Archived: Silver Birch Lodge

Updated 5 April 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At the last inspection on 07 & 09 August 2018 the provider failed to comply with regulatory requirements and was served warning notices for breach of regulations 12 and 17 of the Health and Social Care Act 2008. This inspection was undertaken to check if the provider had made improvements.

Inspection team:

The inspection team consisted of four adult social care inspectors, one adult social care inspection manager and a pharmacist inspector.

Service and service type:

Silver Birch Lodge is a care home. People in care homes receive accommodation and nursing or personal care. 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:

The first, second and fourth days of the inspection were unannounced, we informed the registered manager that we would attend on the third day.

What we did:

Prior to our inspection we looked at all of the information we held about the service. This included any safeguarding investigations, incidents and feedback about the service provided. We looked at any statutory notifications that the provider is required to send to us by law. We used a planning tool to collate all this evidence and information prior to visiting the service.

We spoke with seven people who lived at the service and four relatives. We also spoke with the registered manager and provider, two registered nurses, three senior support workers, the care manager and a domestic worker. We looked at a variety of records which included the care files for eight people who used the service and three staff recruitment files. We also reviewed a number of records related to the operation and monitoring of the service and medicines management.

Updated 5 April 2019

About the service:

Silver Birch Lodge is based in Aughton, near Ormskirk and provides accommodation for up to 31 older people, who require help with personal or nursing care needs. At the time of the inspection there were 21 people who lived at the service.

People’s experience of using this service:

The service had significantly deteriorated since the last inspection.

The provider failed to ensure individual risks for people who lived at the service had been assessed and this placed them at significant risk of avoidable harm.

Medicines were not managed safely and people did not always receive their medicines as prescribed.

People were not always risk assessed in relation to falls and weight loss this meant they were at risk of serious harm.

The provider had not ensured equipment such as bedrails were routinely checked for mechanical safety or that decisions made to use restrictive equipment were in line with people’s wishes or best interests.

We found the provider had not acted upon actions specified in a fire safety inspection report and therefore placed people at risk of avoidable harm in the case of fire. The provider did not have a suitable emergency evacuation procedure in place.

Staff were not always safely recruited. The provider did not always make sure checks were done in relation to suitability to work with vulnerable adults.

The service did not always support people in a person-centred way.

We found shortfalls in relation to the assessment of a person’s mental capacity before restrictive practices were considered. We also found a substantial lack of understanding from the registered manager and senior staff about the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

The provider did not ensure staff had up to date training to be able to provide safe and effective care.

The management and oversight of the service was poor. We found ineffective quality assurance systems and this meant that risks highlighted at this inspection had not already been identified by the provider.

The service was clean and people were protected by the prevention and control of infection.

Throughout the inspection we observed suitable numbers of staff deployed across the service and people who lived at the service and their representatives provided positive feedback about staff who supported them.

We observed staff interacted with people in a dignified and respectful way. People who lived at the service had access to meaningful activities and were encouraged to access the local community.

Rating at last inspection:

Our last inspection report for this service was published on 31 October 2018 and the rating was 'Requires Improvement' across all domains. There were three breaches of regulations 9,12,17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, safe care and treatment and good governance. The provider was also in breach of regulation 18 of the Health and Social Care Act 2008 Registration Regulations 2009, Notifications of other incidents.

Following the last inspection, we took enforcement action and issued the registered provider with warning notices in relation to medicines management, risk assessment and good governance. We also asked the registered provider to tell us what actions they would take to comply with these regulations.

At this inspection in February 2019, we found the provider had made some improvements in relation to the prevention and control of infection. However, we found continuing areas for improvement in relation to governance arrangements, risk assessment and medicines management. Our findings showed there were areas which had deteriorated further and areas that required further improvements and improvements made needed to be imbedded and sustained.

The service had deteriorated and was rated overall Inadequate.

Why we inspected:

This was a scheduled inspection based on the service's previous rating and to review action taken against served warning notices for regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Enforcement:

Please see the 'action we told the provider to take' section towards the end of this report.

Follow up:

The overall rating for this service is inadequate and the service is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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