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Inspection carried out on 20 April 2017

During a routine inspection

Birkdale Park is registered to provided accommodation, nursing and personal care for up to 36 adults. The home admits older people with general nursing care needs. It is a large detached house on a main road leading to Southport town centre. There were 29 people accommodated at the time of the inspection. The home was last inspected in December 2014 and was rated ‘Good’ at that time.

This inspection was carried out over two days on 20 and 24 April 2017 and was unannounced.

At the time of the inspection there was a manager in post but they were not yet registered with us (the Care Quality Commission). A registered manager is a person who has registered with the Care Quality Commission 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. The manager had applied to be registered.

We found some anomalies with the way some medicines were being recorded and monitored. This meant there was a risk these medicines were not being administered consistently. We found the checking and auditing systems of medicines needed some improving to ensure all areas of medication management were being identified and routinely checked.

The manager and senior managers for the provider were able to evidence a range of quality assurance processes and audits carried out at the home. We found some supporting management audits needed to be further developed with respect to medicines. Some clinical records regarding health were not always clear. The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home although criteria for submitting these needed reviewing.

You can see what action we told the provider to take at the back of the full version of this report.

We found some anomalies with the care of two people in the home and found that monitoring of care could improve and be more consistent. We made a recommendation regarding this.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were generally followed in that an assessment of the person’s mental capacity was made but this was not always consistent.

We found the home generally supported people to provide effective outcomes for their health and wellbeing. We saw there was referral and liaison with health care professionals when needed to support people.

We found there were sufficient staff on duty to meet people’s care needs. Staff said they were supported through induction, appraisal and the home’s training programme.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

People we spoke with said they were happy living at Birkdale Park. Staff mostly interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence and helped ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable and safe environment.

The home was clean and we there were systems in place to manage the control of infection.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice. Lunch time was seen to be a relaxed and sociable occasion.

People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care.

People felt involved in their care and there was evidence in the care files to show how people had been included in key decisions.

Social activities were organised in the home. People told us they could take part in social events which were held.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were records of complaints made and there had been a response to these.

Inspection carried out on 11 and 12 December 2014

During a routine inspection

Birkdale Park is registered to provided accommodation, nursing and personal care for up to 36 adults. The home admits older people with general nursing care needs. It is a large detached house on a main road leading to Southport town centre. There were 29 people accommodated at the time of the inspection. The home was last inspected in December 2014 and was rated ‘Good’ at that time.

This inspection was carried out over two days on 20 and 24 April 2017 and was unannounced.

At the time of the inspection there was a manager in post but they were not yet registered with us (the Care Quality Commission). A registered manager is a person who has registered with the Care Quality Commission 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. The manager had applied to be registered.

We found some anomalies with the way some medicines were being recorded and monitored. This meant there was a risk these medicines were not being administered consistently. We found the checking and auditing systems of medicines needed some improving to ensure all areas of medication management were being identified and routinely checked.

The manager and senior managers for the provider were able to evidence a range of quality assurance processes and audits carried out at the home. We found some supporting management audits needed to be further developed with respect to medicines. Some clinical records regarding health were not always clear. The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home although criteria for submitting these needed reviewing.

You can see what action we told the provider to take at the back of the full version of this report.

We found some anomalies with the care of two people in the home and found that monitoring of care could improve and be more consistent. We made a recommendation regarding this.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were generally followed in that an assessment of the person’s mental capacity was made but this was not always consistent.

We found the home generally supported people to provide effective outcomes for their health and wellbeing. We saw there was referral and liaison with health care professionals when needed to support people.

We found there were sufficient staff on duty to meet people’s care needs. Staff said they were supported through induction, appraisal and the home’s training programme.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

People we spoke with said they were happy living at Birkdale Park. Staff mostly interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence and helped ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable and safe environment.

The home was clean and we there were systems in place to manage the control of infection.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice. Lunch time was seen to be a relaxed and sociable occasion.

People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care.

People felt involved in their care and there was evidence in the care files to show how people had been included in key decisions.

Social activities were organised in the home. People told us they could take part in social events which were held.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were records of complaints made and there had been a response to these.

Inspection carried out on 1 November 2013

During a routine inspection

We spoke with people about the service that they received. They told us they were happy with the way staff supported them and the care they carried out for them.

