Birch Hall Care Centre

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.

We found the following examples of good practice.

There were enough stocks of personal protective equipment (PPE). PPE stations and hand sanitiser were available throughout the home which helped ensure staff and visitors had access to it when required. Staff were able to don and doff their PPE safely and had received training in the use of PPE, infection control and hand hygiene. We observed staff and management were using PPE correctly and there were procedures in place to support staff with its use.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included regular testing of staff and people living in the home and testing of visitors to the home, when restrictions allowed. Essential visitors had checks on their health completed before entering the home and were offered PPE if they needed this. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers. This was provided in easy read and large print to be easily understood.

There were sufficient staff to provide continuity of support should there be a staff shortage. All staff had access to appropriate support to manage their wellbeing should it be required. During the outbreak and isolation period, care and housekeeping staff had been allocated to designated areas of the home. This minimised people’s contact with different staff and reduced the risk of spread of infection.

Person centred care plans and risk assessments were in place for people who were in isolation and/or had tested positive. These were detailed and reflected safe and consistent care and support. Regular checks on people’s wellbeing were carried out. Good visual systems were in place to reduce people’s fears and anxieties when staff were wearing PPE.

There was a good standard of cleanliness in all areas seen. Infection prevention and control policies and procedures were up to date and monthly audits were carried out. A Covid-19 Response Plan and business contingency plan were in place and were being followed. The management team were working closely with the local authority and clinical commissioning group and other partners including the community nurses.

Visiting was subject to government restrictions and a national lockdown was in force. In line with visiting guidance and outbreak management guidance, all visits had been restricted and were only allowed in exceptional circumstances. Policies reflected this. People were supported to maintain contact with their relatives in different ways including the use of social media and telephone calls; this assisted in promoting people's mental wellbeing. A safe visiting area in the lounge area was available for when visiting restrictions were eased. During the current outbreak, people were not being admitted to the home.

Birch Hall Care Centre provides accommodation and both nursing and personal care for up to 84 people. The home is divided into different areas to care for people with nursing and personal care needs. There are two further 'units' which cater for older people with dementia and younger adults. People can be admitted for long or short term. There are communal areas and private bedrooms on each unit. The home is situated in Darwen within the Lancashire area. There were 75 people being supported during our inspection.

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. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service was managed by a registered manager who had been registered with CQC since 29 January 2016. A registered manager is a person who has registered with the CQC 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.

At our last inspection of 3 November 2015 we found a breach of Regulation 15 (1) (E) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of maintaining the environment and we made a recommendation in respects of a dependency tool to determine staffing levels. The overall rating for the service was Good, with Safe being rated as requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service and by when. We checked the action plan had been actioned during this inspection and found significant improvements had been made and have rated this service as Good overall.

People who used the service told us staff were extremely kind, caring and respectful towards them. We found evidence that staff had gone above and beyond what would usually be expected from care staff to help people who used the service achieve their goals and aspirations. During the inspection we observed staff members interacted with people in a very person centred way and were extremely caring.

Whilst looking at compliments and feedback the service had received, we noted that a member of the public had written in to state how impressed they were with a young male member of staff that had taken people into a pub they were in.

We noted there was a strong emphasis in the service on promoting people’s independence. All the people we spoke with told us they were encouraged to remain as independent as possible. There was an abundance of equipment available which supported and promoted people’s independence.

Staff members we spoke with fully understood the importance of acknowledging people’s diversity, treating people equally and ensure that they promoted people’s rights. We saw people’s ethnicity and sexual orientation was discussed and recorded in their care plans.

We found overwhelming evidence that staff members went above and beyond their role to ensure that all the people who used the service were engaged and involved in activities and interests to keep them stimulated.

New furniture and soft furnishings had been purchased throughout the service. There had been a programme of re-decoration which people who used the service were able to tell us about. This had made a positive impact on the atmosphere of the service, which felt comfortable and relaxing.

People who used the service, relatives and staff members all told us that staffing levels were adequate within the service. The registered manager informed us they had recruited new staff members and staffing had been increased on nights, on days on the residential unit and on days and nights on Willow House. Records we looked at confirmed this.

People who used the service told us they felt safe. Staff members had received training in safeguarding adults and knew their responsibilities to keep people safe and report any concerns. We saw safeguarding policies and procedures were in place. All the staff we spoke with told us they felt confident to whistleblow (report poor practice).

Records we looked at showed that potential risks to people’s safety and wellbeing had been assessed. Risk assessments were based on good practice guidance. Management strategies had been drawn up to provide staff with guidance on how to manage and minimise risks.

