Birch Hall Care Centre

Updated 22 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Birch Hall Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC. The registered manager was not available for this inspection. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of the inspection, there was an acting manager and a management consultant responsible for the day to day management of the home.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We looked at the information we held about the service. This information included statutory notifications the provider had sent to CQC. A notification is information about important events which the service is required to send us by law. We also spoke with the local authority safeguarding and contract monitoring team and local commissioning teams.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spent time in the communal areas observing how staff provided support for people to help us better understand their experiences of the care they received. We spoke with 12 people living in the home and with four relatives. We also spoke with the acting manager, the management consultant and one of the directors. We spoke with 12 staff working in various roles at the home.

We had a tour of the premises and looked at a range of documents and written records. These included seven people's care and support records, two staff recruitment records, training and supervision records, staff rotas, minutes from meetings and complaints and compliments records, maintenance and servicing certificates and records related to the auditing and monitoring of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 22 October 2021

About the service

Birch Hall Care Centre provides accommodation and both nursing and personal care for up to 84 people. At the time of our inspection, there were 74 people living in the home.

The home is divided into different areas to care for people with nursing and personal care needs, older people living with dementia and younger adults. There are communal areas and private bedrooms on each unit. The home is situated in Darwen within the Lancashire area.

People’s experience of using this service and what we found

The provider's quality assurance systems, audits and action plans were ineffective and there had been a lack of oversight by the provider which had resulted in a number of shortfalls that could place people at risk of not receiving proper and safe care. The provider had failed to notify local commissioners about incidents that had occurred. There had been recent changes to the management and staff team. The current management team were aware of the shortfalls and where improvements were needed; they were taking appropriate action to improve. There was a formal suspension on admissions until commissioners were assured improvements had been made. An updated action plan for improvement was in place.

Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However, records did not always provide staff with clear guidance on how to manage risks in a safe and consistent way. There were significant gaps in the reporting and management of accidents and incidents; records of accidents and incidents were not fully completed or analysed to ensure people’s safety and to avoid reoccurrence. Improvements were necessary to ensure people received their medicines safely as safe processes were not consistently followed on each unit. The management team were receiving support from the local commissioners’ medicines management team. People were protected from the risks associated with the spread of infection. We discussed areas for improvement with regards to the environment.

Some people's care records were well written and provided staff with clear guidance about people's needs whilst others were not sufficiently detailed or kept under regular review. This could result in people not receiving the care they needed or wanted. Record keeping was generally inconsistent across the units and some records were lacking in detail.

Activities were not tailored to people’s needs, choices and preferences. They were inconsistent across the units and were dependent on the availability of staff. People told us there was not enough for them to do. Staff encouraged people to maintain relationships that were important to them. Visitors told us they felt welcomed.

People told us they felt safe living in the home and staff were kind and respectful to them. They told us they were offered choices and involved in decisions about their care. We observed caring interactions. Relatives were confident their family members were safe and made positive comments about the care and support provided by staff. Staff understood how to safeguard people from abuse. The local authority safeguarding team and other agencies were involved in a number of ongoing safeguarding investigations; these had not yet been concluded.

The management team and staff had a clear understanding of their roles and contributions to service delivery. Staff told us morale had been low but there had been recent positive changes to the management team. Staff told us they were being listened to and confirmed training was up to date and said they felt supported. Staff were described as kind, helpful and friendly. However, opinions varied in relation to staffing levels and the use of agency staff. Some people said they received prompt care and support whilst others said they had to wait. Staff felt there were enough staff to meet people’s needs but needed more permanent staff. Safe recruitment procedures ensured staff were suitable to work in the home.

Feedback had been sought from people using the service, visitors, health and social care professionals and staff about the service. However, it was not clear if any actions had been taken following people’s comments. Relatives were happy with the care their family members received and said staff on the units were knowledgeable about their family members. They felt they were kept up to date and involved in decisions.

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

Rating at last inspection

The last rating for this service was Good (published 26 April 2018).

On 20 January 2021, we carried out a targeted inspection to ensure the Infection Prevention and Control practice was safe. A rating was not given at that time as we did not assess all areas of a key question.

Why we inspected

We received concerns in relation to the management of medicines, staffing, activities, quality assurance systems and the management of the home. A number of meetings had been held with local commissioners and the provider and at the time of the inspection, there was a formal suspension on further admissions to the service. As a result, we undertook an unannounced focused inspection to review the key questions of safe, responsive and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birch Hall Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, risk management, record keeping and quality monitoring and assurance systems. We also recommended the provider considered best practice with regards to supporting people with maintaining their interests and taking part in meaningful activities. The provider was working in partnership with local commissioners to ensure improvements were made.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.