CQC report explained · a nursing home
What the CQC found at Silver Trees
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, June 2023
Rated Requires Improvement; inspectors found risks in care records, medicines, staff training and quality checks.
This was a targeted inspection about concerns over safe care and treatment. Inspectors visited on 31 March, 14 April and 28 April 2023. They spoke with people, relatives, staff and a health professional, and checked care plans, staff files, training, medicines and quality records.
The home was not always safe. Inspectors found problems with specialist mattresses, choking information, referrals, medicines storage and medicine records. Some fire doors and the loft area also needed work. The home was clean, but masks were not always worn correctly.
Care was not always effective. Some staff had not completed required training, and training for nursing staff had been delayed. Mealtimes and support with drinking were inconsistent. The home did provide access to GPs, optometrists and podiatrists, and some improvements were made during and after the inspection.
The home was rated Requires Improvement overall, with Safe, Effective and Well-led also rated Requires Improvement. This is a fall from Good at the previous inspection, published on 12 March 2019. CQC identified breaches in safe care and treatment, staffing and good governance, and requested an action plan.
Accessible management
The registered manager was available to people, relatives and staff and was open to CQC feedback. Action was taken on some issues during and after the inspection.
“The registered manager was open and transparent during the inspection and was accessible to people, relatives and staff.” from the report
Healthcare access
People received support with GP, optometrist and podiatrist appointments. A GP visited weekly.
“People received support from the GP, chiropodist and optometrist when required.” from the report
Clean home
Inspectors found the home clean and well presented. People were also supported to receive visits from family and professionals.
“The home was clean and well presented.” from the report
Staff support
Staff said they felt supported by management. Inspectors also observed staff taking time to support people.
“We observed staff and the deputy manager taking their time to support people.” from the report
Personal evacuation plans
People had evacuation plans and the home had a contingency plan, contact details and a grab bag.
“People had personal evacuation plans in place. There was a contingency plan, important contact details, and a grab bag with items staff might need should the building be evacuated.” from the report
Unsafe medicines
seriousMedicines were not always securely locked or given and recorded safely. Some topical cream records, eye drop instructions and arrangements for crushed medicines were incomplete.
“Medicines which needed to be administered at set times, such as antibiotics, were not always being administered in line with the required time scales.” from the report
Incomplete care records
seriousCare plans did not always contain enough information about individual medical needs. Records also did not always show that planned skincare was provided.
“People's care plans did not always contain important information relating to the support they required with their individual medical needs.” from the report
Risks in eating and drinking support
seriousInformation about choking risks was inconsistent, referrals were sometimes delayed, and some people did not receive enough support to meet fluid targets.
“People at risk of choking had inconsistent information within their care plan and other supporting documentation.” from the report
Training gaps
seriousClinical training had been cancelled twice, and many staff had not completed the Care Certificate. Overall training compliance was 72% at the inspection.
“Staff were not always receiving training when a need was identified.” from the report
Quality checks missed problems
seriousDaily and weekly checks had not identified several shortfalls found by inspectors. This meant the home's systems did not give reliable assurance that care was safe and effective.
“Quality assurance systems and processes did not always identify shortfalls during the inspection.” from the report
Mealtimes were inconsistent
needs fixingOn the first inspection day, the nursing floor had no dining room set up and people ate in their rooms. Softer snacks were not always offered.
“No tables and chairs were set up on the nursing floor on our first day.” from the report
- 01What has been done to ensure all medicines are securely locked and given at the right time?
- 02How do you now check that care plans contain clear instructions for choking risks, catheter care, PEG care and other individual medical needs?
- 03How many staff have now completed the Care Certificate and the clinical training identified in the report?
- 04What checks now confirm that specialist mattresses, skincare and fluid support are being managed as planned?
- 05What work has been completed on the fire doors and loft area, and what evidence can you show us?
This was a targeted inspection of concerns about care and treatment, with ratings given for Safe, Effective and Well-led; no separate ratings were given for Caring or Responsive. This explanation was written from the published report of 9 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2019
Rated Good; inspectors found kind, safe care with good activities, but some records and communal bathrooms needed attention.
This was an unannounced inspection on 12 February 2019. Inspectors spoke with people living in the home, relatives and staff. They observed care and reviewed care plans, medicines, staff records, complaints and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were safe, treated kindly and supported by staff who knew them well. People enjoyed activities, outings and relaxed mealtimes. Relatives said communication was good.
The report also identified some areas to improve. Communal bathrooms needed refurbishment. A new electronic care planning system had led to some inaccurate information. Inspectors also highlighted missed knocking before entering rooms and one incomplete end-of-life plan. The overall rating was unchanged from the previous Good rating in November 2016.
Kind and attentive staff
People and relatives described staff as kind, friendly and helpful. Inspectors observed staff spending time with people and supporting them in a cheerful way.
“People were supported and treated with dignity and respect; and involved as partners in their care.” from the report
Activities and social life
People had a range of activities and outings, including walks, shopping, music, painting and church visits. Activities helped people build social relationships.
“People enjoyed the variety of activities provided and going out of the service with staff shopping or for walks.” from the report
Improved staffing
Recruitment had significantly reduced the use of agency staff. People and relatives said staffing was more consistent, and staff reported that the atmosphere had improved.
“The use of agency staff had reduced significantly due to successful recruitment.” from the report
Good food and mealtimes
People spoke positively about the food and had choices about what and where to eat. Inspectors saw relaxed and sociable mealtimes.
“Mealtimes in communal areas were relaxed and sociable.” from the report
Communal bathroom repairs
needs fixingSome refurbishment was needed in communal bathrooms. Routine checks had not identified these requirements.
“However, these checks had not identified some refurbishment requirements in a number of communal bathrooms.” from the report
Care plan accuracy
needs fixingThe new electronic care planning system was still being introduced. Some information was recorded inconsistently, although staff knew people's needs.
“This meant we found some inaccuracies in care plans due to how and where information was recorded.” from the report
Privacy when entering rooms
minorInspectors saw staff enter people's rooms without knocking on three occasions. This was raised with the manager.
“We did observe however, three occasions when staff walked into people's rooms who had the door open without knocking or being invited in.” from the report
End-of-life planning
needs fixingOne person's end-of-life plan had not been completed. It was unclear whether the person had chosen not to record their wishes or had not been consulted.
“However, for one person no plan had been completed and it was not clear if the person did not wish to record this information or had not been consulted.” from the report
- 01Have the communal bathroom refurbishment requirements identified at the inspection now been completed?
- 02How do you check that information in the electronic care planning system is accurate and consistent?
- 03What steps do staff take to knock and seek permission before entering a person's room?
- 04How do you make sure every resident is consulted about and has an up-to-date end-of-life plan?
- 05Has the reduction in agency staff continued since the inspection?
This was an unannounced planned inspection covering all five CQC questions and both the care provided and the care home environment. This explanation was written from the published report of 12 March 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Silver Trees
4 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- June 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Good
- November 2016Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2016Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- October 2011
Registered with the Care Quality Commission on 31 October 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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23 live-in carers within about an hour of North Somerset
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Most charge £1,050 to £1,320 a week. 19 can care for a couple. 12 years' experience on average.
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