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Birchfield Residential Care Home Requires improvement

Reports


Inspection carried out on 9 July 2019

During a routine inspection

About the service

Birchfield Residential Care Home is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 24 people in one adapted building. Bedrooms comprised of 24 single bedrooms, six of which had en-suite facilities, spread over two floors. There was no lift but access could be gained via two stair lifts. There was sufficient washing and toilet facilities for people. People had access to a number of communal areas, including quiet spaces and a garden.

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

The provider had not ensured the recruitment systems and processes in place were robust when employing staff. Medicines were not always managed safely. We have made a recommendation about the management of medicines and oxygen. A number of radiators within the service required covers to reduce the risk to people. The provider took immediate action to address this. Accidents and incidents were not always recorded sufficiently. We have made a recommendation about the recording of accidents and incidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The registered manager did not always ensure care plans were personalised to meet people’s needs. Staff gave us mixed responses about the accessibility of the electronic system and we found this difficult to navigate; care records were often difficult to locate. We have made a recommendation about care plans and their accessibility.

The service was not consistently well-led. The provider and registered manager had quality assurance checks in place. However, these were not sufficiently robust to identify the issues we found during inspection.

People told us they felt safe. One person commented, “I feel safe and secure here no problems.” Staff had been trained in safeguarding and knew their responsibilities to report concerns. We received mixed responses from staff about staffing levels. However, people told us there was always enough staff on duty to meet their needs. People told us the service was clean.

The registered manager ensured staff completed and induction and had access to training to meet the needs of people using the service. The registered manager also supported staff through supervisions and appraisals. People were supported to maintain a healthy and balanced diet. People told us they enjoyed the food. We saw people had choices of what they wanted to eat, and staff supported people as necessary. People had access to healthcare professionals such as GP’s.

People told us they were cared for by staff who were kind and caring. They appeared comfortable around staff and told us their privacy and dignity were respected. People were supported to be independent and express their views.

The provider had systems in place for receiving and responding to complaints. People told us they had not needed to complain but knew who to speak to if they did. There were systems in place to support people at the end of their life.

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 1 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to recruitment, Mental Capacity Act 2005 and 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive a

Inspection carried out on 7 March 2017

During a routine inspection

Birchfield Residential Care Home is registered to provide accommodation for up to 24 older people who require support with personal care. There are ten bedrooms on the ground floor of the service with the remaining being upstairs. The service does not have a lift and the upstairs area is accessed via stairs and/or stair lifts.

At the last inspection the service was rated overall Good. This was an unannounced inspection which took place on the 7 March 2017. At this inspection we found the service remained Good.

The service was meeting all the relevant fundamental standards. People who used the service told us they felt safe and well cared for. Staff members felt supported in their roles and were adequately trained to meet the needs of people who used the service. 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 supported this practice.

Further information is in the detailed findings below.

Inspection carried out on 11 February 2015

During a routine inspection

This was an unannounced inspection which took place on 18 February 2015. We had previously inspected this service in June 2013 when we found it was meeting all of the regulations we reviewed.

Birchfield Residential Care Home is registered to provide accommodation for up to 24 older people who require support with personal care. At the time of our inspection there were 20 people using the service.

There was a registered manager in place at Birchfield. 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 who used the service told us they felt safe in Birchfield and that staff looked after them well. There were sufficient numbers of staff deployed to be able to meet people’s needs in a timely way.

Recruitment processes were sufficiently robust to help protect people who used the service from the risks of unsuitable staff.

Staff had completed training in how to protect vulnerable people who used the service. All the staff we spoke with were aware of the process to follow if they had any concerns about a person who used the service. Staff were confident to report poor practice and were confident they would be listened to by the managers in the service.

Care plans were detailed and provided good information for staff to follow to manage any risks whilst promoting people to retain their independence as much as possible. Risk assessment and risk management procedures were in place to help ensure people who used the service received safe and appropriate care.

