Birches

Updated 21 January 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 11 January 2022 and was announced. We gave the service 24 hours notice of the inspection.

Updated 21 January 2022

We completed an unannounced inspection at the Birches on 8 November 2018. Birches is a care home and accommodates up to six people with a learning disability and or autism. On the day of our inspection, five people were living at the service.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

We carried out an unannounced comprehensive inspection of this service on 25 July 2017. Breaches of legal requirements were found and the service was rated as ‘Requires Improvement’. This was in relation to how staff were supported to provide effective care and support. People who used the service were found not to receive care and support that was based on their individual needs, interests and preferences. After the comprehensive inspection, we served a warning notice on the provider in relation to the governance of the service. The warning notice required the provider to become compliant with the legal regulation within a specified timescale. We inspected the service on 7 November 2017 and found the provider had made the required improvements in the governance of the service. This inspection reviewed if the provider was compliant with the two remaining legal requirements and how the fundamental standards of care were being met.

Since our last inspection, a new registered manager had been appointed and was available during the inspection. 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.

At this inspection we found the provider had made the required improvements in the breaches of legal requirements.

People were protected from abuse and avoidable harm because staff had received adult safeguarding training and followed the provider’s safeguarding policies and procedures. This included being aware of the provider’s whistleblowing process that supported staff to report any concerns of poor or abusive practice.

Risks associated with people’s needs, including the environment had been assessed and staff had clear and up to date guidance of the support required to manage known risks. People had complex needs and positive behavioural support plans were used, to provide staff with guidance of how to manage behaviours safely and effectively. Staff had received accredited refresher training in the safe practice of physical intervention and were clear, this was only used as a last resort and in the least restrictive way.

People were supported by staff who had been safely recruited to ensure, as far as possible, they were suitable to care for people. The staffing levels and deployment of staff considered staff skill mix and met people’s individual needs including wellbeing and safety.

Medicines management followed nationally recognised best practice. People received their medicines safely and in a way, they preferred. People’s medicines were reviewed by external healthcare professionals, to ensure they received the most appropriate medicine that met their needs.

People were protected from the risks associated with infections and cross contamination. Infection control practices were understood and followed by staff and the service was clean and hygienic.

Incidents were recorded, monitored and analysed to ensure people received safe support and if lessons could be learnt to reduce further risks. Staff worked with the provider’s clinical team in effective and safe ways of supporting people with behaviours that could be challenging to the person and others.

People received an assessment of their individual healthcare, social and wellbeing needs prior to moving to the service. The pre-assessment also considered people’s protected characteristics under the Equality Act, to ensure they did not experience any form of discrimination. People’s needs were carefully assessed to ensure they were compatible with the needs of other people living at the service. Before people moved to the service they visited the service, this is known as a transition plan. This supports and prepares the person to familiarise themselves to their new environment and support.

People were supported by staff that had received an induction and ongoing training relevant to their needs and support. This supported staff to provide effective care. Staff received regular opportunities to discuss their work, training and development needs.

People received sufficient to eat and drink, they were involved in menu planning and staff encouraged healthy eating and independence was promoted. People’s physical and mental health needs were assessed, planned for and monitored. Staff worked effectively with health care professionals to support people with their health needs.

People lived in an environment that met their individual needs and preferences. They had a choice of where to spend their time. This included two safe external areas, where sensory opportunities had been created.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the principles of the Mental Capacity Act 2005.

People were supported by staff, who were caring, compassionate and who knew their needs, preferences and what was important to them. Staff respected people’s privacy and dignity, encouraged people with choice making, and promoted independence. Independent advocacy support was made available if required. People who used the service were involved in decisions on their daily care and support needs as fully as possible. Relatives and external professionals were involved in meetings to discuss and agree how care and support was provided.

People’s diverse needs, routines, preferences and what was important to them had been assessed and support plans provided staff with detailed information of how to support people. Staff had a person centred approach in how they supported people and social inclusion was promoted. People received support to pursue activities of interest and to explore and try new experiences. People were part of their local community.

There was an open and inclusive, person centred approach with a clear vision and plan of how the service was to further develop. The registered manager was highly experienced and skilled in working with people living with a learning disability and or autism. They led by example and were a strong and supportive leader. There were systems and processes in place that monitored quality and safety and there was good oversight and accountability by the management team and senior leaders within the organisation.