Birkdale Tower Lodge

Updated 15 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 undertaken by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Birkdale Tower Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

Both days of the inspection were unannounced.

What we did before the inspection

We sought feedback from the local authority and reviewed information we had received about the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with six people who used the service about their experience of the care provided. We spoke with 11 members of staff including the Head of Operations, Regional Quality Manager, Interim manager, deputy manager, senior care workers, care workers, housekeeper and the chef.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 15 October 2021

About the service

Birkdale Tower Lodge is a residential care home providing personal care to 16 people at the time of the inspection. The service can support up to 55 people across three floors.

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

People were not always protected from transmission of COVID-19 because the provider failed to ensure people were consistently tested for COVID-19 in line with Public Health England guidance for care homes.

The provider failed to maintain contemporaneous and complete records about the support they provided for people who lived at the service and when their needs changed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We have made a recommendation about improvements needed for the assessment of people's mental capacity.

Medicines were administered to people in a safe way. However, we found shortfalls in record keeping for topical and when required medicine administration.

The providers governance systems had not highlighted the shortfalls we have reported about. The manager had not applied to become registered with CQC and resigned after the inspection. The provider deployed an interim manager and senior staff to ensure immediate improvements were made during and after the inspection process.

People told us staff responded to their requests for support in a timely way. The provider ensured safe levels of suitably trained staff were deployed.

The environment was clean and staff followed safe infection prevention and control systems. Staff were tested in line with COVID-19 guidance. Visiting procedures were robust and in line with current guidance for care homes.

People told us they were supported by kind and compassionate staff. We observed staff engage with people in a caring way. It was clear people and staff had built trusting relationships.

People were encouraged to maintain their independence and contact with family and friends. People told us they could access meaningful activities. We observed people enjoy recreational activities both on an individual and group basis.

People were able to make their own choices at mealtimes. The chef prepared fresh food and understood people’s nutritional needs. People told us the food was “always lovely” and “fresh, beautiful.”

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

Rating at last inspection

This service was registered with us on 11 December 2019 and this is the first inspection.

Why we inspected

This was a planned inspection. 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.

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 two breaches in relation to infection prevention and control, assessing risk, record keeping and governance at this inspection.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.