The people we spoke with said the staff knew what support they required and did everything that was needed for them. One person told us, “I know I can see my doctor at any time, the staff are quick to organise this.” Also, ‘’The staff are very good and are on hand to help me with my care when I need it.’’

People were supported to be able to eat and drink sufficient amounts to meet their needs. We received the following comments from people about the meals they received: “Very good”, “Plenty to eat”, “You always get a choice”, “The cook will always cook something else if you don’t like what’s on the menu.”

We found the general level of cleanliness and hygiene in the home to be good. There were good systems in place to help monitor standards of cleanliness.

We asked people who used the service about the skills of the nurses and support workers. They told us the staff worked very hard and knew how to do their job. They felt staff were competent.

Inspection carried out on 3 January 2013

During a routine inspection

We spoke with seven people who lived at Birkdale Park about the service they received. They told us they were happy with the way staff supported them and the care they received.

Those we spoke with said the staff knew what support they required and the staff did everything that was needed for them. One person told us, “Staff take their time and take care to respect your privacy.’’ Another person said, ‘’Staff help you when you need it.’’

We spoke with four care staff, as well as nursing staff and the registered manager. They told us they had received relevant training and felt supported by the manager and senior staff in the home.

We asked people who used the service about the skills of the nursing and care staff. They told us the staff worked very hard and knew how to do their job. They felt staff were competent.

We spoke to people about the service they received with regards to their involvement in the quality and development of the service. They told us they were asked their opinions so that their views were known. They said they were able to contact the manager if they ever had a problem with the service.

Inspection carried out on 8 February 2012

During an inspection to make sure that the improvements required had been made

We visited Birkdale Park to follow up and check whether improvements had been made following our last visit in November 2011. We had concerns about three of the outcomes for essential standards of quality and safety that the home needs to meet. These were around the planning of the care and medication management as well as overall concerns about the ability of the service to respond to regulatory requirements in a timely way and to develop the service positively.

We reviewed the nursing care of three people in some depth and found we could follow the care they were being given and this followed good practice.

We spoke with people about the staff. They told us that staff were helpful and supportive when carrying out daily care. We received positive comments about staff and their approach. We spoke with one person who said, ‘’The staff look after me very well.’’ Another person said, ‘’The staff are very kind and do not rush.’’

We spoke with several people who lived in the home about their medicines and the way they were handled. None of them raised any concerns about the way their medicines were being looked after.

Overall we found the home to have improved in all essential standards we looked at.

Inspection carried out on 23 November 2011

During an inspection to make sure that the improvements required had been made

We had concerns from our two previous visits to the service in June and August 2011 that people were not fully consulted about their care. On this visit we spoke with people who lived in the home and asked them how they were supported to consent to care and treatment. Generally they spoke positively about how staff included them in the care. They confirmed that staff asked for their consent to care and treatment as required on a daily basis regarding their personal care. We also spoke with a relative who said that they were kept up to date with any occurrences and had been consulted regarding the ongoing care of their relative.

We asked people how staff approached personal care. Those we spoke with said that staff were supportive when carrying out care and using equipment. We were told by one person that, ‘‘Staff are very kind and help me. They are patient and always explain what they are doing.’’

People spoken with also confirmed that the General Practioner [GP] visits when needed and this is arranged promptly. We saw three people who had more dependant care needs and these had good standards around personal hygiene showing that staff paid good attention to standards in this area.

We spoke with two people who told us that some aspects of care were not consistent. For example, the use of the hoist and the way that staff assisted them to move and mobilise. We still have concerns about some of the inconsistent care in the home.

We did not ask people specific questions regarding the overall management of the home although people spoken with seemed generally satisfied. They felt staff would listen and did not express any concerns about the running of the home. Because of our overall findings we still had concerns however that the home lacks consistent management in key areas.

Inspection carried out on 23 August 2011

During an inspection to make sure that the improvements required had been made

We visited Birkdale Park to follow up and check improvements made from our last visit in June 2011. At that time we had concerns about five of the outcomes for essential standards of quality and safety that the home needs to meet. These were around people’s right to be consulted about care, their right to consent to care, some nursing care practice, medication management and staff recruitment.

