Silver Birches

Silver Birches is a residential care home providing a regulated activity for up to 19 people. The service provides support to people with dementia, physical disability and mental health. At the time of our inspection there were 12 people using the service. The care home accommodates people in one adapted building.

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

Shortfalls remained with infection control processes and procedures with some equipment and bedding found to be unclean. Systems and processes where not robust enough to ensure these checks were consistent enough.

People and their relatives were not always involved when their care needs were reviewed.

We have made a recommendation about reviews of care.

There was limited activity at the service for people to occupy their time.

We have made a recommendation about activities.

The provider and registered manager had addressed a significant number of the concerns we previously identified. They had implemented systems and processes to improve the oversight at the service. More time was required to provide assurance that recent changes to systems were effective and fully embedded.

Medicines and risks to people’s health and welfare were safely managed. Recordings in care plans and risk assessments were detailed and guided staff how to meet people’s needs. Staffing levels were sufficient to meet people’s needs.

Safely recruited staff provided kind and compassionate care. Staff knew people well and how best to support them in line with their individual preferences.

People were safe and protected from the risk of harm.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 May 2023)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of one regulation.

This service has been in Special Measures since 18 May 2023. During this inspection the provider demonstrated that a number of improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silver Birches on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Silver Birches is a residential care home providing a regulated activity for up to 19 people. The service provides support to people with dementia, physical disability and mental health. At the time of our inspection there were 16 people using the service. The care home accommodates 19 people in one adapted building.

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

The environment was not always safe or clean. This meant people were at increased risk of infection.

People’s risks such as pressure damage and diabetes were not always managed safely. Care plans did not always contain the most up to date information. We identified personal emergency evacuation plans (PEEPS) which had not been updated, which put people at risk in the event of a fire.

Medicines were not always managed safely.

We observed, and heard from relatives, there was a lack of staff. Staff were not all up to date with training.

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 service was not well-led. Where there were audits in place, they had failed to take action on the concerns we found at inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

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 received concerns in relation to staffing, infection prevention and the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there were concerns with the provider’s compliance with the Mental Capacity Act and Deprivation of Liberty Safeguards, so we widened the scope of the inspection and included the key question of effective as well.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silver Birches on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the need for consent, safe care and treatment, governance and staffing 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Silver Birches inspection was an ‘inspection using remote technology’. This means whilst we did visit the service on one day, we did not visit on subsequent days and instead used technology such as electronic file sharing to gather information, and phone calls to engage with relatives of people using the service as part of this performance review and assessment.

Silver Birches is a residential care home providing personal care. The care home accommodates 19 people in one adapted building. The service provides support to people with physical disability, mental health needs and/or dementia. At the time of our inspection there were 17 people using the service.

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

A lack of oversight of the service meant some audits and personal emergency evacuation plans lacked detail. We found some care plans did not always contain the necessary information and this was not identified by the provider.

Recruitment was not always robust. Staffing was not always sufficient, and training was not always up to date. Medicines were not always managed safely. Infection prevention and control measures were not always in place to keep people safe.

There was a lack of involvement of people’s relatives and next of kin. For example, relatives reported the service had not sought their views on the service generally or in relation to reviews of people’s care plans.

People told us they felt safe. Staff understood safeguarding well. People were supported to eat and drink enough to maintain a balanced diet. Visiting healthcare professionals were positive about the service.

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 10 September 2021).

Why we inspected

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 received concerns in relation to falls. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Silver Birches 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 and will take further action if needed.

We have identified breaches in relation safe care and treatment and governance of the service 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Silver Birches is a residential care home, providing personal or nursing care to up to 19 people, some of whom are living with dementia care needs. At the time of inspection, 17 people were living at the service.

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

Staffing levels were sufficient. People told us staffing levels were consistent, and they received the care they required.

Medicines were managed effectively. Storage and administration of medicines was safe, and staff were trained in this area.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

The service was clean, tidy, and staff followed infection control procedures.

Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good.

