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Birkdale Residential Home Good

Reports


Inspection carried out on 28 May 2019

During a routine inspection

About the service

Birkdale is a residential care home providing personal care to 25 people, aged 65 and over at the time of the inspection. The service can support up to 27 people. The home accommodates people in one building and has a day care facility on site called the Daisy Club.

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

Governance systems were in place however, some reviews had not been scheduled and care audits needed to be more in-depth. People were positive about the home and staff said they enjoyed coming to work. People told us the management were open and honest and relatives were told when things went wrong. Feedback was gathered from various sources as part of helping the home progress. The management team worked in partnership with others.

People were protected from harm by staff who had been trained in safeguarding procedures. People were supported by sufficient numbers of staff. Risks to people’s safety were assessed and people received their medicine by staff trained to administer. Infection control measures were in place and lessons were learnt when things went wrong.

People’s needs were assessed, and care plans were person centred. Staff received the necessary training to meet people’s needs. People were supported to maintain a balanced diet and had regular access to drinks and snacks. People were supported to access health care and the building was adapted to meet their needs.

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.

People were treated with dignity and respect and they were encouraged to express their views. People’s privacy was maintained.

People were supported to maintain relationships and received information in an accessible format. Complaints were investigated, and feedback provided. People received end of life care in line with local multi-disciplinary guidance.

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 requires improvement (published 7 June 2018).

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.

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 man

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

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