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Birkdale Residential Home Requires improvement

Reports


Inspection carried out on 18 April 2018

During a routine inspection

This inspection took place on 5 and 6 April 2018 and was unannounced. At the last inspection completed on 23 November 2017 we rated the service as inadequate, as the provider was not meeting the regulations for safe care and treatment, person centred care, dignity and respect, consent, responding to complaints and they did not have effective governance arrangements in place.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to provide us with an action plan of how they were going to make improvements. We checked the provider had taken the actions required at this inspection.

At this inspection we found improvements had been made and the provider was meeting the regulations for safe care and treatment, person centred care, dignity and respect, consent, responding to complaints and governance arrangements, however further improvements were needed.

Birkdale residential home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Birkdale residential home accommodates up to 27 people on one adapted building. At the time of the inspection there were 22 people using the service.

There was a registered manager in post at the time of our 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 were supported to manage risks to their safety however improvements were needed to the assessments and plans as they sometimes lacked detail.

Staff had received training, however further work was required to ensure this was kept up to date.

Improvements were needed to the environment to ensure it was suitable for people living with dementia. People did not always receive consistent care. People received support from staff that were caring, however improvements were needed to make this consistent.

People’s preferences were understood by staff. However this did not always inform people’s care planning. People were not consistently supported to follow their interests. Improvements were needed to how people were supported in a way that met their wishes and effectively at the end of their life.

The governance arrangements required further improvement to ensure they were driving improvements and that the changes made were sustainable.

People were safeguarded from potential abuse. People were supported by sufficient numbers of staff that had been safely recruited. People were supported to take their prescribed medicines. People were protected from the risk of cross infection.

People were supported to maintain their health and well-being. People had their rights protected by staff that understood and could apply the principles of the Mental Capacity Act 2005. People were supported to meet their dietary needs.

People were involved in decisions and had their choices respected by staff. People were respected and their dignity was maintained. People understood how to make a complaint and these were responded to and used to make improvements.

Notifications were submitted as required and the registered manager understood their responsibilities. We found people; their relatives and staff felt supported by the registered manager and were able to be involved in their care.

Inspection carried out on 23 November 2017

During a routine inspection

This unannounced inspection took place on 23 November 2017. At our previous inspection in August 2016 we found that service was not always responsive or well led and the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspections we found that minor improvements had been made in one area, however we found further concerns as the service was not consistently safe, effective, caring, responsive or well led. We found six breaches of Regulations. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Birkdale Residential Home provides accommodation and personal care for up to 27 people. At the time of the inspection 25 people were using the service including some people who were living with dementia.

We were supported throughout the inspection by the registered manager. 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.

Risks of harm to people were not being assessed, managed or reduced to prevent further incidents which had resulted in harm. Lessons were not being learned to ensure incidents and accidents were minimised.

People were not protected from the spread of infection as prevention measures were not being followed effectively.

People's medicines were not always administered safely.

There were sufficient numbers of staff however they were not always deployed safely. New staff had been employed through safe recruitment procedures.

People's needs were not assessed holistically to achieve effective outcomes. People were not cared for by staff who were trained and supported to fulfil their roles effectively.

People's nutritional needs were not always met and when people became unwell or their health care needs changed the appropriate health care advice was not always sought in a timely manner.

The principles of the Mental Capacity Act 2005 (MCA) were not always followed to ensure that people who lacked the mental capacity to agree to their care and support were supported to do so in their best interests.

The building and environment required further adaption to meet the needs of people who used the service.

People were not always treated with dignity and respect and people's choices and preferences were not always respected.

People's needs were not assessed effectively and their preferences were not always gained.

Complaints and concerns were not dealt with appropriately and some people did not feel their complaints were taken seriously.

The governance systems the provider had in place to monitor and improve the service were not effective in ensuring improvements were made.

People were safeguarded from the risk of abuse as the staff and management knew what to do if they suspected abuse.

There were a range of hobbies and activities to support people to maintain active and promote their well being.