Audits and checks were in place to find and act on any areas for improvement. Staff felt well supported by the management team.

The management notified CQC of specific events, as and when required.

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 27 October 2018)

Why we inspected

We received concerns in relation to staffing numbers within the service and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 Birches is a residential care home providing accommodation and support for up to 19 people.

Silver Birches had a registered manager in post. 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.

Silver Birches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Silver Birches accommodates a maximum of 16 people in one building, with bedrooms on the ground floor and first floor. At the time of our inspection there were 15 people who lived at the home.

At the last inspection on January 2016 the service was rated as Good. At this inspection we found the service remained Good.

People had their support needs assessed and were involved in the development of their care plan. Staff had access to people’s care plans and received regular updates where people’s needs had changed. Care plans were updated and included changes to peoples’ support needs. People were supported to attended routine and specialist health checks.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. People were aware of their care plans and they were involved in care plan reviews. Staff prompted people’s choices and respected their decisions.

People were provided with a choice of meals that matched their dietary and cultural needs and choices. Staff ensured people were able to maintain contact with their family and friends and visitors were welcome without undue restrictions. There was sufficient person centred and culturally appropriate activities provided on a regular basis.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work with people. All the staff received a training induction and then on-going training for their specific job role. Staff were informed about and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what assistance was available from external bodies to report suspected abuse on to and follow up alleged incidents.

Staff told us they had access to information about people’s care and support needs and what was important to people. People who used the service and staff felt they could make comments or raise concerns with the management team about the way the service was run and were confident these would be acted on.

There was a clear supportive management structure within the service, which meant the staff were aware of who to contact out of hours. The provider undertook quality monitoring in the service and was supported by the compliance manager and staff. Staff were aware of the reporting procedure for faults and repairs and had access to maintenance services and resolve emergency repairs.

The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from a health professional about the support offered to people.

The one person that did speak with us said, 'I am happy here, I wouldn't stay if I wasn't,' they also stated 'she's a good girl, (pointed to a member of staff) she looks after us.'

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection of 7 August 2013 we found that care plans and risk assessments were undated, and there were inconsistencies in the way people's care and treatment was planned and delivered.

At this inspection we found care plans reflected people's needs and staff understood how to support people individual needs in line with their care plans. Care plans were written in an individual way ensuring people received personalised care from staff. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit an application.

However we found medicines were not stored securely, and the record system used for controlled medicines could be made more secure. We also that the storage of care plans and medication details could be made secure and so increase confidentiality. We also found there were instances where repairs had not been quality checked to ensure the area was in full working order.

Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. We also noted that the cleaning schedules did not cover all the areas we would expect in the home, and a number of bins waste bins did not have disposable liners, which would have reduced the occurrence of cross contamination and cross infection in the home.

Is the service effective?

People's health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. However the storage of confidential information could be made more secure.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

The staff took action to ensure a person had not suffered any ill effects from being given a prescribed medicine that may have been stored incorrectly. They called for more specialised advice only after we highlighted the issue during our visit.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People using the service and their relatives, were invited to complete an annual satisfaction survey.

We found people were able to make informed decisions about their care and support. One person told us 'I like it here. The staff look after me well, they are always respectful and polite. I make my own personal choices.' One relative told us Silver Birches is 'brilliant. I cannot fault it at all. I have never had a problem. My [family member] is looked after well.'

We found that care and support may not always be delivered in a way that met people's needs. Whilst we found people's care needs had been assessed, these assessments were not dated. We did not know whether the assessments related to the person's current needs.

People were protected from the risk of abuse and staff knew how to raise any concerns. We found the provider had policies in place relating to the safeguarding of vulnerable adults, and whistle blowing.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We observed staff supporting people with their daily care and noted staff gave clear verbal direction and guidance and provided reassurance to people who were confused. We noted a friendly rapport between people using the service and staff.

We looked at the care plans and records of two people and found that the information they contained provided clear guidance to staff to follow, which supported staff in delivering care which was consistent and reflected the individual needs of people.