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Inspection carried out on 24 & 26 August 2015

During a routine inspection

The inspection was carried out on 24 and 26 August 2015 by two inspectors and an expert by experience. It was an unannounced inspection. The service provides personal care and accommodation for a maximum of 38 older people. The service has 32 single bedrooms and usually only accommodates 32 people unless couples request shared accommodation. There were 32 people living at the service at the time of our inspection. People had varied communication needs and abilities. Most of the people were able to talk with us about their experiences.

There was 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.

The registered manager was supported by a deputy manager and a team of senior carers to ensure the daily management of the service.

People lived in a clean and well maintained environment. Staff had a thorough understanding of infection control practice that followed the Department of Health guidelines, which helped minimise risk from infection. The premises had not been designed to meet the needs of people living with dementia. We have made a recommendation about this.

Staff training was up to date and was renewed annually, and staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs. Some staff in housekeeping and catering roles had not completed training appropriate to their roles. We have made a recommendation about this.

Staff communicated effectively with people and responded to their needs promptly. Staff treated people with kindness and respect, some language used by staff did not reflect the values of the service. We have made a recommendation about this. We observed frequent friendly engagement between people and staff and staff responded positively and warmly to people. People were satisfied with how their care and treatment was delivered.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were sufficient staff on duty to meet people’s needs. Staff had time to spend supporting people in a meaningful way that respected individual needs. Staffing levels were calculated according to people’s needs and were flexible to respond to changes in need.

There were safe recruitment procedures in place. These included the checking of references and carrying out disclosure and barring service checks for prospective employees before they started work. All staff were subject to a probation period and disciplinary procedures if they did not meet the required standards of practice

Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed. This ensured that the staff knew about their particular needs and wishes when they moved in.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). All care staff and management were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation.

The building was warm and welcoming. People lived in a clean environment. People’s own rooms were personalised to reflect their individual tastes and personalities.

The service provided meals, in sufficient quantity that were nutritious and well balanced. People were offered hot drinks and snacks throughout the day. Staff knew about people’s dietary preferences and restrictions.

People were involved in their day to day care. People’s care plans were reviewed with their participation or their representatives’ involvement.

Clear information about the service, the management, the facilities, and how to complain was provided to people and visitors. A brochure and service user guide were available and menus and information regarding activities were displayed.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed twice a year with their participation or their representatives’ involvement. People’s care plans were updated when their needs changed to make sure they received the care and support they needed.

A range of activities was provided. Information about people’s hobbies, interests and skills was not always used to plan how they were supported to spend their time. We have made a recommendation about this.

The service took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon. People’s relatives were asked about their views when they visited the home and when people’s care plans were reviewed. The service sent annual questionnaires to people’s relatives or representatives and analysed and sought to act upon the results of the surveys.

The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.

The registered manager kept up to date with any changes in legislation that may affect the service, and participated in monthly forums with other managers from other services where good practice was discussed. The registered manager and deputy manager carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

Inspection carried out on 11 September 2013

During a routine inspection

We spoke with the owner, manager, three members of staff, six relatives and six people who used the service. We looked at people's care plans, staff files and the service's policies.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.One person told us, "They always ask me if it is all right to do this or that, and they wait to make sure I agree. If I say no then they respect what I say".

People were made aware of the requirements for them to pay for their care, treatment and support and the expected costs. One relative told us, "The agreement of residency and the fees are very clear from the start".

We found that people's needs were assessed and reviewed regularly. Care was planned and delivered in line with individual care plans. One relative told us, "The care is really very good here. When our Mum became ill we were kept informed every step of the way and they took excellent care of her".

There were effective recruitment and selection processes in place. The manager checked the staff had relevant qualifications, knowledge, skills and experience to carry out their role.

There was a complaint policy and procedures in place, and people who lived in Birchwood and their relatives knew the steps to follow should they wish to complain. People told us, "We are not afraid to speak up, we talk with the staff and the manager and things get done".

Inspection carried out on 23 November 2012

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

At our last inspection on 12 July 2012 we found that improvements were needed in relation to people's nutrition, staffing and record keeping. We carried out this follow up inspection to check that these improvements had been made.

People told us that they always had a choice of meals and that they enjoyed the food. One person said “It’s always lovely and hot”. We saw that people were offered choices and were given the support they needed to eat their meals. We heard people telling staff that their meal had been "very nice".

We found that people’s nutritional needs had been assessed and a plan written for how these were to be met. In some cases people needed additional support or nutritional supplements and we saw records that showed that this was being provided. Staff had a good understanding of people’s needs. They had recently completed training in diet and nutrition to help them support those at risk of poor nutrition. Record keeping had been improved and we could see that the records were being used to assess, plan and monitor people's nutritional needs.

We found that the manager had taken action to review people’s experiences in the evening and during the night to check that there were enough staff on duty to meet their needs. The records showed that people were satisfied with the support they were receiving. People we spoke with told us they felt there were enough staff on duty to meet their needs.

Inspection carried out on 12 July 2012

During a themed inspection looking at Dignity and Nutrition

People who use the service told us what it was like to live at this service and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

All of the 10 people with whom we spoke gave us generally positive feedback about the service. One of them said, "Overall, I’ve been happy with coming here. I think that most of the staff are genuinely kind and caring and I’ve always been treated with kindness and had all my needs met. The food’s okay most days and the place is clean."

We found that the location was not compliant with the regulations relating to three outcomes. We saw that some people’s nutritional needs had not been reliably assessed, recorded and met. Some staff did not have all of the knowledge and skills they needed to support people’s nutritional needs. Also, some records not being kept in a way that supported staff to care for people and their nutritional needs.

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