Inspection carried out on 25 August 2016

During a routine inspection

Our inspection took place on 25 and 26 August 2016 and was unannounced. Birkdale residential home provides accommodation and personal care for up to 29 people living with dementia and older people. At the time of our inspection, there were 25 people using the service.

Birkdale residential home is registered to provide diagnostic and treatment procedures, at the time of our inspection this was not being provided by the service so was not inspected.

There was a registered manager in post at the time of our 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. The registered manager received support from a staff team, which included an assistant manager, senior care staff and care staff.

At our last inspection carried out 15 October 2015 we asked the provider to take action to make improvements to the checks required by law to ensure only suitable people were employed at the service, and the provider has taken appropriate action.

People received care and support in a way that kept them safe. Staff protected people from the risk of harm and understood how to report concerns. Staff understood how to identify and minimise risks to help keep people safe. People were supported by safely recruited staff and there were enough staff to support people when they needed it. People received their medicines as prescribed and staff administered them safely.

The service had systems in place to assess people’s mental capacity. The registered manager understood when an application to the authorising agencies for a DoLS was required. Staff understood the principles of the MCA and DoLS and could apply these when delivering care and support.

People received support from trained staff who understood how to meet their needs. People had support to maintain a healthy diet and could access a choice of food and drinks as and when they wanted. People had access to health care professionals when they needed them, which helped people maintain their health and wellbeing.

People had positive relationships with staff that were respectful and caring whilst delivering people’s care and support. People were involved in making decisions about their care and support and were encouraged by staff to remain independent. People had their dignity and privacy respected by the staff who provided their care and support.

People did not always receive care that reflected their needs and preferences. People had access to a range of different activities and could do things they enjoyed. People’s complaints were investigated and responded to appropriately.

People were not supported by a management team who had effective systems and governance in place, which enabled them to recognise areas of improvement required within the service and take steps to make improvements. The registered manager had developed quality assurance systems, however not all of these were effective in making sure improvements were made. People and staff told us they felt confident to raise concerns with the registered manager.

There were two breaches of the regulations, you can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 15 October 2015

During an inspection to make sure that the improvements required had been made

We undertook an unannounced focused inspection of Birkdale Residential Home on 15 October 2015. This inspection was carried out after we received concerns in respect of staff recruitment, staffing levels, induction training and staff not obtaining people’s consent as to what time they were assisted to get up by staff. The inspection team consisted of two inspectors. The team inspected the service against three of the five questions we ask about services: is the service safe, is the service effective and is the service well-led. This report only covers our findings in relation to the concerns shared with us. You can read the report from the last comprehensive inspection, by selecting the ‘all reports’ link for Birkdale Residential Home on our website at www.cqc.org.uk.

At the last inspection visit on 8 April 2015 no breaches of legal requirements were found. However, we told the provider at this time to make improvements in relation to a number of areas. These included staffing, quality assurance, registering a manager, promoting people’s choices and offering opportunities for people to follow their interests.

Birkdale Residential Home is registered to provide accommodation and personal care for a maximum of 29 people. On the day of the inspection there were 17 people living at the home.

The home did not have a registered manager in post at the time of 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. The acting manager had not submitted a valid application to register with us as the manager. This means that the provider remains in breach of their conditions of registration with CQC.

People were not protected by robust recruitment practices that ensured care staff were suitable to work in care settings before they commenced work. Some members of staff had started work with recruitment checks incomplete. The risks to people had not been assessed and managed by the provider to ensure only suitable people were employed to work at the home.

Most people considered staffing had recently improved due to a reduction in the number of people accommodated. We found staffing levels were calculated based on the number of people living in the home and not on people’s individual dependency levels or the layout of the home. Although we saw that people’s physical needs were attended to promptly, there were occasions when some people were left unsupervised for very short periods of time in communal lounges. This was because staff had to attend to the personal care needs of other people living in the home.

