Birchwood Grange Nursing Home

Birchwood Grange Nursing Home is a nursing and residential care home providing accommodation and personal care for up to 150 people. The service provides support to people living with dementia, a mental illness, and/or a physical disability. At the time of our inspection there were 114 people using the service.

People’s experience of the service and what we found:

People told us they felt safe at the service and could speak with staff or managers if they had any concerns. Staff understood how to recognise and report allegations of abuse and said they felt confident the registered manager would act on any disclosures.

People received medicines from trained and competent staff. The service was clean, and staff practised good infection control to help protect people from the risk of infectious diseases.

People were supported by enough staff who were trained to meet their needs. Care plans in place gave detailed guidance for staff to follow to ensure they supported people safely.

People were treated with dignity and respect. We observed kind interactions throughout the inspection. Staff spoke to people respectfully.

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, their relatives and staff told us they we able to make suggestions and raise concerns if needed and their views were listened to. Quality assurance processes were effective in identifying areas for improvement, shortfalls were addressed at the time or shortly following audits.

Staff and the management team worked with health and social care professionals to improve people's care and well-being.

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 outstanding (10 October 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Birchwood Grange Nursing Home is a nursing and residential care home. It is registered to provide accommodation and personal care for up to 150 older people. The service supports people living with dementia, a mental illness, and/or a physical disability. At the time of the inspection there were 150 people living at the service.

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

Staff provided exceptional care. The registered manager and the deputy were passionate about delivering a high-quality service. The service promoted a positive culture that was person-centred, open, inclusive and empowering, which achieved outstanding outcomes for people. The service was effectively monitored, through robust systems of governance. The range of management information that was comprehensive. This supported effective decision making and allowed for prompt action where performance was outside defined parameters. The service had measurable outcomes, and their quality processes demonstrated they were achieving outstanding outcomes for people.

People received safe care. There were examples of good practice in relation to the management of medicines, including storage, disposal, completion of medicine records (MARs), and administration. People were protected from the risk of harm and abuse. Effective standards of practice were followed to protect people from avoidable harm and abuse. A culture of safety was rooted in the philosophy within the service and staff were attentive in noticing risks and addressing them.

The service worked in partnership with other organisations and kept up to date with new research and development to deliver the latest best practice. Professionals gave consistently exceptional feedback about the willingness of the service to work with others. Staff were appropriately trained. They assumed their roles with ease and confidence. The service liaised with other health care professionals to provide staff with specialised training, so they were able to meet people’s individual needs. The service was delivering exceptional dementia care, which was shaped around Bradford University dementia care mapping, which is an established approach to achieving and embedding person-centred care for people with dementia.

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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed. There was evidence the service went the extra mile to ensure people were supported to make decisions.

The service invested time and went above and beyond in getting to know people well and involving them in decisions about their care. We found positive evidence people were listened to and supported by staff to make choices about their care and support. Staff were extremely knowledgeable about diversity and human rights. There was strong evidence people’s human rights were respected. Staff treated people and their relatives with the upmost kindness and provided extra time to support them when they were in distress or feeling anxious. This quality was acknowledged in compliments received from relatives. Staff spoke with people in a respectful way, giving people time to understand and respond. Personal care was given discreetly and sensitively.

The arrangements to provide activities were excellent. The activity coordinator was extremely passionate and worked with staff to create activities to ensure people were not isolated. New technology was also used creatively to offer practical interventions to address the specific circumstances of people, who because of their needs, were not inclined to join in activities. The service delivered high quality person-centred care. Our review of people’s care records evidenced they were personalised and clearly articulated guidance for staff on how to direct people towards their desired goals. The service provided outstanding end of life care. Exceptionally well completed anticipatory care plans were in place, including Do Not Attempt Resuscitation (DNAR) forms. The anticipatory care plans were used to an excellent effect to prevent hospital admissions and enabling death at preferred place.

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 14 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 26 September, 4 & 14 October 2016 and was unannounced. Birchwood Grange care home is a 150 bedded purpose built facility in Preston Hill, Wembley. The home provides accommodation and personal care for up to 150 older people, including people with dementia. On the day of our inspection 143 people were using the service.

The service had a registered manager in post. He had been in post since October 2014. 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 service was owned by a different provider when we last inspected it in December 2013. The service met all legal requirements we checked.

Prior to this inspection we received feedback from the local authority contract monitoring team. They gave us their latest quality monitoring report from February 2016, which showed the service had made significant improvements since Avery Homes (Nelson) Limited took over. At this inspection, we also noted the significant improvements, as did the majority of professionals we spoke with.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people's daily life were assessed and planned for to minimise the risk of harm. We saw evidence that concerns regarding people's safety had been appropriately managed and staff displayed a good knowledge of safeguarding principles.

When staff started employment they had a four week induction programme which covered mandatory training. The induction included the opportunity for new staff to shadow more experienced staff until they felt confident. Staff also had the opportunity to sign up for vocational qualifications in health and social care.

Staff supervisions, appraisals and staff meetings all happened regularly. Staff told us they were well supported. They spoke highly of the support they received from management and were confident they could raise any issues or concerns, knowing they would be listened to and acted upon.

We saw that sufficient numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks to ensure they were suitable for the role. Checks had also been undertaken to ensure that all the nurses who worked at the home had a current registration with the Nursing and Midwifery Council (NMC).

We raised concerns about a prescribed supplement (complan) of one person, which the service investigated and rectified. People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff had completed training in the safe handling and administration of medicines, which was refreshed annually.

We raised concerns about the calculation of people’s nutritional risk, which the service rectified. Overall, we saw that people received on-going healthcare support from a range of external healthcare professionals and their health and nutrition were monitored and responded to in line with nationally recognised practice. We also saw the registered manager took a pro-active approach to ensuring people who lived with a dementia related illness received care based on best practice.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People had access to healthcare services. They received regular visits from healthcare professionals, such as occupational therapists, chiropodists, and speech and language therapists. We saw if staff had any concerns about people's health, immediate referrals were made with appropriate follow up meetings. People were involved in multi-disciplinary team meetings which were held regularly to discuss their health concerns.

The service was outstanding in providing caring support. People were supported with care and compassion. People told us they were treated with dignity and respect. Staff understood the need to protect people's privacy and dignity. People told us staff knocked on their doors before they could enter their rooms.

People were supported to express choice. People who used the service and their relatives consistently said staff supported them with care and compassion and got to know people exceptionally well. People who had limited verbal communication were supported to make choices in relation to what they ate by the use of visual prompts. We saw people were offered a choice of drinks with staff showing people two options and allowing them time to choose.

The service responded to people’s needs and preferences. People received a personalised service which was responsive to their individual needs. Care records were person centred and developed to meet people's individual needs and reviewed if there were any significant changes.

People were supported to lead a full and active lifestyle. Activities and people's daily routines were personalised and dependent on people's particular choices and interests. People were supported to develop their skills and pursue their hobbies and interests.

Complaints were investigated and lessons learnt from them. Any concerns raised were assessed by the management team to see if any changes needed to be made to the service to minimise the risk of similar concerns being raised and to improve the quality of the service.

The service was managed by an experienced, knowledgeable and motivated registered manager who worked in partnership with other organisations to develop new and best practice. There was a strong commitment to deliver a high standard of personalised care and continued improvement based on the views of people who used the service and the enhancement of their lives.

The provider had a quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service and other agencies.