Archived: Birchlands Care Home

This was an additional visit to monitor the homes compliance with Outcome 16. The information collected by the inspector helped answer two of our five questions:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, discussions with management and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Not applicable.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable.

Is the service responsive?

Our observations of records and audits demonstrated that the home was responsive to feedback received. This included feedback from surveys, meetings and complaints. There were clear records demonstrating the action taken by the home.

Is the service well-led?

We found that the provider had taken appropriate action to implement a quality assurance system for the service. Records observed during our visit demonstrated that a range of audits were completed which identified any shortfalls within the service and these were addressed promptly. As a result the quality of the service was continuingly improving.

The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

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

Is the service safe?

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes. The service had taken action to improve the quality of care which people received.

Systems to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations were in the early stage of development.

Records were in place detailing how people should be cared for. Records were stored securely so that the information remained confidential and accessible only to those who needed them.

Improvements had been made in terms of the environment and standards of cleanliness which helped to minimise the risk and spread of infection.

Is the service effective?

The home had appropriate arrangements in place for gaining people's consent. People's health and care needs were assessed with them, and they were involved in decisions regarding their plans of care. This meant that staff were able to deliver care in a way that supported people.

Is the service caring?

People were supported by kind and attentive staff. People told us that they were well cared for. People commented, "I am alright here. Well cared for." We observed staff speaking kindly to people and saw them providing care in a calm and dignified manner.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was being provided in accordance with people's wishes.

Is the service responsive?

We saw that the home had responded to our previous concerns which we had identified in the last inspection in January 2014. They had taken action to address these concerns and were seeking the views of people so that further improvements could be made.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff confirmed that the management were supportive. The service has a new manager who is in the process of applying for registration with the Care Quality Commission. Quality management systems were in the early stages of development as the company had gone into administration and the service was currently being overseen by a management company who had been instructed by the administrators. We will look at this area in further detail during the next inspection of the home.

People's care needs were not always attended to appropriately. We also found evidence that people were not always receiving appropriate pressure care which increased their risk of developing a pressure sore.

People did not always receive sufficient food or drink and staff did not always provide appropriate support in this area. This meant that some people had lost weight.

People were not protected against the risk of infection at Birchlands as standards of cleanliness and infection control were poor.

We looked at staff training and supervision. We found that although training continues and some improvements had been made, there was still not sufficient evidence to demonstrate that the home was compliant in this area. Some people were still not receiving sufficient training or supervision to enable them to carry out their roles effectively.

Although improvements were seen, the registered person had not ensured appropriate standards of cleanliness and hygiene in relation to the premises.

We looked at staff training and supervision. We found that although training continues and some improvements had been made, there was still not sufficient evidence to demonstrate that the home was compliant. Some people were not receiving regular supervision and the training matrix still identified low percentages in some areas of training completed.

We looked at quality monitoring systems and found that although improvements had been made and good management systems were in place. These were not always fully acted upon when concerns had been identified.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person told us "I get well cared for here, they are all very gentle and very friendly."

The home had safe systems in place to ensure that medication was given to people as prescribed by their gp. One person told us "I ask for tablets and I am given them."

People were not protected against the risk of cross infection at Birchlands as standards of cleanliness and infection control were poor.

Although it was evident that the home had provided a significant amount of training since November 2012 we found that not all staff had received this training. This may impact on the way in which care is delivered. We also found that the effectiveness of staff training was not being adequately monitored which would help to ensure staff competency and improved care practice.

Quality management systems were in place but were not always effective in addressing the shortfalls in the service.

Records were generally improved and contained detailed information. Staff told us that they were much better at recording information.

People told us that they were well cared for. Comments included "I like living here, it's nice and warm" and "It's very nice indeed, it couldn't be better."

We took a specialist pharmacist inspector on our visit to follow up the previous concerns we had regarding people's medicines.

We looked at systems for safeguarding people and asked people if they felt safe. One person said "I feel very safe and I am not unhappy about anything here." Another person told us "Sometimes the staff tell me what to do and don't listen but no-one has ever shouted at me." People told us they felt safe. The home had systems in place which helped to protect people.

We were told that staffing numbers had increased and the use of agency hours had been reduced. People told us that they liked the majority of staff. Comments included "We are definitely looked after properly, staff respond quickly if we need them" and "All staff are very nice." Some staff raised concerns about a 'blame culture' developing at the home and felt that they were less supported than they had been previously.

We looked at records and found that although a lot of work had been done some were still not accurate. The provider needs to address this.

People told us that they were well cared for by staff, however we observed practice during our inspection that raised concerns about people's care and welfare. The home were failing to complete records appropriately, failing to provide required treatment advised from health professionals and failing to appropriately manage people's pressure care. This impacted on people's physical well being.

People told us that they felt safe and could raise any concerns or issues with staff working at the home. One person told us "I could tell someone if I had any problem here."

We looked at medication records and found that medication was not ordered, recorded, administered or audited properly which meant that people did not always receive their medication safely.

People told us that they liked the staff but some people were concerned about whether there were enough staff on duty. One person told us "The care and attention is top notch if they have full staff." We spoke to staff who told us that the low staff numbers were impacting on morale and client welfare. Other professionals also raised concern about the home using lots of agency staff and told us that they felt that client care was being compromised.