People were supported by new staff who had not received a structured induction to their role. Although new staff shadowed experienced staff this was not defined on the staffing rota and the acting manager was unable to show how they had ensured that staff had the appropriate skills, knowledge and support before working with people living at the home. The acting manager told us that they had looked into the recently introduced care certificate and what they needed to do to ensure the induction for new staff covered the requirements of the certificate.

Systems to check on the quality and safety of the service were not effective in order for the provider to measure and improve the service. The provider acknowledged the failings of the service and told us how they were going to improve the quality of the service people received.

We found the provider was not meeting all the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 8 April 2015

During a routine inspection

This inspection took place 8 April 2015 and was unannounced.

Birkdale Residential Home is registered to provide accommodation with nursing and personal care for a maximum of 29 people. On the day of the inspection 22 people were living at the home.

The home did not have a registered manager in post at the time of the inspection. The home has been without a registered manager for over three years despite our efforts to pursue the provider to submit an application. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 home. Staff knew how to protect people and report incidents of concern. We identified some window restrictors were not appropriate to keep people safe from the potential risk of harm.

People's medicines were managed safely and staff followed the organisation's guidance in administration, storage and disposal of people's medicines.

We identified a number of concerns about how the provider monitored the cleanliness of the home. There were no audits to monitor cleanliness of the home.

People were not always supported by sufficient numbers of staff to provide them with individualised care. Staff received appropriate training, support and supervision. There was a recruitment procedure in place which was followed. This ensured staff were appropriately checked before they started work at the home.

The manager and staff were familiar with their role in relation to people’s human rights and followed published guidance where people did not have the capacity to make their own decisions.

Health care professionals were accessed for people when they needed them.

People were supported to maintain independence and control over their lives by staff who treated them with dignity and respect. People told us staff were kind and caring and they liked the staff however, there was a lack of social activities available for people to choose from. The registered provider had a complaints policy which was available to everyone. Complaints were managed and in line with the policy.

Although the provider had systems in place to audit the quality of the service provided, we found these were not always effective. The manager acknowledged this was an area requiring improvement.

Inspection carried out on 3 May 2013

During a routine inspection

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We spoke with over half of the twenty two people living at the home, six relatives and eight members of staff including the manager and provider. Some people had health needs which meant they could not share their experiences with us. We spent time in both lounges to observe their care and support. Everyone we met was relaxed and confident and many said they liked living at Birkdale. One person told us, “They are doing a grand job looking after us here."

People were involved in their health, care and treatment in ways they could understand. We saw they were encouraged to choose how to spend their time and were offered the opportunity to take part in variety of activities if they wished to. This was reflected in care records we looked at.

Systems were in place to protect people from the risk of abuse. Staff we spoke with felt the training they had received helped them to be confident to recognise and report abuse.

There were satisfactory recruitment procedures which reduced the risk of unsuitable

people being employed to work at the home. Staff told us they had received all of the necessary support and training they required to help them do their job well.

The management had effective systems to monitor and review the quality of their service. People were regularly reminded about the different ways they could have their say to improve living at Birkdale. We saw these actions had continued to improve the provision of care for people living at home.

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Inspection carried out on 19 April 2012

During an inspection to make sure that the improvements required had been made

We carried out this review to check on the care and welfare of people using this service and to follow up on issues we found during previous inspections in July 2011, October 2011 and January 2012.

In July 2011, we found concerns relating to the care and welfare of people who live in the home, administration of medicines, assessing and monitoring the quality of service provision and records the home are obliged to keep by law. We set 13 compliance actions to make sure the service would improve their standards and comply with our legislation.

When we returned in October 2011 we found little improvement had been made to improve the service. As a result of our findings we served a warning notice on the Registered Provider and the Registered Manager on 25 November 2011 concerning a breach of four of our regulations. It was our expectation the home would be fully compliant with this notice within one month. Shortly after this inspection the Registered Manager stopped working for the service.

Our visit on the 11th and 13th of January 2012 was to review the progress the home had made in response to our warning notice and to see if the home had complied with our regulations. The new manager who had been in post for a short period of time was fully aware of the improvements they needed to make to ensure that they become compliant. They sent us a robust action plan which clearly described actions they planned to take to make permanent changes to improve the lifestyle of people living at the home.

