Birnbeck House - Care Home Learning Disabilities

The provider had an outbreak of Corona virus within in the home. However, at the time of the inspection the outbreak had cleared, and we were assured the provider was keeping people safe. We found the following examples of good practice.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment (PPE) such as gloves, aprons and face coverings. One staff member told us, “I have PPE coming out of my ears, including sanitizer and disinfectant”. We saw staff throughout the day wearing appropriate PPE and refreshing their PPE when moving from room to room.

Due to the recent outbreak the provider had stopped all visitors to the home, to help contain the virus. However, staff told us they worked with relatives and people living in the home to make sure people had contact with their loved ones through use of technology, this included phone and video calls.

Once the outbreak had cleared, staff told us visitors entering the home had their temperatures recorded and were asked to wash their hands, wear masks and maintain social distancing. When staff came on shift they would record their temperatures, sanitise their hands and put on their PPE before entering the building.

The registered manager told us how difficult it was to isolate areas using a zoning system because of the complex needs of people living in the home. The registered manager told us, “Two people were tested negative and their rooms were in the same corridor, we put signs up saying safe zone, we also had another person who was able to self-isolate”. Adding, “We encouraged regular hand washing and implemented additional cleaning methods, staff supported people on a one to one basis, wiping areas they touched as they moved around the home”. The registered manager also told us, “We contracted an external cleaning company for a two-week period to do additional cleaning in the evenings”.

The registered manager had regular contact with Public Health England and the local commissioning team to monitor the outbreak. The registered manager showed us their action plan implemented to manage the outbreak and had confirmation on the day of the inspection that everyone had now tested negative.

The provider was not admitting people to the home currently as they had no vacancies. However, the registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home. Staff we spoke with were confident and knowledgeable about how to protect people from the risk of infection and the environment was clean and well maintained.

Further information is in the detailed findings below.

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. 13 people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

People’s experience of using this service: People were supported by caring, passionate and enthusiastic staff. There was a positive staff culture, stable and effective management and a friendly atmosphere at the service.

People were supported to engage in activities of their choice and reflective of their interests. New opportunities were regularly offered to people. Staffing levels enabled people to be supported in the community and to participate in social clubs and events.

The service was clean and tidy with a pleasant garden area. Regular checks on the environment and equipment were completed.

Care and support was person centred and promoted people’s independence. People’s choices were respected.

Medicines were administered safely. People were supported to access healthcare services. We received consistent feedback from health and social care professionals about the quality of care provided.

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 CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was Good (published 8 February 2017).

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.

Birnbeck House provides accommodation and personal care for up to 13 people with learning disabilities. It is large Edwardian style house located in a residential area of Weston-super-Mare within easy reach of local amenities, the town centre and the beach. The home supports people who are highly dependent but also has facilities for more independent people.

There is 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.

Where records were duplicated, for example completing bowel charts, staff did not always record information accurately. Where additional records were required, such as monitoring a person after a head injury, these records were not completed. .

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems were robust.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

The registered manager undertook spot checks to review the quality of the service provided and made the necessary improvements to the service. Regular audits were completed.

Care records were person centred, clear to read and ensured people and their families were at the centre of all choices and support decisions. Care records were regularly reviewed to remain up to date.

We saw staff offered people choices and were knowledgeable about how people communicated those choices. We saw that staff listened to people and were aware of people's facial expressions and body language. Through their actions, staff showed how well they knew each person's individual needs. Staff were respectful and supported people patiently.

The service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns they may have.

There were processes in place to monitor the quality of service being provided, and we saw that the opinions of people's families were obtained through surveys.

People were spending time in communal areas; some in their rooms whilst others were involved in structured activities. One person was in his room having his hands massaged and a group were in the lounge making music. We noted that wherever people were, there would be staff alongside them or nearby providing support when required.

Staff were able to tell us what peoples' expressions meant because this information was collected by staff observing how people responded to their likes and dislikes. We saw that staff had developed good relationships with people and were knowledgeable about their individual care needs.

We looked at peoples' care files and saw that peoples' care and support was planned and delivered in a way that ensured people's welfare and safety. For instance plans set out what was a good day for a person and what would be a bad day for them. We also saw charts explaining to staff the methods people used to communicate and what they meant.

Having assessed the available evidence, we considered the service demonstrated how it met the safety and welfare needs of the people living in Birnbeck House.