Birchwood Care Home

Updated 22 March 2023

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 Health and Social Care Act 2008.

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

This inspection was carried out by three inspectors, accompanied by a specialist advisor and an Expert by Experience. The specialist advisor was a nursing specialist. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One of the inspectors was a medicines inspector.

Care Homes

Birchwood Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Birchwood Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for 3 months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed notifications and information we had received about the service since the last inspection. We sought feedback from the local authority quality assurance and safeguarding team and other professionals who work with the service. We checked information held by the fire and rescue service, Companies House, the Food Standards Agency and the Information Commissioner’s Office. We checked for any online reviews and relevant social media content of the provider’s website. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people and 6 visiting relatives. We observed people’s care and staff interaction with them throughout the inspection, both formally and informally during medicine rounds, mealtimes and group activities. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We completed SOFI observations on the first day of inspection during lunch service on the ground floor (Walnut Unit) and first floor (Pine Unit).

We spoke with 25 members of staff, including the manager, deputy manager, service manager, clinical lead, a team leader, 5 nurses, 4 residential care officers, 4 dementia practitioners, the head housekeeper, lead activities coordinator, an activities coordinator, the chef, maintenance engineer and 2 office administrators. Residential care officers and dementia practitioners are staff members who are often referred to as senior

Updated 22 March 2023

About the service

Birchwood Care Home is a care home with nursing that provides personal care for up to 60 older people, some of whom may be living with dementia, physical disabilities or sensory impairments. At the time of our inspection there were 39 people living at the service.

There are five separate units within the home, namely Maple, Oak, Pine, Ash and Walnut, set across three floors. Each unit is self-contained with communal and dining rooms. People with more complex nursing needs live on the first floor (Maple and Oak units), whilst people living with dementia are mainly located on the first floor (Pine and Ash units). More independent people live on the ground floor (Walnut unit). People had individual bedrooms with en-suite bathroom facilities. The care home is situated in a residential area. There is a large garden to the rear and side of the building.

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

The provider had not effectively operated assessment and monitoring processes, to ensure that quality and safety were not compromised and risks to people were mitigated, in compliance with regulations. Care plans did not always contain specific risk assessments and management plans to support people who experienced seizures. Medicines were not always managed safely.

People were protected from avoidable harm by staff who had completed safeguarding training and knew how to recognise and report abuse. The manager ensured enough suitable staff were deployed to meet people’s needs safely. Staff completed a robust recruitment process, which explored their conduct in previous care roles, to assure their suitability to support older people. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection, in accordance with provider's policies and procedures, and government guidance.

Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them. Managers effectively supported staff to develop and maintain the skills to support people according to their needs. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff identified when people’s needs changed and quickly sought guidance from health care professionals. This ensured people received the appropriate care to keep them safe and well. The home had been purpose built to accommodate older people and was subject to a rolling programme of assessment and adaptation. This ensured the environment remained dementia friendly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People experienced caring relationships where staff treated them with kindness and compassion in their day-to-day care. People were supported to be independent and make decisions about their care. People’s choices were supported by staff, who treated people with dignity and respect. Staff knew how to comfort and reassure different people when they were worried or confused.

People experienced person-centred care, which consistently achieved good outcomes and had significantly improved the quality of their lives. People received information in a way they could understand, allowing for any impairment, such as poor eyesight or hearing. People were enabled to live as full a life as possible and were supported to take part in activities, which enriched their lives. People were supported to keep in touch with family and friends, which had a positive impact on their well-being. People and relatives knew how to make complaints and were confident the management team would listen and address their concerns. The service worked closely with health care professionals and provided good end of life care, which respected people’s wishes and ensured they experienced a comfortable, dignified and pain-free death.

The management team led by example and promoted a strong caring, person-centred culture where people and staff felt valued. Staff were passionate about their role and consistently placed people at the heart of the service. The manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent further occurrences.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 August 2022). The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 July 2022. Six breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance, safe care and treatment, staffing, fit and proper persons employed, need for consent, dignity and respect.

We undertook this comprehensive follow up inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Caring, Responsive and Well-led which contain those requirements.

At our last inspection we recommended people’s views, and those of legally appointed representatives, were sought when planning and reviewing their care and support. At this inspection we found the manager had implemented our recommendations which had led to the required improvements.

Enforcement

We have identified breaches in relation to safe care and treatment, unsafe management of medicines and good governance.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.