Around half of the 21 people who lived at the home have a dementia related illness. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

As part of our inspection, telephone discussions, written contact and e-mail communications were also held with relatives and other professionals who we were not able to meet during our visits. All the relatives that we spoke with informed us they felt that on the whole the care staff at the home did a good job. People told us they felt the new manager had already made an impact on the home and communication had started to improve. One person told us, “although things are not perfect we can see the staff team are trying to make changes for the better.” Another relative also stated “I am really quite happy with Birkdale even though there is still room for improvement with the care of my relative.”

People that we spoke with at the home told us that they were satisfied with the way that staff looked after them and that staff were kind to them. We were told visitors were made welcome to the home.

We found that the home had several plans in the pipeline to improve the lifestyle of the people who have dementia. The home had recognised these people were not always supported to make choices and have as much control as possible over their daily lives whilst keeping them safe. Staff have received specialist training in preparation for new assessment paperwork being introduced. This will be specifically use used to make sure people with challenges to their memory get the care and support they require.

Major improvements were evident in the way the home had responded to improve their care management systems during the past four months. The staff team demonstrated their commitment to support the manager with these changes to improve standards at the home. As a result staff told us they are feeling more confident and happy at work as they had been getting the direction to move forward in a positive way as a team.

Formal arrangements such as residents’ committees and meetings had been introduced to start to make people feel involved with their care and the running of their home

Staff have undertaken mental health training. This has enabled staff to support people to make decisions for themselves if they can. This made sure their independence was promoted and people were supported to make choices such as what they had to eat. The combination of staff putting their recent nutrition training into practice alongside people being actively involved in meal choices has meant meal times had started to improve.

We found improvements in the provision of care to people using the service. Changes to accident monitoring has resulted in people having fewer falls.

We saw that relationships with health professionals have improved and their advice is being followed.

We saw specific staff had been delegated extra responsibility and have received additional training to promote cleanliness and reduce the risk of infection.

Since our inspection visit in October 2011, the home had been cooperating with a local authority safeguarding investigation for care management issues. Several remedial actions taken by the new manager has made sure people have been kept as safe as possible.

Changes we saw to improve medication management in January 2012 had been maintained and people were seen to be receiving their medication safely in line with the advice of their doctor.

People agreed that the redecoration of the reception area and corridors in the home had made a vast difference to the appearance of Birkdale. Relatives all commented the home was generally a lot tidier and less cluttered when they visited. Better systems to organise maintenance has resulted in the home being a safer place to live.

One of the first priorities of the year was to make sure everyone was provided with the right equipment to keep them safely mobile and independent. We saw people had been supplied with new walking aids following their individual assessments by the community physiotherapist.

We saw that the home team have embraced the training health care professionals working for the NHS Primary Care Trust provided to enable Birkdale raise its standards in as short a time as possible.

Staff reported that they appreciated the changes to their ongoing support and development from the new management. They told us it had resulted in them feeling more valued and confident to work as a team to improve Birkdale. Record keeping confirmed important issues to manage absence and performance were dealt with effectively and appropriately.

We saw the person we registered to be responsible for this service, Mr Nuttall, had improved their communication with the home and had been monitoring the progress at Birkdale on a daily basis offering support when necessary.

We found a lot of effort had been made to improve records. We are aware this was a huge task for the home to undertake. Since our inspection visit in January 2012 the new manager implemented management systems which had made sure records were easy for staff to access and refer to whilst being kept secure. The management of the home recognised this area of the service still required further work to get important record keeping including care plans up-to-date.

Inspection carried out on 13 January 2012

During an inspection to make sure that the improvements required had been made

We carried out this review to check on the care and welfare of people using this service to follow up on issues we found during previous inspections. This was our third visit in eight months.

In July 2011, we found concerns relating to the care and welfare of people who live in the home, administration of medicines, assessing and monitoring the quality of service provision and records the home are obliged to keep by law. We set a total of 13 compliance actions to make sure the service would improve their standards and comply with our legislation.

