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Inspection carried out on 11 June 2019

During a routine inspection

About the service

Birch House is a residential care home providing personal care and accommodation in one adapted building to five people with learning disabilities and or autism aged 18 and over. The service was full at the time of inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Peoples experiences were good, and people continued to receive safe care and support. A skilled and competent staff team provided continuity in care. People received their medicines safely and in accordance with their preferences. Risks people may experience from the environment or because of their support needs were assessed and steps taken to minimise the risk of harm occurring. When people’s circumstances changed risks were reassessed, recorded and updated.

People lived in a safe, clean and well-maintained environment. Accidents and incidents were appropriately reported and acted upon. Analysis of these helped staff learn and improve upon delivery of support.

Staff provided people with support that met their needs and was in line with their care plan preferences. People were supported to maintain a good diet. Staff were informed about people’s health needs and supported them to access health care services when they required.

Staff demonstrated commitment to ensuring that people experienced a good quality of life. They showed kindness and compassion in their interactions with people and spoke about them with warmth and respect. People enjoyed caring relationships with staff and there was laughter and smiles in their engagements with them.

Staff knew people well and understood what and who was important to them. Staff respected people’s dignity and privacy. They sought peoples consent with the support they provided and encouraged people to make decisions for themselves around their day to day care. Staff promoted people’s independence to maximize their potential.

People lived in a well-run service. The manager and staff were committed to providing good quality care and undertook regular quality checks to maintain service delivery. The provider was actively involved in monitoring service quality. They had strengthened their oversight of the service through weekly and monthly checks, prompt action was taken to address areas for improvement. There were opportunities for people staff, relatives and professionals to give feedback about service quality to help improve service delivery.

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. The service met the characteristics of good in all areas. More information is in the detailed findings below.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was GOOD (published 28 December 2016)

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.

Inspection carried out on 16 November 2016

During a routine inspection

This was an unannounced comprehensive inspection that took place on 16 November 2016.

Birch House is a care home registered to provide accommodation for up to four people who have a learning disability or who are on the autistic spectrum. The home is located on two floors. Each person had their own individual room. The home had a communal lounge, kitchen and dining room where people could spend time together. The home had a large garden that people could use. At the time of inspection there were four people using the service.

The service had a registered manager. 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.

People’s relatives told us that they felt that people were safe while they received support from staff at Birch House. Staff understood their responsibilities to protect people from abuse and avoidable harm. There were procedures in place to manage incidents and accidents.

Risks to people’s well-being had been assessed. Where risks had been identified control measures were in place.

There were enough staff to meet people’s needs. Staff had been checked for their suitability before starting work. Staff received support through an induction and supervision meetings with their manager. There was training available for staff to update them on safe ways of working and how to meet people’s needs.

There were plans to keep people safe in case of significant events such as a fire. The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice whenever necessary. Staff had been trained to administer medicines and had been assessed for their competency to do this.

People chose their own food and drink and were encouraged to maintain a healthy diet. They had access to healthcare services when required to promote their well-being.

People were supported in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff and the registered manager had an understanding of the MCA. We found that appropriate DoLS applications had been made. Staff told us that they sought people’s consent before delivering their support.

People received support from staff who showed kindness and compassion. Their dignity and privacy was protected including staff discussing people in a professional and discreet manner. Staff knew people’s communication preferences and used these to support people effectively.

People were involved in decisions about their support. We saw that people’s records were stored safely.

People were supported to develop skills to maintain their independence. People and their relatives had contributed to the planning and review of their support. People had care plans that were centred on them and their needs. Staff knew how to support people based on their preferences and how they wanted to be supported. People took part in activities and hobbies that they enjoyed.

People’s relatives knew how to make a complaint. The provider had a complaints policy in place that was available for people and their relatives.

People’s relatives and staff felt the service was well managed. The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009. Staff felt supported by the registered manager.

Systems were in place which assessed and monitored the quality of the service and identified areas for improvement.

Inspection carried out on 24 April 2014

During a routine inspection

The inspection was carried out by one Inspector over three and a half hours. During this time we met and talked with people living in the home, and with staff on duty. The manager was present throughout the inspection and assisted us in providing documentation for us to view. We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We found that staff understood safeguarding procedures, and how to safeguard the people they supported. There were systems in place to make sure that the staff learnt from events such as accidents and incidents, complaints, concerns, and investigations. Staff had been trained in regards to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLs) although it had not been necessary to submit any DOLs applications.

We saw that the staff interacted well with people, had a caring attitude, and showed them respect.

We assessed staff recruitment procedures, and found that these were correctly applied and included checks for any criminal records. This meant that the staff had been assessed as suitable people to look after vulnerable adults.

Is the service effective?

During the inspection we talked with people living in the home and staff. We viewed the premises and observed staff giving general care and attention to people living in the home. The staff supported people with making their own decisions about the things that they would like to do during the day. We read documentation which included care planning files, staff training information and the complaints procedure. The documentation confirmed that staff were fully aware of people's needs and how to meet these.

We found that the company had provided staff with appropriate training and support, so that they could meet the needs of people living in the home.

Is the service caring?

We met the three people who were living in the home. We saw that they were generally smiling and relaxed. They made positive comments about living in the home such as �I like living here�; and �Yes, I am happy here.�

We found that people�s preferences and interests had been recorded, and care and support was provided in accordance with people�s wishes.

Is the service responsive?

We found that the manager was approachable to people living in the home, and to the staff. She encouraged people to voice any concerns or ideas for change.

The service operated a system to obtain the views of people living in the home, family members and staff. We saw evidence to show that appropriate action was taken in response to the things that people identified, and which needed to be addressed.

People knew how to raise a concern or complaint, and had their comments and complaints listened to and acted on.

Is the service well-led?

The service worked well with other services and health professionals to make sure that people received the care that they needed.

We found that there were robust auditing procedures in place to ensure that people�s care was being given correctly, and to check that the home�s policies and procedures were properly applied.