This inspection took place on 26 January 2018 and was unannounced. Silverdale 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 accommodates up to four people who have autistic spectrum disorders. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum. At the time of the inspection one person was living at the service and two people were receiving regular respite care including overnight stays. The service consists of a two story detached house set within its own gardens.

The service 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. The registered manager was also responsible for providing leadership at two of the providers other services in the west of Cornwall. At Silverdale the registered manager was supported by a deputy manager who was based in the service full time and allocated four hours of administration time each week.

People were relaxed and at ease in Silverdale and their relatives told us, “I think people are very safe.” Staff had received safeguarding training and understood their responsibilities in relation to protecting people from abuse and harm. All staff had received safeguarding training and information about how to report concerns outside of the service was readily available.

People’s relatives told us, “[My relative] likes it there” and “I am happy with the care they provide.” During the inspection we observed numerous interactions between people and their support staff. People were comfortable requesting support and did so without hesitation. Staff provided support with kindness and compassion and took pleasure in describing people achievements. Staff comments included, “I love it, I really enjoy it here” and “It is nice to watch [Person’s name] grow.”

The registered manager was responsible for overseeing three local services. There was a full time deputy manager at Silverdale and Staff told us they were well support by the registered manager who visited regularly. Staff comments in relation to the registered manager included, “[The registered manager] visits three times each week and the deputy manager does have four hours administrative time each week”, “[The registered manger] is as good as gold”, and “I think the managers are great.”

Staff were well motivated and relations between the service and the providers senior management had improved since our last inception. Staff said, “I think there has been a lot better communication” and “[The Operations director] was here on Monday.” The registered manager had focused on encouraging and fostering the development of a positive culture within the home and a staff compliments book had been introduced to enable staff to share positive feedback. Staff said, “It’s a good place to work, we have quite high morale and that’s quite rare for a care home” and the registered manager told us, “I am very proud of this house.”

The service’s complaints procedures was available in accessible formats and care plan’s included guidance for staff on how to support people and members of the public to make complaints. Where complaints had been received these had been investigated and acted upon by the registered manager to improve the service’s performance.

Information was stored securely and there were systems in place to monitor the service’s performance, gather feedback from people and their relatives and identify where improvements could be made.

The service was adap

During our inspection of this service we considered our findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

At the time of our inspection we found that Silverdale provided a safe service due to:

We saw that staff communicated and responded to people who used the service with respect.

Care plans were individualised and contained information that directed and informed staff to provide appropriate care and support. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped to continually improve the service.

Spectrum had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that they were using these protections appropriately.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk, but also had access to choice and remained in control of decisions about their care and lives.

Medication systems were robust so that people who used the service received their medication as prescribed.

Is the service effective?

At the time of our inspection we found that Silverdale provided an effective service due to:

We noted from care records that people’s health and care needs were assessed with them, and their care plans were discussed with them. We saw the persons care plan was up to date and accurately reflected their current needs. There were good arrangements in place to gain consent from the person in relation to the care they received.

The person’s preferences, interests, aspirations and different needs had been recorded and care and support had been provided in accordance with their wishes.

We found all people who used the service had a care plan and found the information was up to date and had been reviewed regularly.

Is the service caring?

At the time of our inspection we found that Silverdale provided a caring service due to:

We saw people who used the service were treated with respect and dignity by the staff. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the person they cared for.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

Is the service responsive?

At the time of our inspection we found that Silverdale provided a responsive service due to:

We found people who used the service were involved in making day to day decisions. During the inspection we noted that people were given choices in how they wanted to occupy their time, this meant they had opportunities to pursue their interests.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of our inspection we found that Silverdale provided a well lead service due to:

The service had a quality assurance system, and records showed problems and opportunities to change things for the better were addressed. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We saw minutes of regular meetings held with the staff and management team. This showed the management consulted with staff regularly to gain their views and experiences and improve support for people who lived at the service.

Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

We met with three people who lived at Silverdale. Due to their complex communication needs we saw how people who used the service interacted with staff. We saw people approach staff in a relaxed manner and staff responded to their approach. We spoke to a relative who told us that they felt without the “involvement of Silverdale and Spectrum we don’t know what we would have done”.

We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people's privacy and dignity was respected by the way that staff assisted people with their personal care.

We examined people’s care file and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home. We noted that people received a varied and nutrious diet.

We noted that minimum staffing levels were met on the majority of occasions at the home. Staff said they had received sufficient training and support to enable them to carry out their roles competently.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people’s rights. Secure access to the premises needs to be maintained at all times to ensure peoples safety.

We inspected Silverdale on 7 July 2015, the inspection was unannounced. We visited the senior management team at Spectrums headquarters on 8 and 14 July 2015. The service was last inspected in May 2014 we did not identify any concerns. Silverdale provides care and accommodation for up to four people who have autistic spectrum disorders. At the time of the inspection four people were living at the service.

Silverdale has a registered manager in place. 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.

We received anonymous concerns from staff in respect of Silverdale and the senior management of Spectrum prior to our visit. These concerns related to staff being dissatisfied with various issues such as staffing levels, lack of staff support and feeling undervalued and not appreciated by senior managers. We were also told us staff were reluctant to raise issues directly with managers in case of “repercussions.” At the inspection the majority of staff told us they felt supported by their line manager at Silverdale but not with senior managers who are based at Spectrum headquarters. We discussed the concerns with the registered manager and senior management team. We found that there was not an open culture within the service and organisation which allowed staff to feel supported to raise concerns without fear of recrimination.

We have made a recommendation about supporting staff to raise concerns in the report.

Managers had not undertaken a staff survey of how people felt about working for Silverdale or for the organisation. Therefore Spectrum did not have an understanding of how staff saw the orgainisation, for example what it did well or any areas where staff felt improvements could be made. We have made a recommendation about gathering the views from staff in the report.

People were happy and relaxed on the day of the inspection. We saw people moving around the home as they wished, interacting with staff and smiling and laughing. Staff were attentive and available and did not prevent people from going where they wished. Staff encouraged people to engage in meaningful activity and spoke with them in a friendly and respectful manner. Staff were knowledgeable about the people they supported and spoke of them with affection.

Care records were detailed and contained specific information to guide staff who were supporting people. One page profiles about each person were developed in a format which was more meaningful for people. This meant staff were able to use them as communication tools.

Incidents and accidents were recorded. These records were reviewed regularly by all significant parties in order that trends were recognised so that identified risks could be addressed with the aim of minimising them in the future.

Risk assessments were in place for day to day events such as using a vehicle and one off activities. Where activities were done regularly risk assessments were included in people’s care documentation. People had access to a range of activities. These were arranged according to people’s individual interests and preferences. Staff identified with people future goals and aspirations and worked with the person to achieve them.

The service adhered to the requirements of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards.

Staff were well supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively.

The staff team were supportive of each other and worked together to support people. Staffing levels met the present care needs of the people that lived at the service.