Improvements needed to be made to the way medicines were managed in the service. This was because medication administration record (MAR) charts were not always fully completed; this meant we could not be certain that medicines had always been administered as prescribed.

It was evident from our observations and discussions with staff that they knew the people who used the service well. Staff received induction, training, supervision and appraisal to help ensure they were able to deliver effective care to people.

Staff were aware of the principles of the Mental Capacity Act (MCA) 2005: this legislation provides legal safeguards for people who may be unable to make their own decisions. The registered manager had assessed the capacity of people who used the service to consent to the care and treatment they required. Where necessary, applications had been made to the local authority to ensure any restrictions in place were legally authorised under the Deprivation of Liberty Safeguards (DoLS).

People made positive comments about the food provided in Birchfield. We saw systems were in place to help ensure people’s nutritional and health needs were met.

Care plans included clear guidance for staff to follow to ensure they always gained consent from people who used the service before providing any care or support. People who used the service confirmed staff would always ask for their agreement before any care or support was delivered. We saw that care plans were detailed and provided good information about people’s wishes and preferences in relation to the care they needed.

People told us staff were kind and caring in their approach. This was confirmed by our observations during the inspection. We also saw positive feedback had been received about staff in the most recent satisfaction survey.

There were opportunities for people who used the service to comment on the quality of care in Birchfield. Care records showed that people were regularly involved in reviewing whether the care they received met their needs. Regular meetings also took place for people who used the service and their relatives to discuss the care provided in Birchfield with the managers of the service. We noted positive comments had been made in these meetings.

A regular programme of activities was provided in the service. The registered manager had plans to involved people who used the service in an activity committee to help decide what events and activities should take place.

There were a number of quality assurance systems in place in the service. The registered manager had signed up to the social care commitment; this is designed to improve confidence in adult social care services and lead to better quality and standards.

Staff told us they enjoyed working at Birchfield and considered the managers in the service were approachable and fair. There were regular opportunities for staff to provide feedback on improvements which could be made in the service.

Inspection carried out on 5 June 2013

During a routine inspection

We spoke with five people who lived at Birchfield and six visitors. All the people spoken with told us they were happy with the care provided at Birchfield. One person told us, “I’m being well looked after”. A professional visitor commented, “I feel this is a very good care home. I always ask the residents I see and they tell me they are happy”.

We reviewed the care files held for four people who lived at Birchfield. We found care plans were individualised and provided good information for staff about how people wanted their care needs to be met.

We found that people were provided with appropriate nutrition and had a choice in relation to the food available to them at mealtimes. We also observed staff ensure that people had access to drinks and snacks throughout the day.

We found the premises were safe and secure. We saw a programme of renovation and refurbishment was in place for the home. All the people we spoke with told us they felt safe and comfortable at Birchfield.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people in Birchfield.

Inspection carried out on 11 December 2012

During a routine inspection

We spoke with five people who used the service as well as two relatives. All the people spoken with told us they were happy living in the home and that the staff were caring and helpful. One person told us,"I love it here", while another commented, "I'm very happy. I have no complaints at all".

We reviewed the care files of three people using the service and found evidence that there were procedures in place to ensure that consent was gained from the person or their representative in relation to the care provided for them. We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered. One person told us, "I get the care I need when I want it".

People spoken with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We spoke with three members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with training relevant to their role.

We found that there were sufficient numbers of staff on duty to meet the needs of people using the service.

We found that there were effective systems in place for the completion and storage of records relating to the care of people using the service and the maintenance of the premises

Inspection carried out on 1 November 2011

During a routine inspection

People who used the service said they were treated with privacy to help them retain their dignity. People who used the service were able to be involved in care planning to ensure they received the care they desired. The food served at the home met with peoples tastes and nutritional requirements.

People felt safe. People said they were looked after by a well trained staff team. People living at Birchfield residential home said they were happy and treated well. There were choices within the routine to enable people who used the service to feel contented with their care.

Reports under our old system of regulation (including those from before CQC was created)