Robust recruitment processes and systems were in place. Staff had been suitably checked prior to commencing employment and should be safe to work with vulnerable adults.

We looked at medicines management and found safe systems and processes were in place. People told us they received their medicines on time. Only staff that had been sufficiently trained were able to administer medicines.

All the people we spoke with felt they were cared for and supported by staff members who had the appropriate skills and knowledge. We saw new staff members were to complete an induction when commencing employment. Various training opportunities were available to staff.

The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and worked to ensure people's rights were respected. We saw capacity assessments had been undertaken and Deprivation of Liberty Safeguards (DoLS) applications had been submitted as and when required.

People were supported to eat and drink enough to maintain a balanced diet. We saw people had a choice of two hot meals at each meal time as well as a variety of cold choices. We saw ample supplies of food were in stock, including food for those people who required a special diet such as gluten free. All the people we spoke with told us they were able to comment on the food and make requests for changes.

The service was committed to ensuring those people who could not verbally communicate had all their needs met. Detailed care plans were in place to ensure staff knew how best to communicate with people and how they may communicate their needs, such as facial expressions.

We asked people who used the service if they were involved in the development of care plans. We received very positive comments about the level of involvement people had in their care plans. Care plans we looked at were very person centred and were regularly reviewed to ensure they continued to meet people’s changing needs.

Our observations and feedback received during the inspection showed the home was very well run and the registered manager was committed to delivering outstanding care. People who used the service, relatives and staff members spoken with during our inspection made extremely positive comments about the registered manager. The registered manager used various methods to monitor the quality of the service and drive improvements.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. People who used the service said, "I know I can talk to the manager or whoever is in charge if I had any complaints but I don't have any", "I know who I can talk to if I have any concerns and also my family" and "My family and friends visit regularly. I can speak to them if I have any concerns but I do not have any problems here". This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe, clean and hygienic. There were policies and procedures for the control of infection. There were dedicated domestic staff to clean the home. Three people who used the service told us, "It is wonderful here. My room is lovely. The home is clean and tidy", "I have a lovely room. It is always clean and tidy" and "The home is always clean and tidy". The laundry was run by dedicated staff and was operated in a way which reduced possible cross infection. All three people we spoke with said they thought the laundry service was good.

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. We saw that all four plans of care we looked at had been agreed to and signed by people who used the service. Three people who used the service told us, "The staff talk to me about my care and care plan", "I get the same care staff to look after me so they know what they are doing. It makes life easier. They talk to me about my care to see if it what I expect. They do a lot for me and treat me privately and with dignity" and "The staff talk to me about my care. They make sure I am all right".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and mental capacity. The information was used to improve the service.

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff chatted to people who used the service throughout the day. Three people who used the service told us, "All the staff are very kind to me", "The staff have been very good to me since I have been here. The staff are kind and approachable" and "I am very happy with the way staff treat me. The staff are all good to me".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. Three people told us, "I like my room. I have a lot of new furniture which I chose", "I have a lovely room. I have a lot of my own photographs of family and other things to make it like my own place" and "My room is lovely".

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. There was a minibus which had been adapted for wheelchair users. Three people who used the service told us, "I like to read. I don't want to join in the activities and they respect that. I have been here six years and have loved every minute", "I like to play dominoes but especially like the quizzes. I also watch a lot of television. Quiz shows and a lot of sport" and "I like to listen to music, watch television and join in the activities I like. I like going shopping. We have been to Blackpool and I am going again later in the year for another holiday".

The registered manager and key staff held regular meetings with people who used the service. There was a staff meeting held at least once a week for various grades. Each day staff attended a 'handover' meeting to ensure they were up to date and unit managers met to discuss any problems or if they needed to plan for events like somebodies birthday. Staff were able to voice their opinions. We saw that results from questionnaires had been very positive.

Was 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. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the registered manager. The records were stored securely and easily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Two staff members we spoke with told us of their involvement with care plans which was suitable for their roles. They said they had been well trained and the home was clean and tidy. They said, "We get well supported from our unit managers but we can also speak to the registered manager if we want to" and "I like working here. It is a good home. As far as nursing homes go it is a good home".

Three people who used the service told us, "I could not manage so I had to come in here. I had a look around and they told me what to expect. I found it difficult to begin with but they did their best to help me settle. They give me a lot of freedom and ask me what I want to do. I can give my consent for any care or for what I want to do", "They talk to me about my care. They discuss how I am and I have agreed to what they do for me" and "They talk to me about my care. I cannot sign my plan but I understand it". Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found people were able to raise their concerns if they wished and felt they were listened to.

Staff received sufficient support and training to competently look after the people accommodated at the home.