Birling House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Incidents and accidents were recorded by staff. When concerns arose, staff took action to ensure people were safe. Actions were taken to reduce future risks and where possible people were involved in how these risks were managed. For example, one person was at risk from falls. Staff had discussed this risk with them and the person had decided they wanted to use a mobility aid to reduce the risk. This was put in place.

Incidents and accidents were reviewed for trends. The provider had introduced an electronic system which supported staff to identify trends. When trends were identified, action was taken. For example, staff had identified that one person fell more often at a certain time of day. They discussed this with the person and supported the person who chose to change part of their daily routine which reduced the risk.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s needs were assessed prior to moving into the service to enable staff and people to plan the move. People had the opportunity to visit the service prior to moving in to ensure they were happy with their decision. When people moved in, they were supported through the transition by staff. The home manager told us, “When people move into the service it can be an anxious time for them. They are assigned a member of staff, and we put an extra member of staff on the rota, including for the night, as it can be disorientating.”

When people moved between services, such as when they went to hospital, they were usually supported by a member of staff to support people to communicate with health care workers.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had a good understanding of how to identify abuse and were confident action would be taken if there were concerns. Staff told us they would act if concerns were not addressed. Comments included, “If nothing was done, I would report it to CQC.” And “If there was poor care I would go to the manager, or I could raise a safeguarding.”

The provider worked well with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a proactive approach to involving people in managing risks to their health and to enabling positive risk taking. Where possible, people were involved in discussions about how they wanted to manage risk. If people wanted to take risks, for example, to swim or groom a horse, they were supported to do so. Staff ensured people understood any risks they faced and encouraged people to reduce risks whilst still respecting their choices.

Staff had a good understanding of the risks people faced and how to provide support to people. For example, staff knew who was at increased risk from choking, what to do if a person choked and how to provide basic life support, including for people who used wheelchairs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

For example, the provider ensured all actions had been taken to safely evacuate people in the event of an emergency. Fire drills, to check staff had the practical skills needed, had taken place with all staff. The service had ensured that people had the equipment in place to safely evacuate them in the event of a fire, and there was clear and appropriate signage to the fire doors and exits.

People benefitted from an environment that was warm and clean. Radiators were covered, flooring throughout was swept clean and free from obstruction. Window restrictors were in place and functional, both in communal areas and in people’s bedrooms. Rooms, corridors and doors were wide enough for wheelchairs. There were adaptable showers and bath equipment for people so those using wheelchairs could bath or shower.

The décor celebrated and supported people's individuality. Seasonal art was on display and people’s birthdays and special events were commemorated. People’s bedrooms were clean, tidy and personalised with their own furniture, games, music and film collections.

The provider ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

They made sure staff received effective support, supervision and development, and staff worked well together to provide safe and effective care that met people’s individual needs. One health care professional told us, “The residents are so well cared for; clean, content, and clearly having their needs not only met, but truly understood as individuals”.

People, their relatives, staff and health care professionals told us that the staffing level at the service was good. One relative told us, “She is always with her key worker when we visit”. A health care professional told us, “The staff are genuinely very good at this service and their presence is everywhere without being intrusive”.

An effective staff training programme was in place, and staff had received the training required to meet their role and responsibilities. Checks were in place to ensure staff were recruited safely; all necessary checks had been carried out and documents were up to date. A robust induction and probationary period were followed, and all staff benefited from regular supervision and appraisal. One staff member told us, “I enjoy supervision. It’s a chance to talk about how you are feeling, any training needs, and updates.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading, and shared concerns with appropriate agencies promptly. The home manager explained the service had learnt from Covid and used this learning to manage a recent outbreak of diarrhoea and vomiting. They used gowns to cover staff clothing and supported people to isolate to reduce the risk of infection spreading.

We spoke with cleaning staff who told us there was enough staff and they had the time they needed to keep on top of things. One staff member was undertaking a deep clean. They told us, “We do a deep clean for the ‘room of the day’, everything is cleaned on that day, and I get the time to do it properly.”

The service smelt pleasant. One person told us, “It’s clean and smells nice”.

Staff told us they had sufficient PPE (personal protective equipment) to provide safe care, and we saw this was available throughout the service. Staff had received infection prevention and control (IPC) training and were familiar with IPC processes to mitigate infection risks.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

The provider had not made sure people’s medicines were always administered as prescribed. Where medicines were time sensitive, staff had not always ensured they were given at the correct time. However, our concerns were immediately addressed after the inspection and auditing systems were updated to reduce the risk of the concern arising again.

People’s medicines were stored safely in a secure temperature-controlled environment. Medicines were disposed of as required.

Where people were prescribed ‘as and when’ medicines, for example pain relief, there was information for staff about these, such as what they were for and when they should be offered to people. There was also information for staff to help them identify when people were in pain when people could not express this. Medicines were reviewed when required with people, the GP and other health care professionals involved in their care.

Equipment used to manage people’s health and medicines such as blood sugar monitors were regularly checked to ensure they were working correctly.