Silver Birch

About the service

Silver Birch is a residential care home providing personal and nursing care to six people who are living with a learning disability and/or have a sensory impairment. The service can support up to seven people.

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

People were supported by staff who knew them well and the risks to them, but people’s care records did not consistently provide staff with the most up to date information on how to support them safely and effectively. A number of incidents had not been recognised as safeguarding concerns and had not been reported to the appropriate authorities. Medicines were not always appropriately managed. We were not fully assured regarding some areas of infection control and the provider's infection control policy was not up to date. Accidents and incidents were recorded but there was a lack of analysis to identify any trends learn lessons when things went wrong.

Staff felt supported and valued, but raised concerns regarding the lack of specialist training available to them to enable them to support people effectively.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led key questions the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for the people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People’s support focused on them having the choice and opportunities to gain new skills, where appropriate, and to become more independent.

Quality assurance systems had failed to identify areas for improvement found on inspection. The current systems in place did not provide the registered manager with complete oversight of the service. The service worked alongside other professionals to obtain support for people. Relatives were complimentary of the service, the care staff and the registered manager.

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 7 January 2018).

Why we inspected

We received information in relation to a number of incidents that had not been recognised as potential safeguarding concerns, staff training and a lack of learning from accidents and incidents.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control 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 COVID-19 and other infection outbreaks effectively.

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 in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

The provider responded to the concerns raised during the inspection and action was taken to address these concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silver Birch 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 will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding service users and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Silver Birch accommodates seven people in one adapted building.

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.

The service was inspected in October 2015 and the service was rated Good. The service was further inspected in February 2017. That was an inspection that focussed on how safe the service was. We rated the service as Requires Improvement for Safe.

At this inspection we found the service remained Good overall and that the Safe rating had improved to Good.

People looked comfortable and at ease around care staff. Relatives we spoke with told us they felt assured their family member was being cared for in a safe way by care staff who understood how to keep them safe. People were supported by staff that understood people’s health needs and the risks to people’s health that people lived with. Staff had access to information on how best to support people and understood the risks to their health that they lived with. People received help to take their medicines and people medicines were safely administered and stored. The registered manager made regular checks to ensure people received the correct support.

People were supported by staff that had access to regular supervision and training. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain a healthy lifestyle and could access additional medical support when they needed it.

People and their relatives told us, staff were kind and compassionate. Staff worked as a team to ensure people were supported with respect and their dignity maintained. People benefitted from the staff using different approaches and communication equipment to support them to make choices and be involved in their care decisions as much as possible.

People said their needs were met by staff, that were knowledgeable about their rights and preferences. People were supported to raise concerns and where this was done, people’s concerns were investigated and action taken.

People liked and knew the registered manager and staff reported they enjoyed working at the home and felt part of a team. Staff felt empowered to share their ideas to help improve people’s care and worked with other stakeholders to improve people’s experience of care.

Further information is in the detailed findings below.

Silver Birch provides accommodation without nursing for up to seven people who are living with learning disabilities and have sensory impairments. At the time of the focussed inspection seven people were living at the home.

There is a registered manager at the service who was present throughout 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.

People told us they felt safe living at the home. Staff were knowledgeable about the different types of abuse and told us appropriate action they would take should they have concerns. There were enough staff available to meet people’s requests for support although we noted that the deployment of staff needed reviewing in order to promptly meet people’s specific care needs.

There were systems in place to enable people to receive their medicines safely and to monitor medicine administration.

Staff had a good knowledge of the people they supported however this was not reflected in people’s care plans and risk assessments. We found some records did not reflect people’s current needs. There was a risk that people would not receive consistent, safe support with their care needs.

We received assurance from the registered manager that the issues identified would be addressed.

At this visit we met four people who lived in the home, two members of staff and a relative of a person who lived in the home. We also looked at a sample of records.

We found that staff followed the instructions in people's plans to make sure that people were supported to be as independent as possible. The plans showed that people had been consulted about their preferences and staff respected the choices which people had made.

People told us that they liked living in this home. They told us how staff supported them to keep in touch with family and friends. We saw pictures of people taking part in a variety of activities. Two people made hot drinks for us, demonstrating their independence skills.

We found that staff supported people to eat healthy diets. The records showed that people had been helped to reach weights which were considered to be more healthy and this meant that their mobility had increased.

We found good arrangements for the storage, recording and administration of medicines in the home.

The records showed that staff had good opportunities for training. Staff told us that there were checks on people's understanding of their training to make sure that staff were competent in their roles.

People who lived at Silver Birch told us they were happy with the way staff supported them with their care. One person told us, 'The staff are nice and they listen to me.'

Relatives we spoke with told us they were happy with the care their family member received. They told us, 'Staff worked very hard to get to know XX and understand his specific needs' and 'XX is settled and I am able to talk with staff about any concern I may have.'

Each person had a care plan. We saw some of the information in it was written in a way that was easy for people to understand with the use of photographs and symbols.

We found that staff knew people as individuals and understood how people communicated their needs. We saw that people were relaxed and at ease with staff supporting them with their care.

We found procedures in place to protect people from harm and staff described what these were and how they would report any suspicion of abuse.

We found systems in place for monitoring the quality and safety of the service.

Information about staff's suitability to work at Silver Birch was missing in two of the three staff files we looked at. The registered manager advised us that action would be taken to ensure this information was available.