When we returned in October 2011 we found little improvement had been made to improve the service. As a result of our findings we served a warning notice on the Registered Provider and the Registered Manager on 25 November 2011 concerning a breach of four of our regulations. It was our expectation the home would be fully compliant with this notice within one month.

Our visit on the 11th and 13th of January 2012 was to review the progress the home had made in response to the major concerns we identified in our warning notice and to see if the home had complied with our regulations.

We reviewed all the information we hold about this provider, observed how people were being cared for, talked to staff and talked to 10 people who live at the home.

Over half of the 23 people who live at the home have a dementia related illness. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

As part of our inspection, telephone discussions, written contact and e-mail communications were also held with relatives and other professionals who we were not able to meet during our visits. They contacted us to share their disappointment that no one from the home had told them we had issued a warning notice.

All the relatives that we spoke with informed us they felt that the care staff at the home did a good job. One person wrote,

“I am completely satisfied with the care my family member receives. I am very vigilant and I have only ever seen the care workers be careful and good at their jobs.”

People told us they felt the management had not been strong enough at the home and did not communicate with them very well. One person told us, “If I want to know anything I have had to go and ask. You would have to wait a long time if you wanted them to tell you anything.”

People that we spoke with at the home told us that they were satisfied with the way that staff looked after them and that staff were kind to them. We were told visitors were made welcome to the home.

We found that the home had fully complied with one of the four of our regulations in our warning notice which related to medicine management.

Major improvements were evident in the way the home had responded to improve their systems to manage the medication people have prescribed by their GP. We saw that the home now had effective systems for recording the receipt, administration and disposal of medicines.

Although we found improvements in the provision of care to people using the service, more needs to be done to make sure that the needs of people using the service are met. We found that some people who lived at Birkdale, particularly those with dementia were not always supported to make choices and have as much control as possible over their daily lives whilst keeping them safe. We discussed this with the new manager who confirmed the action they were taking to address this.

We saw that the home did not always seek or follow medical and specialist advice that was needed to promote people's health and well-being. We saw that for two people this had led to an increased risk of harm to other people who live and work at home. Since our inspection visit in October 2011, the home has been cooperating with the local authority safeguarding investigation for these types of issues.

We found some effort had been made to improve records. We also found they were not always up-to-date and did not always contain enough information to make sure that people living at the home received the care they needed and were free from harm or injury. Records did not include clear guidance to staff on how to meet the care and health needs of people living at Birkdale.

Since the last visit the registered manager has left. The new manager has been in post for a short period of time and told us the improvements they need to make to ensure that they become compliant. They recognised that there had been little progress with audit systems and intends to address this.

They were aware that issues including accident management had not been fully addressed and as a result changes to maximise the safety of people had not been considered.

After our warning notice was issued, health care professionals working for the NHS Primary Care Trust have offered a wealth of professional expertise and support to enable Birkdale raise its standards in as short a time as possible. The home is now working in partnership with other agencies to improve standards at the home as a matter of priority.

Following our inspection visits we have held a meeting with the person we registered to be responsible for this service, Mr Gordon Nuttall.

Further compliance actions have been made as part of our enforcement activity to ensure standards of care and support improve at Birkdale within a reasonable timescale.

Inspection carried out on 20 October 2011

During an inspection to make sure that the improvements required had been made

People that we spoke to in the home told us that they were satisfied with the way that staff looked after them and that staff were kind to them. We were told visitors were made welcome to the home.

We found that 10 compliance actions issued on our last visit were not met.

We found that some people who lived at Birkdale, particularly those with dementia are not supported to make choices and have as much control as possible over their daily lives.

We saw that records did not show that people were supported to have appropriate representation when decisions were being made about them. This included when people were unable to consent to care and treatment.

During the visits we observed that not all people's rights to privacy and dignity was maintained particularly in relation to the way some medication was administered and for people living in shared rooms.

