Archived: Birchwood

Birchwood had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manager 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 inspection took place over two days and was unannounced. The previous inspection carried out on 21 May 2015 found the service was meeting the requirements of regulations at that time.

We received mainly positive feedback about the service. Comments included, “I feel safe because I know the staff,” and “They (staff) are always in twos.” Relatives told us that there had been issues in the past but it’s alright now.

There were safeguarding procedures and training on abuse to provide staff with skills and knowledge to recognise and respond to safeguarding concerns.

People received their medicine as specified by the GP. The Medication Administration Records (MAR) had been correctly completed. All staff that administers medicines had been trained in the administration of medicines.

We found sufficient staff were available to meet people’s needs. Recruitment procedures were robust to make sure people were supported by staff with the skills required to carry out their role.

Supervisions were not always taking place on a regular basis to ensure staff felt supported. Staff received training in the services mandatory requirements. However, we saw some staff carrying out procedures without evidence of having training in this area.

Care plans had been written to document the needs and preferences of people living at the service. However, these had not always been kept up to date to reflect people’s changing needs. People had a range of activities they could take part in.

Evacuation plans were in place in the event of an emergency. Fire alarms were tested on a weekly basis and fire drills took place at regular intervals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the service had policies and procedures to support this.

Consent was not always sought for people who had bed rails in place for their safety.

We found records had not been maintained to a good standard and were difficult to locate. We requested some records to be sent to us following our inspection. Auditing systems were not robust to identify where the service needed improvements. Notifications were not always submitted when an incident occurred.

The service was not always cleaned to an acceptable standard. Staff were expected to carry out cleaning duties as part of their daily work. We had no documented evidence of cleaning that had taken place the service did not have a cleaning schedule to confirm areas had been cleaned. We saw opened undated food in one of the services fridge.

We have made recommendations in relation to supervisions and premises and equipment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People's care and support plans were individualised and centred on people's individual needs and preferences. However, one person's support file we viewed contained out of date contact details. The person had moved into the home three weeks before our visit yet their personal and professional contacts were in relation to where they had previously lived. We also noted a personal evacuation plan in their support file which related to their previous home too and the meeting points they were to meet at were not relevant.

One person's support file did not contain any evidence of any annual health care checks having been undertaken. For example, there was no documentation to show they had regular eye sight tests, dental check ups or hearing tests. We were informed by the manager and the person themselves that their family dealt with their health care checks. However, there was no assessment of need or documentation within their file to confirm family took responsibility or a signed document by them agreeing to this. It was apparent the staff were not aware or able to advise when their last annual health checks had been undertaken. This meant the person's health care needs were not monitored by the service appropriately to ensure their health care needs were met appropriately.

Some risk assessments completed provided staff with guidelines which enabled them to manage risk and promote people's comfort and safety whilst maintaining people's independence wherever possible. However, we did note in one person's care file that they were at high risk of pressure ulcers but there was no specific plan of care in place detailing the actions staff were to take to minimise such risks.

During our visit we became aware of staff moving and handling people who had not received any moving and handling training. This was clearly not in line with the organisation's moving and handling policy which stated staff were to undertake moving and handling training before they undertook such a task. This practice placed people at risk of harm.

People who use the service were not protected from the potential risk of financial abuse because staff were not following the organisations policy and procedure to safeguard people's monies.

These findings demonstrated to us that the service was not safe.

Is the service effective?

People received co-ordinated care. We saw evidence in people's support plans which demonstrated people had been visited by health care professionals such as the district nurses and speech and language therapists and appropriate advice sought when required.

Any accidents or incidents were recorded appropriately detailing the actions taken and measures put into place to prevent a recurrence.

It was evident through discussions with staff and through observing their interactions with people that they had a good relationship and understanding of everyone's needs and knew them well.

These findings demonstrated to us that the service was effective.

Is the service caring?

People's care plans were individualised and centred on each person's specific needs. We saw evidence that people and their family members were involved in the planning of the care and support. This enabled them to be have a say in how they wished their care and support to be provided taking into account their wishes and preferences.

Throughout the visits we observed staff interacting with people living in the home. Staff were seen to be talking and supporting people in a kind, gentle and attentive way. Staff showed patience and encouragement when supporting people and had a good understanding of people's needs.

Comments from people who used the service included 'they (the staff) look after me well and I feel very safe.'' ''I am happy here.'' ''I would tell a team coordinator if I was unhappy. I have talked to them about a staff member, they listened and changed my support worker.''

These findings demonstrated to us that the service was caring.

Is the service responsive?

The service was responsive to people's individual needs in relation to their health, social and personal care needs. People's care and support plans included information on their likes and dislikes, activities they enjoyed and whether they were able to communicate their needs. Where people could not communicate verbally we saw communication aids in use which were tailored to people's individual needs and enabled people to express themselves more effectively with people around them.

People had choice in the type of activities they took part in both within the home and local community and were supported to follow their interests.

The service responds appropriately in notifying the Commission about incidents and events which affect people who use the service whilst receiving, or as a result of, the care and support provided.

During our visits we fed back some information of concern to the manager, in which an allegation of poor moving and handling practices had been undertaken that evening. Following our visit, we were notified by the manager of the actions taken in response to our feedback which included a referral made to the local authority. This showed the service had been responsive, followed procedures and made an appropriate referral to the local authority as well as their own internal safeguarding team in response to the information of concern we raised.

These findings demonstrated to us that the service was responsive.

We found care was personalised to the needs of the individuals. Support plans included a "What is important to me" or "How best to support me" page. People told us they were involved in developing their support plans and felt safe and cared for. People were able to make choices about what to eat, when to eat and what activities to take part in.

We saw safeguarding incidents were reported and acted upon. All incidents and concerns were investigated internally by the provider and actions were put in place to respond to the concerns. However, the provider was not following their own policy or the local authority's guidance, which required all safeguarding concerns to be reported to them. This meant people could not be assured they were protected against the risk of abuse. In addition the provider had not notified us about two allegations of abuse although they had notified the Care Quality Commission (CQC) of other incidents that impacted the service they provided.

People were cared for by staff who felt supported and who were fit and suitably qualified to perform their role. People told us they felt safe and "The best part of being here are the staff." We observed staff supported people in a way to encourage independence and to assist them to make choices.

The provider had systems in place to monitor the quality of the service and we saw they responded to feedback in an appropriate way.

Staff told us they felt well-supported in their roles and their development, and praised the work and attitude of the home manager, saying he was "very involved, and really approachable."

People said the staff helped them to integrate into the local community, by shopping and taking part in activities. One person said they enjoyed the activities on offer, particularly the Art classes, and they were proud of their art work on display. We noted that all art work on the walls of the home was the Art Group's own work. Another person told us of a holiday to America last summer, and a third described a whole-home visit for a Christmas meal.

People told us staff made their family and friends welcome when they visited, and ensured they were provided with refreshments. They said the food was chosen by people who use the service, and there was always a choice available at mealtimes.

They told us they felt safe and cared for, and if they had a concern, they knew how to address it; they told us they were sure the manager would act upon concerns quickly, and to their satisfaction.