Archived: Silver Birches

We found the following examples of good practice.

¿ Different visiting and contact methods had enabled people to see and/or speak with their relatives. A wooden gazebo had been built in the garden and a special visiting pod was nearing completion. Health, social care and maintenance staff followed infection prevention guidelines to be allowed entry to the home.

¿ Some people lived with dementia and did not understand the need for social distancing. The premises however, were unitised within to provide small living areas. Bedrooms were single occupancy with en-suite bedrooms. These facilities decreased the need for close contact for long durations.

¿ People wanting to move in had to comply with strict rules. These included a negative COVID-19 test result prior to, and a self-isolation period of no less than 10 days, when admitted to the home.

¿ Staff worked closely with infection control professionals and had introduced isolation procedures to ensure infection outbreaks were effectively prevented or managed.

¿The environment was clean. Staff completed regular touch point cleaning and deep cleans to decrease a possibility of infection outbreak.

¿ Staff had received a range of Infection Prevention and Control (IPC) training which included donning and doffing of Personal Protective Equipment (PPE) and PPE usage. The provider's IPC policy was up to date and had been implemented within the home.

People's experience of using this service:

• People and their relatives told us they were happy with the care provided.

• All staff demonstrated a commitment to providing person-centred care.

• People had developed positive relationships with staff who had a good understanding of their individual needs.

• People were supported to maintain contact with their family and were encouraged to be involved with the running of the service.

• Care and support was tailored to each person's needs and preferences.

• Systems were in place to support and monitor people's safety.

• People were protected from possible harm.

• Staff had a good understanding of how to safeguard people and were confident to raise any concerns they identified.

• People were stimulated by meaningful activities and care and support was personalised to each individual.

• There was a registered manager at the service who demonstrated a commitment to providing person centred care for people.

• Staff felt the management team were supportive and approachable.

• Staff were happy in their role which had a positive effect on people's wellbeing.

Rating at last inspection: This service was last inspected in October 2015 and was rated Good overall.

Why we inspected: This was a planned inspection based our inspection schedule. Prior to our inspection we received information of concern from a whistle blower which we used to inform our inspection planning.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Silver Birches provides residential care for up to 50 people, some of whom have dementia or physical disabilities. The bedrooms are located on the ground and the first floor. The service is split into three units: Robin, Jay and Kingfisher. Kingfisher unit supports people with advanced dementia who have a high level of care needs. At the time of our inspection there were 49 people using the service.

A registered manager was in post. 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.

People told us their care and support needs were met by staff who were knowledgeable and knew them well. Staff had undertaken training relevant to the specific needs of people who lived at the home and staff told us they were supported within their job roles.

Everyone we spoke with said they thought Silver Birches was a safe place to live and that they were well cared for. Staff had a good understanding of how to report any concerns of a safeguarding nature. Overall, staff had a good understanding of how to keep people safe. However, we found one occasion when poor communication between the staff team had resulted in the risk associated with a person’s care not being well managed.

Staff were not always available at the times people needed them. The registered manager told us actions were being taken to address this. A dependency tool was used to assess the number of staff needed. The number of care staff on each shift had recently been increased during busy periods there were not always enough staff to respond to people’s needs without delay. The registered manager told us further actions were being taken to address this.

People received their medicines as prescribed and checks were undertaken to ensure they received them in a safe way.

Mental capacity assessments were completed when needed and specified the nature of the decision the person was being asked to make. This demonstrated that the provider was following the principles of the Mental Capacity Act (2005). When people had a DoLS authorisation in place for continuous monitoring, it was reviewed within the specified time frame to ensure that people were not being deprived of their liberty unlawfully.

Most staff ensured they maintained people’s privacy and dignity and treated people with compassion and respect. However, we observed two occasions where this was not the case.

Health and safety risk assessments had been completed. Specific risk assessments had been completed for moving and handling and falls whilst other risks and interventions were assessed using the care plan documentation. Any incidents were logged and an analysis of accidents and incidents was completed so staff could identify any trends and manage them accordingly.

There were robust recruitment procedures in place which included checking people’s full employment history, references and a DBS check. This reduced the risk of unsuitable staff being employed by the service.

People’s nutritional and hydration needs were being met. People had a choice of meals which met their dietary requirements and preferences. People were supported to maintain their health.

People had opportunities to pursue their hobbies and interests and maintain relationships with people important to them.

People and their relatives knew how to raise complaints and were confident actions would be taken in response to these. People had opportunities to put forward their suggestions about the service provided.

There were processes to monitor the quality and safety of the service provided and actions were taken to drive improvement in the service.

We found there were 40 people living at the home at the time of our inspection. We were able to speak with 11 people and two visiting relatives about their experiences of the care and support they received at Silver Birches.

