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.