On the day of the site visit eight people who live in the home were interviewed and asked their views. All confirmed that they felt their views were being taken into account by staff in the decision making for the care and treatment they received at the home. Many expressed the view that they felt like they were treated with respect and dignity. People spoken with said that staff are both competent and respectful in terms of any privacy and dignity issues.

We saw three people who have more dependant care needs and all people we saw had good standards around personal hygiene showing that staff paid good attention to standards in this area. We saw that specialised equipment such as pressure relief mattresses were in use and that people looked comfortable.

We spoke with people about the staff. They told us that staff were helpful and supportive when carrying out daily care and were easily identifiable. We received positive comments about staff and their approach. This helps people to feel safe in the home.

We had concerns from our visit in June 2011 that people are not fully consulted about their care. We found that senior staff were unclear about assessing people's mental capacity and how this effects their decisions about care and how staff can support people and act in their best interest if needed. We also found inadequate care planning around key areas of care such as wound care. We set compliance actions for these to be addressed through training and better understanding. This would help ensure people’s rights are protected and they receive consistent care.

On this visit people generally spoke positively about how staff included them in the care and confirmed that staff asked for their consent to care and treatment as required on a daily basis regarding their personal care. We discussed, however, some of the people needing specific nursing care interventions and found that there were some issues that still needed more thorough assessment around people’s ability and right to consent. Care planning was not clear and staff knowledge around some key issues was also not clear. This lack of appropriate assessment and care planning may still place people at risk of inconsistent or inadequate care.

At our last visit on 19th May 2011 we found medicines to be disorganised and some medicines were being given at the wrong time. Following this visit we found some improvements but some issues had not been fully addressed. We found gaps in the medication recording, lack of adequate auditing, lack of management plans for some medication such as PRN [give when needed] and lack of clarity around application of topical creams.

Overall we recognise the improvements made to the service in meeting two out of the five essential outcomes we assessed. There have also been some improvements evidenced in the other three. We still have concerns however and will continue to follow these up with further visits to Birkdale Park.

Inspection carried out on 10 May 2011

During an inspection in response to concerns

Prior to the site visit to the home we had a concern expressed by one relative that the family had not been consulted about a key area of care for their relative. They told us that senior nursing staff had been evasive about consulting them about care and had initially been dismissive of their concerns. The care was thought not to be appropriate by the family member as the person shared a room at a critical point in their care and privacy was felt to be compromised.

On the day of the site visit most people confirmed that they felt like they were encouraged to express their views openly. They were of the opinion that these views were being taken into account by staff in the decision making for the care and treatment they received at the home. For example one person told us about they had been involved in deciding about a doctor’s visit and this had been discussed with them.

People expressed the view that they felt like they were treated with respect and dignity. They told us that staff were available to offer support and that they approached care well and were patient and supportive. They felt care staff were competent in terms of delivering basic personal care and maintained their privacy and dignity.

We spoke with one person who, although pleased with the overall level of care had an issue over the use of bedrails. They had had some discussion with staff about this aspect of care but had received conflicting information and was unsure why they were needed. They felt their dignity was compromised.

We spoke with four of the people who live in the home and discussion referred to their views on being supported to consent to care and treatment. Comments received indicate that some areas of care were more inconsistent than others. One person said that staff conferred with them about a recent referral to the GP as a visit was needed. Another was fully aware about the role of visiting professionals in their care and how this was arranged. One person was not involved, however, in the decision to use bedrails and a relative was concerned that nobody had been consulted about a change of bedroom. Full consultation is important so that people’s rights are respected.

The dependency of people living in the home can be high and we asked some people about how staff approached personal care. Those we spoke with said that staff were supportive when carrying out care and using equipment. We saw two people who have more dependant care needs and all people we saw had good standards around personal hygiene showing that staff paid good attention to standards in this area.

This shows us that people are happy with the general personal care being delivered.

We spoke with three people who lived in the home about their medicines and observed some medicines being given to people. All three people said they were happy and comfortable living in the home and they thought their medicines were given to them properly. We observed inconsistencies in the administration of medicines however and these could put people at risk.

We had mixed opinions from health care professionals who visit the home. There were some concerns expressed about how certain areas of care are managed such as wound care.

Reports under our old system of regulation (including those from before CQC was created)