This was the first inspection since the provider registered with the Care Quality Commission on the 22 November 2017. Prior to this the provider was registered under a different name. The new registration has not affected the accommodation and care arrangements for people living at Silvermead.

Silvermead is a residential care home, which provides accommodation, and supports the needs of people with a learning disability and associated conditions such as autism. 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.

The service was registered to accommodate and support a maximum of 13 people. At the time of the inspection 11 people were living at the service.

The requirements of the provider’s registration meant the service had to have 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. At the time of this inspection a registered manager was in post.

We reviewed whether or not the service was being run in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. The Care Quality Commissions policy relating to ‘Registering the Right Support’ states that people with learning disabilities and autism can live an ordinary life as any citizen. The values that underpin this policy include choice, promotion of independence and inclusion. We found improvements were needed in the overall culture and running of the service to help ensure these values continued to be maintained and promoted.

The planning and delivery of care was not in all cases personalised and did not always take into account people’s choice, preference and aspirations. Staff were very caring and observations we made clearly demonstrated that people felt safe and cared for in their home. Other agencies were positive about the service and said the management and staff were very caring and provided particularly good support when people were unwell, or at end of life. However, the care planning process did not demonstrate that consideration had been given to people’s lives beyond their immediate need for the service. Care plans did not include information about people’s goals or how the service would support people to develop their skills and independence.

The culture and some of the practices we observed were not personalised and did not always promote people’s independence, privacy and dignity. For example, we saw staff doing tasks for people, instead of encouraging people to do for themselves. Practices in relation to medicines and the management of finances were not personalised and did not take into account people’s preferences, skills and independence. Some of the language used by staff about people did not respect their age or promote people’s dignity.

Systems were in place to monitor the quality of the service. However, the provider did not have a clear set of values and aims against which to measure quality and outcomes for people and auditing processes had not identified areas of concern found during this inspection.

Staff were aware of risks associated with people’s care. For example, some people had risks associated with their diet and eating. Referrals had been made to speech and language therapists and any guidance was followed by staff to keep people safe. However, information about some known risks and how staff would mitigate them had not been clearly detailed for staff to follow. The absence of this written detail could mean staff did not have the information required to provide consistent care and to keep people safe.