatives of people using the service said that they are always made to feel welcome and can call in at any time. They described the home as clean and staff as “friendly” and “approachable”. One relative informed us that “we are really happy and pleased that mum is living at Silver Court” and another stated “our relative is safe here and that gives us peace of mind”.

The only recurring theme where people expressed that they we not so happy was in relation to the food. We joined residents in their dining areas for their breakfast and lunchtime meals. Whilst people told us that they enjoyed their breakfasts, they were less positive about the food served at lunch. One resident described the quality of lunch as “very poor and insufficient” whilst another said “I don’t like the food, I could cook better myself”. A relative also told us they had raised concerns about the food at the home.