Background to this inspection
Updated
24 July 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 prevention and control measures in place. This was conducted so we could 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 carried out by two inspectors, two ‘Experts by Experience’ and a specialist nurse advisor. 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
Birch Court is a ‘care home’. People in care homes receive accommodation, nursing and / or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We also sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. 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. We used all of the information we received to plan our inspection and formulate a ‘planning tool’.
During the inspection
We spoke with the registered manager, an area manager, 15 members of staff, one-unit manager, a registered general nurse, and 22 relatives about their experiences of care their loved ones received.
We reviewed a range of records; these included seven people’s care records, multiple medication administration records, and three staff personnel files in relation to recruitment. We also reviewed a variety of records relating to the management and governance of the service, including policies and procedures.
After the inspection
We continued to review evidence that was sent remotely as well as seeking clarification from the provider to validate evidence found. We looked at audit and governance data, as well as infection prevention and control policies and procedures. We also informed the local authority of the concerns and areas of risk we identified.
Updated
24 July 2021
About the service
Birch Court is a ‘care home’ providing accommodation, nursing and / or personal care for up to 150 older adults; some of whom lived with dementia. At the time of the inspection 71 people were living at the home across three separate units.
People’s experience of using this service and what we found
Recruitment processes were safely in place, but staffing levels were not safely or effectively managed. Observations during the inspection and feedback we received, confirmed that inadequate staffing levels was impacting the provision of care people received. One relative expressed that the home was "grossly understaffed."
People were not receiving a safe level of care, areas of risk were not robustly reviewed or safely managed. Care records contained information and guidance that staff needed to follow as a measure of managing risk and keeping people safe, but this was not always followed.
Infection prevention and control (IPC) measures and arrangements were not embedded and we were not assured that people were protected from risk. Both internal and external premises were unkempt, shortfalls were not identified or responded to in a timely manner.
Poor quality assurance and governance measures meant that the quality and safety of care people received was compromised. The provider did not ensure that quality performance measures were robustly in place, that areas of risk were safely managed, or regulatory requirements were complied with. Ineffective audits, tools and governance checks meant that the provision of care was not suitably assessed, monitored or improved upon.
Medication procedures had improved. People received their medicines by trained and competent members of staff, people received support with their medicines in line with administration guidance and ‘as and when’ (PRN) protocols were in place. However, we identified some areas that need strengthening. We have made a recommendation regarding this.
Staff were passionate about providing care and support that people needed but they told us they didn’t feel valued or supported in their roles. Staff expressed that they were under a lot of pressure, weren’t listened to when raising concerns about staffing levels and their well-being was impacted upon.
Rating at last inspection and update
The last rating for this service was ‘requires improvement’ (published 17 December 2019). We found breaches of regulation in relation to safe care and treatment and staffing. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made. We found the provider was still in breach of multiple regulations.
Why we inspected
We carried out an unannounced inspection to follow up on concerns we had received from the Local Authority in relation to staffing levels and the impact this was having on the quality of care people were receiving. The information The Care Quality Commission (CQC) received indicated that there were concerns around staffing as well as safe care and treatment.
Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
We looked at IPC 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 coronavirus and other infection outbreaks effectively.
Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the effective, caring and responsive key questions were not looked at during this visit. 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 to calculate the overall rating at this inspection.
The overall rating for the service has remained ‘requires improvement’. This is based on the findings at this inspection. We found evidence that the provider still needs to make improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Birch Court Care Home 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 have identified breaches in relation to safe care and treatment, staffing, premises and equipment and good governance. Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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. We will request that the provider submits further action plans to determine if they have addressed the breaches of regulation we identified.
We will meet with the provider following the publication of this report to discuss how they will continue to make changes to ensure they improve their rating to at least ‘Good’. We will work with the local authority to also monitor progress.