We saw that the care management records did not evidence that staff provided all the care of people needed to maintain their health and well-being.

Two people told us that they liked the food provided but other people told us that they were not as satisfied and would welcome improvements in the quality and variety of food served. We saw the communication between staff and people in the dining room at mealtimes was poor and meant that some people with dementia did not know what the meal was that was put in front of them. Poor organisation at lunchtime meant that the hot pudding was served cold.

We saw that the home did not always seek or follow medical and specialist advice needed to promote people's health and well-being. We saw that for one person this had led to an increased risk of harm to other people who live and work at home.

Staff told us that recent changes at the home meant they were able to spend more time with the people who live there and that they felt this had meant the standard of care had improved.

All the staff spoken to told us they had undertaken training in how to keep people in their care safe from harm and the risk of abuse. We saw that a safeguarding issue had been raised as a complaint but this had not been referred to the local safeguarding team or CQC.

The infection control team at the Primary Care Trust (PCT) have been offering advice and support for the previous two years. During this time standards have not been raised and improvements made have not been sustained. We saw that a start had been made to improve the cleanliness and appearance of the home but this needed more staff time and investment.

The way that medicines were administered by staff caused concern as record-keeping was poor, safeguards were not in place for people who look after their own medicines and stocks of medicines were allowed to run out.

People who were able to had personalised their rooms and they were seen to be clean and tidy. The radiators in the home were not covered and there were no risk assessments in place to make sure that people were safe from the risk of burns. Some furniture and fittings are significantly worn through wear and tear and lack of ongoing investment and maintenance.

We saw that some equipment had been tested and serviced to make sure that it was working properly and safely. We also saw that a recommendation from the Fire Service in July 2011 that the fire risk assessment should be reviewed had not been undertaken.

The training records did not show that staff undertook refresher training or that all the training the home had told us it was going to do had taken place.

Staff records did not show that supervision was used to evaluate individual’s performance and issues of concern about two staff raised in a complaint were not recorded in their staff file and the training needs identified following the complaint had not been followed through.

We saw that some audit systems have been set up but these records were incomplete and were not kept in a way that meant the findings could be used to improve the quality of the service or environment.

Lack of audits meant that issues relating to poor medicine management and ineffective handling of complaints were not addressed.

We found that records were not always up-to-date and did not always contain enough information to make sure that people living at the home received the care they needed and were free from harm or injury. Records did not include clear guidance to staff on how to meet individuals care and health needs.

In view of the major concerns identified in outcome areas care and welfare, administration of medicines, assessing and monitoring the qualtiy of service provision and records the Care Quality Commission served a Warning Notice on the Registered Provider and the Registered Manager on 25 November 2011.

Inspection carried out on 12 May 2011 and 18 September 2012

During a routine inspection

People we spoke with told us they were happy with the care they receive and that the staff are,

“Very friendly and approachable – they always make time to speak to you.”

People told us that the meals are generally good and that they are always given a choice. One person regularly tells their visitor that meals are, “Gourmet style. “

People told us they were happy with the laundry service.

People told us they were happy with their bedrooms and that the home is usually kept clean and tidy. One person did comment that they were pleased their bedroom was to be decorated shortly.

We were told there always seem to be enough staff on duty and that staff are thoughtful and always help where needed.

A relative told us that the communication from the home is good and that they are kept up to date with any changes in their relative's condition.

Staff told us that they enjoy working at the home and that they receive the support they need to do their job. They said that they have good training opportunities. They were able to tell us about the individual needs of the people they care for.

Health care professionals from the local Primary Care Trust have also kept in touch with us on a regular basis. They told us about the slow progress that the home has made in response to recommendations they have made for Birkdale to improve infection control standards and practices in the home.

Since our visit to the home we have been in contact with the Public Protection department of the local council as we saw that they were monitoring this home due to breaches of health and safety legislation.

We were able to confirm that records are not being kept up to date, delays in training, and lack of oversight of important care issues are not being managed and accounted for properly. These issues have challenged the impact of the quality of care given at this home.

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