We carried out observations of care throughout the home. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and visiting relatives told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was maintained and suitable for the needs of the people.

People and relatives told us they felt they and their relatives were well looked after. We were told: 'If you want them to help, they help you', 'You can do what you like, have a shower when you like. Have a bath when you like' and, 'I don't find anything I don't like.'

We found staffing levels at the home met the needs of the people. The registered manager told us they had recently increased staffing numbers by one care staff member on each unit. Staff we spoke with told us this increase in staffing had helped. One staff member said: 'We can spend time with people more.'

We spoke with staff who told us they had not read or accessed people's care records on a regular basis. This had the potential to place people at risk of receiving inappropriate care and support. Staff we spoke with raised concerns with us about the numbers of agency staff available. Staff told us agency staff shadowed other care staff but only read one or two care plans before they provided care to people because they did not have sufficient time to read more.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We spoke with the registered manager about the recent judgement by the Supreme Court in relation to (DoLS). They told us they had taken appropriate advice to ensure they complied with any changes in the local authority's policy and procedures. The registered manager told us they were considering making applications to the local authority for a number of people who used the service where the judgement potentially impacted on their rights to freedom.

Is the service effective?

People and relatives we spoke with told us they were happy with the care provided. One person told us that when they rang their call bell, staff came: 'Within 3 minutes. They are very good like that."

We found some of the care records we looked at did not reflect people's current needs. These care records did not contain any risk assessments or have the appropriate guidance for staff to follow to ensure they did not place people at risk of receiving inappropriate care.

We saw care records had been reviewed, however these reviews did not support people's current or changing care needs. The registered manager acknowledged these concerns and agreed to make improvements to the records.

We have asked the provider to provide us with information as to how they will ensure care plans support people's individual care needs.

Is the service caring?

People were supported by staff who were kind and attentive. We saw and heard people given choices throughout the day about where and what they wanted to eat or drink, where they wanted to sit and what they wanted to do. We saw staff spent some time with people on a one to one basis. We also saw staff spent time with people and cared for people at their preferred pace.

Some staff we spoke with told us they felt they were not always able to provide the care they wanted because they did not have time to read people's care records. One staff member told us: 'When you're providing care, you just don't get time and we have a lot of agency staff.' This staff member also said: 'Most staff have learnt from residents and each other.' Another staff member told us: 'Staff aren't updating the professional visits logs which they should do.'

Is the service responsive?

People were supported to participate in activities inside and outside of the home. At the time of our inspection people played skittles in the lounge area. We also saw one person who smoked, sat in the garden area. This person said: 'I am always in the shelter, I like it here.'

Is the service well led?

The service did not have an effective system in place that assured them of the quality of service they provided. The service completed some checks and sought the views of people who used the service. However, there was little evidence to demonstrate what actions had been taken that led to improvements.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people receive a quality of service.

We also discovered systems were not in place to ensure the safe administration of controlled drugs. There was also a problem with the first floor medicines fridge which meant a medicine was not stored within the correct temperature range.

During our latest visit on 5 August 2013, we found our concerns had been addressed. We saw evidence that the medicines management procedure had been improved and appropriate action taken to correct our areas of concern. We spoke with a senior carer, who was the officer in charge, two care workers and four people who used the service. One staff member said, 'The medicines procedures are much clearer now.' People we spoke with said they received their medicines when they needed them. One person said, 'They are very regular and I always get a smile.'

We spent time sitting with people in the three lounges known as Kingfisher, Jay and Robin. This was so we could observe how people were being cared for. These observations were used alongside other information gathered to assess the quality of care and support. We saw there was a calm and relaxed atmosphere in the home.

People we spoke with and visitors were positive in their comments. One person said, 'The staff are friendly and there's a good atmosphere.' A relative of a person who lived at the home told us the home is, 'Absolutely wonderful. They have made her (mother) feel so at home.'

People looked clean and tidy. We saw staff supported people to maintain their independence. For example, we saw one person helped to dry cups in the kitchen. At lunch time we saw people enjoying their meals. Some people commented the food was 'excellent'. Those who needed assistance were supported by staff. We observed staff were respectful towards people and interacted with a pace and level appropriate for people's needs. One person said, 'I'm very happy since I've been here.'

During this visit we found some progress had been made to address the improvements needed for effective medicine management within the home. We found further actions were required before the service would be fully compliant.

During our last visit we also identified improvements were needed in relation to the staffing arrangements. This also resulted in a compliance action being issued.

During this visit we found sufficient improvements had been made for the service to be compliant. We observed that staff were not rushing to carry out their duties as they were previously. We saw volunteers were helping out on the units. We saw evidence that staffing arrangements were being reviewed. This included plans to closely monitor changes in people's needs to identify where any staff increases may be needed.